The Evaluation of a Self-enumerated Scale of Quality of Life (CASP-19) in the Context of Research on Ageing: A Combination of Exploratory and Confirmatory Approaches

This paper describes the conceptual development of a self-enumerated scale of quality of life (CASP-19) and presents an empirical evaluation of its structure using a combination of exploratory and confirmatory factor analytic approaches across three different survey settings for older people living in England and Wales in the new millennium. All evaluations are conducted using MPlus which allows the analyst to evaluate the properties of the scale for a set of multivariate categorical items which are subject to item non-response. CASP-19 is a subjective measure of well-being derived from an explicit theory of human need spanning four life domains: control, autonomy, self-realisation and pleasure. Put formally, CASP-19 is a self-reported summative index consisting of 19 Likert scale items. The three survey settings include a postal survey of 263 people in early old age followed up from childhood when the respondents were first interviewed in the 1930's, the first wave (2002) of the English Longitudinal Study of Ageing (ELSA_1) and the eleventh wave of the British Household Panel Survey (BHPS_11) also conducted in 2002. These nationally representative surveys consisted of 9300 and 6471 respondents aged 55 years and older. The Boyd-Orr sample provides an exploratory context for the evaluation and ELSA_1 together with BHPS_11 provide the opportunity for confirmatory analyses of three measurement models. There is some support for the use of CASP-19 as a stand alone summative index. However, the analysis reveals that a shortened 12-item scale which combines the life domains 'control and autonomy' in a second order measurement model is the recommended model for analysts. The work was funded under the UK's Economic and Social Research Council's Growing Older Programme and their Priority Network on Human Capability and Resilience. Grant Nos. L480254016 & L326253061.

Measuring and understanding the well-being of South Africans: Everyday quality of life in South Africa

South Africa has a Gini co-efficient of 62, one of the world’s highest (Finmark: Project FinScope 2004 and 2005, FinMark Trust, Johannesburg). Hence, measures of wealth are ubiquitous social indicators in South Africa. However, a growing emphasis in government towards measurable service delivery targets and remedial action to redress the inequalities of our past makes the reliable measurement of people’s quality of life in greater depth in quantitative terms an imperative.We have developed a simple framework to measure people’s quality of life in key domains that extend beyond that simply of wealth, using composite indices to allow progress to be tracked and to make valid comparisons across our diverse population. Termed the Everyday Quality of Life Index (EQLi), it comprises a suite of measures encompassing socio-economic status (with special reference to poverty), urbanisation, health (nutrition, exercise and fitness), stress/pressure, quality of the environment, satisfaction of human needs, connectivity, optimism, subjective well-being (happiness, after Diener and Lucas: 2000, in M. Lewis, J.M. Haviland (eds.), Handbook of Emotions. (2nd ed) (Guilford, New York)), and the overall measure of well-being, the EQLi itself.The initial framework was developed from a structured questionnaire administered to a probability sample of 2000 South African adults in 2002. From this, a 52-item shortlist was derived to create the series of measures. This has been tested and refined in three subsequent annual studies, each of 3500 people across urban and rural South Africa. In 2004, items involving work as well as determining the balance of skills and challenges at work using the concept of “flow” (Csikszentmihalyi: 1990, Flow: The Psychology of Optimal Experience (Harper and Row, New York)) were added.This paper outlines the rationale behind the selection and development of these measures, describes the EQL of South Africans using these and other key measures and concludes with implications for policy-makers and service providers in South Africa. Some marketing implications are also given: there is a growing emphasis worldwide on corporate social investment initiatives and, particularly in South Africa, on community upliftment and development – poverty alleviation and improving the lives of the disadvantaged (“people” rather than “consumers”). Further, people’s well-being affects how they react to marketing activities.     

