COMPREHENSIVE QUALITYOF LIFE SCALE SCHOOL VERSION

(Grades 7-12)

FIFTH EDITION (ComQol-S5)

Robert A. Cummins
School of Psychology Deakin University

MANUAL 1997

Correspondence to: Robert A. Cummins Ph.D., F.A.P.S. School of Psychology Deakin University 221 Burwood Highway Burwood, Melbourne Victoria 3125 AUSTRALIA e-mail: robert.cummins@deakin.edu.au ISBN 0-7300-2726-0 Published by the School of Psychology Deakin University

Contents

Introduction
1.1 1.2 1.3 1.4 1.5 Measuring and defining quality of life The Scale Prior editions of the scale ComQol-S5 Summary

Administration
2.1 General information

3 4

Comprehensive Quality Of Life Scale (ComQol-S5) Calculation of results

4.1 4.2 4.3 4.4 4.5 Coding the objective data Coding the subjective data Data cleaning Dealing with data skew Forms of data analysis 4.5.1 For the practitioner or service provider 4.5.2 For the researcher 4.5.3 % SM: A standardised comparison statistic Individual SQOL diagnostic data tables

4.6

Theoretical Issues
5.1 5.2 5.3 5.4 5.5 5.6 Why use the Delighted-Terrible scale? Should not important at all be scored as 1 or 0? Should mixed satisfaction/dissatisfaction be scored as 0? Why not score the satisfaction scale from +1 to +7? Why not use the Ferrans and Powers (1985) scoring system? Why not use the Raphael et al. (1996) scoring system?

Alternative Forms of the Scale

6.1 6.2 Parallel versions of the scale Additional domains

Psychometric Data
Study Codes 7.1 7.2 Objective means Subjective means 7.2.1 Importance sub-scale 7.2.2 Satisfaction sub-scale 7.2.3 Importance x Satisfaction Reliability 7.3.1 Cronbachs alpha 7.3.2 Internal reliability 7.3.3 Test-retest reliability Validity 7.4.1 Content validity 7.4.2 Construct validity

7.3

7.4

References to the text

APPENDIX A: Psychotropic drug names APPENDIX B: Scoring ComQol APPENDIX C: Author publications

Acknowledgements
The author gratefully acknowledges comments and ideas which have contributed to this fifth edition from the following people: Christine Baxter, Eleonora Gullone, Marita McCabe, Shelley Reid, Dale Fogarty, Julie Cochrane. I am also greatly indebted to the students who have worked with me to produce many of the data presented in this manual. I thank Sheryl Monteath for her able assistance with data analysis for studies A6 and A7. I also thank Rai Sahib, Julie Asquith, Trudy Wallace, Natasha Cho and Betina Gardner for word-processing this document.

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 surprising that there is neither an agreed definition nor a standard form of measurement. This is not due to a lack of ideas. Cummins (1996a) has recorded well over 100 instruments which purport to measure life quality in some form, but each one contains an idiosyncratic mixture of dependent variables. It is also notable that many QOL instruments have been developed for highly selected groups in the population; particularly in regard to scales devised to monitor medical conditions or procedures. 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 all sectors of the population. Those created for the general adult population cannot be used with some population sub-groups such as people with cognitive impairment and children. This is an important limitation since it means that the QOL experienced by such groups cannot be norm-referenced back to the general population. In order to remedy this situation, the Comprehensive Quality of Life Scale (ComQol) has been developed. This scale has been designed in parallel forms suitable for any population sub-group. These forms are: ComQol A: ComQol I: designed for use with the general adult population. designed for use with people who have an intellectual disability or other form of cognitive impairment. designed for use with adolescents 11-18 years who are attending school.

ComQol S:

The scale also contains features of construction which reflect contemporary understanding of the 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 operationalization of the following definition of quality of life: Quality of life is both objective and subjective, each axis being the aggregate of seven domains: material well-being, health, productivity, intimacy, safety, community, and emotional well-being. Objective domains comprise culturally-relevant measures of objective well-being. Subjective domains comprise domain satisfaction weighted by their importance to the individual.

1.2 The scale

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

(a) It is multidimensional. There is consensus within the field that the most useful measures of life quality must incorporate the separate components which comprise this construct, even though the precise nature of these components are somewhat conjectural (Felce & Perry, 1995). ComQol defines life quality in terms of seven domains which together are intended to be inclusive of all QOL components. These are: Material well-being, health, productivity, intimacy, safety, place in community, and emotional well-being. Evidence for the adoption of these seven domains has been presented by Cummins (1996b, 1997a). A discussion of additional domains is provided in 6.2. (b) It is multi-axial. This takes two forms. The first is in the separate measurement of objective and subjective components. The contemporary literature is quite consistent in 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, physical health and perceived health are poorly correlated (see 7.6.1). The scale is also multi-axial in terms of its subjective measures. Each domain is separately rated in terms of its importance to the individual as well as on its perceived satisfaction. It is notable that importance and satisfaction generally are moderately positively correlated with one another (see 7.6.2). The level of importance then provides an individualised weighting factor for each domain such that the subjective QOL measurement can be expressed as Importance x Satisfaction. (c) It can be used with any section of the population. Two parallel versions of the adult ComQol have been developed. ComQol-S is for use with adolescent students, while ComQol-I is designed for people who have an intellectual disability or other form of cognitive impairment. This latter scale incorporates a pre-testing protocol to determine whether, and to what level of complexity, respondents are able to use the scale. This pre-testing progressively moves responding from concrete to abstract. It commences with an ordering task involving differently sized printed blocks, progresses to a task involving block size matching to a printed ladder scale (e.g. the largest block corresponds with the top of a printed ladder), and ends with the use of a Likert scale involving the abstract conception of importance. At each stage of this testing, people commence with a task involving choice between two types of response (e.g. one large and one small block) and can progress to a maximum of five. The number of response choices successfully negotiated in the final abstract task is then used to determine the Likert Scale complexity to be used with ComQol-ID. For example, if a respondent is only able to manage the abstract task as a choice between two levels of importance, then they will be provided with a version of ComQol-ID where Likert scales are presented as a binary choice.

The use of this process eliminates those respondents who do not have the cognitive capacity to respond validly to the scale. This is crucial given our understanding that people who are placed in a forced-choice situation, where they do not understand the task, will often respond either at random or in a manner they consider will please the interviewer. Pre-testing therefore ensures that each respondent is provided with a level of Likert scale complexity which approximates their discriminative capacity. (d) The scale is psychometrically sound. It is reliable, stable, valid and sensitive (see Section 7). The sum of the domain scores for satisfaction can be referenced to the goldstandard of 75 2.5% SM (Cummins, 1996b).

(e)

1.3 Prior editions of the scale

Fourth Edition While the wording of the subjective items is essentially the same as in the third edition, more substantial changes were made to the wording of a number of the objective items. In all cases this involved a clarification or elaboration of the item rather than a total change in content. The rating scale for each objective item also increased from three-point to five-point. This meant that each objective domain score was now free to vary from 3 to 15 instead of 3 to 9 as in the third edition. The purpose of this change was to increase the discriminative power of the objective domain scores. Fifth Edition The 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 has remained. Item 3c has been completely changed. This was the only item that failed to display a significant intra-domain correlation in the fourth edition. No data are available on how this new item 3c performs. The satisfaction questions use a 7-point , rather than a 5-point response scale, since we have found this age group to experience no difficulty in using the more complex version.

1.4 ComQol-S5
This is a parallel version of ComQol-A5.

Some items have been modified to make them appropriate for the target group. These are indicated by an asterisk (*)

1.5 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. 2. 3. 4. 5. 6. 7. Material well-being Health Productivity Intimacy Safety Place in community Emotional well-being

The measurement of each SQOL domain is achieved by obtaining a satisfaction score of that domain which is weighted by the perceived importance of the domain for the individual. Thus, SQOL = (Domain satisfaction x Domain importance).
Note This fifth edition of ComQol can be viewed both as a research instrument and a standardised test. The first edition was compiled in 1991. It is anticipated that several further editions will be produced as new data and ideas indicate ways that the scale can be improved. To this end comments are welcomed.

