Importance is Not Unimportant: The Role of Importance Weighting in QOL Measures

The effect of relative domain importance as a weighting mechanism in quality of life (QoL) measures has been a topic of debate for decades. Studies investigating the role of domain importance in QoL measures have produced mixed results. The mixed results may very well be the consequences of a limited choice of global satisfaction or QoL measures, measurements of domain satisfaction, measurements of domain importance and weighting approaches applied to date. This study investigated the effect of importance weighting without assigning any arbitrary weighting function of domain importance. A cluster analysis was first used to classify individuals into groups, based on their perceived importance of various life domains, and then the relationship between global life satisfaction measure and the composite of domain satisfaction scores between these groups was compared. Results of this study showed that the relationship between global life satisfaction and composite of satisfaction scores did not remain consistent for respondents with different importance rankings of major life domains, which suggested an important effect of domain importance in QoL measures.     

Self-Efficacy,Pulmonary Function,Perceived Health and Global Quality of Life of Cystic Fibrosis Patients

This study examined the extent that pulmonary function is related to perceived health status and global quality of life in adults suffering from cystic fibrosis, and the extent that self-efficacy modifies these relationships. Our sample comprised 86 adults (48% female; mean age, 29 years; age range, 18–54 years) with cystic fibrosis, recruited from the Norwegian Competence Centre for Cystic Fibrosis (83% response rate). Both subjective data on psychosocial aspects of living with cystic fibrosis, and objective data on pulmonary function (FEV1%) were assessed. Psychosocial aspects were assessed by a questionnaire that included St George’s Respiratory Questionnaire (perceived health status), the Generalized Self-Efficacy Scale (perceived self-efficacy), and the Quality of Life Scale (global quality of life). We found that self-efficacy is an additional factor explaining health status and global quality of life. Pulmonary function is important for health status, but not for global quality of life, for which perceived self-efficacy and health status are the most significant variables. These results show that self-efficacy is as important as pulmonary function for the perceived health status and global quality of life of patients. These valuable findings should be considered in the treatment and care of adult patients suffering from cystic fibrosis.     

Measures of the perceived overall quality of life

Respondents participating in a national quality of life study were asked to assess their levels of satisfaction or dissatisfaction with each of a set of fifteen domains of their lives. They were also asked to describe their lives as a whole, using both satis-faction and semantic-differential types of scales. Canonical correlation analysis was used to find the combinations of domain-specific and global items with the highest correlation. The two indices derived from this analysis, the Index of Well-being and the Index of Domain Satisfactions, have been examined in relation to a variety of demographic and situational variables, including age, indicators of socioeconomic status, employment status, and size of community. The relationships discovered provide some preliminary evidence for the validity of these indices. The reliability of the measures (as measured cross-sectionally) and their stability over a period of some eight months are both acceptably high. We conclude that both of these measures form acceptable indicators of the perceived overall quality of life.     

Socio-demographic vs domain predictors of perceived stress: Racial differences among American women

Using data from a national probability sample of black and white females, this study focuses on racial differences and similarities in factors affecting levels of global perceived stress. Selected socio-demographic characteristics as well as satisfactions with the major domains of life — such as self, standard of living, health, family life, and leisure — are examined as predictors of global perceived stress. Generally, domain satisfactions are found to be stronger predictors of perceived stress than are socio-demographic characteristics. Moreover, no racial differences between black and white females are found when socio-demographic factors are controlled. However, a significant racial difference is encountered for one domain: satisfaction with leisure appears to be a stronger predictor of perceived stress for black females than it is for white females.     

Social Exclusion and Quality of Life: An Empirical Study from Turkey

We examine the perception of social exclusion and quality of life and their interactions among a group of Turkish citizens. For this purpose we used the social exclusion scale developed by Jehoel-Gijsbers and Vrooman and the WHOQOL-BREF scale. The study group consists of 2,493 participants who are residents of a city in Turkey. Our study was based on self reporting and voluntary participation. We used SEM (Structural Equation Modeling) for the analysis. We observed significant paths among several dimensions of quality of life and social exclusion. We found that the material deprivation dimension of social exclusion has a direct and negative impact on the environment and social relationships domains of quality of life. The material deprivation dimension explains 36% of the variation in the environment and 16% of the variation in social relationship domains of quality of life. This finding indicates that the material deprivation and social participation play an important role in the perception of environmental and psychological life quality. Physical health, social relationships, and environmental domains of life quality are important in the social participation dimension of perceived social exclusion.     