城市居家老人生活质量研究——以上海为例

本文针对城市居家老人的需要和特点,从评估城市居家老人生活质量的六个维度即经济状况与消费水平、居住条件与家庭设施、躯体健康与心理健康、社会支持、闲暇生活质量、生活满意度方面入手,深入开发了上海市老年人口状况与意愿跟踪调查数据资料,使用分等级加权评分法综合评估了城市居家老人生活质量以及分性别和年龄的老人生活质量。     

Retrospective and prospective evaluations of environmental quality under urban renewal as determinants of residents’ subjective quality of life

Claims about the impacts of environmental quality associated with urban renewal on the resident’s subjective quality of life are more speculative than empirically grounded. To clarify the impacts of environmental quality under urban renewal, this study surveyed 876 residents living in housing surrounding seven urban renewal sites in Hong Kong. It shows that environmental quality, both perceived (retrospectively) during and expected (prospectively) after urban renewal, exhibited positive effects on the resident’s subjective quality of life. Furthermore, it reveals that the subjective quality of life of the resident with higher education was less responsive to environmental quality perceived during urban renewal. The findings imply that more measures to mitigate the adverse social impact of urban renewal are preferably available to residents with less education.     

Changes in quality of life perceptions in Saskatoon,Saskatchewan: comparing survey results from 2001 and 2004

There is a growing interest in quality of life (QoL) as an integrated approach to addressing key social, environmental and economic determinants of health. The University of Saskatchewan’s Community-University Institute for Social Research (CUISR) has examined the process and results of a multi-stakeholder approach to the ongoing sustainability of Saskatoon, Saskatchewan as a healthy city with an improving and a more equitably distributed QoL. Using quantitative and qualitative analysis, this research has examined QoL across three locales in Saskatoon—representing Low, Middle and High socio-economic status neighbourhoods. Two large telephone surveys were conducted with residents of the city in 2001 and 2004. This paper presents the major findings from these two surveys according to four overarching research questions posed by the CUISR QoL team. The questions relate to a number of QoL issues including the socio-demographic characteristics of respondents, place related measures, aspects influencing excellent or very good QoL in Saskatoon and feelings of a strong sense of place. The paper also assesses the changes in the results of the four questions between 2001 and 2004.

Religiosity and quality of life in South Africa

Using nationally representative survey data, this paper explores the relationship between religiosity and quality of life. Three indicators of religiosity are used: (i) frequency of attendance at religious services or meetings, (ii) orthodoxy of beliefs in relation to Biblical teachings and (iii) religious denomination. Quality of life (QoL) is measured in terms of (i) household access to modern conveniences, (ii) self-assessed life satisfaction and (iii) level of satisfaction with government institutions. The data shows a significant but not very strong statistical relationship between religiosity and QoL. People who attend religious meetings most frequently and who hold the most orthodox religious views are thus more likely to have access to modern conveniences and to be satisfied with their lives. Satisfaction with government, however, tends to be highest amongst nominally religious people and lowest amongst both the most orthodox and the least religious.     

A Note on the Dimensionality of Quality of Life Scales: An Illustration with the Satisfaction with Life Scale (SWLS)

A case is made that measures used in quality of life and happiness research will be essentially unidimensional: inherently tapping minor dimensions. This is illustrated using Diener’s Satisfaction with Life Scale (SWLS). It is shown that the SWLS does not meet the standard of strict unidimensionality, but that the interpretation of the total scale score is not compromised because the additional dimensions are relatively minor. In the context of the example, a multi-step strategy is described that allows researchers to test for essential unidimensionality. Throughout the article, essential unidimensionality is contrasted with the received view of strict unidimensionality and confirmatory factor analysis methods.

Measurement of the quality of family planning services

The quality of health services is a subject of increasing interest to health care providers and organizations responsible for financing and promoting health services. The importance of the client's perspective (and by inference, the perspective of potential clients, as well) is now well established, but efforts to define and measure quality have thus far been limited to the perspective of experts even when the experts claim to speak for the clients. In this paper we utilize family planning programs to explore issues of the quality of health services. We propose that a better understanding of the view of quality actually held by family planning program clients will clarify the influence of quality on the use of services, a clarity that has not been possible by looking at quality only as defined by providers, managers or experts. We review the literature on quality of services and identify the gaps in research that must be filled if a better understanding of what quality is and how it relates to service outcomes is to be obtained. A first step must be the research required to develop a set of measures of quality that reflects the multi-dimensional nature of quality, includes the clients' view of services in the definition of quality, and incorporates methodologies required to ascertain the true view of clients. Finally, we suggest that dimensions of quality identified as important for clients as a group will be more predictive of use of services than dimensions identified as important to providers.     