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2 Administration
2.1 General Information
The scale is intended to be self-administered. It should be noted that the instrument exists in two parts, as objective and subjective. Under normal conditions these two parts show little relationship to one another. This is consistent with the broader literature on QOL which clearly indicates the independence of objective and subjective variables. Hence, the full administration of the scale yields two measures of life quality which are quite separate from one another. Whether one, or both parts of the scale should be administered is a decision to be made depending on the purpose of scale administration. If only subjective QOL is of interest then only this part of the scale needs to be used. If it is given in a group situation, it should be emphasised that there is no time limit and that people may ask for assistance with any question that they do not fully understand. ComQol takes about 15-20 minutes to complete. The subjective section alone takes about five minutes to complete.

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3 ComQol-S5
This scale has three sections. The first will ask you for some factual information. The next two will ask how you feel about various aspects of your life. To answer each question put a () in the appropriate box. Please ask for assistance if there is anything you do not understand. Please answer all the questions and do not spend too much time on any one item.

What is your date of birth?

______/______/______ day month year

What is your sex? (circle one)

Male

Female

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Section 1
This section asks for information about various aspects of your life. Please tick the box that most accurately describes your situation. *1(a) Where do you live? A house A flat or apartment Own A room (e.g. in a hostel) or caravan Rent Do your parents own the place where you live or do they pay rent?

*b)

How many clothes and toys do you have compared with other people of your age? More than most people About average Less than most people Less than almost anyone

More than almost anyone

*c) Father Mother

If either of your parents has paid work, please give the name of their job. _______________________________________________________ _______________________________________________________

2a)

How many times have you seen a doctor over the past 3 months? None 1-2 3-4
(about once a month)

5-7
(about every two weeks)

8 or more
(about once a week or more)

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b)

Do you have any on-going medical problems? (e.g. visual, hearing, physical, health, etc.). Yes If yes please specify: Name of medical condition e.g. Visual Diabetes Epilepsy Extent of medical condition Require glasses for reading Require daily injections Requires daily medication No

_______________________ _______________________ _______________________

___________________________________ ___________________________________ ___________________________________

(c)

What regular medication do you take each day?

If none tick box or Name(s) of medication (dont worry if you get the spelling wrong) _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

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3(a)

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

0 Hours work for pay (not counting pocket money)

1-10

11-20

21-30

31-40+

Hours at school or college Hours unpaid child care

0 0

1-10 1-10

11-20 11-20

21-30 21-30

31-40+ 31-40+

(b)

In your spare time, how often do you have nothing much to do? Usually Sometimes Not Usually Almost never

Almost always

(c)

On average, how many hours TV do you watch each day?

Hours per day None 12 35 69 10 or more

4(a)

How often do you talk with a close friend? Several times a week Once a week Once a month Less than once a month

Daily

(b)

If you are feeling sad or depressed, how often does someone show they care for you? Usually Sometimes Not Usually Almost never

Almost always

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(c)

If you want to do something special, how often does someone else want to do it with you? Usually Sometimes Not Usually Almost never

Almost always

5(a)

How often do you sleep well? Usually Sometimes Not Usually Almost never

Almost always

(b)

Are you safe at home? Usually Sometimes Not Usually Almost never

Almost always

(c)

How often are you worried or anxious during the day? Usually Sometimes Not Usually Almost never

Almost always

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*6(a) Below is a list of leisure activities. Indicate how often in an average month you attend or do each one for your enjoyment (not employment). Activity Number of times per month

(1) (2) (3)

Go to a club/group/society Meet with friend(s) Watch live sporting events (Not on TV) Go to a place of worship Chat with neighbours Eat out Go to a movie Visit family Play sport or go to a gym

__________ __________

__________ __________ __________ __________ __________ __________ __________ ___________________________________

(4) (5) (6) (7) (8) (9)

(10) Other (please describe)

(b)

Do you hold an unpaid position of responsibility in relation to any team, club, group, or society? Yes No If no, go to question (c)

If yes, please indicate the highest level of responsibility held: Committee Member Committee Chairperson/Convenor Secretary/Treasurer/Team Vice-captain Captain, Group President, Chairperson or Convenor

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(c)

How often do people outside your home ask for your help or advice? Quite often Sometimes Not often Almost never

Almost every day

7(a)

How often can you do the things you really want to do? Usually Sometimes Not Usually Almost never

Almost always

(b)

When you wake up in the morning, how often do you wish you could stay in bed all day Usually Sometimes Not Usually Almost never

Almost always

(c)

How often do you have wishes that cannot come true? Usually Sometimes Not Usually Almost never

Almost always

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Section 2 How Important are each of the following life areas to you?
Please answer by placing a () in the appropriate box for each question. There are no right or wrong answers. Please choose the box that best describes how important each area is to you. Do not spend too much time on any one question.

1.

How important to you ARE THE THINGS YOU OWN?

Could not be more important

Very important

Somewhat important

Slightly important

Not important at all

2.

How important to you is YOUR HEALTH?

Could not be more important

Very important

Somewhat important

Slightly important

Not important at all

3.

How important to you is WHAT YOU ACHIEVE IN LIFE?

Could not be more important

Very important

Somewhat important

Slightly important

Not important at all

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4.

How important to you are CLOSE RELATIONSHIPS WITH YOUR FAMILY OR FRIENDS?

Could not be more important

Very important

Somewhat important

Slightly important

Not important at all

5.

How important to you is HOW SAFE YOU FEEL?

Could not be more important

Very important

Somewhat important

Slightly important

Not important at all

6.

How important to you is DOING THINGS WITH PEOPLE OUTSIDE YOUR HOME?

Could not be more important

Very important

Somewhat important

Slightly important

Not important at all

7.

How important to you is YOUR OWN HAPPINESS?

Could not be more important

Very important

Somewhat important

Slightly important

Not important at all

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Section 3
How satisfied are you with each of the following life areas? There are no right or wrong answers. Please ( ) the box that best describes how satisfied you are with each area.

1.

How satisfied are you with the THINGS YOU OWN?

Delighted

Pleased

Mostly satisfied

Mixed

Mostly dissatisfied

Unhappy

Terrible

2.

How satisfied are you with your HEALTH?

Delighted

Pleased

Mostly satisfied

Mixed

Mostly dissatisfied

Unhappy

Terrible

3.

How satisfied are you with what you ACHIEVE IN LIFE?

Delighted

Pleased

Mostly satisfied

Mixed

Mostly dissatisfied

Unhappy

Terrible

4.

How satisfied are you with your CLOSE RELATIONSHIPS WITH FAMILY OR FRIENDS?

Delighted

Pleased

Mostly satisfied

Mixed

Mostly dissatisfied

Unhappy

Terrible

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5.

How satisfied are you with HOW SAFE YOU FEEL?

Delighted

Pleased

Mostly satisfied

Mixed

Mostly dissatisfied

Unhappy

Terrible

6.

How satisfied are you with DOING THINGS WITH PEOPLE OUTSIDE YOUR HOME?

Delighted

Pleased

Mostly satisfied

Mixed

Mostly dissatisfied

Unhappy

Terrible

7.

How satisfied are you with YOUR OWN HAPPINESS?