Developing measures of perceived life quality: Results from several national surveys

This report presents the current status of a series of studies oriented toward the assessment of perceived life quality. The conceptual model proposes that a person's overall sense of life quality is understandable as a combination of affective responses to life ‘domains’, which are of two types-role situations and values. Over 100 items used to measure a wide variety of domains and 28 items assessing perceived overall life quality are presented. Various subsets of these items were used in interviews with several representative samples of American adults. Based on these data the domain items were grouped into a smaller number of semi-independent clusters which were internally stable across 10 different subgroups of the respondents and whose interrelationships were highly replicable in independent national samples. A series of analyses, some replicated in more than one survey showed: (1) an additive combination of 12 selected domains explained 50–60% of the variance in an index of overall life quality, (2) neither other domains nor several social characteristic variables contributed additional explanatory power, (3) this level of explanation was achieved in each of 22 subgroups of the population, and (4) additive combinations of domains worked as well as more complicated combinations.     

Revisiting the Disengagement Theory with Differentials in the Determinants of Life Satisfaction

This study proposes that differentials in the determinants of life satisfaction can be used to test if the elderly have a new equilibrium. One's global life satisfaction is taken as an indicator for one's inner world and for the elderly, global life satisfaction is assumed to be not influenced by life domains which indicate drastic social changes, because they are supposed to be disengaged from social activities. On the other hand, global life satisfaction for other adults is affected by life domains indicating social changes, because they are still tightly involved with social activities. The differentials in the determinants of global life satisfaction thus indicate that the elderly have a new equilibrium.A national survey on Taiwanese living conditions conducted by the Ministry of Interior, the Republic of China, in 1998 is used to test the above hypotheses. The analytical results show that the elderly have perceived drastic social changes. Moreover, they do have an equilibrium that is different from the other two age groups.     

The domains of life satisfaction: An attempt to order chaos

While life satisfaction is commonly measured as an aggregate of individual life domains, the characterisation of such domains is uncertain. This study attempts to group 173 different domains names derived from the literature under seven headings as used by the Comprehensive Quality of Life Scale (ComQol). It was found that 68% could be classified in this way. Moreover, due to the repeated use of some domain names, the ComQol classification included 83% of the total reported data. The ComQol domain data did not differ from single-item global measures of life satisfaction and the within-study variance was lower using the ComQol rather than the original domains. A hierarchy of domain satisfaction was found which was dominated by the domain of intimacy. The other ComQol domains were quite tightly clustered within a range of 1.08 standard deviations. No difference was found between normative data and data gathered from people with a chronic medical condition, but people selected on psychiatric criteria had a lower life quality, most particularly in the domain of intimacy. It is concluded that life satisfaction, and therefore subjective well-being, can be economically and validly measured through the seven ComQol domains.     

The Importance of General Self-Efficacy for the Quality of Life of Adolescents with Chronic Conditions

We investigated the influence of general self-efficacy perceived by adolescents with chronic conditions and parents on quality of life. This cross-sectional study used the general self-efficacy scale and DISABKIDS condition-generic module to survey adolescents (92/293; 31 %) with type I diabetes, juvenile rheumatoid arthritis, cystic fibrosis, kidney/urological conditions, and neuromuscular disorders; and parents (121/293; 41 %). Self perceived and parents’ perceived general self-efficacy of adolescents was compared using paired t-tests, and adolescents’ quality of life and general self-efficacy were compared among conditions using analysis of variance. Bivariate correlations between general self-efficacy and quality of life were identified, and multiple regression sought predictors of quality of life after controlling for background variables. Social quality of life was lowest among those with neuromuscular disorders. General self-efficacy was highest among adolescents with cystic fibrosis and lowest among those with urological conditions. Parents’ perceptions of general self-efficacy were higher than adolescents’ (p ≤ 0.05), although absolute differences were small. General self-efficacy perceived by parents and adolescents was related to emotional, physical, and social quality of life. Adolescents’ perceived self-efficacy predicted all quality of life domains. Parents’ perceptions of the adolescents self-efficacy predicted the adolescents’ social quality of life (β = 0.19; p ≤ 0.01). General self-efficacy of adolescents with chronic conditions as perceived by themselves and their parents is important for adolescents’ quality of life. Interventions to improve general self-efficacy should benefit quality of life among these adolescents.     