Safe drinking water and satisfaction with environmental quality of life in some oil and gas industry impacted cities of Nigeria

The availability and safety of drinking water and the environmental quality of life was investigated in five cities located in an oil-producing area of Nigeria using questionnaire-based scales, discussion and laboratory tests. Polythene-packaged sachet water and commercial and non-commercial private boreholes largely met the drinking water requirement of the cities. Consumption of sachet water was high (14.0–20.0 points vs. 25.0 points) but regression analysis indicated strong negative relationships with income group (β = −0.75, P < 0.005) and educational level (β = −0.77, P < 0.005) of respondents (658). Private borehole water was prevalent (18.7–19.9 vs. 20.0) while public water supplies were almost non-existent (4.8–5.6 vs. 20.0) in the cities. Vulnerability to contamination in all water sources was indicated following unacceptable counts of total and faecal coliform bacteria in 10–62.5 and 3–25% of samples, respectfully. Respondents were not satisfied with environmental quality of life indicated by the quality of housing, school, health services, refuse disposal, recreation, streetlight, transport and police (3.43–4.01 vs. 10). It is concluded that modernization and industrialization due to the oil and gas industries, tended to increase individualization to the negligence of common services as evidenced by the preponderance of private boreholes and sachet water.     

Changes in the quality of life of Durban’s people

Durban, the busiest port and second largest industrial hub in South Africa, has a developmental vision that sees its residents living in ‚acceptably serviced housing’ and enjoying a ‚generally high quality of life that can be sustained’. This vision is in response to South Africa’s transitional aspirations to move from an inequitable apartheid state to a democratic society with greater socio-economic parity. Since 1998 the eThekwini Municipality, which is the local authority responsible for the city of Durban, has conducted annual surveys to monitor the changes in the quality of life of Durban’s people. Structured questionnaire interviews were administered in 14 300 dwellings between 1998 and 2005. The samples drawn each year were representative of the city’s demographics and covered a wide range of housing types. Results indicate that parity of life satisfaction between race groups is as far apart in 2005 as it was in 1998. The paper undertakes trend analysis, from a local government perspective, of key objective and subjective variables in the surveys. It identifies the domains that have the greatest impact on satisfaction with life, and reports the salient issues for black householders, who have the lowest level of life satisfaction.The Research Locale:  Durban, which is a port city on the east coast of South Africa, has a population of over 3 million people. The population is comprised of the following groups: Asian (20%), black (68%), coloured (3%) and white (9%). It is Africa’s busiest port and is South Africa’s second largest industrial hub. It provides key trade linkages to Johannesburg, which is South Africa’s largest industrial hub. The major economic sectors are manufacturing, tourism, finance and transport. The complex topography is intersected by 19 rivers that flow to 98 kms of coastline.     

Examining the appropriateness of importance weighting on satisfaction score from range-of-affect hypothesis: hierarchical linear modeling for within-subject data

This study examines the range-of-affect hypothesis in a within-subject context using the weighting situation faced in quality of life (QOL) measurement. Data collected in Wu and Yao’s (2006b) study were used (332 undergraduates at National Taiwan University). The mean age was 19.80 years (std = 1.98). They completed a QOL questionnaire and indicated satisfaction, importance, and perceived have–want discrepancy on 12 life domains. Hierarchical linear modeling with a random-coefficients regression model was applied. At the first level (within-individual level), the satisfaction scores for each item were regressed on the have-want discrepancy, importance, and the interaction between have-want discrepancy and importance (have-want discrepancy ×  importance) of the same item. At the second level (between-individual level), the intercept, coefficients of have-want discrepancy, importance and the interaction between have-want discrepancy and importance at the first level were regarded as varying randomly over all participants. Results of this study supported the range-of-affect hypothesis, showing that the relationship between item have-want discrepancy and item satisfaction is stronger for high importance items than low importance items for a given individual. Implications for important weighting on item satisfaction scores were discussed.     

