Psychology RootsShort-Form-36 Health Survey (SF-36)
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About Short-Form-36 Health Survey (SF-36)
Scale Name
Short-Form-36 Health Survey (SF-36)
Author Details
RAND Corporation and John E. Ware Jr.
Translation Availability
English
Background/Description
The Short-Form-36 Health Survey (SF-36) is a widely used, standardized health-related quality of life (HRQoL) instrument. Developed as part of the RAND Medical Outcomes Study (MOS), it condenses the original 245-item MOS questionnaire into 36 items without losing measurement breadth or psychometric rigor (Ware & Sherbourne, 1992).
Its primary goal is to provide a generic indicator of health status for use in population surveys and evaluative studies of health policy. It is also frequently paired with disease-specific tools to assess treatment outcomes in clinical practice and research (Ware et al., 2000).
The SF-36 measures eight key dimensions of health:
- Physical Functioning (PF) – 10 items
- Role Limitations due to Physical Health (RP) – 4 items
- Bodily Pain (BP) – 2 items
- Social Functioning (SF) – 2 items
- Mental Health (MH) – 5 items
- Role Limitations due to Emotional Problems (RE) – 3 items
- Vitality (VT) – 4 items
- General Health Perceptions (GH) – 5 items
It also includes one question about change in health over the past year, which is not scored as part of the eight dimensions but provides a useful indicator of perceived change.
Version 2 (1996) addressed criticisms of Version 1 by replacing dichotomous role-limitation items with five-point scales and refining item wording for clarity (Ware et al., 1996). Both four-week and one-week recall versions exist.
The SF-36 is a 36-item self-report questionnaire comprising eight subscales (McHorney, Ware, Lu, & Sherbourne., 1994). The subscales measure: physical functioning, role limitations due to physical health problems, bodily pain, social functioning, general mental health, role limitations due to emotional problems, energy/fatigue, and general health perceptions.
Researchers reported that alpha internal consistency coefficients on seven of the subscales exceed .80. The exception is the social functioning scale, for which alpha reliability is .76 (McDowell & Newell, 1996). The SF-36 has been validated against several criteria such as the ability to work, symptoms, utilization of care, and a wide range of mental health functioning (Ware, Snok, & Kosinski, 1993).
Administration, Scoring and Interpretation
- Format: Self-administered paper form, optical scan sheet, computer-based form, or interviewer-administered (in person or by telephone).
- Time Required: Approximately 5–10 minutes for most adults; up to 15 minutes for elderly respondents.
- Recall Period: Standard version = 4 weeks; acute version = 1 week (for repeated measures).
- Scoring: Each scale is scored from 0 (worst) to 100 (best health status). Dimension scores can be combined into two summary measures: Physical Component Summary (PCS) and Mental Component Summary (MCS).
- Materials: User manuals, machine-readable forms, and scoring algorithms are provided by QualityMetric.
Reliability and Validity
- Internal Consistency: Cronbach’s α > 0.80 for most subscales in general populations (McHorney et al., 1993).
- Test–Retest Reliability: Stable across 2–4 weeks in chronic disease samples (Ware et al., 1993).
- Construct Validity: Demonstrated by differentiating groups with known health conditions; correlates strongly with disease-specific instruments (Ware & Sherbourne, 1992).
- Cross-Cultural Validity: Multiple validated translations confirm psychometric equivalence across countries (Gandek et al., 1998).
Available Versions
36-Items
12-Items
Reference
McHorney, C. A., Ware Jr, J. E., Lu, J. R., & Sherbourne, C. D. (1994). The MOS 36-ltem Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical care, 32(1), 40-66.
Important Link
Scale File:
Frequently Asked Questions
Q1: What is the difference between SF-36 Version 1 and Version 2?
Version 2 uses five-point scales for role-limitation questions and refines several item wordings, improving sensitivity and reducing ceiling effects.
Q2: How are the scores interpreted?
Each subscale is scored from 0 to 100, with higher scores indicating better health status. Two composite scores (PCS and MCS) summarize physical and mental health.
Q3: Is the SF-36 disease-specific?
No. It is a generic measure designed to be applicable across diseases and populations.
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