QOL toolbox

WeD Toolbox No. 1: The WeD-QoL (WeD measure of individual Quality of Life) Version dated January 2006

1. What is the WeD-QoL
2. The conceptual rationale for the WeD-QoL
3. How it contributes to WeD research
4. Description
5. How it was developed
6. How it was implemented
7. Potential analysis
8. Links to other WeD research tools
9. Appendices
10. Phase 1 Short summaries
- Short summary- Ethiopia
- Short summary - Thailand
- Short summary - Bangladesh
- ECB - Peru (information to follow)
11. Further Reading

 

1. What is the WeD-QoL?

The WeD-QoL is a measure of an individual’s perceived Quality of Life (QoL), which can be interview-administered. Its purpose is to enable researchers and practitioners to analyse and compare how people experience and evaluate their lives in a practical and rigorous way. This will include the level of satisfaction people feel in relation to valued aspects of their lives and their life ‘as a whole’.

QoL is provisionally defined as:

This definition was developed during the second stage of a multi-phase process comprising:

i. A first phase (July to December 2004), which was primarily exploratory and used participatory and ethnographic techniques
ii. A second conceptual phase (November 2004 to January 2005), which integrated the results of the first phase with the best of contemporary thinking on defining and measuring QoL
iii. A third phase of methodological development and fieldwork (February to October 2005), which produced a multidimensional instrument covering aspects of QoL and related variables to be field tested for each of the WeD countries
iv. A fourth phase of psychometric analysis (October 2005 to February 2006) which will use the data from Phase 3 to establish a reliable and valid scale or interconnected set of scales which can be used to measure QoL in developing countries. We will call this the WeD-QoL measure. See insert.

2. Conceptual rationale for the WeD-QoL

The goal of the WeD QoL research is to produce a methodology that creates a space for self-evaluation, where people can tell us what they value, what they have experienced, and how satisfied they are with what they have, and what they can do and be. The conceptual starting point for our approach was the World Health Organisation definition of Quality of Life:

The WeD-QoL aims to operationalise this definition by directly assessing the relationship between people’s “goals, expectations, standards and concerns”. It was also influenced by the ‘gap’ theories popular in QoL and Health-related QoL research (for example, Calman [1984], Michalos [1985], Ruta et al [1994]), which argue that the main determinant of people’s perceived quality of life is the gap between their expectations and their experiences. However, their expectations are not static, but are influenced by prevailing ideologies, social comparison, adaptation, and values. These influences cause people to evaluate their situation more or less favourably than might be expected, accounting for the discrepancies between objective and subjective measures, which have previously caused researchers to undervalue subjective accounts (e.g. Sen 1984:309).

3. How it contributes to WeD research

The process of developing the WeD-QoL has already enabled us to:

i. Understand the categories and components of QoL in the specific localities we are working in and, within these, the relative influence of the subjective, inter-subjective, and material dimensions of people’s lives
ii. Distinguish between components of QoL at the universal level and those of the locality and the culture-group, and explore the relationship between them
iii. Assess the level at which it is possible to produce a measure of QoL that is meaningful to respondents, analysts and development practitioners, and develop methods that will best achieve this

This culminated in the development of the WeD-QoL Phase 3 instrument, which provides data on people’s happiness and satisfaction with ‘life as a whole’ (subjective wellbeing), and the interaction of goals, resources, and values in producing these states, and will ultimately be used to produce the WeD-QoL measure itself.

4. Description

At this stage (prior to the psychometric analyses of Phase 4) we cannot specify the content of the ultimate WeD-QoL measure.

At Phase 3, The WeD-QoL instrument from which data were collected had two components:

1. A battery of four ‘native’ scales that measure Goals, Resource Availability, Goal Achievement, and ‘personal’ and social Values.

The native scales consist of the following:

A ‘core’ of cross-cultural ‘items’ Each question in the WeD-QoL comprises item content, e.g. ‘house’, preceded by a question stem, e.g. ‘how is your [house]?’ Respondents are read an item response scale, e.g. ‘[My house is] bad/ adequate/ good’, so that they can respond to the question in a uniform manner, enabling easy analysis
Country-specific items (for example, ‘feeling metta-karuna [universal love-compassion] for others’ in Thailand)
Question stems
Item response scales, either three or five point

Peru and Ethiopia also developed items specific to the site or section of the site to capture important differences between the communities.

2. Two adaptations of internationally validated scales that measure the following:

· Satisfaction with life as a whole (Satisfaction with Life Scale, Diener et al 1985)
· Presence of positive and negative affect (Positive & Negative Affect Scale, Watson et al 1988)

5. How WeD-Qol Phase 3 was developed

The four scales that formed the core of the WeD-QoL instrument (Goals, Resource Availability, Goal Achievement, and Values) were developed using data from multiple sites within Ethiopia, Bangladesh, Thailand, and Peru, which was collected during the first phase of the QoL research.