The Well-Being of 12 - to 16-Year-Old Adolescents and their Parents: Results from 1999 to 2003 Spanish Samples

This study adopts satisfaction with life as a whole and satisfaction with specific life domains as indicators to analyse the relationships between the well-being of 12 to 16-year-old adolescents and some related constructs such as self-esteem, perceived control and perceived social support. Well-being indicators from a 2003 Spanish sample using an 11-point scale (N = 1,634) are compared with an equivalent 1999 Spanish sample using a 5-point scale (N = 1,618). The different results obtained from the 2003 sample with a Principal Component Analysis (PCA) using a shorter and a longer list of life domains are also discussed. A sub-sample of the adolescents’ results from the 2003 sample are compared with their parents’ answers, using the same well-being indicators. Using a list of 8 life domains, and despite the change of scale used, overall results show no relevant changes in adolescents’ satisfaction with life domains between 1999 and 2003 in Spain and are in agreement with normative data expected from western societies [Cummins: 1998, Social Indicators Research 43, pp. 307–334; Cummins et al.: 2001, Australian Unity Well-being Index (Australian Centre on Quality of Life, Deakin University, Melbourne)]. Adolescents’ overall life satisfaction has been shown to correlate consistently with the other well-being related constructs. However, it clearly decreases with age over the period studied. The results also show that increasing the list of life domains has a major impact on the structure of the results obtained. When we compare results from parents with those from their own child, outstanding differences in well-being appear between generations: few domain satisfaction dimensions show significant correlation between parents and children and more than 20% of the population studied shows high discrepancies in the answers in four domains.     

Examining the Influence of the Wine Festival Experience on Tourists’ Quality of Life

Hosting events and festivals is the best way of providing the wine tourism experience. Wine festivals offer a wide range of experiences that are different from day-to-day living, offer a lifestyle package and are an indicator of lifestyle tourism experience. Tourists travel to wine festivals for wine and other leisure-related experiences, including opportunities for social and/or cultural experiences, interactivity and personal development. Therefore, wine festivals should provide an experience that can influence the quality of life (QoL) of the attending tourist. QoL is influenced by various life domains, which include social, leisure and recreational, intellectual, culinary, and travel life. By its nature, a wine festival is able to influence life domains, thereby decreasing or increasing the level of satisfaction with QoL, according to the level of satisfactory experience. The purpose of this article is to examine the influence of the wine festival experience on the QoL of attending tourists. The structural relationship between the wine festival experience on tourists’ QoL is shown in a structural equation model (SEM), which is based on the notion that the QoL of attending tourists will be influenced by their level of satisfaction in various life domains. A self-administrated questionnaire was distributed during the Wacky Wine Festival in Robertson South Africa. The data from 329 (N) eligible questionnaires was cleaned, captured and analysed using SPSS. Furthermore, Amos was used to test the structural model providing statistical support. From the study’s findings, managerial recommendations were made with the aim of maximising attending wine tourists’ QoL. The research contributes to the literature related to QoL.     

Quality of Life and Well-Being Ranking of Selected Districts of Khyber Pakhtunkhwa,Pakistan

Quality of life (QoL) is a multidimensional concept encompassing many aspects of an individual’s existence. It is not just a measure of material resources but of intangible environments which affect quality of life. The study concentrates on the province of Khyber Pakhtunkhwa, Pakistan, and looks at the QoL and well-being in thirteen districts representing the province’s major population. It followed an integrative approach to measuring quality of life. Principal component analysis was used to tackle with multidimensionality. Weighted factor scores were used as an index for ranking QoL and well-being on the basis of social indicators chosen in different life domains. The results show that districts having high urban disposition top the ranks in QoL in Khyber Pakhtunkhwa, like Peshawar, Mardan, Swat and Charsadda, while Bannu, Kohat and Lower Dir fall amongst the bottom districts in terms of QoL. The rural/urban ranking also follows similar patterns with a few exceptions.     

Does Weighting Capture What’s Important? Revisiting Subjective Importance Weighting with a Quality of Life Measure

The present study evaluated subjective importance weighting using data collected with the Injection Drug User Quality of Life Scale (IDUQOL). Weighted and unweighted IDUQOL scores from 241 adults were correlated with convergent, discriminant, and criterion measures. Regression analysis was used to examine the contribution of importance ratings to scores on a global measure of life satisfaction and the corrected weighted IDUQOL total scores. Overall, the results showed that weighted scores did not perform better than unweighted scores in measuring quality of life. However, the mean satisfaction ratings for important domains correlated significantly higher with convergent measures than did the mean satisfaction ratings for unimportant domains. This finding suggests further attention needs to be paid to the meaning and measurement of subjective importance and how it may be incorporated more effectively into measures of quality of life.     