Leisure and quality of life in an international and multicultural context: what are major pathways linking leisure to quality of life?

This paper aims at advancing the conceptualization of leisure as a contributor to quality of life (QOL) in an international and multicultural context, based on an extensive and critical review of literature on leisure and QOL from a global, international perspective. Given the central role of culture in conceptualizing this notion, this paper gives attention to various cultural contexts world-wide. To illustrate the diversity of our societies, examples are introduced specifically from three culturally unique contexts in this paper – i.e., Asian, Middle-East, and Indigenous contexts. Also, some examples are drawn from other cultural groups in global and international contexts, particularly, in non-western contexts. Then, the final section of this paper aims at integrating and synthesizing the knowledge gained from this review to develop a tentative/working proposition about how leisure can contribute to QOL from international and cross-cultural perspectives. Specifically, based on such integration, this paper identifies and describes major pathways linking leisure to QOL. Overall, an overarching theme common to almost all cultural contexts examined appears to be the role of leisure-like activities as a context or space for creating meanings which then help to promote the quality of people’s lives. Major pathways or mechanisms that can facilitate meaning-making and life-quality-enhancement highlighted in this review include: (a) positive emotions and well-being experienced from leisure, (b) positive identities and self-esteem gained from leisure, (c) social and cultural connections and a harmony developed through leisure, and (d) leisure’s contribution to learning and human development across the life-span. Also, emphasized in this paper is the role of leisure as a context for realizing and utilizing human strengths and resilience. It is important, however, to stress that in people’s quest for a meaningful life, the benefits of meaning-making through leisure involve both “remedying the bad” and “enhancing the good,” as shown throughout this paper. Despite these benefits, we should not ignore that leisure experiences are socially and culturally constructed and shaped by the inequalities of society. Thus, the reality of power imbalance and inequalities should be acknowledged and appropriately addressed socially, culturally, and politically. Particularly, providing culturally relevant and meaningful leisure opportunities for less privileged population groups world-wide is clearly a top priority.     

Health related quality of life of women at the sixth week and sixth month postpartum by mode of birth

Background

Health-related quality of life of women in the postpartum period may depend on the mode of birth. However, previous findings are contradictory.

Quality of life research: New challenges and new opportunities

In recent years there has been growing interest in applied quality of life research and involving the community in the research process with the ultimate goal of improving the social and economic circumstances of people. Increasingly, community-university partnerships are seen as an effective vehicle to achieve this. The Community-University Institute for Social Research (CUISR) based in Saskatoon, Saskatchewan, Canada is a successful example of such as partnership. CUISR’s quality of life module has conducted extensive research in Saskatoon and has been active in engaging the community in developing strategies and setting priorities for action. This paper serves as a brief introduction to the Special Edition of Social Indicators Research. It provides the context for the collection of articles contained in the publication and outlines its organization.     

Effect of audit and feedback on the availability, utilisation and quality of emergency obstetric care in three districts in Malawi