The initial exploratory phase (Phase 1)

The key questions for the exploratory phase were as follows:

What goals and experiences (‘havings’, doings, beings, feelings, and meanings) contribute to people’s QoL in the context of their particular community, cultural grouping, and nation
What ‘resources’ are considered necessary to achieve or maintain QoL. Resources in the WeD model can be material, environmental, human, social, or cultural. They are perceived as resources by the respondent because they enable them to achieve their goals (“self-congruent”) or meet specific environmental demands (“environmentally-congruent”).
What role do values play in this process

The process of establishing the conditions for QoL in each country began with the WeD Inaugural Workshop in 2003 and continued with ‘expert’ workshops on QoL during the summer of 2003.

It also involved field research with a wider range of informants, which produced both data and methodological reflections. The WeD QoL Phase 1 fieldwork took place in rural, peri-urban, and urban sites in Bangladesh, Ethiopia, Thailand and Peru. The average sample size for the countries was 360 (range 314-419) and age and gender were used as the key breaking variables, followed by religion or ethnicity. The fieldwork used locally appropriate qualitative and quantitative methods, including semi-structured interviews (This included the ‘Entrevista a profundidad sobre Compenents del Bienestar’ or ECB developed by WeD-Peru), focus groups, the Person Generated Index (PGI) The PGI is an individualised QoL measure, which asks people to nominate aspects of life that contribute to their wellbeing and rate them according to how important they are and how satisfied they are with them. [Ruta et al 1994, 1998], and the Satisfaction with Life Scale (SWLS) The SWLS is a widely used 5-item measure that assesses people’s satisfaction with their life ‘as a whole’ [Diener et al 1985].

The Phase 1 data were supplemented by information from the Community Profiling, some of which asked questions relating to quality of life and wellbeing (see particularly the Wellbeing and Illbeing Dynamics in Ethiopia study, WIDE 2). It also incorporated findings from the Resources and Needs Questionnaire (RANQ) (see RANQ toolbox).

The second conceptual phase (Phase 2)

The exploratory phase was followed by a second conceptual phase of analysis and theoretical integration. At an international workshop in the UK country representatives reviewed the findings of the first phase and discussed whether, and how, we might develop a generic measure of QoL specific to developing countries.

It was agreed to extend the psychometric methodology used by WeD-Peru to all the countries and develop and test a common suite of measures (the WeD-QoL instrument used in Phase 3) which could then be subjected to psychometric analysis. This decision was ratified through face-to-face and email consultations with our QoL Steering Group (comprising psychologists and psychometricians). The draft structure of the WeD-QoL Phase 3 instrument and the Terms of Reference for developing and administering it were then agreed at a further international workshop in Thailand.

Once the country versions of the WeD-QoL Phase 3 instrument had been agreed and translated (a process that involved all members of the research team), they were tested in a selection of research sites with older and less-educated respondents who were likely to find the WeD-QoL questions more difficult to respond to (‘pre-piloting’). The draft WeD-QoL Phase 3 instrument was then revised to take the interviewers’ feedback into account and tested again in a similar selection of research sites with similar respondents (‘piloting’). The instrument was revised again following feedback from the piloting and was then ready for the final administration.

This iterative development process ensured first that all items were relevant to the locations in which the instrument would be used, and the second that the majority could be analysed cross-culturally.

6. How WeD-Qol Phase 3 was implemented

The WeD-QoL Phase 3 instrument was administered to 370 men and women in each country (approximately 60 per research site) in the local language by a team of interviewers selected by each of the country teams. Before this fieldwork commenced, interviewers underwent intensive training from country researchers, supported by researchers from WeD-Peru and WeD-Central who had both extensive psychometric experience and experience of the QoL fieldwork of another WeD country. The interviewers’ understanding was furthered by their participation in the pre-piloting and piloting phases of the WeD-QoL instrument.

All respondents to the WeD-QoL Phase 3 instrument had also completed RANQ, and as many as possible had been involved in other research, for example, the Income and Expenditure survey or the Core Household diaries. The remainder was sampled proportionately according to age, socio-economic status, ethnicity, and religion.

Upon completion, the responses were entered by the country teams into a specially designed Microsoft Access database in English. In the case of Peru and Thailand, the data were ‘double entered’ by two staff members into two copies of the database, which were then compared to identify any errors in data entry. In all cases, the databases were checked by the project data manager ‘by eye’ and through a series of queries, for further errors and anomalies.

Once the four countries’ data were approved as ‘clean’, they were exported into SPSS in preparation for the psychometric scale development process (Phase 4).

