Psychometric validation of the Amharic WHOQOL-BREF in Ethiopian adults with non-communicable diseases: a cross-sectional study

Abstract Background The WHOQOL-BREF is a widely used instrument for assessing health-related quality of life (HRQoL). Although an Amharic version has previously been evaluated among Ethiopian patients with specific chronic conditions, evidence regarding its psychometric performance in a broader population of adults with non-communicable diseases (NCDs) remains limited. This study aimed to evaluate the reliability and validity of the Amharic WHOQOL-BREF among Ethiopian adults with NCDs receiving care in a tertiary hospital setting. Methods A hospital-based cross-sectional study was conducted among 422 adults with physician-confirmed NCDs attending Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, from June to August 2023. HRQoL was assessed using a culturally adapted Amharic WHOQOL-BREF developed before data collection using recommended translation and cultural adaptation procedures. Formal written permission from the WHO Permissions Team was subsequently obtained retrospectively on 15 June 2026 (Request ID: 202609336), covering the completed translation, research use, and intended scientific publication. Internal consistency reliability was evaluated using Cronbach’s alpha (α) and McDonald’s omega (ω). Structural validity was examined using confirmatory factor analysis (CFA) of the hypothesized four-domain structure. Construct validity was evaluated using correlations with the global quality-of-life and general health items and by testing a priori hypotheses regarding associations with relevant clinical and socio-behavioral characteristics using multivariable linear regression. Results The Amharic WHOQOL-BREF demonstrated satisfactory psychometric performance. Internal consistency reliability was acceptable across all domains, with Cronbach’s alpha and McDonald’s omega coefficients ranging from 0.79 to 0.89. CFA showed acceptable model fit and provided support for the hypothesized four-domain structure (CFI = 0.92, TLI = 0.90, RMSEA = 0.060, SRMR = 0.045). Moderate correlations between domain scores and the global quality-of-life and general health items ( r = 0.42–0.60) provided evidence supporting construct validity. Furthermore, the instrument demonstrated theoretically consistent associations with relevant clinical and socio-behavioral characteristics, providing additional supporting evidence for the prespecified construct-validity hypotheses. Conclusions These findings provide supporting evidence for the reliability, structural validity, and construct validity of the Amharic WHOQOL-BREF among Ethiopian adults with NCDs receiving care in a tertiary hospital setting. The instrument demonstrated satisfactory psychometric properties, supporting its use in research and potentially in clinical assessment among similar hospital-based NCD populations. Further validation studies in broader community and primary healthcare settings are warranted to evaluate generalizability across diverse Amharic-speaking populations.