Delighted

Pleased

Mostly satisfied

Mixed

Mostly dissatisfied

Unhappy

Terrible

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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 a missing value). Estimated income: The average adult Australian full-time wage in February 1997 was $38,063 per year. Users in other countries will need to modify the scoring of income on a pro rata basis. MATERIAL WELL-BEING 1(a) Accommodation: house + own flat/apartment + own house + rent flat/apartment + rent Room + either

=5 =4 =3 =2 =1

(b)

Possessions: More than almost anyone = 5 More than most people = 4 About average =3 Estimated income: More than $56,000 $41,000 - $55,999 $26,000 - $40,999

Less than most people =2 Less than almost anyone = 1

(c)

=5 =4 =3

$11,000 - $25,999 Below $10,999

=2 =1

An estimation of the above categories can be obtained from the following occupational groupings obtained from the Year Book Australia (1994) and Castles (1992). Below $10,999 Students People who are unemployed $11,000 - $25,999 Laborers and related workers

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$26,000-$40,999 School teachers Paraprofessionals Clerks Drivers Personal service workers Salespersons Tradespersons Junior academics $41,000-$55,999 Legislators & government appoint officials Managers and administrators School principals Professionals Engineers & building professionals Social professionals Business professionals 56,000+ Managing directors/General managers Medical doctors Senior academics HEALTH 2(a) Doctor None = 5 1-2 = 4 3-4 = 3

Farmers & farm managers Managing supervisors Artists & related professionals Technical officers Nurses Police Plant & machine operators/drivers

5-7 = 2 8 or more visits = 1

b) 5= 4= 3=

2=

Disability or medical condition No disability Minor disability (e.g. eyeglasses) not likely to interfere with normal life activities or routines Constant, chronic condition that interferes to some extent with daily life (e.g. diabetes, heart condition, Alzheimer's disease, migraines, infertility, asthma when nothing is recorded under medication, arthritis when nothing is recorded under medication) Disability likely to restrict social activities (e.g. profound deafness, blindness, significant physical disability, depression, schizophrenia, arthritis, Parkinsons Disease, paraplegia, asthma needing regular medication, arthritis needing regular medication, limb missing)

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1=

Major disability likely to require daily assistance with personal care (e.g. severe psychiatric condition, advanced multiple sclerosis, severe cognitive or physical impairment, quadriplegia)
Note It is sometimes difficult to choose between categories, eg. multiple sclerosis or Alzheimers in the early stages would probably score 3, but in the latter stages score 2. Put them into these categories unless there is some information that tells otherwise. Eg. Assume that a person who has Alzheimers, but is able to answer the questionnaire scores 3, because once social activities become markedly restricted they would probably not be capable of completing the questionnaire. If a person has mild deafness, score 3, but if they are completely deaf, score 2.

c)

Medication No regular medication = 5 Single non-psychotropic medication = 4 Multiple non-psychotropic medication = 3 Psychotropic medication = 2 Psychotropic 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 are provided in Appendix A.

PRODUCTIVITY 3a) Number of hours 31-40+ work, education or child care = 5 21-30 hours combined work/education/child care = 4 11-20 hours combined work/education/child care = 3 1-10 hours combined work/education/child care = 2 Neither work nor education nor child care = 1 Spare time (Note reverse score) Almost always = 1 Not usually Usually =2 Almost never Sometimes =3 Hours TV each day None =5 1-2 hours =4 3-5 hours =3

b)

=4 =5

c)

6-9 hours 10+ hours

=2 =1

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INTIMACY 4a) Talk Daily Several Once a week

=5 =4 =3

Once a month =2 Less than once a month = 1

b)

Care Almost always = 5 Usually =4 Sometimes =3 Activity Almost always = 5 Usually =4 Sometimes =3

Not usually =2 Almost never = 1

c)

Not usually = 2 Almost never = 1

SAFETY 5a) Sleep Almost always = 5 Usually =4 Sometimes =3 Safe Almost always = 5 Usually =4 Sometimes =3 Anxiety (Note reverse score) Almost always = 1 Usually =2 Sometimes =3

Not usually = 2 Almost never = 1

b)

Not usually = 2 Almost never = 1

c)

Not usually = 4 Almost never = 5

PLACE IN COMMUNITY 6a) (i) Activity For each separate activity calculate 0.2 + (0.2 x frequency) for each activity up to a maximum frequency of 4/month. i.e. Each activity is scored to a maximum of 1.0.

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(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) (7) (8) eat out movies other take aways - exclude watched videos - exclude people sometimes write something that should come under one of the previous categories, [eg. tennis club or yacht club should come under (i)] put them under the category that seems most appropriate.

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 e.g: captain of basketball team, convenor of a social group = 5 Treasurer/ Secretary or other title denoting specific major area of responsibility eg: Immediate past-president, vice-captain = 4 Sub-committee chairperson or other indication of minor area of responsibility or active involvement eg: Responsible for catering arrangements = 3 Committee or team 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 Quite often =4 Sometimes =3

Not often =2 Almost never = 1

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EMOTIONAL WELL-BEING 7a) Can do Almost always = 5 Usually =4 Sometimes =3 Bed (reversed scored) Almost always = 1 Usually =2 Sometimes =3 Wishes (reversed scored) Almost always = 1 Usually =2 Sometimes =3

Not usually = 2 Almost never = 1

b)

Not usually = 4 Almost never = 5

c)

Not usually = 4 Almost never = 5

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4.2 Coding the subjective data

IMPORTANCE

Could not be more important 5

Very important 4

Somewhat important 3

Slightly important 2

Not at all important 1

Missing value 9

SATISFACTION

Delighted 7

Pleased 6

Mostly Satisfied 5

Mixed 4

Mostly Dissatisfied 3

Unhappy 2

Terrible 1

Missing value 9

Note We use the score of 9 to allow computer identification of missing values. If this scheme is used, care needs to be taken that these 9 values are recognized as excluded values, and not included as data.

IMPORTANCE x SATISFACTION In order to calculate a meaningful subjective QOL (SQOL) score (Importance x Satisfaction) for each domain, the satisfaction data need to be re-coded as follows:

Delighted +4

Pleased +3

Mostly Satisfied +2

Mixed +1

Mostly dissatisfied -2

Unhappy -3

Terrible -4

Following this recoding procedure each SQOL domain score is calculated as (IxS), and the overall SQOL = (IxS). See Appendix B for a more detailed description. As a result of this procedure the SQOL obtained for any domain ranges between -20 and +20.

4.3 Data cleaning

It is recommended that the raw data files be carefully examined prior to the implementation of analytic procedures. In particular; (a) (b) An analysis of response frequency data for each variable will allow the determination that the computer is recognising '9' as a missing variable. If a table of raw data is examined, the data for each subject can be visually scanned to detect patterns of response that are consistently at the top of either the importance or satisfaction scales over the seven domains. In study A6 (see ComQol A5 Section 7) which included 794 adults, 1 percent of subjects

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recorded this type of response. Such data are excluded prior to analysis since they provide no variance 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 negatively skewed. To restore normality, the most appropriate transformation is reflect and square root. Opinion is divided among statisticians as to whether this procedure is appropriate. I recommend that the data not be transformed for the following reasons: 1. Authorities such as Tabachnick and Fidell (1996) recommend against transforming data which are known to be naturally skewed. In my experience of checking the effects of transformation when applying multivariate statistics, the influence is very small.

2.

A related issue concerns the increased intra-group variance that is created by forming a 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 a somewhat reduced coefficient of variation (mean/standard deviation) it is not recommended for two reasons as: (a) It does not seem to improve the data sensitivity to between-group differences, and (b) the power of importance to weight the satisfaction scores is reduced.

4.5 Forms of data analysis

Note: For 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 the objective QOL this involves a sum of the three component scores for each domain. Reference data are available in section 7.1 For subjective QOL the domain scores are obtained by (Importance x Satisfaction) following the recoding of Satisfaction as described in 4.2. Reference data are provided in Section 7.2 and the construction of individual diagnostic tables are described in 4.5.

