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14-09-2015 | Uitgave 4/2016 Open Access

Quality of Life Research 4/2016

The application of a network approach to Health-Related Quality of Life (HRQoL): introducing a new method for assessing HRQoL in healthy adults and cancer patients

Quality of Life Research > Uitgave 4/2016
Jolanda J. Kossakowski, Sacha Epskamp, Jacobien M. Kieffer, Claudia D. van Borkulo, Mijke Rhemtulla, Denny Borsboom



Health-Related Quality of Life (HRQoL) research has typically adopted either a formative approach, in which HRQoL is the common effect of its observables, or a reflective approach—defining HRQoL as a latent variable that determines observable characteristics of HRQoL. Both approaches, however, do not take into account the complex organization of these characteristics. The objective of this study was to introduce a new approach for analyzing HRQoL data, namely a network model (NM). An NM, as opposed to traditional research strategies, accounts for interactions among observables and offers a complementary analytic approach.


We applied the NM to samples of Dutch cancer patients (N = 485) and Dutch healthy adults (N = 1742) who completed the 36-item Short Form Health Survey (SF-36). Networks were constructed for both samples separately and for a combined sample with diagnostic status added as an extra variable. We assessed the network structures and compared the structures of the two separate samples on the item and domain levels. The relative importance of individual items in the network structures was determined using centrality analyses.


We found that the global structure of the SF-36 is dominant in all networks, supporting the validity of questionnaire’s subscales. Furthermore, results suggest that the network structure of both samples was highly similar. Centrality analyses revealed that maintaining a daily routine despite one’s physical health predicts HRQoL levels best.


We concluded that the NM provides a fruitful alternative to classical approaches used in the psychometric analysis of HRQoL data.

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