BACKGROUND: Facility-based maternal death reviews and criterion-based clinical audit, were introduced in three districts in Malawi in 2006. RESEARCH QUESTION: Can audit and feedback improve the availability, utilisation and quality of emergency obstetric care (EmOC)? PARTICIPANTS AND METHODS: Observational study in which emergency obstetric care offered to women who gave birth in 73 health facilities (13 hospitals and 60 health centres) in three districts in Malawi in 2005 (baseline, 41,637 women) was compared to 2006 (43,729 women) and 2007 (51,085 women). RESULTS: The number of comprehensive and basic EmOC facilities did not change over the 3-year period (p for trend=1.000). Although institutional delivery rate decreased in 2006, overall it increased over 3 years (p for trend<0.001) - 31.8% (2005), 31.1% (2006) and 34.7% (2007), and Caesarean section rate was low and did not change (p for trend=0.257) - 1.7% (2005), 1.6% (2006) and 1.5% (2007). There was a significant increase in the met need for EmOC (p for trend<0.001) - 15.2% for 2005, 17.0% for 2006 and 18.8% for 2007. Maternal mortality decreased significantly from 250 per 100,000 women in 2005 to 222 in 2006 and 182 in 2007 (p for trend<0.001). Similarly, the case fatality rate decreased monotonically (p for trend<0.001) - 3.7% (2005), 3.0% (2006) and 1.5% (2007). DISCUSSION: Audit and feedback can improve availability, utilisation and quality of emergency obstetric care in countries with limited resources. CONCLUSION: There is need to increase availability of emergency obstetric care by upgrading some health centres to EmOC level through training of staff and provision of equipment and supplies.     

Health and quality of life of older people,a replication after six years

Replicating a survey of 875 people 55 years old or more undertaken in September 1999 throughout the former Northern Interior Health Region (NIHR) of British Columbia, in September 2005 a sample of 656 people completed a 22-page questionnaire. The average age of the respondents was 68, with a range running from 55 to 96 years, and 64% were women. Responses to the SF-36 questionnaire indicated that for male respondents aged 55–64, the mean score for the 8 dimensions was 76.1. This mean was a bit higher than the 74.4 mean of 1999. For male respondents aged 65 and older the mean was 69.0, which was also higher than the 68.3 mean of 1999. For females aged 55–64, the mean score for 8 dimensions was 73.1, versus 73.0 in 1999. For female respondents aged 65 and older, the mean score was 67.0, versus 65.4 in 1999. Based on these mean scores for the 8 dimensions, then, it is fair to say that the overall health status of males and females aged 55 years and older in the region in 2005 was at least as good as (i.e., the same as or better than) that in 1999. Comparing 28 average figures for the 2005 respondents on satisfaction with specific domains of life (e.g., financial security, health, sense of meaning) and three global indicators (satisfaction with life as a whole and with the overall quality of life, and happiness) with those of the 1999 respondents, we found that the scores for the 2005 sample were at least as high as those of the other sample. Thus, it seems fair to say that the perceived quality of life of older people in the former NIHR so far as it is revealed in domain and global satisfaction and happiness scores, is at least as good as the perceived quality of life of a similar sample in 1999. Although a large majority perceived increases in crime in the 2 year periods prior to both surveys, smaller percentages of the 2005 sample than of the 1999 sample thought that crime had increased over the past two years, avoided going out at night, feared for their safety, had crime-related worries, engaged in crime-related defensive behaviours and were actually the victims of any crimes. Therefore, it seems fair to say that, so far as crime-related issues are concerned for the two samples of seniors responding to our surveys, there is more evidence of improvement than of deterioration. Applying stepwise multiple regression, each of the eight dependent variables was explained on the basis of four clusters of predictors separately and then a final regression was run using only the statistically significant predictors from the four clusters. Broadly speaking, 7 SF-36 health status scales explained from 28% to 45% of the variance in the 8 dependent variables, running from satisfaction with the overall quality of life (28%) to the single item measure of general health (45%). The seven predictors in the Social Relations cluster explained from 7% of the variance in the SF-36 General Health scale scores to 57% of the variance in the Life Satisfaction scores. The four predictors in the Problems cluster explained from 10% of the variance in the SF-36 General Health scale scores to 24% of the variance in the SWLS scores. The 11 predictors in the Domain Satisfaction cluster explained from 14% of the variance in the SF-36 General Health scale scores to 64% of the variance in the SWB scores. Putting all the significant predictors together for each dependent variable, in the weakest case, 4 of 11 potential predictors explained 33% of the variance in the SF-36 General Health scale scores and in the strongest case, 9 of 15 potential predictors explained 70% of the variance in Life Satisfaction scores. Among other things, these results clearly show that respondents’ ideas about a generally healthy life are different from, but not independent of, their ideas about a happy, satisfying or contented life, or about the perceived quality of their lives or their subjective wellbeing. Finally, the 7 core discrepancy predictors of MDT plus incomes were used to explain the eight dependent variables. From 13% of the variance in the SF-36 General Health scale scores to 57% of the variance in SWLS scores was explained using those predictors. Based on an examination of the Total Effects scores for the predictors of the 8 dependent variables, the most influential predictors were Self-Wants, followed by Self-Others and then Self-Best. In other words, the most influential discrepancy predictors of respondents’ overall life assessments were those between what respondents have versus what they want, followed by what they have versus what others of the same age and sex have, and then by what they have versus the best they ever had in the past. We would like to thank the Social Sciences and Humanities Research Council of Canada for support of this research with funds granted to Alex C. Michalos through the Gold Medal Award in 2004.     