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4.5.2 For the Researcher The most useful level of analysis may be at the level of the domain for all three axes; objective, importance and satisfaction. It has been found that importance and satisfaction are often fairly independent and their separate variation is likely to be of interest to any investigation of the QOL construct (see 7.6.2). Note: Group 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 of importance and satisfaction which has been expressed in relation to a domain. This cannot be made directly since importance has been scored on a 5-point scale and satisfaction on a 7-point scale. The comparison can be achieved by converting each to a statistic which reflects the extent to which a score approximates the maximum score which could be obtained. The formula is as follows: % of scale maximum = (Score -1) x 100/(number of scale points -1) EXAMPLES Importance coded +1 to +5 For example, with an importance score of 4.0 and a 5-point scale % scale max = (4-1) x 100/(5-1) = 75% Satisfaction coded +1 to +7 For a satisfaction score of 5.2 and a 7-point scale % scale max = (5.2-1) x 100/(7-1) = 70% Satisfaction coded -4 to +4 (see 4.2) The calculation here requires a modified formula as: (a) POSITIVE S scores use: % sm = (b)

[ (score -1) +3]

x 100/6

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

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Importance x Satisfaction scores For an I x S score to be expressed in this way: a) b) The S score must be recoded on a +4 to -4 scale (see 4.2) Any I x S score of -1 to +1 is converted to +1 (note this is the midpoint of the recoded satisfaction scale). POSITIVE I x S scores use the formula: % scale maximum = [(score -1) + 19] x 100/38 NEGATIVE I x S scores use the formula: % scale maximum = [(score +1) + 19] x 100/38.

c)

d)

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

4.6 Individual SQOL diagnostic data tables

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

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Table 1 Example of a client diagnostic table Material well-being Importance (I) (Coded +1 to +5) 2 3 5 1 5 5 5 3 3 5 3.70 Satisfaction (S) (Coded -4 to +4) 4 1 4 3 -4 4 1 -3 2 -4 0.80

Client 1 2 3 4 5 6 7 8 9 10 Mean

IxS 8 3 20 3 -20 20 5 -9 6 -20 1.6

An interpretation of the above data can be made in relation to the following studies (see 7. in ComQol A5 for study descriptions). In summary form the I x S results were as follows:
IMPORTANCE X SATISFACTION (Coded +1 to (Coded -4 to +4)

Domain Study Material Health Productivity Intimacy Safety Community Emotion

% of Negative I x S Scores A1 + A2 2.6 8.8 2.6 4.9 2.0 3.9 7.8 A6 2.1 7.4 5.6 3.1 1.9 4.8 5.5

Mean + S.D. A1 + A2 A6 8.04 + 4.23 8.44 + 4.65 7.62 + 6.31 8.78 + 6.92 7.97 + 5.66 7.45 + 5.50 9.85 + 7.35 11.51 + 6.34 9.81 + 4.04 10.00 + 5.04 4.90 + 4.29 7.14 + 5.09 8.36 + 6.82 8.98 + 6.09

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

33

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 of any scale. Andrews & Withey (1976) have reported that the D-T scale creates a more pronounced 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 S score would also be zero. In logical terms this could be reasonable; if a domain really does have no importance then 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 satisfaction scale. This indicates that levels of satisfaction may be experienced even though the respondent regards the domain as having no importance. There are several possible reasons for this findings as: 1. Importance and Satisfaction are largely independent constructs. Certainly they can be independently experienced. Thus, even if one's material things are 'not important at all', this will not prevent the experience of being satisfied or dissatisfied in this domain. It might be argued that no domain could actually have a zero importance since all domains form a part of each person's continuous life experience. The real meaning, then of 'not important at all' is of very low importance. This notion would be consistent with the very gross nature of the scales, where only five points span the continuum of 'importance'. If this argument is accepted, then, for the purposes of using importance as a weighting factor, it would be preferable to score 'no importance at all' in a neutral way rather than in a canceling way. Thus, a score of '1' is preferable to a score of '0'. This allows the lowest rating of importance to have no weighting influence on the measure of satisfaction. It also has the advantage of allowing a greater range of I x S scores in the lowest range.

2.

3.

34

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 midpoint i.e. +1, 0,-1. However, it would have the disadvantage of creating a zero I x S combination whenever a 'mixed' level of satisfaction was recorded. The meaning of a zero I x S score in this context is unclear. It would mean the negation of any assigned score of importance and, thereby, the loss of discriminative data. It also loses the meaning of the data; a response of mixed satisfaction does not imply zero satisfaction. Rather it implies a neutral level of satisfaction/dissatisfaction for 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 of the resultant interval scale around the point of neutrality i.e. +2, +1, -2. It is clear that this cannot be a true interval scale. However, Likert scales cannot conform to the strict logic of interval scales; they are contrived approximations which are dependent on the assumption of an equal degree of psychological separation between the response points. In this case the point of neutrality (scale mid-point) is conceived as encompassing the range (+1-1), and the response point on either side depicts the addition of one additional unit. See also the scoring of I x S (section 4.4.3, IxS, b) in which scores of -1 and +1 are treated as being equivalent and if substituted in formulae 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 be ambiguous. For example, a score of +4 could be the combination of either low I and high S, or high I and low S (dissatisfaction). By constructing the scale as it is, these ambiguities 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 'A little bit important' x 'Somewhat happy' ( 2 x 2). While these could be distinguished by examining the raw data, for most purposes of the scale this would not be necessary. More importantly, the distinction between response satisfaction and dissatisfaction is made unequivocal by the adopted scoring system of +4 to 4.

35

The possible combinations of I and S scores are as follows: IxS Score 20 19 18 17 16 15 14 13 12 11

Note (a) (b) (c)

Possible Combinations Positive Negative 5x4 5 x -4 4x4 4 x -4 5x3 5 x -3 4 x 3, 3 x 4 4 x -3, 3 x -4 -

IxS Score 10 9 8 7 6 5 4 3 2 1

Possible Combinations Positive Negative 5x2 5 x -2 3x3 3 x -3 4 x 2, 2 x 4 4 x -2, 2 x -4 3 x 2, 2 x 3 3 x -2, 2 x -3 5x1 4 x 1, 1 x 4, 2 x 2 1 x -4, 2 x -2 3 x 1, 1 x 3 1 x -3 2 x 1, 1 x 2 1 x -2 1x1 -

Possible importance scores are +1, +2, +3, +4, +5 Possible satisfaction scores are +4, +3, +2, +1,-2, -3, -4 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 of negative combinations.

5.5 Why not score the satisfaction scale according to the procedure of Ferrans and Powers (1985)?
These authors use an alternative system to ComQol, but it seems to have no advantages. Their procedure is as follows: 1. 2. 3. Importance is scored +1 to +6. Satisfaction is scored +1 to +6. The Satisfaction scores are recoded by subtracting 3.5 from each one. ie. Original: Recode: 4. +1 -2.5 +2 -1.5 +3 -.5 +4 +.5 +5 +1.5 +6 +2.5

Importance is then multiplied by recoded S and 15 added to the product. They claim: "This adjustment (recode) produces the highest score for items that have high satisfaction/high importance responses, and the lowest score for high dissatisfaction/high importance responses. --- If scores were not recoded, a person who was very dissatisfied with an area of high importance would

36

receive the same item score as a person who was very satisfied with an area of low 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 the Ferrans & Powers formula are as follows: IxS Score 30 27.5 25 24 22.5 21 20 19.5 18 17.5 17 16.5 16 15.5 IxS Score 14.5 14 13.5 13 12.5 12 10.5 10 9 7.5 6 5 2.5 0

Possible combinations 6 x 2.5 5 x 2.5 4 x 2.5 6 x 1.5 3 x 2.5, 5 x 1.5 4 x 1.5 2 x 2.5 3 x 1.5 2 x 1.5, 6 x .5 1 x 2.5, 5 x .5 4 x .5 1 x 1.5, 3 x .5 2 x .5 1 x .5

Possible combinations 1 x -.5 2 x -.5 1 x -1.5, 3 x -.5 4 x -.5 1 x -2.5, 5 x -.5 2 x -1.5, 6 x -.5 3 x -1.5 2 x -2.5 4 x -1.5 3 x -2.5, 5 x -1.5 6 x -1.5 4 x -2.5 5 x -2.5 6 x -2.5

A comparison of the above distribution with that previously provided for ComQol yields the following observations. 1. The form of each distribution is roughly equivalent, with combinations bunching around the mid-point. The F & P distribution is symmetrical around the mid-range score of 15, while the ComQol distribution shows a reduced number of negative combinations due to the absence of -1 as a recoded satisfaction score. Thus, the I x S score combinations lying just below the mid-range are less ambiguous in the case of ComQol. The area of maximum I x S score ambiguity, in terms of their composition, is greatest in both distributions just above the mid-range. For example, over a range 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 is

2.

