COMPREHENSIVE QUALITYOF LIFE SCALE ...level of Likert scale complexity which approximates their...

COMPREHENSIVEQUALITYOF LIFE SCALE -

INTELLECTUAL/COGNITIVEDISABILITY

FIFTH EDITION(ComQol-I5)

Robert A. CumminsSchool of Psychology

Deakin University

MANUAL

1997

Correspondence to:

Robert A. Cummins Ph.D., F.A.P.S.School of PsychologyDeakin University221 Burwood HighwayMelbourneVictoria 3125AUSTRALIA

e-mail: [email protected]

ISBN 07300-27252

Published by the School of PsychologyDeakin University

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Contents

1 Introduction 71.1 Measuring and defining quality of life 71.2 The Scale 81.3 Prior editions of the scale 91.4 Summary 9

2 Scale and Administration Procedures 112.1 General information 112.2 The testing environment 112.3 Pre-testing 122.4 Proxy responding 122.5 Testing procedure 12

3 Comprehensive Quality Of Life Scale (ComQol-I5) 13

Objective Scale 14

3.1 Subjective testing 203.1.1 Client testing for acquiescent responding 203.1.2 Client testing for discriminative competence 20

- Phase 1: Order of magnitude 22- Phase 2: Scale with a concrete reference 23- Phase 3: Scale with an abstract reference 25

Importance Scale 27

3.2 Pre-testing for domain satisfaction 28

Satisfaction Scale 30

3.3 Subjective data from primary carer 31- Importance scale 31- Satisfaction scale 33

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4 Calculation of results 354.1 Coding the objective data 354.2 Coding the subjective data 394.3 Data cleaning 414.4 Dealing with data skew 414.5 Forms of data analysis 41

4.5.1 For the practitioner or service provider 414.5.2 For the researcher 424.5.3 % SM: A standardised comparison statistic 42

4.6 Individual SQOL diagnostic data tables 43

5 Theoretical Issues 455.1 Why use the ‘Delighted-Terrible’ scale? 455.2 Should ‘not important at all’ be scored as 1 or 0? 455.3 Should ‘mixed satisfaction/dissatisfaction’ be scored as 0? 455.4 Why not score the satisfaction scale from +1 to +7? 465.5 Why not use the Ferrans and Powers (1985) scoring system? 475.6 Why not use the Raphael et al. (1996) scoring system? 485.7 Why not use the Mattika (1996) scoring system? 49

6 Alternative Forms of the Scale 506.1 Parallel versions of the scale 506.2 Additional domains (see ComQol-A) 50

7 Psychometric Data 52

Study Codes 52

7.1 Objective means 527.2 Subjective means 53

7.2.1 Importance sub-scale 537.2.2 Satisfaction sub-scale 537.2.3 Importance x Satisfaction 54

7.3 Reliability 557.3.1 Cronbach’s alpha 557.3.2 Internal reliability 567.3.3 Test-retest reliability 57

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7.4 Scale construction issues 587.4.1 Objective vs. Subjective 587.4.2 Importance vs. Satisfaction 58

8 References to text 59

AppendicesAppendix A: Acquiescent responding scale 61

Appendix B: Psychotropic drug names 62

Appendix C: Scoring ComQol 63

Appendix D: Author publications 66

Appendix E: Testing materials 69

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Acknowledgements

The author gratefully acknowledges comments and ideas which have contributed to this fifthedition from the following people: Dr Christine Baxter, Professor David Felce, Dr EleonoraGullone, and Professor Marita McCabe.

I am most particularly indebted to Dr Eleonora Gullone for her artwork in producing thedelightful figures and faces that have been incorporated into the scales.

My thanks go also to Rai Sahib and Betina Gardner for their careful word-processing of thismanuscript.

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1 Introduction

1.1 Measuring and defining quality of life

The quality of life (QOL) construct has a complex composition, so it is perhaps not surprisingthat there is neither an agreed definition nor a standard form of measurement. This is not dueto a lack of ideas. Cummins (1996a) has recorded well over 100 instruments which purportto measure life quality in some form, but each one contains an idiosyncratic mixture ofdependent variables.

It is also notable that many QOL instruments have been developed for highly selected groupsin the population; particularly in regard to scales devised to monitor medical conditions orprocedures. Because of this, they are unsuitable for use with the general population.However, even the more general scales which have been devised cannot be used with allsectors of the population. Those created for the general adult population cannot be used withsome population sub-groups such as people with cognitive impairment and children. This isan important limitation since it means that the QOL experienced by such groups cannot benorm-referenced back to the general population.

In order to remedy this situation, the Comprehensive Quality of Life Scale (ComQol) hasbeen developed. This scale has been designed in parallel forms suitable for any populationsub-group. These forms are:

ComQol - A: designed for use with the general adult population.

ComQol - I: designed for use with people who have an intellectual disability or other formof cognitive impairment.

ComQol - S: designed for use with adolescents 11-18 years who are attending school.

The scale also contains features of construction which reflect contemporary understanding ofthe QOL construct. the details of test development have been published elsewhere(Cummins, 1991; Cummins, McCabe, Romeo and Gullone, 1994).

Definition

The scale that follows is an operationalisation of the following definition of quality of life:

Quality of life is both objective and subjective, each axis being the aggregate of sevendomains: material well-being, health, productivity, intimacy, safety, community, andemotional well-being. Objective domains comprise culturally-relevant measures ofobjective well-being. Subjective domains comprise domain satisfaction weighted bytheir importance to the individual.

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1.2 The scale

ComQol incorporates a contemporary understanding of the QOL construct. As such itcontains the following features:

(a) It is multidimensional. There is consensus within the field that the most usefulmeasures of life quality must incorporate the separate components which comprisethis construct, even though the precise nature of these components are somewhatconjectural (Felce & Perry, 1995). ComQol defines life quality in terms of sevendomains which together are intended to be inclusive of all QOL components. Theseare: Material well-being, health, productivity, intimacy, safety, place in community,and emotional well-being. Evidence for the adoption of these seven domains hasbeen presented by Cummins (1996b, 1997a). A discussion of additional domains isprovided in 6.2.

(b) It is multi-axial. This takes two forms. The first is in the separate measurement ofobjective and subjective components. The contemporary literature is quite consistentin its determination that, while both of these axes form a part of the QOL construct,they generally have a very poor relationship to one another. For example, physicalhealth and perceived health are poorly correlated (see 7.6.1).

The scale is also multi-axial in terms of its subjective measures. Each domain isseparately rated in terms of its importance to the individual as well as on its perceivedsatisfaction. It is notable that importance and satisfaction generally are moderatelypositively correlated with one another (see 7.6.2). The level of importance thenprovides an individualised weighting factor for each domain such that the subjectiveQOL measurement can be expressed as Importance x Satisfaction.

(c) It can be used with any section of the population. Two parallel versions of the adultComQol have been developed. ComQol-S is for use with adolescent students, whileComQol-I is designed for people who have an intellectual disability or other form ofcognitive impairment.

This latter scale incorporates a pre-testing protocol to determine whether, and to whatlevel of complexity, respondents are able to use the scale. This pre-testingprogressively moves responding from concrete to abstract. It commences with anordering task involving differently sized printed blocks, progresses to a task involvingblock size matching to a printed ladder scale (e.g. the largest block corresponds withthe top of a printed ladder), and ends with the use of a Likert scale involving theabstract conception of 'importance'. At each stage of this testing, people commencewith a task involving choice between two types of response (e.g. one large and onesmall block) and can progress to a maximum of five. The number of response choicessuccessfully negotiated in the final abstract task is then used to determine the LikertScale complexity to be used with ComQol-ID. For example, if a respondent is onlyable to manage the abstract task as a choice between two levels of importance, thenthey will be provided with a version of ComQol-ID where Likert scales are presentedas a binary choice.

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The use of this process eliminates those respondents who do not have the cognitivecapacity to respond validly to the scale. This is crucial given our understanding thatpeople who are placed in a forced-choice situation, where they do not understand thetask, will often respond either at random or in a manner they consider will please theinterviewer. Pre-testing therefore ensures that each respondent is provided with alevel of Likert scale complexity which approximates their discriminative capacity.

(d) The scale is psychometrically sound. It is reliable, stable, valid and sensitive (seeSection 7). Normative data are also provided (study A6, page 33).

(e) The sum of the domain scores for satisfaction can be referenced to the ‘gold-standard’of 75 ± 2.5% SM (Cummins, 1996b).

1.3 Prior editions of the scale

Fourth EditionWhile the wording of the subjective items is essentially the same as in the thirdedition, more substantial changes were made to the wording of a number of theobjective items. In all cases this involved a clarification or elaboration of the itemrather than a total change in content. The rating scale for each objective item alsoincreased from three-point to five-point. This meant that each objective domain scorewas now free to vary from 3 to 15 instead of 3 to 9 as in the third edition. Thepurpose of this change was to increase the discriminative power of the objectivedomain scores.

Fifth EditionThe wording of subjective items has remained unchanged. Within the objective scale,the wording of several items has been simplified but the sense of the items hasremained. Item 3c has been completely changed. As can be seen from 7.3.2, this wasthe only item that failed to display a significant intra-domain correlation in the fourthedition. No data are available on how this new item 3c performs.

1.4 Summary

This instrument is based on the following propositions:

• Quality of life (QOL) can be described in both objective (O) and subjective (S) terms.

• Each objective (OQOL) and subjective (SQOL) axis is composed of 7 domains.

1. Material well-being2. Health3. Productivity4. Intimacy5. Safety6. Place in community7. Emotional well-being

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• The measurement of each OQOL domain is achieved by obtaining an aggregate scorebased on the measurement of three objective indices relevant to that domain. Forexample, "material well-being" is measured by an aggregate score of income, type ofaccommodation and personal possessions.

• The measurement of each SQOL domain is achieved by obtaining a satisfaction scoreof that domain which is weighted by the perceived importance of the domain for theindividual. Thus,

SQOL = (Domain satisfaction x Domain importance).

NoteThis fifth edition of ComQol can be viewed both as a research instrument and a standardised test. Thefirst edition was compiled in 1991. It is anticipated that several further editions will be produced as newdata and ideas indicate ways that the scale can be improved. To this end comments are welcomed.

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2 Scale Administration

2.1 General information

The scale is intended to be administered on an individual basis. The objective sub-scaleshould involve both the interviewee and a non-disabled friend, family member, or staffmember, but the subjective sub-scale should involve the interviewee either alone or with oneclose friend.

