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You are here: Questionnaires » QualityOfLife

Quality of Life & Well-being Questionnaires

ACORN has initiated a research program to develop state of the art quality of life and happiness/ well-being questionnaires. The purpose of the initiative is to develop a pool of items representative of existing quality of life and well-being questionnaires, and to subject these items to rigorous psychometric analysis. A large and diverse normative sample with regards to age and ethnicity, and including those who are employed, unemployed, students, or homemakers provides a rich source of data to test items and explore the underlying structure of questionnaire. Support for this initiative is provided by the Center for Clinical Informatics, the Institute for Health and Productivity Management, and Lifesynch, a Humana company.

An article describing the development of this questionnaire was published in the Journal of Health and Productivity, December, 2013.

If you wish to assist with the research effort, please download and distribute the questionnaire. All responses are confidential: QualityOfLife-ResearchForm.pdf

The item content for inclusion in the initial pool was selected based on a review of the literature of existing measures ( Wellbeing and measurement - literature search.pdf). Items are drafted in the same format as other ACORN items. In most instances, items closely reflecting item content from other measures already existed in the ACORN item inventory and were in use on various ACORN questionnaires. In these instances, the known psychometric properties of these items were taken into account when selecting items, including evidence that they tended to show improvement with treatment.

Conceptualization of quality of life, happiness, and well-being vary from questionnaire to questionnaire, with little attention given to the underlying factor construct of these concepts. Happiness and well-being are generally construed to reflect positive emotions, though some authors have argued to include items reflecting negative emotions also. Quality of Life is conceptualized to include emotion states, but is expanded to include health status, life satisfaction, freedom from financial pressures, and safety/stability of living situation.

Measures of work place productivity and societal costs have also been shown to be highly correlated to items reflecting mental health symptoms of stress, anxiety and depression. Click here for: Economic Burden Of Depression-references.docx. For this reason, the item pool includes items broadly reflective of productivity at work and in daily life. In the ACORN data repository, these items have high correlations with clients estimates of work time lost due to feelings of stress, anxiety and depression. Among those seeking mental health services, the mean reported lost productivity is 25%.

With these thoughts in mind, items were selected and grouped into four domains, reflecting Flourishing/Happiness/Well-being; Physical and Mental Health Symptoms, Quality of Life, Productivity, and Substance Abuse. Items were assigned to domains based on face validity, without regard to any knowledge of the underlying psychometric construct, as determined by performing a factor analysis.

A quick examination of the items reveals that the assignment to domains is somewhat arbitrary in that many items could easily be assigned to more than one domain. This may largely be a matter of personal preference, as based on data collected so far all of the domains appear to load on a common factor. Continued detailed item analyses with a large and diverse normative samples will reveal to what extent these domains should be altered to reflect the underlying factor structure, however the existing sample size is sufficiently large to provide confidence that the factor structure will remain relatively constant with the addition of a additional respondents.

Understanding the underlying psychometric properties of these items will permit us to develop relatively brief measures of quality of life and well-being with high reliability, validity and well understood factor structure. A high degree of shared variance across domains would mean that it will be possible to design questionnaires using the right mix of items, depending on the target population and measurement needs, while being assured of high reliability and concurrent validity when compared to other questionnaires measuring quality of life/well-being and/or distress/symptoms.

Normative sample

Data on the new questionnaire continues to come in from a number of sources. The normative sample was collected from the community, with research assistants distributing the questionnaire through various social networks and workplace settings.

Sample consists of 478 adults, ranging in age from 18 to 90, with a mean of 39. Males comprise 81% of the sample. Score differences between males and female are non-significant.

81% of respondents were employed, with the remainder roughly equally divided between students, homemakers, and unemployed.

List of items by domain

(Mean, Standard Deviation, and Reliability of sub-scale in parentheses)

Following is a list of items organized by domain. Reliability of scales for each of the domains was calculated using Chronbach's Coefficient alpha. Reliability for full scale (excluding substance abuse item) is .91.

How often in the last two weeks did you...

Flourishing (mean=2.7; SD=.64; reliability = .78)

  • Feel good/positive about yourself?
  • Enjoy your leisure time?
  • Have a good energy level?
  • Enjoy spending time with family or friends?
  • Enjoy your work and other activities of daily life?
  • Have the right amount of sleep?

Mental/Physical Health (mean=2.5; SD=.7; reliability = .84)

  • Have physical pain or other health problems?
  • Worry about a lot of things?
  • Feel unhappy or sad?
  • Feel nervous or anxious?
  • Cut back on activities due to physical or emotional health problems?
  • Feel hopeless about the future?
  • Feel lonely?
  • Worry about money?

Quality of Life/Life Satisfaction (mean=2.8; SD=.78; reliability = .70)

  • Feel fulfilled in life?
  • Feel happy with your living situation?
  • Feel fortunate about your social relationships?

Productivity (mean=2.4; SD=.68; reliability = .70)

  • Feel unmotivated to do anything?
  • Feel unproductive at work or other daily activities?
  • Have a hard time paying attention?
  • Accomplish most of what you wanted to do?

Substance Abuse (mean=3.8; not normally distributed; reliability NA for single item)

  • Have problems at work, school or home due use of drugs or alcohol?

Full Scale (mean=2.6; SD=.56; reliability=.91)

Factor analysis

factor analysis reveals that the sub-scales for Flourishing, Health, Quality of Life and Productivity all loading heavily on a common factor. The reliability (coefficient alpha) for the full scale Well-being score is .91 further evidence of a high degree of correlation between items.

Following is the simple correlation matrix between domains. All correlations greater than .15 are statistically significant.

  Flourishing Health Q of L Productivity Substance Abuse
Flourishing 1 .57 .69 .65 .07
Health .57 1 .57 .59 .18
Q of L .69 .57 1 .53 .08
Productivity .65 .59 .53 1 .13
Substance Abuse .07 .18 .08 .13 1
Total Well-being .85 .88 .77 .81 .19
Following are the correlations between each domain sub-scale and the global common factor (after varimax rotation).

  • Flourishing: .87
  • Mental/Physical Health: .82
  • Quality of Life: .82
  • Productivity: .82
  • Substance Abuse: .20

Further factor analysis at the item level confirmed that all items were loading on a common factor.

This is strong evidence that each of the sub-scales are measuring a common factor, and the questionnaire can be safely scored as a single measure reflecting overall Quality of Life and Well-being. The total well-being score can be expected to correlate highly with other self report measures designed to assess depression, anxiety, quality of life, social relationships, and work place productivity.
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