The introduction of quality of life (QOL) assessment has shifted clinical focus away from symptom measurement towards assessment of functional areas important to the patient. Most QOL instruments were conceptualized and developed primarily in Western society, and have not been validated against non-Western indigenous beliefs of what it means to have quality of life. As a result QOL assessment has cultural limitations. Only by awareness of these limitations can one validly interpret QOL findings from non-Western cultural groups. This article highlights the main areas for attention: concept and construct of QOL, peoples' baseline and expectations of QOL, coping mechanisms and communication of QOL. A literature review from 1966 to present of QOL in non-Western cultures revealed that many studies comparing cross-cultural QOL scores do not consider such cultural limitations. In addition the most popular QOL cross-cultural assessment tool, the WHOQOL, does not consider all factors. We conclude that only through true appreciation and understanding of the cultural limitations of QOL can one validly interpret results from non-Western QOL assessments.