It should be noted that the instrument exists in two parts, as objective and subjective. Undernormal conditions these two parts show little relationship to one another. This is consistentwith the broader literature on QOL which clearly indicates the independence of objective andsubjective variables. Hence, the full administration of the scale yields two measures of lifequality which are quite separate from one another.

If it is intended to administer both the objective and subjective scales then it is useful toadminister the objective scale first. This allows the client to become familiar with the testadministrator and procedures.

It should be emphasised that there is no time limit. The pre-testing and the full scaleadministration takes about 45 minutes to complete.

2.2 The testing environment

When using the scale with people who have a suspected intellectual or cognitive disability itis vital to ensure that the information they supply is valid. This requires great care on the partof the interviewer due to the problem of acquiescent responding.

People with an intellectual or cognitive disability are substantially more likely, then aremembers of the general population, to answer in ways that are perceived by the respondent tobe desired by the interviewer. This problem is exacerbated by:

• questions that seek self-disclosure;• controversial questions;• a sense of threat or unease. This may be generated through the perception of a power

differential or being questioned in an unfamiliar environment.

In an attempt to overcome these problems the questions have been framed as simply aspossible. Additionally, the interviewer should take special precautions with the interviewprocess. The interviewer should dress in a manner which does not invoke anxiety, theyshould be prepared to engage in simple social rituals, such as having a cup of tea or meetingother members of the household before testing takes place, and should be perceived by theinterviewee as friendly, or at least neutral. The interview should be held on home-ground forthe interviewer, in a quiet place away from the distractions of other people or television, andthe interviewer should be reasonably confident that each question has been understood,attended to, and answered as accurately as possible.

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There are several procedures which may be utilised to facilitate this process. The mostsimple is to enlist the help of a non-disabled friend, family member, or staff member ('carer')who can provide support in answering the questions comprising the objective sub-scale.However, carers MUST NOT assist the interviewee to formulate their responses to thesubjective sub-scale questions. When answering this part of the questionnaire intervieweesshould be seen either alone or with one supportive friend of their choice.

2.3 Pre-testing

In a further attempt to elicit valid responding, ComQol-I5 utilises the pre-testing protocoldescribed in Section 3.1. This procedure is designed to determine whether the intervieweecan understand the kinds of abstract reasoning required by the subjective sub-scale and, ifthey can, the maximum degree of scale complexity they can reliably utilise.

It is vital that the test administrator is fully conversant with the testing procedures beforeattempting serious test administration. Prior practice is essential.

2.4 Proxy responding

A review of proxy, vicarious, or third-party responding can be found in Cummins and Baxter(1993). Essentially, both the previous literature and our data suggest that considerablecaution should be used in the interpretation of such responses. Even people who claim toknow another person very well are not normally able to accurately report on the otherperson's subjective states at the level demanded by ComQol-I5.

However, it must be acknowledged that some people are more able at this task than othersand, if interviewees are unable to complete the scale on their own, there is a temptation to useproxy responding in the hope that it is better than nothing.

To date, very little research has attempted to elucidate the particular characteristics whichpermit accuracy in proxy responding. It might reasonably be assumed, however, that someessential characteristics would be that the respondent have empathy in relation to the client,and that they have been intimately associated for a reasonable period of time.

A scale suitable for eliciting proxy responses from carers is provided in section 3.3.

2.5 Testing procedure

Provide the client and carer with a copy of the questionnaire to share between them. Instructthat you will read each question, and that you will mark their response on your copy. Theydo not need to write anything.

When questions involve Likert scales, obtain an initial response without specifying the Likertscale descriptors. The question can be re-read. If the response is not clearly related to one ofthe response categories, state the two closest response categories and obtain a choice betweenthem.

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3 ComQol - I5

[Questions are asked by the interviewer]

“I am going to ask some questions about your life. [Carer] can help you at the start. Later Iwill ask you to answer some questions by yourself. Is that OK?”

“If you do not understand a question, just let me know.”

When were you born? ______/______/______ day month year

Client sex? (circle one) Male Female

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Objective Scale

1(a) Where do you live?

A house Do you own the place where youlive or do you rent?

A flat or apartmentOwn

A room (e.g. in a hostel)Rent

(Prompt: Think about the things you own, like your clothes, furniture, etc.)(b) How many personal possessions do you have compared with other

people?

More thanalmost anyone

More thanmost people

Aboutaverage

Less thanmost people

Less thanalmost anyone

(c) What is your personal or household (whichever is most relevant toyou) gross annual income before tax?

Less than $10,999 $41,000 –$55,999

$11,000 - $25,999 More than $56,000

$26,000 - $40,999

2(a) How many times have you seen a doctor over the past 3 months?

None 1 - 2 3-4 5-7 8 or more(about once (about every (about once a week

a month) two weeks) or more)

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(b) Do you have other disabilities or medical conditions? (other than anintellectual or cognitive disability) (e.g. visual, hearing, physical, health, etc.).

Yes No

If yes please specify:

Name of disability Extent of disability or medical condition or medical condition

e.g. Visual Require glasses for readingDiabetes Require daily injectionsEpilepsy Requires daily medication

_______________________ ___________________________________

_______________________ ___________________________________

_______________________ ___________________________________

(c) What regular medication do you take each day?

If none tick box

or

Name(s) of medication

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

3(a) How many hours do you spend on the following each week?(Average over past 3 months)

Hours paid work 0 1-10 11-20 21-30 31-40+

Hours formal education 0 1-10 11-20 21-30 31-40+

Hours unpaid child care 0 1-10 11-20 21-30 31-40+

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(b) In your spare time, how often do you have nothing much to do?

Almost always Usually Sometimes Not Usually Almost never

(c ) Do you watch TV? How much TV do you watch? (average over atypical week).

Hours per day

None 1 – 2 3 – 5 6 – 9 10 or more

4(a) Do you have a close friend?How often do you talk with your friend?

Daily Several timesa week

Once a week Once a month Less thanonce a month

(b) If you are feeling sad or depressed does someone show they care for you?How often?


(c) If you want to do something special, how often does someone elsewant to do it with you?How often?


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5(a) Do you sleep well?How often?


(b) Are you safe at home?How often?


(c) Are you ever worried or anxious during the day?How often?


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6(a) Below is a list of leisure activities. Indicate how often in an averagemonth you take part in or attend each one for your leisure (not foremployment).

Activity Number of times per month

(1) Go to a club/group/society __________

(2) Go to a hotel/bar/pub __________

(3) Watch live sporting events (Not on TV) __________

(4) Go to a place of worship __________(e.g. church)

(5) Chat with neighbours __________or shopkeepers

(6) Eat out __________

(7) Go to a movie __________

(8) Visit family or friend __________

(9) Play sport or go to a gym __________

(10) Other (please describe) _____________________________

(b) Do you belong to any club, group, or society?

Yes No If no, go to question (c)

Do you hold an unpaid position of responsibility?

If ‘yes’, please indicate the highest level of responsibility held:

Committee Member

Committee Chairperson/Convenor

Secretary/Treasurer

Group President, Chairperson or Convenor

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(c ) Do people outside your home ask for your help or advice?How often?

Almost every day Quite often Sometimes Not often Almost never

7(a) Can you do things you really want to do?How often?


(b) When you wake up in the morning, do you ever wish you couldstay in bed all day?How often?


(c) Do you have wishes that cannot come true?How often?


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3.1 Subjective Testing

3.1.1 Client testing for acquiescent responding

While acquiescent responding contaminates all survey and interview data tosome degree, people with an intellectual or cognitive disability are particularlyprone to this form of responding. There are two main reasons. The first isdeference to an authority figure (the interviewer) learned as a consequence ofinstitutional living or dependence on caregivers. The second is a defenceagainst appearing incompetent when asked questions they do not understand.Agreement with the question, or answering in the affirmative, is the form ofresponse that is least likely to generate a negative consequence for the personbeing questioned.

In using the ComQol scale with people who have a mild/moderate level ofintellectual disability, and in the absence of pre-testing, we often find up to 25percent of people consistently answer at the top of the importance orsatisfaction scale. This may be due to the use of low - discrimination scales(2- or 3- point scales) such that the normal negative response-skew forcesresponse consistency. Alternatively, it may represent acquiescent responding.

It is therefore recommended that pre-testing for subjective QOL commenceswith the brief acquiescence scale presented in Appendix A. If people respondaffirmatively to the two acquiescent items, further testing on the subjectivescales should not proceed.

3.1.2 Client testing for discriminative competence

The purpose of the following procedures is to establish whether the client isable to independently respond to the subjective components of the scale.Ideally the primary caregiver should leave during this testing. If theirpresence is unavoidable, the client must respond without assistance.

The testing moves through three phases which are designed to determinewhether the client can:

(A) identify items in order of magnitude,(B) use a scale by matching to concrete reference,(C) use a scale with an abstract reference.

The testing protocol moves responding from concrete to abstract. Within eachof the three testing phases the tasks progress in complexity from binary choiceto a choice involving five elements.

When the client makes an error, return to the previous (simpler) task, andrepeat the question. If the client fails again proceed no further with that phaseand move onto the next. The client must respond correctly, at least using thebinary choice, in order to proceed to the next phase. If the client is unable torespond correctly to all three testing phases at least at the level of a binarychoice, they should not be requested to complete the subjective scale.

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Provided that the client is able to successfully complete each phase of this pre-testing, they may progress to the subjective ComQol-I5 subscale. Thefollowing should be noted:

(a) The level of choice provided in the importance subscale should bedetermined by the maximum level of discriminative competence displayedduring the third phase which used the concept of ‘importance’. That is, ifa client was able to complete phase (C) at the level of a three-point choice,then subsequent testing on importance will also use a three-point choice.

(b) The subjective questions should not be asked in the presence of theprimary carer if that can be avoided.

EquipmentThe diagrams that are provided will need to be detached from this manual, orcopied, so that they can be presented to the client as single pages.

ProcedureThe client responds to the questions by pointing.

During testing, the client should be seated at a table with the drawings in frontof them.

The following matters should be noted:

1. Whether to start testing at the beginning (size discrimination between twoblocks) or the end of the sequence (abstract use of 5-step importance scale)is a matter for judgement on the part of the test administrator. In this, it isa balance between engaging in unnecessarily simplistic tasks which aclient may find insulting, and incurring repeated failure due to starting at alevel that is overly demanding. The best source of advice on a startingpoint is the primary caregiver. If in doubt, start low.

2. It is important that the client has a minimal experience of failure. If theycannot do a task, minimise negative feedback and return to a level of taskat which they can succeed. Motivation can be enhanced throughappropriate praise and encouragement.