3.

37

marginally less ambiguous with seven I x S combinations over an equivalent score-range of 2 to 4. 4. Both distributions produce a few I x S combinations which are very ambiguous indeed. For example, an I x S score of 17.5 in the F & P distribution could be the combination of either 'lowest I x highest S' or 'second-highest I x mid-range S'. An equivalent degree of confusion is provided by the ComQol I x S score of 4.

Conclusion The Ferrans and Powers formula is not superior to the simpler ComQol recoding procedure.

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 uses satisfaction (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 Importance: Satisfaction: 1.67, 2, 4 1.33, 1, 3 1, 0, 2 0.67, -1, 1 0.33 -2

The following observations can be made: 1 The differential weighting of adjacent items is reduced from 1 in ComQol to 0.33. The relative weighting by importance is thus reduced. The possible range of values is +3.33 to -3.33. This seems an awkward range to deal with. A satisfaction score of 3 leads to a QOL = 0 regardless of the importance score. The authors state This is consistent with our conceptual thinking that moderate enjoyment of an aspect of life should result in a neutral QOL score, whether it is important or not. (p.369). See 5.3 for comment.

Conclusion This dual transformation of both importance and satisfaction data has no advantages over the ComQol procedure.

38

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-S5 there are: ComQol-A5. This has been designed for the general adult population. It is available as a separate manual. ComQol-I5. This has been designed for people who have an intellectual disability or other form of cognitive impairment. It is available as a separate manual.

6.2 Additional domains

The ComQol scale can be modified through the addition of other domains. To date three modifications of this type have been considered using ComQol-A and these will be described. However, a major consideration in this regard is the amount of additional unique variance accounted for by the addition of new domains. Using an internal, stepwise multiple regression procedure where each (IxS) domain is regressed against the total subjective (IxS) score it has been determined that, using the seven standard domains, around 80% of the variance is shared and each domain contributes only 1 to 3% of unique variance (Cummins, in preparation). Thus, the seven domains are probably adequate to measure overall subjective QOL. While other domains are able to contribute unique variance, their addition would be for the purpose of investigating the specific domain in question rather than contributing variance 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. It certainly includes all of the terms listed under Productivity. However, it also severely overlaps with Place in Community, in that most, if not all activities involving others may be considered useful. It is concluded that it combines elements of both productivity and place in community. LEISURE: This is a slippery concept. Unlike the other domains where generally more is better, this does not apply to leisure. And as soon as some qualifier is introduced, such as quality leisure, it immediately overlaps with other domains (e.g. productivity). It is concluded that leisure is subsumed within emotional well-being.

2.

39

3.

SPIRITUAL WELL-BEING: Four studies have experimented with the inclusion of this domain (A7, A9, A10, A14). In each case only the subjective axis has been explored using How important to you are your religious or spiritual beliefs?, and, How satisfied are you with your religion or spirituality?. The main issues and findings to emerge are as follows: (a) About one-third of Australian people have neither religion or spirituality. Thus, the satisfaction question must be preceded by a statement which gives respondents 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- item responses. This introduces a complication into the subsequent analysis. As with the other domains (see above), the domain of spiritual wellbeing adds only a small amount of unique variance when added to the usual seven domains. The data obtained are as follows:

(b)

Study A9

Sample Farmer Ex farmer Metro TOTAL

Importance 2.8 + 1.3 3.4 + 1.4 2.7 + 1.4

(% sm) Satisfaction 59.3 71.3 62.0 5.2 + 1.1 5.4 + 1.0 5.2 + 0.9

(% sm) 71.9 72.8 70.4

IXS 7.6 + 5.8 9.6 + 5.4 8.0 + 5.0

(%sm) 69.2 73.1 69.3

Unique1 Variance

4% 3.2 + 1.4 3.7 + 1.3 3.8 + 1.3 55.8 67.3 69.0 5.2 + 1.3 5.6 + 1.1 5.8 + 1.0 70.0 77.3 79.5 8.8 + 7.1 11.1 + 6.5 11.6 + 5.8 70.6 76.6 77.8 4%

A7

Young Mid-age Older TOTAL

These estimates of unique variance have been calculated on combined sample data using an 'internal' form of multiple regression, where each domain is regressed against the total [ (IxS)] score. The square of the semi-partial correlation for each domain yields its unique variance.

Conclusion The seven original domains are sufficient to measure subjective QOL for most purposes. Spiritual well-being may be usefully added as an eighth domain if the population under investigation is highly spiritual/religious or if this particular aspect of the QOL construct is to be examined.

40

4.

FAMILY AND FRIENDS: The fourth domain is normally stated as a combined source of intimacy involving family and friends. This is recommended for normal use. However, under some circumstances it may be desirable to obtain separate ratings for each component. Our data on this separation are as follows:
Sample Youth Elderly (Family) (Friends) (Family) (Friends) Importance 4.1 + 0.8 4.2 + 0.6 4.3 + 0.7 3.7 + 0.7 % sm 77.5 79.7 82.0 68.5 Satisfaction 5.5 + 1.2 5.7 + 0.8 5.9 + 1.1 5.6 + 0.8 (% sm) 75.6 78.3 81.3 76.8 IXS 10.9 + 6.8 11.4 + 4.2 12.7 + 6.0 10.1 + 4.1 (%sm) 76.0 77.4 80.6 73.7

Study A10

A11

Using an internal multiple regression, the amount of unique variance contributed by each domain was: Family = 2.9%, Friends = 1.5%.

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

41

7 Psychometric data
Study Codes
The data to be reported have been drawn from the following studies: Note Additional psychometric data on adults is available from the ComQol-A5 manual. Study S1: (Gullone & Cummins, 1998, Third edition). 264 adolescents aged 14.6 years (range 12 to 18 years) completed ComQol-S3. The sample was drawn from 7 schools in metropolitan Melbourne and comprised 52.9% females. (Bearsley, 1997, Fourth edition). 524 adolescents aged 15.8 years (range 1417y), 57.2% female comprised three groups as: (a) homeless and at risk of homelessness (N=105), community school students with a high frequency of emotional, behavioral, learning, or family problems (N=82), and non-homeless secondary school students (N=337).

Study S2:

7.1 Objective means

Study S1 Material Health Productivity Intimacy Safety Community Emotion MEAN 8.43 + 1.01 8.42 + 1.02 6.02 + 1.16 12.09 + 2.29 11.73 + 2.24 6.16 + 1.19 8.80 + 2.18 9.34 + 0.68 % sm 45.3 5.4 45.2 5.5 25.2 4.9 75.8 14.4 72.8 13.9 26.3 5.1 48.3 12.0 52.8 3.8

42

7.2 Subjective means

7.2.1 Importance (coded +1 to +5)
Study S1 Raw Material Health Productivity Intimacy Safety Community Emotion MEAN 3.65 + 0.78 3.91 + 0.82 3.61 + 0.84 4.16 + 0.80 3.80 + 0.84 3.33 + 0.98 4.06 + 0.85 3.79 + 0.54 % sm 66.3 14.2 72.8 15.3 65.3 15.2 79.0 15.2 70.0 15.5 58.3 17.2 76.5 16.0 69.8 9.9 Material Health Productivity Family Friends Safety Community Emotion MEAN Study S2 % sm 66.9 18.3 77.1 17.3 78.4 16.5 72.7 22.7 72.4 19.4 70.7 21.8 54.4 24.6 78.7 18.1 71.2 12.1