Determinants of Health and the Quality of Life in the Bella Coola Valley

The aim of this investigation is to obtain some baseline self-reported data on the health status and overall quality of life of all residents of the Bella Coola Valley of British Columbia aged 17 years or older, and to measure the impact of a set of designated health determinants on their health and quality of life. In the period from August to November 2001, a variety of procedures were used to ensure that all eligible residents of the Valley received a copy of our questionnaire, and 687 useable questionnaires were obtained for our working dataset. Health status was measured by SF-36 and the U.S. Centers for Disease Control healthy days items. Thirty-one items were used to measure the Provincial Health Officer’s designated determinants of health in four clusters, namely, biological, social and economic, health behaviours and health services determinants. Quality of life was measured by satisfaction levels in 13 specific domains of life (e.g., family, financial security), four global items (e.g., happiness, life satisfaction) and one global Subjective Well-Being Index. Besides obtaining baseline figures on all our measures for the Valley, we made some comparisons among our figures and those from other areas, e.g., Prince George, BC. Most of the measures indicated that the health status and quality of life of Bella Coola Valley residents were lower than those of Prince George residents. For the sample as a whole, SF-36 scores on the eight dimensions ran from 82.3 (physical functioning) to 50.0 (social functioning), with a mean of 62.7. Residents in the Valley averaged 6.5 days in the past 30 in which their health was physically not good, 5.5 days when it was mentally not good and 4.1 days when their health limited their usual daily activities. Eleven percent of respondents described their general health as “excellent” and another 27% said it was “very good”. On a 7-point scale from 1=very dissatisfied to 7=very satisfied, respondents had average life satisfaction and satisfaction with the overall quality of life scores of 5.5. For specific domains of life, the lowest mean level of satisfaction was reported for federal and provincial government officials (3.3) and the highest was reported for living partners and personal safety around home (5.8). Regarding bivariate relations, each of the eight dimensions of SF-36 was significantly correlated with a single item measure of general health, and five of the eight were significantly correlated with the number of good health days. Happiness and the Subjective Well-Being Index were positively but moderately correlated with six of the eight dimensions, and life satisfaction was positively correlated with five. Age was negatively related to general health, but positively related to life satisfaction. Not being of aboriginal descent was positively related to all of the four global health indicators and to the Subjective Well-Being Index. Education was positively related to the four global health measures but not to the three global quality of life measures. The Social Support and Good Family Indexes were positively related to all seven global measures. There was a positive correlation between six of the seven global measures and the frequency with which respondents participated in activities sponsored by voluntary organizations. Frequency of smoking was negatively associated with every global dependent variable except the Physical Health Index. Frequency of skipping meals was negatively associated and average hours of sleep per night was positively associated with all seven global measures. Turning to multivariate relationships, the four clusters of health determinants explained from 12% (SF-36 Mental Health Index) to 24% (general health) of the variance in the dependent global health variables, and from 20% (happiness) to 26% (Subjective Well-Being Index) of the variance in the dependent global quality of life variables. Adding domain satisfaction scores to the total set of predictors allowed us to explain from 20% (SF-36 Mental health Index) to 29% (general health) of the variance in the dependent global health variables, and from 39% (happiness) to 62% (life satisfaction) in the dependent global quality of life variables. By including measures of social support and good family relationships in our set of health determinants, we practically guaranteed that the latter would be relatively strongly predictive of global quality of life.     

Assessing quality of life in Singapore: An exploratory study

This article attempts an exploratory study of the quality of life in Singapore. The first objective of this study was to gauge how Singaporeans view the quality of their lives and the extent to which demographic characteristics affect life satisfaction. Secondly, the importance of the different pre-selected domains of life was also individually investigated. Finally, the levels of satisfaction with each of these domains were also assessed. It was found that there were no significant relationships found between life satisfaction and demographic characteristics. In addition, people in Singapore attached great importance to being healthy and having a happy family life. Finally, it was also determined that they were in general very satisfied with the various domains of life, particulary with family life and life in Singapore as a whole.     

Comparing Self-Rated Health, Satisfaction and Quality of Life Scores Between Diabetics and Others Living in The Bella Coola Valley