3. As with the administration of all psychological tests, it is vital that thetester is completely familiar with the instrument before it is given.Practice sessions on family, friends and volunteers is an absolutenecessity.

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Testing procedure

Ask the carer and client to name some possession which the client regards as highlyimportant. This will be used in the third phase of testing.

Item of importance ___________________________________________________________

Subjective Testing: Phase 1

Order of Magnitude Test

Whether testing starts at (a), (b) or (c) is at the discretion of the test administrator. Theadvice of a primary carer is likely to be useful.

(a) Present client with 2 blocks of extreme sizes. Record of clientSuccess (√) orFailure (x)

Q: Please point to the BIGGEST block

Q: Please point to the SMALLEST block

Note: If the client makes an error, repeat the instruction once. Unless it is certain that the client cancomplete this task, subjective testing should not proceed.

(b) Present the 3 blocks of differing sizes.


Q: Please point to the MIDDLE SIZED block


Note: If the client makes an error with (b), repeat task (a).

(c) Present the five blocks of differing sizes



Q: Please point to the MIDDLE SIZED block

Q: Please point to the SECOND BIGGEST block

Q: Please point to the SECOND SMALLEST block

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Subjective Testing: Phase II

Scale with a Concrete Reference

Procedure: Present the two-blocked diagram and the two-step scale.

Instruction: “I am going to show you the blocks again.” [present the two-block diagram].“And some steps” [present the two-step diagram].

“I want you to show me how the blocks match the steps. There are rules. Thebig block fits on the top step. The small block fits on the bottom step.

So, when I point to the big block [point] I want you to point to the top step[point]. Is that OK?” Repeat if client seems uncertain.

“When I point to the small block [point] I want you to point to the bottom step[point]. Is that OK?”

Record of clientSuccess (√) orFailure (x)

Q:

[Point to the big block]

“Where does the big block go on the steps?”

(client to point to place on the steps)

Q:

[Point to the small block]

“Where does the small block go on the steps?”

If the client succeeds: proceed to the 3-block problem.If the client fails: ask whether they would like you to go over the rules again. Ifaffirmative, repeat the instructions. If negative, repeat the task.

If the client fails again, cease testing and do not proceed with the satisfaction orimportance questions.

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Present the 3-Block Diagram and 3-Steps

Instruction: Here is another set of blocks and steps. This time you can see there is a middle-size block [point] and a middle step [point].

Just like before, I want you to point to the step that matches each block Is that OK?

Q:

[Point to the big block]

“Where does the big block go on the steps?”

Q:

[Point to the small block]

“Where does the middle-size block go on the steps?”

If the client succeeds, proceed to the 5-block problem. If they fail, use the samestrategy as described for failure in the 2-block problem.

If the client fails again, proceed to the next testing phase using only the binarychoice.

Present the 5-Block Diagram and 5-Stairs

Instruction: “Here is the last set of blocks and stairs.

Just like before, I want you to point to the step that matches each block. Is thatOK?

Q:

[Point to the smallest block]

“Where does this block go on the steps?”

Repeat for other blocks in the following sequence:

The middle-size block

The second biggest block

The second smallest block

If the client succeeds, proceed to the next testing phase. If the client fails, repeatas before.

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Subjective Testing: Phase III

Scale with an Abstract Reference

Recall: The possession named at the start of the objective testing which the clientregarded as highly important to them.

Present: The 2-steps of importance

Instruction: “This time I am going to show you some steps that have a meaning. They aresteps of importance. The top step [point] matches ‘very important’ and thebottom step [point] matches ‘not important’.

So, let me tell you the new rules. If you think something is very important youmust point to the top step [point]. And if you think something is not importantyou must point to the bottom step [point]. Is that OK?” Repeat if client seemsuncertain.

- Recall the personal possession that is important to the client.

Ask “Is ......... very important to you?”

- Ask “Where would you put it on these steps

- Ask “If something was not important to you where would

you place it on the steps

If the client succeeds: proceed to the 3-step problem.

If the client fails: ask whether he/she would like you to go over the rules again.If affirmative, repeat the instructions. If negative, repeat the task.

If the client fails again, cease testing and do not proceed with the importance orsatisfaction questions.

Present: The 3-steps

Instruction: “Here is another set of steps. This time you can see there is a middle step[point]. this step matches ‘somewhat important’.

Just like before, I want you to point to the step that matches how importantsomething is for you. Is that OK?

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Q: If something was very important, where would you put it on the scale?

Q: Not important?

Q: Quite important?

If the client succeeds, proceed to the 5-step problem. If they fail, use the samestrategy as described for failure in the 2-step problem.

If the client fails, proceed to test ComQol ‘importance’ and ‘satisfaction’ usingbinary-choice scales.

Present: 5-steps of importance

“Here is the last set of importance steps.

This time there are five steps. There are three you have seen already and twonew ones.

The ones you know are [point to each in turn] ‘very, very important’, ‘not at allimportant’, and somewhat important.

The new ones are [point to each in turn], ‘a little bit important’ and ‘a lotimportant’.

So, going up the steps we have [point to each in turn] ‘not at all important’, ‘alittle bit important’, ‘somewhat important’, ‘a lot important’, and ‘very, veryimportant’. Is that OK?

Q: If something was very, very important to you, where would you point?

Q: Not important?

Q: Quite important?

Q: A little bit important?

Q: A lot important?

If the client succeeds, proceed with the ComQol importance testing using the 5-point scale.

If the client fails, repeat the sequence of the five-steps. If the client fails again,proceed with ComQol importance testing using the 3-point scale.

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Importance Scale

Procedure: Test the client alone if possible, or with one close friend.Use the 2, 3 or 5-point importance scale as previously determined.

Note: Record the level of scale complexity that is to be used:

Instruction: “Now I want to find out how important some real things are to you. Just likebefore, I want you to point to the step that matches the importance you feel. Areyou ready to start?

Each question begins with “How important to you is/are...”

Response

1. the things you have? Like the money you have and the thingsyou own

2. how healthy you are?

3. the things you make or the things you learn?

4. having a close friend or family?

5. how safe you feel?

6. doing things with people outside your home?

7. your own happiness?

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3.2 Pre-testing for Domain Satisfaction

Procedure: Faces scales are provided in Appendix X

Now I want you to do a different job. It’s another pointing job, but this timethere are 2 faces.

One is a happy face [point], one is a sad face [point].

What makes you happy? Record of client success( √ ) or failure (x)

Reply - X

So if I said “How happy are you about X?”, which face would you point to?

What makes you sad?

Reply Y

So if I said, “How sad are you about Y?”, which face would you point to?

If the client succeeds: proceed to the 3-faces problem.

If the client fails: ask whether he/she would like you to explain the faces again.If affirmative, repeat the instructions. If negative, repeat the task.

If the client fails again, cease testing and do not proceed with the satisfactionquestions.

Present: The 3-faces

Instruction: “Here is another set of faces. This time you can see there is a middle face[point]. This face is not happy or sad.

Q: If you felt very happy about something which face would you pointto?

Q: If you felt very sad about something which face would you point to?

Q: If you felt neither happy nor sad which face would you point to?

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Present: The 5-faces

Instruction: “Here is the last set of faces.

This time there are five faces. There are three you have seen before and twonew ones.

The ones you know are [point to each in turn] ‘very sad’, ‘neither happy norsaid’, and ‘very happy’.

The new ones are [point to each in turn], ‘a little bit sad’, and ‘a little bit happy’.

So, going over the faces again we have [point to each in turn], ‘very sad’, ‘a bitsad’, ‘neither happy nor sad’, ‘a bit happy’, and ‘very happy’. Is that OK?

Q: If you felt very happy about X which face would you point to?

Q: If you felt a bit happy about X, which face would you point to?

Q: If you felt very sad about X, which face would you point to?

Q: If you felt a bit sad about X, which face would you point to?

Q: If you felt neither happy nor sad about X, which face would you point to?

If the client succeeds, proceed with the ComQol satisfaction testing using the 5-faces scale.

If the client fails, repeat the sequence of the 5-steps. If the client fails again,proceed with ComQol satisfaction testing using the 3-faces scale.

30

Satisfaction Scale

Note: Record the level of scale complexity that is to be used:

Each question begins with: “How happy or sad do you feel about ...”

Response

1. the things you have? Like the money you have, and the thingsyou own?

2. how healthy you are?

3. the things you make or the things you learn?

4. your friends or family?

5. how safe you feel?

6. doing things with people outside your home?

7. your own happiness?

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3.3 Subjective Data from Primary Carer

Caveats for the use of vicarious responding have been presented in the introduction. Thefollowing scales are presented either for research into the degree of congruence between carerand client data, or for situations where a client is unable to complete the pre-testing and it isfelt that the carer may be able to provide valid proxy data.

Importance

Statement:

“I am going to ask you how IMPORTANT you think some aspects of life are to (client). Todo this I want you to answer as though you were (client). This is going to be quite difficultfor you. I do NOT want you to answer as you think (client) should respond. That is, do notimpose your views on (client). Rather, the answers that you give should be the answers thatyou think (client) would give. OK?

Provide the IMPORTANT scale to carer and describe its construction.

“So, I am now going to name some aspects of life and you will tell me how IMPORTANTeach one is for (client).”

[When sure that the task is understood proceed. The carer holds the steps-scale. The testermarks responses onto the scales below.]

32

1. How Important to (client) ARE THE THINGS he/she OWNS?

Could not bemore important

Very important Somewhatimportant

Slightlyimportant

Not importantat all

2. How Important to (client) is his/her HEALTH?



Slightlyimportant

Not importantat all

3. How Important to (client) are the THINGS he/she MAKES OR THINGS he/sheLEARNS?



Slightlyimportant

Not importantat all

4. How Important to (client) are CLOSE RELATIONSHIPS WITH FAMILY ANDFRIENDS?



Slightlyimportant

Not importantat all

5. How Important to (client) is HOW SAFE he/she FEELS?



Slightlyimportant

Not importantat all

6. How Important to (client) is DOING THINGS WITH PEOPLE OUTSIDEhis/her HOME?



Slightlyimportant

Not importantat all

7. How Important to (client) is his/her OWN HAPPINESS?



Slightlyimportant

Not importantat all

33

Satisfaction

Statement:

“Now I want to ask you a different set of questions. This time I will ask you howSATISFIED you think (client) is with each of the life areas. I still want you to answer asthough you were (client). OK?”

[Provide 5-faces scale to carer and describe its construction.]

“So, I am now going to name the same areas of life as before and you will tell me howSATISFIED (client) is with each one.”