7.2.2 Satisfaction (coded -4 to +4)

Study S1 Raw Material Health Productivity Intimacy Safety Community Emotion MEAN 2.33 0.75 1.89 0.89 2.16 0.76 2.59 0.85 2.29 0.74 2.22 0.84 2.18 0.89 2.25 0.55 % sm 72.2 10.2 64.8 11.8 69.3 10.2 76.5 11.6 71.5 10.0 70.3 11.3 69.7 12.0 70.8 7.4 Material Health Productivity Family Friends Safety Community Emotion MEAN Study S2 % sm 78.9 13.9 71.9 18.8 72.2 17.4 73.4 19.3 77.4 16.2 73.8 14.5 70.5 16.1 72.2 18.2 73.6 10.9

7.2.3 Importance x Satisfaction

Study 1 Raw Material Health Productivity Intimacy Safety Community Emotion MEAN 9.34 6.29 7.74 8.89 9.17 6.24 11.67 7.16 8.89 6.69 8.06 6.35 10.12 7.48 9.59 4.79 % sm 71.9 16.5 67.7 23.4 71.5 16.4 78.1 18.8 70.8 17.6 68.6 16.7 74.0 19.7 72.6 12.6 Material Health Productivity Family Friends Safety Community Emotion MEAN Study 2 % sm 74.4 10.9 71.6 16.8 72.7 15.5 72.9 15.5 75.0 13.5 72.2 10.4 66.3 11.8 72.3 15.6 71.9 9.1

43

7.3 Reliability
7.3.1 Cronbachs alpha Boyle (1991) and Cortina (1993) strongly condemn the classical psychometric belief that high alphas are better in terms of intra-scale reliability. Boyle quotes Hattie (1985) as alpha can be high even if there is no general factor, since (1) it is influenced by the number of items and parallel repetitions of items, (2) it increases as the number of factors pertaining to each item increases, and (3) it decreases moderately as the item communalities increase. (pp. 1578). He concludes that there is an optimum range of internal consistency/item homogeneity if significant item redundancy is to be avoided. According to Kline (1979, p. 3), with item intercorrelations lower than 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 too narrow and too specific... If one constructs items that are virtually paraphrases of each other, the results would be high internal consistency and very low validity. Kline also states maximum validity... is obtained where test items do not all correlate with each other, but where each correlates positively with the criterion. Such a test would have only low internalconsistency reliability. (p.3)

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

7.3.2 Internal Reliabilities (Cronbach alpha) SUBJECTIVE Importance Satisfaction Importance x Satisfaction Study S1 .76 .80 .81

44

OBJECTIVE Alpha Domain vs total objective subscale correlations

Intra-domain correlations vs Item (1) vs Item (2)

Item vs total domain score correlations

A. MATERIAL
a(1) Income a(2) Number of possessions a(3) Standard of accommod.

.09

.43*** .02 .09 .91*** .36*** .27*** .73*** .23*** .17*** .43** .66*** .61*** .48*** .38*** .79*** .58*** .67*** .68***

.07

B. HEALTH
b(1) Number visits to doctor b(2) Extent of disability b(3) Severity of medication

.47

.18**

C. PRODUCTIVITY
c(1) Hours per week c(2) Time on desired goals c(3) Things made, etc.

.05

.33*** .03 .02

.13**

D. INTIMACY
d(1) Freq. talk to friends d(2) Freq. joined in activities d(3) Freq. others care when depressed

.62

.32*** .23*** .09

.36***

E. SAFETY
e(1) Freq. easily fall asleep e(2) Freq. anxious durg day e(3) Freq. feel safe at home

.52

.29*** .19*** .06 .42*** .77*** .13** .23*** .76*** .77*** .38*** .73*** .67***

.07

F. COMMUNITY
f(1) Extent comm. activities f(2) Extent comm. resp. f(3) Extent valued by comm.

.30

.41*** .14* .04

.24***

G. EMOTION
g(1) Freq. choose activities g(2) Freq. impossible wishes g(3) Freq. wish to stay in bed

.17

.34*** .04 .04

.25***

Note Alpha for the objective sub-scale comprising the seven domain scores is .39. Alpha for the sub-scale comprising the 21 individual objective items is 0.47 * p < 0.05 ** p < 0.01 *** p < 0.001

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7.3.3 Test-retest Reliability

Study SI: One week Objective Imp Material Health Productivity Intimacy Safety Community Emotion TOTAL .85 .88 .60 .76 .73 .66 .56 .83 .51 .62 .40 .56 .66 .50 .58 .74

Sat .59 .40 .60 .54 .48 .45 .70 .73

IxS .64 .40 .63 .68 .60 .49 .74 .79

7.4 Validity
7.4.1 Content validity The major validity data have been published as follows: Cummins (1995a) combined the data from 16 studies that measured life satisfaction among large samples drawn from the general population. It was found that their combination could be described by 75 + 2.5%SM. It was proposed that this statistic, and the implied normative range of 70 - 80%SM could be considered as the gold standard for Western populations. This statistic has subsequently been elaborated to include non-Western populations (Cummins, 1998). Cummins (1996b) demonstrated that, of 173 different domain-satisfaction names drawn from the literature, 68% of the names and 83% of the data they represented could be grouped under the 7 ComQol domains. Moreover, when the data grouped under the 7 domains were combined they yielded an average of 73.6 + 3.0%SM. From this it is concluded that content validity has been established and also that the data derived from the 7 domain satisfaction scores can be compared against the normative standard of 75 + 2.5%SM. 7.4.2 Construct validity Study SI: Used the Revised Childrens Manifest Anxiety Scale (RCMAS: Reynolds & Richmond, 1985), and the Fear Survey Schedule for Children - II (FSSC-II; Gullone & King, 1992). The correlations with ComQol domains were:

46

Objective :Anxiety - inverse correlations (-.15 to -.47) with safety, emotion, health, and intimacy. :Fear - inverse correlations (-.13 to -.28) with safety and emotion. Imp x Sat :Anxiety - inverse correlations (-.14 to -.32) with material, health, safety, community, emotion, and total score. :Fear - N.S. Study S2: Used the Life Attitude Profile - Revised (Reker, 1992) to demonstrate the following relationships with SQOL across the whole sample: Personal meaning (.61), existential vacuum (-.48), choice and responsibleness (.45), goal seeking (.16), death acceptance (-.01).

7.5 Sensitivity
Study S2: Subjective QOL was compared across the three groups, F (2,280) = 10.689, p <0.001. The non-homeless adolescents had a higher mean score (see 7.2.3) than both the homeless and at-risk adolescents (60.3 17.1%SM) and the nonhomeless community school adolescents (67.2 9.5%SM).

47

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 of life quality. New York: Plenum Press. Bearsley, C. (1997). No place called home: Quality of life and meaning in life of homeless youths. Melbourne: Honours Thesis, School of Psychology, Deakin University. Boyle, G.J. (1991). Does item homogeneity indicate internal consistency or item redundancy in psychometric scales? Personality and Individual Differences, 12, 291-294. Castles, I. (1992). 1990 Survey of income and housing costs and amenities Australia: Persons with earned income. Catalogue #6546.0. Canberra: Australian Bureau of Statistics. Cortina, J.M. (1993). What is coefficient alpha? An examination of theory and applications. Journal of Applied Psychology, 78, 98 - 104. Felce, D., & Perry, J. (1995). Quality of life: Its definition and measurement. Research in Developmental Disabilities, 16, 51-74. Ferrans, C.E., & Powers, M.J. (1985). Quality of life index: Development and psychometric properties. Advances in Nursing Science, 8, 15-24. Gullone, E., & Cummins, R.A. (1998). The Comprehensive Quality of Life Scale - School version: A psychometric investigation (submitted). Gullone, E., & King, N.J. (1992). Psychometric evaluation of a revised fear survey schedule for children and adolescents. Journal of Child Psychology and Psychiatry, 33, 987998. Hattie, J. (1985). Methodology review: assessing unidimensionality of test and items. Applied Psychological Measurement, 9, 139-164. Kline, P. (1979). Psychometrics and psychology. London: Academic Press. Raphael, D., Rukholm, E., Brown, I., Hill-Bailey, P., & Donato, E. (1996). The quality of life profile - Adolescent version: Background, description, and initial validation. Journal of Adolescent Health, 19, 366-375. Recker, G.T. (1992). Life Attitude Profile-Revised. Canada: Trent University Reynolds, C.R., & Richmond, B.O. (1985). Revised Childrens Manifest Anxiety Scale (RCMAS) manual. Los Angeles, CA: Western Psychological Services.