A further data entry check was conducted at this stage, by back-checking a random sample of the original protocols against the SPSS database, and calculating the percentage data entry error.

When the psychometric phase has been completed, the resultant WeD-QoL measure will be ‘virtually’ returned to the field. This means that only those variables which form part of the resulting internally coherent scales will be included in the WeD-QoL measure. For the purpose of reliable and efficient measurement of QoL, other items may be deleted from the scales. A post-phase 4 dataset, containing data only from the variables included in the final WeD-Qol measure, will also be produced as a result of this ‘virtual fieldwork’. The data (Two alternative datasets, one pre- and one post- the psychometric refinement, could be made available, the former containing a wider range of variables. To be decided), the measure and the methodology will be made available for use by other researchers or practitioners. After its completion, the psychometric development process will be documented comprehensively.

7. How can it be analysed?

The WeD-QoL data will permit analysis a) within a site, b) across sites of the same country, eg. by rural and urban areas, and c) across the four countries.

In analyses, it will be possible to make use of the whole range of variables included at Phase 3, as well as the psychometrically developed Phase 4 WeD-Qol measure.

It will thus be possible to explore the following for different individuals in different sites across the four countries:

1. What goals they perceive as important or relevant
2. How satisfied they are with their achievement of the goals they care about
3. Their perception of the resources they have to pursue these goals
4. Their values
5. Their perception of the values of people in their community
6. Their mood
7. Their satisfaction with life as a whole
8. Their level of subjective quality of life

Below are some of the research questions the earlier participatory work and the data from the measure will enable us to address:

To what extent do ‘felt’ needs and ‘objective’ needs satisfiers differ between sites and individuals within those sites? How is perceived need satisfaction or goal achievement related to life satisfaction and mood? Does this relationship differ between sites and individuals within those sites?
How does perceived access to different types of resources differ between sites and individuals within those sites?
How do socio-demographic variables (like education and religion) relate to the personal values people endorse? Is there any relationship between particular value clusters and goal achievement, life satisfaction, or mood?
How strong is the relationship between perceived and objective resources? (recorded in the RANQ and Income and Expenditure surveys) Which category has the greater effect on life satisfaction and mood?
How do conceptions of the good life and sources of happiness and unhappiness differ between sites and between individuals within those sites?
What are the connections between the exploratory quality of life research and the results of the WeD-QoL? This mostly compares qualitative and quantitative findings. For example, where people have said in focus groups that having a strong family is the most important aspect of a good life, how does this reflect in the number of WeD-QoL Phase 3 respondents endorsing the relevant item as ‘very necessary’, and, on a quantitative level, how does achieving a strong family relate to greater happiness and life satisfaction?

8.Links to other WeD research tools

The WeD-QoL data enables us to explore the relationship between perceived and objective resources (recorded in the RANQ and Income and Expenditure surveys), and between both types of resources and feelings of positive emotion and satisfaction with life. It complements the more descriptive components of RANQ, the community profiles, and research into processes and structures by providing information on people’s subjective perceptions of wellbeing. This allows exploration of the relationship between objective and subjective dimensions of wellbeing.

9. Appendices

WeD-QoL Ethiopia (Phase 3) - draft version see Laura Camfield l.camfield@bath.ac.uk
Person Generated Index (PGI) (Ruta et al)
Satisfaction with Life Scale (SWLS) (Diener et al)

10. Phase 1 Short summaries
- One page summary - Ethiopia
- One page summary - Thailand
- One page summary - Bangladesh
- ECB - Peru

11. Further Reading
Camfield, L., McGregor, J.A., & Yamamoto, J. (2006) Quality of Life and its relationship to wellbeing (forthcoming)

Calman, K. C. (1984). QOL in cancer patients a hypothesis. Journal of Medical Ethics, 10, 124-7.

Diener, E., Emmons, R., Larsen, J., Griffin, S. (1985). The Satisfaction With Life Scale. J Personality Assessment, 49(1), 71-75.

Michalos, A. C. (1985). Multiple discrepancies theory MDT. Social Indicators Research, 16, 347-413.

Ruta, D. A., Garratt, A. M., Leng, M., Russell, I.T., & MacDonald, L.M. (1994). A new approach to the measurement of QOL. The Patient Generated Index. Med Care, 32(11), 1109-1126.

Ruta, D. A. (1998). Patient generated assessment: The next generation. MAPI Quality of Life Newsletter, 20, 461–489.

Sen, A. (1984). Resources, values and development. Oxford, UK: Blackwell.

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

WHOQOL Group. (1995). The World Health Organisation Quality of Life assessment (WHOQOL): Position paper from the World Health Organisation. Social Science & Medicine, 41, 1403-1409.