[When sure that the task is understood proceed. The carer holds the faces-scale. Theinterviewer marks responses on to the scales below.]

34

1. How Satisfied is (client) with the THINGS he/she OWNS?

Delighted Pleased Mixed Unhappy Terrible

2. How Satisfied is (client) with his/her HEALTH?


3. How Satisfied is (client) with the THINGS he/she MAKES OR THE THINGShe/she LEARNS?


4. How Satisfied is (client) with his/her CLOSE RELATIONSHIPS WITHFAMILY AND FRIENDS?


5. How Satisfied is (client) with HOW SAFE he/she FEELS?


6. How Satisfied is (client) with DOING THINGS WITH PEOPLE OUTSIDEhis/her HOME?


7. How Satisfied is (client) with his/her OWN HAPPINESS?


35

4 Calculation of results

4.1 Coding the objective data

The following information is relevant to the scoring procedures:

Missing values: Score as 9 (then get the computer to recognise ‘9’ as denoting amissing value).

Estimated income: The average adult Australian full-time wage in February 1997was $38,063 per year. Users in other countries will need to modify the scoring ofincome on a pro rata basis.

MATERIAL WELL-BEING

1a) Accommodation:house + own = 5flat/apartment + own = 4house + rent = 3flat/apartment + rent = 2Room + either = 1

b) Possessions:More than almost anyone = 5 Less than most people = 2More than most people = 4 Less than almost anyone = 1About average = 3

c) Estimated income:

More than $56,000 = 5 $11,000 - $25,999 = 2$41,000 - $55,999 = 4 Below $10,999 = 1$26,000 - $40,999 = 3

HEALTH

2a) Doctor: None = 5 5-7 = 21-2 = 4 8 or more visits = 13-4 = 3

b) Disability or medical condition

5 = No disability4 = Minor disability (e.g. eyeglasses) not likely to interfere with normal life

activities or routines3 = Constant, chronic condition that interferes to some extent with daily life (eg.

diabetes, heart condition, Alzheimer's disease, migraines, infertility, asthma

36

when nothing is recorded under medication, arthritis when nothing is recordedunder medication)

2 = Disability likely to restrict social activities (e.g. profound deafness, blindness,significant physical disability, depression, schizophrenia, arthritis, Parkinson’sDisease, paraplegia, asthma needing regular medication, arthritis needingregular medication, limb missing)

1 = Major disability likely to require daily assistance with personal care (e.g.severe psychiatric condition, advanced multiple sclerosis, severe cognitive orphysical impairment, quadriplegia)

Note: It is sometimes difficult to choose between categories, eg. multiple sclerosis orAlzheimers in the early stages would probably score 3, but in the latter stagesscore 2. Put them into these categories unless there is some information thattells otherwise. Eg. Assume that a person who has Alzheimers, but is able toanswer the questionnaire scores 3, because once social activities becomemarkedly restricted they would probably not be capable of completing thequestionnaire. If a person has mild deafness, score 3, but if they arecompletely deaf, score 2.

c) Medication:No regular medication = 5Single non-psychotropic medication = 4Multiple non-psychotropic medication = 3Psychotropic medication = 2Psychotropic plus non psychotropic medication = 1

Note: Psychotropic medication indicates drugs for the control of epilepsy,psychoses, and other abnormal mental states. They include tranquilisers,sedatives, barbiturates and a host of others. Some of these drug names areprovided in Appendix A.

PRODUCTIVITY

3a) 31-40+ work, education or child care = 521-30 hours combined work/education/child care = 411-20 hours combined work/education/child care = 31-10 hours combined work/education/child care = 2Neither work nor education nor child care = 1

b) Spare time: (Note reverse score)Almost always = 1 Not usually = 4Usual = 2 Almost never = 5Sometimes = 3

c) Hours TV each dayNone = 5 6-9 hours = 21-2 hours = 4 10+ hours = 13-5 hours = 3

37

INTIMACY

4a) Talk: Daily = 5 Once a month = 2Several = 4 Less than once a month = 1Once a week = 3

b) Care: Almost always = 5 Not usually = 2Usually = 4 Almost never = 1Sometimes = 3

c) Activity: Almost always = 5 Not usually = 2Usually = 4 Almost never = 1Sometimes = 3

SAFETY

5a) Sleep: Almost always = 5 Not usually = 2Usually = 4 Almost never = 1Sometimes = 3

b) Home: Almost always = 5 Not usually = 2Usually = 4 Almost never = 1Sometimes = 3

c) Anxiety: Almost always = 1 Not usually = 4(Note reverse score) Usually = 2 Almost never = 5

Sometimes = 3

PLACE IN COMMUNITY

6a) Activity:

(i) For each separate activity calculate 0.2 + (0.2 x frequency) for each activity upto a maximum frequency of 4/month. i.e. Each activity is scored to amaximum of 1.0.

(ii) Aggregate the total scores across all activities up to a maximum of 5 activities.Round all fractions to the nearest integer, i.e. the maximum score possible is 5

Additional Comments:

(6) eat out “take aways” - exclude(7) movies “watched videos” - exclude(8) other people sometimes write something that should come

under one of the previous categories, [eg. tennis clubor yacht club should come under (i)] put them underthe category that seems most appropriate.

38

If rather than writing how many times in last month, people write:occasionally record “1”numerous “4”sometimes “1”seldom “9” (i.e. missing value)weekends “4”

b) Responsibility:Chairperson/ President/ Convenor eg: Manager of basketball team, boatcaptain, convenor of family support group = 5

Treasurer/ Secretary or other title denoting specific major area ofresponsibility eg: Immediate past-president, co-ordinator of friends’ group,executive member, trainer for junior football club = 4

Committee chairperson or other indication of minor area of responsibility oractive involvement eg: Librarian of volunteer group = 3

Committee member = 2

If they say they hold a position but do not state what the position is = 1

None = 1

c) Advice: Almost every day = 5 Not often = 2Quite often = 4 Almost never = 1Sometimes = 3

EMOTIONAL WELL-BEING

7a) Can do: Almost always = 5 Not usually = 2Usually = 4 Almost never = 1Sometimes = 3

b) Bed: Almost always = 1 Not usually = 4(reversed scored) Usually = 2 Almost never = 5

Sometimes = 3

c) Wishes: Almost always = 1 Not usually = 4(reversed scored) Usually = 2 Almost never = 5

Sometimes = 3

39

4.2 Coding the subjective data

IMPORTANCE


Veryimportant

Somewhatimportant

Slightlyimportant

Not at allimportant

Missingvalue

Deligh

NoteWe useneeds t

Delig

+4

9

7

5

ted Pleased

the score of 9 to be taken that th

In order to cSatisfaction) f

hted Please

+3

Following thisand the overalAs a result of and +20.

4

S

MostlySatisfied

M

o allow computer ese ‘9’ values are

IMPORTA

alculate a meanor each domain,

d MostlySatisfied

+2

recoding procel SQOL = (Ithis procedure t

5

3

ATISFACT

ixed MostDissatis

identification of recognized as e

NCE x SA

ingful subjectithe satisfaction

Mixed

+1

dure each SQOxS). See Apphe SQOL obtai

2

ION

lyfied

Unhappy

missing values. Ixcluded values, an

TISFACTION

ve QOL (SQOL data need to be

Mostlydissatisfied

-2

L domain scorendix B for a mned for any dom

1

Terrible Mv

f this scheme is ud not included as

) score (Imporre-coded as follo

Unhappy T

-3

e is calculated aore detailed descain ranges betw

issingalue

9
6 4 3 2 1
sed, caredata.

tance xws:

errible

-4

s (IxS),ription.een -20

40

Scale Conversion Tables

Where clients use simpler forms of the Importance and Satisfaction rating scales,values are assigned to responses so as to conform to the respective 5-point standardsgiven above. Conversions are as follows:

Importance Scale Conversion Table

ScalePoints Rating and Assigned Value

5 Could not bemore

important

Veryimportant

Somewhatimportant

Slightlyimportant

No importanceat all

5 4 3 2 1

3 Veryimportant

Somewhatimportant

Notimportant

5 3 1

2 Veryimportant

Notimportant

5 1

Satisfaction Scale Conversion Table

ScalePoints Rating and Assigned Value

5 Very happy Happy Neither happynor sad

Sad Very sad

4 2.5 1 -2.5 -4

3 Very happy Neither happynor sad

Very sad

4 1 -4

2 Very happy Very sad

4 -4

41

4.3 Data cleaning

It is recommended that the raw data files be carefully examined prior to theimplementation of analytic procedures. In particular;

(a) An analysis of response frequency data for each variable will allow thedetermination that the computer is recognising '9' as a missing variable.

(b) If a table of raw data is examined, the data for each subject can be visuallyscanned to detect patterns of response that are consistently at the top of eitherthe importance or satisfaction scales over the seven domains. In study A6 (seeSection 7) which included 794 adults, 1 percent of subjects recorded this typeof response. Such data are excluded prior to analysis since they provide novariance and likely reflect a response set.

4.4 Dealing with the data skew

Both the importance, satisfaction, and I X S data are typically moderately negativelyskewed. To restore normality, the most appropriate transformation is reflect andsquare root.

Opinion is divided among statisticians as to whether this procedure is appropriate. Irecommend that the data not be transformed for the following reasons:

1. Authorities such as Tabachnick and Fidell (1996) recommend againsttransforming data which are known to be naturally skewed.

2. In my experience of checking the effects of transformation when applyingmultivariate statistics, the influence is very small.

A related issue concerns the increased intra-group variance that is created by forminga product of importance and satisfaction. We have attempted to reduce this by adding(I + S), both with and without transformation. While this procedure does achieve asomewhat reduced coefficient of variation (mean/standard deviation) it is notrecommended for two reasons as: (a) It does not seem to improve the data sensitivityto between-group differences, and (b) the power of importance to weight thesatisfaction scores is reduced.

4.5 Forms of data analysis

NoteFor a step-by-step scoring procedure see Appendix B.

4.5.1 For the practitioner or service provider

The most useful level of analysis is in terms of domain scores. For theobjective QOL this involves a sum of the three component scores for eachdomain. Reference data are available in section 7.1

For subjective QOL the domain scores are obtained by (Importance xSatisfaction) following the recoding of Satisfaction as described in 4.2.

42

Reference data are provided in Section 7.2 and the construction of individualdiagnostic tables are described in 4.5.

4.5.2 For the Researcher

The most useful level of analysis may be at the level of the domain for allthree axes; objective, importance and satisfaction. It has been found thatimportance and satisfaction are often fairly independent and their separatevariation is likely to be of interest to any investigation of the QOL construct(see 7.6.2).