我国人民生活质量的实证分析

虽然生活质量在过去的十年里,在大多数国家里已经得到了很大的提高,但确并没有引起我们的足够重视。生活质量在健康和医疗行为上都是一个基本的指示器,所以对生活质量的研究显得非常重要,特别是计算出有关我国各省自治区人民的生活质量综合得分,再通过它去评估我国人民的生活质量和解决与生活质量有关的问题。在这篇文章中我们运用了因子分析的方法进行研究,从而建立分析模型。     

Quality of Life in the Economic and Urban Economic Literature

Quality of life (QoL) is increasingly becoming a concept researched empirically and theoretically in the field of economics. In urban economics in particular, this increasing interest stems mainly from the fact that QoL affects urban competitiveness and urban growth: research shows that when households and businesses decide where to locate, QoL considerations can play a very important role. The purpose of the present paper is to examine the way economic literature and urban economic literature in particular, have adopted QoL considerations in the economic thinking. Moreover, it presents the ways various studies have attempted to capture the multidimensional nature of the concept, and quantify it for the purposes of empirical research. Conclusions are drawn on the state of affairs regarding the study of QoL in economics, as well as the problems of measurement arising mainly from the complex nature of the concept.      

Gender differences in health promotion behaviors and quality of life among community-dwelling elderly

The differences of basic attributes, health promotion behaviors, and quality of life between elderly males and females in Taiwan were compared. Several scales were used to examine the gender differences and the factors associated with quality of life. Regression analysis revealed that gender, education level, depression level, and healthy diet were key factors influencing the overall quality of life. The education level of females was lower, and their depression level was higher; however, females had healthier diets. With regards to their satisfaction in the quality of life, elderly males scored higher than females in both the physical and psychological domains.     

Individual quality of life: can it be accounted for by psychological or subjective well-being?

There is ongoing discussion in the scientific literature about the need for a more theoretical foundation to underpin quality of life (QoL) measurement. This paper applied Keyes et al.’s [J. Pers. Soc. Psychol. 82 (2002) 1007] model of well-being as a framework to assess whether respondents (n = 136 students) focus on elements of subjective well-being (SWB), such as satisfaction and happiness, or on elements of psychological well-being (PWB), such as meaning and personal growth, when making individual QoL (IQoL) judgments using the Schedue of the Evaluation of Individual Quality of Life (SEIQoL). The Keyes et al.’s model was confirmed and explained 41% of the variance in SEIQoL scores. Both SWB and PWB were correlated with the SEIQoL Index Score and SWB was found to be an important mediating variable in the relationship between PWB and SEIQoL. When analyzing different well-being combinations, respondents with high SWB/high PWB had significantly higher SEIQoL scores than did those with low SWB/low PWB. Respondents with high PWB/high SWB had higher SEIQoL scores than did those with high PWB/low SWB. Longitudinal studies in different patient groups are needed to explore the dynamic relationship between IQoL and well-being. Further investigation of the relationship between PWB and SWB with other instruments purporting to measure QoL would contribute to an enhanced understanding of the underlying nature of QoL.