Objective: To investigate the relative effect that diabetes has on self-rated health, satisfaction with various specific domains of life, and satisfaction with quality of life operationalized as happiness, satisfaction with life as a whole, and satisfaction with overall quality of life. Design: Mixed methods – mailed survey and chart review. Study Population: All people aged 17 years or older, residing in the Bella Coola Valley in September 2001 and having a chart at the Bella Coola Medical Clinic. Main outcome measures: Self-rated health, self-rated stress, rating of self-care received, global life satisfaction (Life as whole; Overall standard of living; Overall quality of life; and Overall happiness); and satisfaction with various domains of life. Results: A total of 968 useable surveys were returned for a response rate of 56 (968/1734). Age was negatively related to General Health, but positively related to Life Satisfaction. Not being of Aboriginal descent was positively related to all of the four global health indicators and to Subjective Well-Being. After accounting for age, race, and weight, we found that diabetics report significantly poorer self-rated health, and lower satisfaction with health scores compared to people without diabetes. Participants with diabetes who were the least compliant with their treatment regimens rated their current health significantly lower than those who were the most compliant. People with diabetes were, however, no more likely to be unhappy or dissatisfied with their lives as a whole or with the overall quality of their lives compared to people without diabetes. Among people with diabetes, however, those who used insulin did report significantly less satisfaction with the overall quality of their lives than those who didn’t use insulin. Conclusion: Diabetics understand they have poorer health than others, but they do not have poorer global life satisfaction scores. This may explain why it is difficult to get diabetics to adopt behaviours which may lower their quality of life – e.g., diet plans, lose weight, engage in exercise programs, or take medications.     

Impact of Individual and Organizational Variables on Quality of Life

The general goal of this study consists of analyzing the influence of different types of human services in the quality of life of their nested users. Several multilevel models were proposed to test for significant differences not only in the overall quality of life score, but also in each of the eight core domains. Participants included 11,624 users of social and human services and the assessment quality of life instrument was the GENCAT Scale. Variables that were studied in the different models were gender, age, and diagnostic group (elderly, intellectual disability, physical disability, mental health problems, and chemical dependency) at the individual user level (level 1: individual), while type of services—in terms of the main population addressed by their supports (i.e. the aforementioned groups)—was studied at service level (level 2: organizational). In order to explain differences, individual characteristics were introduced first, types of services were introduced next, and finally joint individual and service variables were introduced in a single model. The main results of this study were that personal and organizational variables exhibited a different level of influence on users’ quality of life; and also that the type of services significantly influenced the quality of life of its users. The results of this study lead to practical implications for services providing support to these diagnostic groups, especially for those interested in managing, assessing, and improving quality of life related personal outcomes at the user level as well as quality enhancement at the organizational level.     

The relationship between measures of subjective and economic well-being: A new look

The objective of this research is to examine the importance of variable specification in using economic variable to explain the variance in individual's perceived (1) overall psychological, (2) economic, and (3) non-economic well-being. Results indicate that careful specification of economic variables improves the explained variance of perceived subjective well-being. Specification of dependent variable, life satisfaction, based on a domain-specific scale, proves superior to using the response to the global satisfaction question, “How do you feel about life as a whole?’ Economic variables prove significant in explaining both perceived economic and non-economic domains of life satisfaction. Although its overall effect on life satisfaction is negative, increased family size is found to enhance non-economic life satisfaction, while detracting from economic aspects of life satisfaction.     

Self-Evaluation Processes in Life Satisfaction: Uncovering Measurement Non-Equivalence and Age-Related Differences

This study demonstrates how self-evaluation processes explain subgroup differences in ratings of life satisfaction (population heterogeneity). Life domains differ with regard to the constraints they impose on beliefs in internal control. We hypothesized that these differences are linked with cognitive biases in ratings of life satisfaction. In fact, two subgroups of respondents needed to be distinguished, for which life satisfaction scores were non-equivalent measures. Self-evaluation processes also helped to explain age-related differences in life satisfaction. Age was unrelated or positively related to life satisfaction in a subgroup of respondents who perceived comparatively high levels of control over high-constraining life domains such as work, income, and standard of living. However, age yielded a substantial negative relationship with life satisfaction among participants who reported reduced levels of control in these domains. Results from a German representative sample were replicated with data from an online survey.     

The quality of life in Australia

This paper outlines a long term project on the quality of life in Australia and presents some initial survey data. The long term project is intended (1) to find which domains of life most affect the perceived well-being of Australians and the values/satisfactions people wish to achieve in these domains (2) to propose policy programs designed to enhance satisfaction with particular domains and (3) to assess the political feasibility of proposed programs. Policy programs intended to enhance satisfaction are termed positive welfare programs to distinguish them from conventional compensatory welfare programs. The survey data analysed here (national sample, N=679) deal with the satisfactions and dissatisfactions of Australians, the correlates of perceived well-being and the links between domains and values. Perceived well-being is measured by Andrews and Withey's Life-as-a-whole index and Bradburn's Affect Balance scale. Satisfactions are measured on a 9 point modified version of Andrews and Withey's delighted-terrible scale. Readers familiar with American, British and Canadian findings will find the results reported here broadly similar. However, the linkage between people's sociological characteristics and their satisfaction levels appears to be exceptionally weak in Australia, which tends to confirm the view that Australia is a comparatively unstratified society.