48

Appendix A
Psychotropic drug names (Both generic and trade)
Acetophenazine Adapin Aldazine Alprazolam Amitriptyline Anetensol Atarax Atenoiol Ativan Aventyul Blocadren Buspar Buspirone Calmazine Carbamazepine Catapres Celontin Centrax Chlordiazepoxide Chlorpromazine Chlorprothixene Cibalith-s Clonazepam Clonidine Clorazepate Compazine Cylert Decanoate Depakene Desipramine Desyrel Dexedrine Dextroampetharnine Diazepam Dilantin Doxepin Droleptan Elavil Endep Equanil Eskalith Ethosuximide Ethotoin Fluphenazine Halazepam Haldol Haloperidol Hydroxyzine Imavate Inderal Isocarboxazid Janamine Klonopin Larquactil Librium Limbitrol Lithane Lithicarb Lithobid Lithonate Lopressor Lorazepam Loxapine Loxitane Ludiomil Maprotiline Marplan Mebaral Melleril Mephenytoin Mephobarbital Meprobamate Mesantoin Mesoridazine Methsuximide Metroprolol Milontin Miltown Moban Modecate Molindone Mutabon Mysoline Nardil Navane Neulacctil Norpramine Nortriptyline Novane Orap Oxazepam Pamelor Paradione Paramethadione Parnate Paxiparn Peganone Permoline Perphenazine Perrnitil Pertrofrane Phenelzine Phenobarbital Phensuximide Phenytoin Piperacetazine Prazepam Priadel Primidone Prochloperazine Prolixin Propanalol Quide Ritalin Serax Serenace Serentil Sinequan SK-Pramine Stelazine Surmontil Taractan Tegretol Tenormin Thioridazine Thiothixene Thorazine Timolol Tindal Tofranil Tranxene Tranylcypromine Trazodone Triavil Tridione Trifluoperazine Triflupromazine Trilafon Trimethadione Trimipramine Valium Valproic Acid Vesprin Vistaril Vivactil Zanax Zarontin

49

Appendix B
Scoring ComQol

1 Recode satisfaction data +4 Delighted +3 Pleased +2 Mostly satisfied +1 Mixed -2 Mostly dissatisfied -3 Unhappy -4 Terrible

2 Obtain individual 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 (without satisfaction) (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 (without satisfaction) (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 (without importance) (a) Use non-recoded data: i.e. Use scores coded 1 (Terrible) to 7 (Delighted). (b) Take the satisfaction score for each domain. Call this score x. (c) Use the formula %SM = (score x-1) x 100/(7-1).

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7 Obtain overall satisfaction score for each person (without importance) (a) Sum the 7 satisfaction scores (scored 1 to 7). (b) Divide total by 7. Call this score x. (c) Use formula in (5). 8 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 = [19 + (Score x-1)] x 100/38 (d) If result is negative use formula % scale maximum = [19 + (Score x+1)] x 100/38 (e) This figure is the overall subjective domain score expressed as %SM. 9 Obtain average subjective scores (i x s) for each domain using grouped data (a) Recode the satisfaction score for each person as for (1.). (b) Calculate (IxS) for each domain for each subject. (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 100/38 (e) If result is negative use formula % scale maximum = [(Score x +1) + 19] x 100/38 (f) This gives the average domain subjective score across the group for each domain expressed as %SM. EXAMPLE 1 Overall objective score Sum 1a to 7c =53 53/21 = 2.52 % scale max = (2.52-1) x 100/(5-1) = 38%

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2 Overall I x S score Sum I x S scores (data for IDNUMOO1) Domain 1 2 3 4 5 6 7 TOTAL 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 Importance 3 4 4 5 4 4 4 28 Satisfaction +1 -3 +2 +4 +3 +3 -2 8 IxS 3 -12 8 20 12 12 8 35

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Appendix c
Author publications (from 1991) (as at 11/8/98)
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 intellectual disabilities 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 7 to 12.

Available translations * The adult version is available in Greek, Italian, Spanish and Persian from the author.

Publications by the author over the past five years:

Baxter, C., & Cummis, R.A. (1993). Extending network support through shared family care: Impact on children with a disability and their families. Proceedings, Fourth Australian Family Research Conference, Electronic Database, Australian Institute of Family Studies, Document #18951. Cummins, R.A. (1993). Health promotion and the Comprehensive Quality of Life Scale. Health Promotion Journal of Australia, 3, 46-47. Cummins, R.A. (1993). In the Community: An Evaluation of the Community Living Support Service. Melbourne: Community Services Victoria, (pp.1-306). Cummins, R.A. (1993). On being returned to the community: Imposed ideology vs. quality of life. Australian Disability Review, 2-93, 64-72. Cummins, R.A. (1993). Tranquilisers and your brain. In: E. Ree (Ed.). A training manual for health professionals in the treatment of benzodiazepine dependence and withdrawal. Melbourne: TRANX, 75-80. Cummins, R.A., & Baxter, C. (1993). A case for the inclusion of subjective quality of life data in service-delivery evaluations. Proceedings, Australasian Evaluation Society International Conference. Brisbane: Australian Evaluation Society, 201-211. McCabe, M.P., Cummins, R.A., Hinchy, J., Whitmore,M., & Gee, D. (1993). Changing Attitudes towards Self, Family and Boys Held by Young Adolescent Females. Melbourne: Psychology Research Center, Deakin University, (pp.1-82). Polak, S., Cummins, R.A., & Baxter, C. (1993). Attitudes of families to the Community Living Support Service. Interaction, 6(1), 25-26. Cummins, R.A., & Baxter, C. (1994). Choice of outcome measures in service delivery evaluations for people with disabilities, Evaluation Journal of Australia, 6, 22-30. Cummins, R.A., Jauernig, R., Hudson, A., & Baxter, C. (1994). A model system for the construction and evaluation of General Service Plans. Australia and New Zealand Journal of Developmental Disabilities, 19, 221-231. Cummins, R.A., McCabe, M.P., & Romeo, Y. (1994). The Comprehensive Quality of Life Scale Intellectual disability: Results from a Victorian survey. Proceedings, 29th National Conference of the Australian Society for the Study of Intellectual Disability, 93-98.