NoteGroup I x S statistics must be based on individually calculated I x S scores.

4.5.3 % SM: A standardised comparison statistic

In some circumstances it may be useful to compare the relative extent ofimportance and satisfaction which has been expressed in relation to a domain.This cannot be made directly since importance has been scored on a 5-pointscale and satisfaction on a 7-point scale. The comparison can be achieved byconverting each to a statistic which reflects the extent to which a scoreapproximates the maximum score which could be obtained. The formula is asfollows:

% of scale maximum = (Score -1) x 100/(number of scale points -1)

EXAMPLES

Scales coded +1 to +5For example, with an importance score of 4.0 and a 5-point scale% scale max = (4-1) x 100/(5-1)

= 75%

Scales coded +1 to +7For a satisfaction score of 5.2 and a 7-point scale% scale max = (5.2-1) x 100/(7-1)

= 70%

Scales coded -4 to +4 (see 4.2)The calculation here requires a modified formula as:

(a) POSITIVE S scores use:% sm = [ (score -1) +3] x 100/6

(b) NEGATIVE S scores use:% sm = [ (score +1) + 3] x 100/6

43

Importance x Satisfaction scores

For an I x S score to be expressed in this way:

a) The S score must be recoded on a +4 to -4 scale (see 4.2)

b) Any I x S score of -1 to +1 is converted to +1 (note this is the mid-point of the recoded satisfaction scale).

c) POSITIVE I x S scores use the formula:% scale maximum = [(score -1) + 19] x 100/38

d) NEGATIVE I x S scores use the formula:% scale maximum = [(score +1) + 19] x 100/38.

An interpretation of this statistic can be made using the Cummins (1995a)paper which brought together previously published studies on overall lifesatisfaction. It reported an average 75.0 ± 2.5 % sm. Section 7.2 reports lifesatisfaction data using ComQol.

4.6 Individual SQOL diagnostic data tables

The following table is an example of how ComQol can be used as a diagnosticinstrument for the individual. Each importance and satisfaction rating has been scoredaccording to Section 4.2. The I x S score is then a standardised measure of domainquality for each client with a range +20 to -20.

Table 1 Example of a client diagnostic table

Material well-being

ClientImportance (I)

(Coded +1 to +5)Satisfaction (S)(Coded -4 to +4) I x S

1 2 4 82 3 1 33 5 4 204 1 3 35 5 -4 -206 5 4 207 5 1 58 3 -3 -9 9 3 2 610 5 -4 -20

Mean 3.70 0.80 1.6

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An interpretation of the above data can be made in relation to a reference group of794 non-disabled adults drawn randomly from the general population. In summaryform the I x S results were as follows:

DomainIMPORTANCE X SATISFACTION(Coded +1 to +5 (Coded -4 to +4)

Mean + S.D.% of Negative I x S Scores

Material 8.44 + 4.65 2.1

Health 8.78 + 6.92 7.4

Productivity 7.45 + 5.50 5.6

Intimacy 11.51 + 6.34 3.1

Safety 10.00 + 5.04 1.9

Community 7.14 + 5.09 4.8

Emotion 8.98 + 6.09 5.5

From the above table it can be seen that the reference group had a strong tendency toscore above the scale mean of zero. Consequently, the presence of a negative IxSscore is indicative of a poor quality domain for that person. It can be seen that fewerthan 9% of the samples obtained a negative IxS on any domain.

45

5 Theoretical issues

5.1 Why use the 'Delighted-Terrible' scale?

A major problem with QOL data is their tendency to cluster at the favorable end ofany scale. Andrews & Withey (1976) have reported that the D-T scale creates a morepronounced spread of upper-end results than does the more conventional scale of'Extremely satisfied' to 'Extremely dissatisfied'.

5.2 "Should 'not important at all' be scored as 1 or 0"

The importance score is used as a weighting for satisfaction (I x S) as indicated below.Consequently if 'not important at all' was scored as '0' then the product with any Sscore would also be zero.

In logical terms this could be reasonable; if a domain really does have no importancethen the level of satisfaction is irrelevant and the I x S product should always be zero.However, people who respond 'no importance at all' do still respond to the satisfactionscale. This indicates that levels of satisfaction may be experienced even though therespondent regards the domain as having no importance.

There are several possible reasons for this finding as:

1. Importance and Satisfaction are largely independent constructs. Certainly theycan be independently experienced. Thus, even if one's material things are 'notimportant at all', this will not prevent the experience of being satisfied ordissatisfied in this domain.

2. It might be argued that no domain could actually have a zero importance sinceall domains form a part of each person's continuous life experience. The realmeaning, then of 'not important at all' is of very low importance. This notionwould be consistent with the very gross nature of the scale. where only fivepoints span the continuum of 'importance'.

3. If this argument is accepted, then, for the purposes of using importance as aweighting factor, it would be preferable to score 'no importance at all' in aneutral way rather than in a canceling way. Thus, a score of '1' is preferable toa score of '0'. This allows the lowest rating of importance to have noweighting influence on the measure of satisfaction. It also has the advantageof allowing a greater range of I x S scores in the lowest range.

5.3 "Should 'mixed satisfaction/dissatisfaction' be scored as 'O'?"

If this was adopted, then the scale on either side could be scored (+1, -1), (+2, -2), (+3,-3). This system would create a more reasonable interval scale around the mid-pointi.e. +1, 0,-1. However, it would have the disadvantage of creating a zero I x Scombination whenever a 'mixed' level of satisfaction was recorded.

46

The meaning of a zero I x S score in this context is unclear. It would mean thenegation of any assigned score of importance and, thereby, the loss of discriminativedata. It also loses the meaning of the data; a response of 'mixed' satisfaction does notimply zero satisfaction. Rather it implies a neutral level of satisfaction/dissatisfactionfor which a score of '1' would be more appropriate. In this way the importance'weighting' score would remain uninfluenced by the rating on satisfaction.

One problem with this approach may be seen in terms of the mathematical logic ofthe resultant interval scale around the point of neutrality i.e. +2, +1, -2. It is clear thatthis cannot be a true interval scale. However, Likert scales cannot conform to thestrict logic of interval scales; they are contrived approximations which are dependenton the assumption of an equal degree of psychological separation between theresponse points. In this case the point of neutrality (scale mid-point) is conceived asencompassing the range (+1-1), and the response point on either side depicts theaddition of one additional unit. See also the scoring of I x S (section 4.4.3, IxS, b) inwhich scores of -1 and +1 are treated as being equivalent and if substituted informulae c and d, yield 50% scale maximum.

5.4 Why not score the satisfaction scale from +1 (Terrible) to +7(Delighted)?

If this system was to be adopted then the I x S score interpretation would beambiguous. For example, a score of +4 could be the combination of either low I andhigh S, or high I and low S (dissatisfaction). By constructing the scale as it is, theseambiguities have been reduced, but not entirely eliminated. For example, a score of+4 could be generated by either 'Not important at all' x "Pleased" (1 x 4), or by 'Alittle bit important' x 'Somewhat happy' ( 2 x 2). While these could be distinguishedby examining the raw data, for most purposes of the scale this would not benecessary. More importantly, the distinction between response satisfaction anddissatisfaction is made unequivocal by the adopted scoring system of +4 to -4.

The possible combinations of I and S scores are as follows:

I x S Possible Combinations I x S Possible CombinationsScore Positive Negative Score Positive Negative20 5 x 4 5 x -4 10 5 x 2 5 x -219 - - 9 3 x 3 3 x -318 - - 8 4 x 2, 2 x 4 4 x -2, 2 x -417 - - 7 - -16 4 x 4 4 x -4 6 3 x 2, 2 x 3 3 x -2, 2 x -315 5 x 3 5 x -3 5 5 x 1 -14 - - 4 4 x 1, 1 x 4, 2 x 2 1 x -4, 2 x -213 - - 3 3 x 1, 1 x 3 1 x -312 4 x 3, 3 x 4 4 x -3, 3 x -4 2 2 x 1, 1 x 2 1 x -211 - - 1 1 x 1 -

Note(a) Possible importance scores are +1, +2, +3, +4, +5(b) Possible satisfaction scores are +4, +3, +2, +1,-2, -3, -4(c) The above table is essentially symmetrical between the positive and negative combinations

with the exception of I x S scores of 4, 3, 2 and 1 which demonstrate a reduced number ofnegative combinations.

47

5.5 Why not score the satisfaction scale according to the procedure ofFerrans and Powers (1985)?

These authors use an alternative system to ComQol, but it seems to have noadvantages.

Their procedure is as follows:

1. Importance is scored +1 to +6.

2. Satisfaction is scored +1 to +6.

3. The Satisfaction scores are recoded by subtracting 3.5 from each one.

ie. Original: +1 +2 +3 +4 +5 +6Recode: -2.5 -1.5 -.5 +.5 +1.5 +2.5

4. Importance is then multiplied by recoded S and 15 added to the product. Theyclaim: "This adjustment (recode) produces the highest score for items thathave high satisfaction/high importance responses, and the lowest score forhigh dissatisfaction/high importance responses. --- If scores were not recoded,a person who was very dissatisfied with an area of high importance wouldreceive the same item score as a person who was very satisfied with an area oflow importance." (p. 18)

In fact, however, their recoding procedure does not eliminate this problem.The possible I X S scores (recoded -2.5 to 2.5) obtained through the use of theFerrans & Powers formula are as follows:

I x S I x S Score Possible combinations Score Possible combinations

30 6 x 2.5 14.5 1 x -.5 27.5 5 x 2.5 14 2 x -.5 25 4 x 2.5 13.5 1 x -1.5, 3 x -.5 24 6 x 1.5 13 4 x -.5 22.5 3 x 2.5, 5 x 1.5 12.5 1 x -2.5, 5 x -.5 21 4 x 1.5 12 2 x -1.5, 6 x -.5 20 2 x 2.5 10.5 3 x -1.5 19.5 3 x 1.5 10 2 x -2.518 2 x 1.5, 6 x .5 9 4 x -1.517.5 1 x 2.5, 5 x .5 7.5 3 x -2.5, 5 x -1.5 17 4 x .5 6 6 x -1.5 16.5 1 x 1.5, 3 x .5 5 4 x -2.5 16 2 x .5 2.5 5 x -2.5 15.5 1 x .5 0 6 x -2.5

48

A comparison of the above distribution with that previously provided for ComQolyields the following observations.

