Purpose  The aim of the study was to investigate and identify aspects of health-related quality of life (HRQoL) that are most valued by isiXhosa-speaking people resident in under-resourced areas of Cape Town.

Methodology  Fifty-seven domains of HRQoL were identified as important through group discussions with isiXhosa-speaking people. Participants randomly selected from the community (n = 601) and from individuals seeking medical attention at a local clinic (n = 102) graded the domains on a visual analogue scale (VAS) ranging from 0 as “not at all important” to 10 as “ very important”. The domains were then mapped to the categories of the International Classification of Functioning, Disability, and Health.

Results  The domains regarded as being most important were food availability (9.5, SD = 1.52), owning a brick house (9.4, SD = 1.57), access to medical services (9.4, SD = 1.55), and family safety (9.4, SD = 1.7). Having no bodily pain was ranked 40th. Environmental factors were valued significantly more than the other two categories and those related to body functions were valued more highly than domains in the category of activity/participation.

Discussion and conclusion  Despite being asked specifically to answer the questions in relation to their health status, the participants apparently did not differentiate between general quality of life (QoL) and specific HRQoL. It appears that members of an under-resourced community regard socioeconomic and service delivery aspects of their lives as integral to their perceived state of health. It may be that it is not possible to separate factors relating to general quality of life from those specifically related to HRQoL in an under-resourced population and such populations might not be suitable for inclusion in certain clinical trials where improvement in HRQoL is the required outcome. Alternatively, if a HRQoL instrument is to be used to monitor the impact of medical intervention, the inclusion of environmental factors should be considered.