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Cummins, R.A., McCabe, M.P., Romeo, Y., & Gullone, E. (1994). The Comprehensive Quality of Life Scale: Instrument development and psychometric evaluation on College staff and students. Educational and Psychological Measurement, 54, 372-832. McCabe, M.P., & Cummins, R.A. (1994). Sexual abuse among people with intellectual disabilities: Fact or fiction. Proceedings, 29th National Conference of the Australian Society for the Study of Intellectual Disability, 250-254. McCabe, M.P., Cummins, R.A., & Reid, S.B. (1994). An empirical study of the sexual abuse of people with intellectual disabilty. Journal of Sexuality and Disability, 12, 297-306. Parmenter, T., Cummins, R.A., Shaddock, A., & Stancliff, R. (1994). Quality of life for people with disabilities: The view from Australia. In Goode, D. A. et al . An international perspective on quality of life and disability. New York: Brookline Press, pp.75-102. Baxter, C., Cummins, R.A., & Polak, S. (1995). A longitudinal study of parental stress and support: The influence of child disability from diagnosis to leaving school. International Journal of Disability, Development and Education, 42, 125-136. Cummins, R.A. (1995). On the trail of the gold standard for life satisfaction, Social Indicators Research, 35, 179-200. Cummins, R.A. (1995). The Comprehensive Quality of Life Scale: Development and evaluation. Proceedings. Health Outcomes and Quality of Life Measurement Conference. Australian Institute of Health and Welfare, pp. 18-24 (reprinted in Health Outcomes Bulletin, 7, 7-14). Cummins, R.A., Fogarty, D., McCabe, M.P., & Hammond, J. (1995). Using the Comprehensive Quality of Life Scale: A comparison between elderly Australians and normative data. Proceedings, 12th World Congress, International Federation of Physical Medicine and Rehabilitation, 1-10. Gullone, E., Cummins, R.A., & King, N. (1995). Adaptive behaviour in children and adolescents with and without intellectual disability: Relationships with fear and anxiety. Behaviour Change, 12, 227-237. Cummins, R.A. (1996). Directory of instruments to measure quality of life and cognate areas. Second edition. Melbourne: School of Psychology, Deakin University. Cummins, R.A. (1996). The domains of life satisfaction: An attempt to order chaos. Social Indicators Research , 38, 303-332. Cummins, R.A., Baxter, C., Jauernig, R., & Hudson, A. (1996). A model system for the construction and evaluation of Individual Program Plans. Journal of Intellectual and Developmental Disability, 21, 59-70. Cummins, R.A., & Gullone, E. (1996). Measuring the quality of life of people with an intellectual disability. Proceedings, integrating health outcomes measurement in routine 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 initial evaluation of the Comprehensive Quality of Life Scale Intellectual Disability. International Journal of Disability, Development and Education, 44, 7-19. Gullone, E., Cummins, R.A., & King, N.J. (1996). Fears of youth with mental retardation: Psychometric evaluation of the Fear Survey Schedule for Children - II (FSSC-II). Research in Developmental Disabilities, 17, 269-284. Gullone, E., Cummins, R.A., & King, N.J. (1996). Self-reported fears: A comparison study of youths with and without an intellectual disability. Journal of Intellectual Disability Research, 40, 227240. McCabe, M.P., & Cummins, R.A. (1996). An evolutionary perspective on human female sexual desire. Sexual and Marital Therapy, 12, 121-126. McCabe, M.P., & Cummins, R.A. (1996). The sexual knowledge, experience, feelings and needs of people with mild intellectual disability. Education and Training in Mental Retardation and Developmental Disabilities, 31, 13-21. McCabe, M.P., Cummins, R.A., & Romeo, Y. (1996). Personal relationships, relationship quality and health. Journal of Family Studies, 2, 109-120.

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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). Bibliography on quality of life and cognate areas of study. Third Edition. Melbourne: School of Psychology, Deakin University, (pp.1-97). (ISSN 1326-2173). Cummins, R.A. (1997). Directory of Instruments to measure quality of life and cognate areas. Third Edition. Melbourne: School of Psychology, Deakin University, (pp.1-58). (ISSN 13250752). Cummins, R.A. (1997). Measuring quality of life for people with an intellectual disability: A review of the scales. Journal of Applied Research in Intellectual Disability, 10, 199-216. 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., & Baxter, C. (1997). The influence of disability on quality of life within families. International Journal of Practical Approaches to Disability, 21, 2-8. Cummins, R.A. McCabe, M.P., Romeo, Y., Reid, S., & Waters, L. (1997). An initial evaluation of the Comprehensive Quality of Life Scale - Intellectual Disability. International Journal of Disability, Development and Education, 44, 7-19. Cummins, R.H., McCabe, M.P., & Cummins, R.A. (1997). The Girls Guide. Melbourne: Harper Collins (pp.1-161). Fogarty, G.J., Bramston, P., & Cummins, R.A. (1997). Validation of the Lifestress Inventory for people with a mild intellectual handicap. Research in Developmental Disabilities, 18, 435-456. Baxter, C., & Cummins, R.A. (1998). An international standard for life satisfaction. Proceedings, First International Conference on Quality of Life in Cities, Singapore, 1-9. Best, C., Cummins, R.A., & Lo, S.K. (1998). Evidence for domain compensation involving the homeostatic control of subjective life quality among ex-farmers in Australia. Proceedings, First International Conference on Quality of Life in Cities, Singapore, 10-16. Cummins, R.A. (1998). The Comprehensive Quality of Life Scale (fifth edition). Proceedings, First International Conference on Quality of Life in Cities, Singapore, 67-77. Cummins, R.A. (1998). The second approximation to an international standard of life satisfaction. Social Indicators Research, 43, 307-334. Cummins, R.A. (1998). Quality of Life Definition and Terminology. Blackburg, Virginia: The

International Society for Quality-of-Life Studies. http://www.cob.vt.edu/market/isqols/bibres.htm (pp.1-111).

Web

address:

In press: Baxter, C., Cummins, R.A., & Yiolitis, L. (1998). Parental stress attributed to disabled family members: A longitudinal study. International Journal of Disability Research (in press). 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). Bramston, P., & Cummins R.A. (1998). Stress and the move into independent accommodation. Journal of Intellectual and Developmental Disability (in press). Bramston, P., Fogarty, G., & Cummins, R. A (1998). The nature of stressors experienced by people with an intellectual disability. Journal of Applied Research in Intellectual Disability (in press). Clements, J., Rapley, M., & Cummins, R.A. (1998). On, to, for, or with vulnerable people and the practices of the research community. British Journal of Clinical Psychology (in press). Cummins, R.A. (1998). The measurement of subjective health outcome: Issues of concern. Proceedings, International Conference on Health Outcome, (in press). McCabe, M.P., & Cummins, R.A. (1998). Sexuality and quality of life among young people. Adolescence (in press). O'Brien, P., Tuck, B., Elkins, J., & Cummins, R.A. (1998). Exploration of visual behavior in diadic relationships of people with and without a disability. Journal of Intellectual Disability Research (in press).

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Submitted: Best, C., & Cummins, R.A. The quality of rural and metropolitan life (submitted). Cummins, R.A. Normative life satisfaction: Measurement issues and a homeostatic model (submitted). Cummins, R.A. & Baxter, C. The influence of disability on quality of life within families (submitted). Foroughi, E., & Cummins, R.A. The influence of migration, social support and social integration on the life quality of Persians in Australia (submitted). Fraid, R., & Cummins, R.A. Spiritual well-being and quality of life (submitted). Golding, D., & Cummins, R.A. The contribution of spiritual well-being to quality of life (submitted). Gullone, E., & Cummins, R.A. Fear, anxiety and quality of life: Adolescent self-reports (submitted). Kelly, J., & Cummins, R.A. The concept and measurement of quality of life in psychology (submitted). McCabe, M.P., & Cummins, R.A. The changing attitudes of adolescent females towards boys, themselves and their families over a ten year period (submitted). McCabe, M.P., Cummins, R.A., & Deeks, A.A. Construction and psychometric properties of sexuality scales (submitted). Mellor, D., Cummins, R.A., & Loquet, C. The gold standard for life satisfaction: Confirmation and elaboration using an imagined scale (submitted). Misajon, R., & Cummins, R.A. Subjective quality of life among Filipino-Australians (submitted). Nistico, H., & Cummins, R.A. Maintaining subjective well-being and avoiding depression: The role of cognitive illusions (submitted). Petito, F., & Cummins, R.A. Social integration, stress and life quality among Italian migrants in Australia (submitted). Verri, A.P., Cummins, R.A. Vallero, E., Monteath, S., Gerosa, E., & Nappi, G. An Italian-Australian comparison of life quality among intellectually disabled people living in the community (submitted). Yiolitis, L., & Cummins, R.A. The effects of social interaction and stress on the life quality of GreekAustralians, (submitted). In preparation: Bearsley, C., & Cummins, R.A. No place called home (in preparation). Cummins, R.A., & Baxter, C. The experience of stress and quality of life among people who are disabled, (in preparation). Cummins, R.A., & Hastings, M. Quality of Life as a function of participation in physical activity and self-esteem (in preparation). Germano, D., & Cummins, R. A. Quality of life for people with arthritis (in preparation). Hutton, D.M., & Cummins, R.A. A structural model of organisational commitment and career satisfaction (in preparation). Mallamace, J., & Cummins, R. A. The effects of social and competitive sport participation on subjective quality of life (in preparation). Simm, L., & Cummins, R. A. Quality of life, work and retirement (in preparation).