1. The form of each distribution is roughly equivalent, with combinationsbunching around the mid-point.

2. The F & P distribution is symmetrical around the mid-range score of 15, whilethe ComQol distribution shows a reduced number of negative combinationsdue to the absence of -1 as a recoded satisfaction score. Thus, the I x S scorecombinations lying just below the mid-range are less ambiguous in the case ofComQol.

3. The area of maximum I x S score ambiguity, in terms of their composition, isgreatest in both distributions just above the mid-range. For example, over arange of three integer units in the F & P distributions, from scores of 12 to 14,eight I x S combinations are represented. The ComQol distribution ismarginally less ambiguous with seven I x S combinations over an equivalentscore-range of 2 to 4.

4. Both distributions produce a few I x S combinations which are veryambiguous indeed. For example, an I x S score of 17.5 in the F & Pdistribution could be the combination of either 'lowest I x highest S' or'second-highest I x mid-range S'. An equivalent degree of confusion isprovided by the ComQol I x S score of 4.

ConclusionThe Ferrans and Powers formula is not superior to the simpler ComQol recodingprocedure.

5.6 Why not use the Raphael et al. (1996) scoring system?

These authors have devised the 54-item Quality of Life Profile which also usessatisfaction (scored 1-5) weighted by importance (scored 1-5). Their formula is:

QOL = (Importance score/3) x (satisfaction score -3)

Thus, the possible scores are:

5 4 3 2 1

Importance: 1.67, 1.33, 1, 0.67, 0.33

Satisfaction: 2, 1, 0, -1, -2

The following observations can be made:

1. The differential weighting of adjacent items is reduced from ‘1’ in ComQol to0.33. The relative weighting by importance is thus reduced.

49

2. The possible range of values is +3.33 to -3.33. This seems an awkward rangeto deal with.

3. A satisfaction score of 3 leads to a QOL = 0 regardless of the importancescore. The authors state “This is consistent with our conceptual thinking thatmoderate enjoyment of an aspect of life should result in a ‘neutral’ QOLscore, whether it is important or not.” (p.369). See 5.3 for comment.

ConclusionThis dual transformation of both importance and satisfaction data has no advantagesover the ComQol procedure.

5.7 Why not use the scoring system of Mattika (1996)?

In order to handle the problem of scale complexity vs. cognitive ability, this authorasked respondents to initially answer questions on 'happiness' using a yes/no format.Then, "those who answered affirmatively were then asked to clarify their responseswith further answers such as 'fairly'/'to an extent'/'sometimes' or 'very'/'a lot'/'often'.The answers were then developed into an ordinal variable which assigned thefollowing values to the responses: A 'no' response scored -1, 'yes, to an extent' scored0.5. 'Yes' without further specification scored +1, 'Yes, a lot' responses scored +1.5.The sum scores were calculated by summing up the original variables." (p.119).

This is a poor technique for the following reasons:

1. No objective criteria are specified in order to make the determination thatpeople have the ability to respond to more than a binary choice.

2. The resultant scores are ordinal. It is therefore psychometrically unsound tosum those scores to obtain a total.

3. The scale is biased in terms of degrees of positive discrimination. That is,people who respond in the negative are not permitted to express degrees ofnegativity.

4. Because each negative response can only score -1, while each positiveresponse can score from 0.5 to 1.5, the sum of scores cannot yield an unbiasedestimate of happiness/unhappiness.

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6 Alternative forms of the scale

6.1 Parallel versions of the scale

ComQol has been designed to have three parallel versions. In addition to ComQol-Ithere are:

ComQol-A. This has been designed for adults comprising the general population. Itis available as a separate manual.

ComQol-S. This has been designed for students at school aged 11-18 years. It isavailable as a separate manual.

6.2 Additional domains

The ComQol scale can be modified through the addition of other domains. To datethree modifications of this type have been considered and these will be described.However, a major consideration in this regard is the amount of additional uniquevariance accounted for by the addition of new domains.

Using an internal, stepwise multiple regression procedure where each (IxS) domain isregressed against the total subjective (IxS) score it has been determined that, using theseven standard domains, around 80% of the variance is shared and each domaincontributes only 1 to 3% of unique variance (Cummins, in preparation). Thus, theseven domains are probably adequate to measure overall subjective QOL. Whileother domains are able to contribute unique variance, their addition would be for thepurpose of investigating the specific domain in question rather than contributingvariance to the total subjective QOL score.

The additional domains that have been considered so far are as follows:

1. USEFULNESS: In some ways this is a better term for Productivity. Itcertainly includes all of the terms listed under Productivity. However, it alsoseverely overlaps with Place in Community, in that most, if not all activitiesinvolving others may be considered useful. It is concluded that it combineselements of both productivity and place in community.

2. LEISURE: This is a slippery concept. Unlike the other domains wheregenerally ‘more is better’, this does not apply to leisure. And as soon as somequalifier is introduced, such as ‘quality leisure’, it immediately overlaps withother domains (eg. productivity). It is concluded that leisure is subsumedwithin emotional well-being.

3. SPIRITUAL WELL-BEING: Four studies have experimented with theinclusion of this domain. In each case only the subjective axis has beenexplored using “How important to you are your religious or spiritual beliefs?”,and, “How satisfied are you with your religion or spirituality?”. The mainissues and findings to emerge are as follows:

51

(a) About one-third of Australian people have neither religion or spirituality.Thus, the ‘satisfaction’ question must be preceded by a statement which givesrespondents a choice of answering the item or not. As a consequence of this,the resultant data set for satisfaction comprises a mixture of 7- and 8- itemresponses. This introduces a complication into the subsequent analysis.

(b) As with the other domains (see above), the domain of spiritual well-being addsonly a small amount of unique variance when added to the usual sevendomains. The data are presented in ComQol-A5. No data derived fromComQol-I5 are available.

ConclusionThe seven original domains are sufficient to measure subjective QOL for mostpurposes. Spiritual well-being may be usefully added as an eighth domain if thepopulation under investigation is highly spiritual/religious or if this particular aspect ofthe QOL construct is to be examined.

4. FAMILY AND FRIENDS: The fourth domain is normally stated as acombined source of intimacy involving ‘family and friends.’ This isrecommended for normal use. However, under some circumstances it may bedesirable to obtain separate ratings for each component. The data arepresented in ComQol-A5. No data derived from ComQol-I5 are available.

NoteThe intimacy domain is normally rated as higher than the other domains in terms of bothimportance and satisfaction. Consequently, the use of two 'intimacy' domains as family andfriends will bias the aggregate [ (I x S)] such that it may be higher than the normative valueof 75 ± 2.5 %SM (Cummins, 1996b). It is therefore recommended that, when two separatedomains of family and friends are employed, their average combined score is used incombination with the other six domains when calculating SQOL.

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7 PSYCHOMETRIC DATA

Study codes

The data to be reported have been drawn from the following studies.

Study I-1: (1992: Third edition): The 59 subjects were aged 37 ± 14 years (range 17 to63 y), 39% female, mean age equivalent (Slosson) 5.4 ±1.68 y (range 2.7 to 9.3 y). All were residing in grouphomes housing 4-6 people.

Study I-2: (1995: Fourth Edition): The 115 subjects (reduced from 130 due to responsesets) were aged 33 ± 11 years. All were residing ingroup homes.

Study I-3 (1996: Fourth Edition): The 256 subjects were recruited from group homes andsheltered workshops. The group comprised 53.1%males.

7.1 Objective means

Study I-2 Study I-3RAW %SM RAW %SM

Material 7.25 ± 1.78 35.5 7.41 ± 1.69 36.8Health 10.58 ± 3.29 63.3 11.98 ± 2.57 74.5Productivity 10.18 ± 2.74 59.4 10.56 ± 2.86 63.0Intimacy 11.88 ± 2.52 73.9 11.69 ± 2.58 72.4Safety 12.29 ± 2.25 77.9 12.54 ± 2.17 79.5Community 6.64 ± 1.98 29.9 6.31 ± 1.90 27.6Emotion 10.16 ± 2.74 59.7 10.34 ± 2.79 61.2TOTAL 9.85 ± 1.94 57.1 10.12 ± 1.23 59.3

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7.2 Subjective means

7.2.1 Importance sub-scale

Study I-1 Study I-2RAW %SM RAW %SM

Material 4.49 ± .99 87.3 4.43 ± .78 85.8Health 3.80 ± 1.52 70.0 3.74 ± 1.21 68.5Productivity 4.04 ± 1.32 76.0 4.17 ± 1.08 79.3Intimacy 4.37 ± 1.14 84.3 4.47 ± .88 86.8Safety 3.95 ± 1.42 73.8 4.22 ± 1.14 80.5Community 3.38 ± 1.51 59.5 4.14 ± 1.18 78.5Emotion 4.43 ± .98 85.8 4.22 ± 1.17 80.5TOTAL 4.04 ± .64 76.0 4.20 ± .95 80.0

7.2.2 Satisfaction sub-scale (Coded -4 to +4)

Study I-1 Study I-2RAW %SM1 RAW %SM

Material 3.00 ± 1.98 83.3 2.29 ± 2.29 71.5Health 0.98 ± 3.26 33.7 2.24 ± 2.25 70.7Productivity 2.75 ± 2.27 79.2 2.17 ± 2.22 69.5Intimacy 2.03 ± 2.95 50.5 2.46 ± 2.33 74.3Safety 2.48 ± 1.87 74.7 2.18 ± 2.43 69.7Community 0.22 ± 3.24 37.0 1.90 ± 2.40 65.0Emotion 2.16 ± 2.88 69.3 2.08 ± 2.52 68.0TOTAL 1.95 ± 1.52 65.8 2.19 ± 1.60 69.8

1NoteThe formula for converting -4 to +4 coded data into %SM is [(score - 1) + 3] x 100/6

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7.2.3 Importance x Satisfaction

Study I-1 I-1Importance X Satisfaction

(Coded +1 to +5) (Coded -4 to +4)Mean ± S.D. %SM1

% of I x SScores

< 0.0Material 13.45 ± 10.02 82.8 5.1Health 5.90 ± 12.69 62.7 28.8Productivity 10.34 ± 10.91 74.6 8.5Intimacy 8.97 ± 13.98 71.0 16.9Safety 10.49 ± 8.23 75.0 1.7Community 0.63 ± 12.30 49.0 37.3Emotion 9.49 ± 13.37 72.3 13.5MEAN 8.73 ± 6.64 70.3 16.0

1NoteI x S values are converted to %SM through the formula [(score - 1) + 19] x 100/38

Study I-2Material 76.1Health 71.3Productivity 73.4Intimacy 78.4Safety 74.7Community 69.8Emotion 71.2MEAN 73.7

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7.3 Reliability

7.3.1 Cronbach’s alpha

Boyle (1991) and Cortina (1993) strongly condemn the 'classical'psychometric belief that high alphas are better in terms of intra-scalereliability. Boyle quotes Hattie (1985) as “alpha can be high even if there isno general factor, since (1) it is influenced by the number of items and parallelrepetitions of items, (2) it increases as the number of factors pertaining to eachitem increases, and (3) it decreases moderately as the item communalitiesincrease.” (pp. 157-8). He concludes that there is an optimum range ofinternal consistency/item homogeneity if significant item redundancy is to beavoided. According to Kline (1979, p. 3), with item intercorrelations lowerthan about 0.3 “each part of the test must be measuring something different...A higher correlation than (0.7), on the other hand, suggests that the test is toonarrow and too specific... If one constructs items that are virtually paraphrasesof each other, the results would be high internal consistency and very lowvalidity.” Kline also states "maximum validity... is obtained where test itemsdo not all correlate with each other, but where each correlates positively withthe criterion. Such a test would have only low internal-consistencyreliability." (p.3)

For the purpose of evaluating ComQol, sub-scale alphas will be sought in therange 0.3 to 0.7.

