Conceptual Mapping of Health-Related Quality of Life, Quality of Life, and Wellbeing: A Systematic Review and Assessment of Commonly Used Patient-Reported Outcomes Measures

Background Health-Related Quality of Life (HRQoL), Quality of Life (QoL), and Wellbeing (WB) are widely used outcome constructs in health research, clinical care, and policy. These concepts often overlap but are used in different contexts and disciplines, raising concerns regarding their comparability and relevance in health assessments and policy-making. This study review aims to perform a conceptual mapping of these commonly used concepts, propose evidence-informed frameworks, and map them to commonly used Patient-Reported Outcome Measures (PROMs). Methods We conducted a qualitative systematic review of conceptual frameworks for HRQoL, QoL, and WB published between 1990 and 2023. We searched PubMed, Scopus, and PsycINFO for peer-reviewed publications explicitly describing conceptual models. A thematic synthesis approach was used to analyze domains, subdomains and facets. We also assessed domain coverage of 10 widely used PROMs to explore alignment with the conceptual models. Results From 14,114 records, we included 35 studies reporting 36 conceptual frameworks (HRQoL = 10; QoL = 12; WB = 14). We retrieved 168 first-level, 225 second-level, and 79 third-level domains, curated into 118 unique entities: 82 for HRQoL, 49 for QoL, and 69 for WB. Overlap analysis revealed 26 shared domains, 26 unique to WB, 29 to HRQoL, and 7 to QoL. Final models included 18 HRQoL, 22 QoL (18 from HRQoL plus 4), and 10 WB dimensions. PROMs mapping showed heterogeneous coverage of commonly used PROMS. The EQ-HWB had the broadest coverage of HRQoL (17/18) and WB (5/10). Conclusions Conceptual inconsistency and overlap exist in the literature across HRQoL, QoL, and WB. The absence of clear conceptual and operational definitions limits their measurement validity. This study supports the development of clearer frameworks to enhance measurement and policy relevance. The conceptual coverage of commonly used PROMS appears sub-optimal and heterogeneous. These findings have implications for instrument selection, outcome interpretation, and the design of patient-centered evaluations. Greater clarity in conceptual definitions and improved alignment between theory and measurement tools are needed to support meaningful assessments of people’s lived experiences. Systematic review registration OSF, CRD42023469014.