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7.3.2 Internal reliability

OBJECTIVE SUB-SCALE (Fourth Edition)

Alpha Domain vs.objective

Intra-domaincorrelations

Item vs. totaldomain score

sub-scalecorrelations

vs.Item (1)

vs.Item (2)

correlations

A. MATERIAL .14 .16a(1) Income .13a(2) Number of possessions .13 .13a(3) Standard of

accommodation

B. HEALTH .64 .42b(1) Visits to doctor .18b(2) Extent of disability .16 .43***b(3) Severity of medication .15 .49** .42***C. PRODUCTIVITY .35 .54c(1) Hours per week .29*c(2) Time on desired goal .32** .28*c(3) Things made, etc. .17 .13 .18D. INTIMACY .45 .45d(1) Freq. talk to friends -.11d(2) Freq. joined in activities -.15 -.09 -.09d(3) Freq. others care .01 .03 .04E. SAFETY .56 .74e(1) Freq. easily fall asleep .17e(2) Freq. anxious during the

day

.19 .31*

e(3) Freq. feel safe at home -.03 .35** .27*F. COMMUNITY .15 -.17f(1) Extent comm. activities .51***f(2) Ext community resp. .39*** .42***F(3) Ext valu’d by community .44*** .33** .46***G. EMOTIONAL .42 .47g(1) Freq. choose activities .49***g(2) Freq. impossible wishes .55*** .36**g(3) Freq. wish to say in bed .25* .17 .23NoteItem a(3s provides no correlational data since all were residing in the same standard of accommodation.* p < 0.05 ** p < 0.01 *** p < 0.001

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Objective Inter-Domain Correlations (Study I-3)

HLTH PROD INT SAF COM EMOMAT .13 - .03 - .25 .06 .06 - .07HLTH .11 - .04 .18 - .04 - .09PROD .19 .14 - .07 .12INT .12 .10 .19SAF - .17 .17COM - .10

SUBJECTIVE (Alpha values using the 7 domains)

Study I-1Importance .48Satisfaction .65Imp. x Sat. .68

7.3.3 Test - retest reliability

Study I-1 1-2 WeeksN=9

2-4 WeeksN=11

4-8 WeeksN=11

IMP SAT IMP SAT IMP SATMaterial .53 .82** .15 .33 .16 .10Health .69** .59* .00 .06 .39 .27Productivity .82** .29 .09 .08 -.15 .51Intimacy .12 .60* .12 .01 -.19 .69**Safety .50 .13 .44 .16 .56* .60**Community .84** .86** .85*** .56* .19 .16Emotion .97*** .54 -.14 .17 -.32 .50*TOTAL .87*** .82** .05 .23 .15 .39

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7.4 Scale construction issues

7.4.1 Objective vs. Subjective

The QOL literature is generally consistent in reporting a low relationshipbetween objective and subjective QOL. ComQol data also reflect this opinion.

7.4.2 Importance vs. satisfaction

The general trend, reported in ComQol-A, is for importance and satisfaction toshow a low-moderate positive correlation. These trends are repeated here:

Study I-2Material .28Health .31Productivity .27Intimacy .43Safety .41Community .21Emotion .30

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8 References to the text

(for references to Cummins, see Appendix C)

Andrews, F.M., & Withey S.B. (1976). Social indicators of well-being: Americans’ perceptions oflife quality. New York: Plenum Press.

Antonovsky, A. (1987). Unraveling the mystery of health. San Francisco: Jossey-Bass.

Best, C. (1996). The quality of rural and metropolitan life. Melbourne: Honours Thesis, Schoolof Psychology, Deakin University.

Boyle, G.J. (1991). Does item homogeneity indicate internal consistency or item redundancy inpsychometric scales? Personality and Individual Differences, 12, 291-294.

Bradburn, N.M. (1969). The structure of psychological well-being. Chicago: Aldine.

Cortina, J.M. (1993). What is coefficient alpha? An examination of theory and applications.Journal of Applied Psychology, 78, 98 - 104.

De Longis, A., Folkman, S., & Lazarus, R.S. (1988). The impact of daily stress on health andmood: Psychological and social resources as mediators. Journal of Personality and SocialPsychology, 54, 486-495.

Felce, D., & Perry, J. (1995). Quality of life: Its definition and measurement. Research inDevelopmental Disabilities, 16, 51-74.

Ferrans, C.E., & Powers, M.J. (1985). Quality of life index: Development and psychometricproperties. Advances in Nursing Science, 8, 15-24.

Ferris, C., & Bramston, P. (1994). Quality of life in the elderly: A contribution to itsunderstanding. Australian Journal on Aging. 13, 120-123.

Fogarty, D.M. (1994). Quality of life of aging Australians: The importance of health and socialsupport perceptions. Melbourne: Honours Thesis, School of Psychology, DeakinUniversity.

Foroughi, E. (1995). The life quality of Persian-Australians. Melbourne: Clinical MastersThesis, School of Psychology, Deakin University.

Fraid, R. (1995). Spiritual well-being and quality of life. Melbourne: Honours Thesis, School ofPsychology, Deakin University.

Gallagher, L. (1995). The effect of social activity and intimacy on the quality of life of people whoare elderly. Melbourne: Honours Thesis, School of Psychology, Deakin University

Germano, D. (1996). Quality of life and sense of coherence in people with arthritis. Melbourne:Clinical Masters Thesis, School of Psychology, Deakin University.

Golding, D. (1996). The relationship between spirituality, quality of life, and happiness.Melbourne: Honours Thesis, School of Psychology, Deakin University.

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Hattie, J. (1985). Methodology review: assessing unidimensionality of test and items. AppliedPsychological Measurement, 9, 139-164.

Hunt, S.M., McEwen, J., & McKenna, S.P. (1986). Measuring Health Status. Croom Helm:London.

Kline, P. (1979). Psychometrics and psychology. London: Academic Press.

Mallamace, J. (1996). The effects of sport and exercise on well-being. Melbourne: HonoursThesis, School of Psychology, Deakin University.

Miller, R.S., & Lefcourt, H.M. (1982). The assessment of social intimacy. Journal of PersonalityAssessment, 46, 514-518.

Oritt, E.J., Paul, S.C., & Behrman, J.A. (1985). Perceived Social Network Inventory. Journal ofCommunity Psychology, 13, 565-581.

Petito, F. (1995). A comparative study of the effects of stress and social integration on the lifequality of Italian immigrants and Australians. Melbourne: Honours Thesis, School ofPsychology, Deakin University.

Procidano, M.E., & Heller, K. (1983). Measures of perceived social support from friends and fromfamily: Three validation studies. American Journal of Community Psychology. 11, 1-24.

Raphael, D., Rukholm, E., Brown, I., Hill-Bailey, P., & Donato, E. (1996). The quality of lifeprofile - Adolescent version: Background, description, and initial validation. Journal ofAdolescent Health, 19, 366-375.

Rosenberg, M. (1965). Society and the adolescent self-image, Princeton, N.J.: PrincetonUniversity Press.

Schaefer, M.T., & Olson, D.H. (1981). Assessing intimacy: The Pair Inventory. Journal ofMarital and Family Therapy, January, 47 - 60.

Simm, L. (1996). Quality of life, work and retirement. Melbourne: Honours Thesis, Schoolof Psychology, Deakin University.

Tabachnick, B. G., & Fidell, L.S. (1996). Using multivariate statistics. Third edition. NewYork: Harper Collins.

Ware, J.E., & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473-481.

Watson, D., Clark, L.A., & Tellegen, A. (1988). Development and validation of briefmeasures of positive and negative affect: The PANAS scales. Journal ofPersonality and Social Psychology, 54 1063-1070.

Yiolitis, L. (1994). The Quality of life of Greek Australians. Melbourne: Honours Thesis,School of Psychology.

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Appendix A

ACQUIESCENT RESPONDING SCALE

Procedure

The primary carer may be present for the administration of this test. However, if they arepresent it is essential that they:

1. Be instructed to make no response whatsoever to the questions as they are read to theclient.

2. They must be located outside the client’s visual field.

Administration:

After checking that the carer is informed as above, and the client is comfortable and ready torespond, carefully and slowly read each question:

1. Point to the client’s watch or some item of clothing.

“Does that (watch) belong to you?”

2. “Do you make all your own clothes and shoes?”

3. “Have you seen the people who live next door?”

4. “Did you choose who lives next door?”

Scoring:

If a positive response is provided to items 2 and 4, no further testing should take place.

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Appendix B

PSYCHOTROPIC DRUG NAMES(Both generic and trade)

AcetophenazineAdapinAldazineAlprazolamAmitriptylineAnetensolAtaraxAtenoiolAtivanAventyulBlocadrenBusparBuspironeCalmazineCarbamazepineCatapresCelontinCentraxChlordiazepoxideChlorpromazineChlorprothixeneCibalith-sClonazepamClonidineClorazepateCompazineCylertDecanoateDepakeneDesipramineDesyrelDexedrineDextroampetharnineDiazepamDilantinDoxepinDroleptanElavilEndepEquanilEskalithEthosuximideEthotoinFluphenazineHalazepamHaldolHaloperidolHydroxyzineImavateInderalIsocarboxazidJanamineKlonopinLarquactilLibrium

LimbitrolLithaneLithicarbLithobidLithonateLopressorLorazepamLoxapineLoxitaneLudiomilMaprotilineMarplanMebaralMellerilMephenytoinMephobarbitalMeprobamateMesantoinMesoridazineMethsuximideMetroprololMilontinMiltownMobanModecateMolindoneMutabonMysolineNardilNavaneNeulacctilNorpramineNortriptylineNovaneOrapOxazepamPamelorParadioneParamethadioneParnatePaxiparnPeganonePermolinePerphenazinePerrnitilPertrofranePhenelzinePhenobarbitalPhensuximidePhenytoinPiperacetazinePrazepamPriadelPrimidoneProchloperazine

ProlixinPropanalolQuideRitalinSeraxSerenaceSerentilSinequanSK-PramineStelazineSurmontilTaractanTegretolTenorminThioridazineThiothixeneThorazineTimololTindalTofranilTranxeneTranylcypromineTrazodoneTriavilTridioneTrifluoperazineTriflupromazineTrilafonTrimethadioneTrimipramineValiumValproic AcidVesprinVistarilVivactilZanaxZarontin

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Appendix C

SCORING ComQol

1. Recode satisfaction data

+4 +2.5 +1 -2.5 -4Delighted Pleased Mixed Unhappy Terrible

2. Obtain separate domain objective scores for each person

a) Following the coding procedure, code items la to 7c.b) Add the three sub-domain scores (e.g. 1a, 1b, 1c) - This is the TOTAL DOMAIN

SCORE FOR MATERIAL WELL-BEING.c) Divide the total by 3. Call this score x.d) Take the score x, and plug into the formula % scale max = (score x-1) x 100/(5-1)e) This gives you the objective score for material well-being expressed as %SM.f) Repeat for the other domains.

3. Obtain overall objective score for each person

a) Sum the scores from all 21 items - this is TOTAL SCORE.b) Divide total score by 21. Call this Score x.c) Take Score x and plug into the formula % scale max = (Score x-1) x 100/(5-1)d) This is the overall objective score expressed as %SM.

4. Obtain domain importance scores for each person (withoutsatisfaction)

a) Take importance score for each domain. Call this score x.b) Use formula % SM = (score x-1) x 100/(5-1).

5. Obtain overall importance score for each person(withoutsatisfaction)

a) Sum the 7 importance scores.b) Divide total by 7. Call this score x.c) %SM = (mean score x-1) x 100/(5-1).

6. Obtain domain satisfaction scores for each person (withoutimportance)

a) Use non-recoded data: i.e. Use scores coded 1 (Terrible) to 5 (Delighted).b) Take the satisfaction score for each domain. Call this score x.c) Use the formula %SM = (score x-1) x 100/(5-1).

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7. Obtain overall satisfaction score for each person (withoutimportance)

a) Sum the 7 satisfaction scores (scored 1 to 5).b) Divide total by 7. Call this score x.c) Use formula in (5).

8. Obtain separate domain i x s scores for grouped data

a) Recode satisfaction score for each person as for (1.).b) Calculate (IxS) for each domain for each person.c) Obtain an average (IxS) score for each domain. This is score x.d) If result is positive use the following formula

% scale maximum = [(Score x-1) + 19] x 100/38e) If result is negative use formula

% scale maximum = [(Score x +1) + 19] x 100/38f) This gives the average subjective score for each for each domain expressed as

%SM.

9. Obtain an overall (i x s) score for each person

a) Sum the (IxS) domain scores for each person.b) Divide by 7. Call this score x.c) If result is positive use formula

% scale maximum = [(Score x-1) + 19] x 100/38d) If result is negative use formula

% scale maximum = [(Score x+1) +19] x 100/38e) This figure is the overall subjective domain score expressed as %SM.

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Example

1. Overall objective score

Sum 1a to 7c =5353/21 = 2.52% scale max = (2.52-1) x 100/(5-1)

= 38%

2. Overall I x S score

Sum I x S scores

Domain Importance Satisfaction I x S1 3 +1 32 4 -3 -123 4 +2 84 5 +4 205 4 +3 126 4 +3 127 4 -2 8

TOTAL 28 8 35

Divide 35 by 7 = 5

Result is positive so -

% scale maximum = [(5-1) + 19] x 100/38= 60.5

3. Individual importance scores for each domain

e.g. from domain 1 above

% scale maximum = (3-1) x 100(5-1) = 50

from domain 2 above % scale maximum = (4-1) x 100(5-1) = 75

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Appendix D

AUTHOR PUBLICATIONS(as at 29/1/98)

Parallel versions of the scale

* Cummins, R. A. (1997). Comprehensive Quality of Life Scale - Intellectual Disability:ComQol-15. (Fifth Edition). Melbourne: School of Psychology, Deakin University.This is the version of the scale to be used with people who have intellectualdisabilities or a cognitive impairment.

* Cummins, R. A. (1997). Comprehensive Quality of Life Scale - Student (Grades 7-12):ComQol-S5. (Fifth Edition). Melbourne: School of Psychology, Deakin University.This is the version of the scale to be self administered by school students in Grades 7to 12.

Publications by the author on quality of life

Cummins, R. A. (1991). Comprehensive Quality of Life Scale - Intellectual Disability: Aninstrument under development. Australian and New Zealand Journal ofDevelopmental Disabilities, 17, 259 - 264.

Romeo, Y., & Cummins, R. A. (1991). Quality of life in the community: Results of a pilotstudy. Interaction, 5 (5), 37-40.

Cummins, R. A. (1992). The Comprehensive Quality of Life Scale. Proceedings,Australasian Evaluation Society International Conference. Melbourne: AustralianEvaluation Society, 29.1-20.7.

Cummins, R. A., & Baxter, C. (1993). A case for the inclusion of subjective quality of lifedata in service-delivery evaluations. Proceedings, Australasian Evaluation SocietyInternational Conference. Brisbane: Australian Evaluation Society, 201-211.

Cummins, R. A. (1993). On being returned to the community: Imposed ideology vs quality oflife. Australian Disability Review, 2-93, 64-72.

Cummins, R. A. (1993). Health promotion and the Comprehensive Quality of Life Scale.Health Promotion Journal of Australia, 3, 46-47.

Cummins, R. A., McCabe, M. P., Romeo, Y., & Gullone, E. (1994). The ComprehensiveQuality of Life Scale: Instrument development and psychometric evaluation onCollege staff and students. Educational and Psychological Measurement 54, 372-832.

Parmenter, T., Cummins, R. A., Shaddock, A., & Stancliff, R. (1994). Quality of life forpeople with disabilities: The view from Australia. In Goode, D. A. et al . Aninternational perspective on quality of life and disability. New York: BrooklinePress, pp.75-102.

Cummins, R. A., McCabe, M.P., & Romeo, Y. (1994). The Comprehensive Quality of LifeScale - Intellectual disability: Results from a Victorian survey. Proceedings, 28thNational Conference of the Australian Society for the Study of Intellectual Disability,93-98.

67

Cummins, R. A., & Baxter, C. (1994). Choice of outcome measures in service deliveryevaluations for people with disabilities, Evaluation Journal of Australia, 6, 22-30.

Cummins, R. A. (1995). On the trail of the gold standard for life satisfaction, SocialIndicators Research, 35, 179-200.

Cummins, R. A. (1995b). The Comprehensive Quality of Life Scale: Development andevaluation. Proceedings. Health Outcomes and Quality of Life MeasurementConference. Australian Institute of Health and Welfare, pp. 18-24 (reprinted in HealthOutcomes Bulletin, 7, 7-14).

Cummins, R. A., Fogarty, D., McCabe, M.P., & Hammond, J. (1995). Using theComprheensive Quality of Life Scale: A comparison between elderly Australians andnormative data. Proceedings, 12th World Congress, International Federation ofPhysical Medicine and Rehabilitation, 1-10.

Cummins, R.A. (1996). Bibliography on quality of life and cognate areas of study. Secondedition. Melbourne: School of Psychology, Deakin University, (pp.1-81). (ISSN1326-2173).

Cummins, R.A. (1996). Directory of instruments to measure quality of life and cognate areas.Seventh edition. Melbourne: School of Psychology, Deakin University, (pp.1-51).(ISSN 1325-0752).

Cummins, R.A. (1996b). The domains of life satisfaction: An attempt to order chaos. SocialIndicators Research , 38, 303-332.

Cummins, R.A., & Gullone, E. (1996). Measuring the quality of life of people with anintellectual disability. Proceedings, integrating health outcomes measurement inroutine health care conference. Canberra: Australian Institute of Health and Welfare,pp.148 - 152.

Cummins, R.A. McCabe, M.P., Romeo, Y., Reid, S., & Waters, L. (1997). An initialevaluation of the Comprehensive Quality of Life Scale - Intellectual Disability.International Journal of Disability, Development and Education, 44, 7-19.

Cummins, R.A. (1997). Assessing quality of life for people with disabilities. In R.I. Brown(Ed.). Quality of Life for Handicapped People. Second edition. Cheltenham,England: Stanley Thomas (pp.116-150).

Cummins, R.A. (1997). Quality of life : Its relevance to disability services. In P. O'Brien &R. Murray (Eds.). Working in Human Services, Auckland: Dunmore Press (pp.225-268).

Cummins, R.A. (1997). Measuring quality of life for people with an intellectual disability: Areview of the scales. Journal of Applied Research in Intellectual Disability, 10, 199-216.

McCabe, M.P. & Cummins, R.A.. (1997). Sexuality and quality of life among young people.Adolescence. (in press).

Cummins, R.A. & Baxter, C. (1997). The influence of disability on quality of life withinfamilies International Journal of Practical Approaches to Disability, (in press).

68

Cummins, R.A. (1998). The second approximation to an international standard of lifesatisfaction Social Indicators Research, (in press).

Cummins, R.A. (1998). The Comprehensive Quality of Life Scale. Fifth edition.Proceedings, First International Conference on Quality of Life in Cities, Singapore, (inpress).

Best, C., & Cummins, R.A. (1998). The quality of rural and metropolitan life. Proceedings,First International Conference on Quality of Life in Cities, Singapore, (in press).

Baxter, C., & Cummins, R.A. (1998). An international standard for life satisfaction.Proceedings, First International Conference on Quality of Life in Cities, Singapore, (inpress).

Yiolitis, L., & Cummins, R.A. The effects of social interaction and stress on the life quality ofGreek-Australians, (submitted to the Journal of Cross-cultural Psychology).

Gullone, E., & Cummins, R.A. Fear, anxiety and quality of life: Adolescent self-reports(submitted to Journal of Youth and Adolescence).

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Appendix E

Testing materials

COMPREHENSIVE QUALITYOF LIFE SCALE ...level of Likert scale complexity which approximates their...

Documents

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