Measuring Quality of Life (Self-assessment)

Why it is Necessary to Consider Quality of Life

The thoughts that pass through your head and the feelings that well up whenever you’re around that special person are changing the chemistry of your body. Your dinner last night, now ground and churned into protein chains and fat molecules, is affecting your motivation to read this post right now. 

What I am trying to say is that your mind and your body are related. Scientists and philosophers and doctors and psychologists have been puzzling over this relationship ever since the two—that is, your mind and body—were separated. Reneé Descartes, who was writing during the 1600s, is often credited with this separation. Descartes believed that his ability to think about chewing the end his quill pen was different than his bodily ability to chew. For Descartes, thinking was a mysterious quality of living. Before Descartes, 15 Centuries of religious mystics believed that the soul was separate from the body. They believed that the human body, with its private parts and bad eyesight, was weak and temporary, but that the soul was pure and lived eternally.

In the history of Western thinking, there has been at least 2000 years of believing that within every living, breathing, walking human skeleton there is a second, invisible but no less important, thing. It doesn’t matter if you follow Jesus Christ or neuroscientist Franscisco Varela: you believe that there is something mysterious secreted away in every living human body.

Doctors confront this conundrum regularly. They know that if a patient needs an oral sedative, then it matters what size and color the pill is. If the pill is small and orange, then it will not be as effective a sedative as if the pill were large and blue. The chemical make-up of each pill could be identical, of course, but its potency would change based on how the pill is perceived by the patient. In other words, it matters whether or not the patient believes in the pill they are swallowing. 

With this in mind, imagine now that a patient has presented in a doctor’s office with the following symptoms: they are tired; they just can’t seem to get going in the morning; they cannot focus at work, and they struggle to complete simple tasks around the house such as blowing leaves or mowing the lawn. Do you think it would be helpful to learn that this patient’s dog has recently died? Of course. Relationships, economic volatility, self-esteem, and other life drama contribute to a person’s health and well-being. 

The reverse is also true. A broken leg or bacterial infection or other common injury does not limit its effects to bodily tissue. With a sprained ankle, the walk from car to office building seems much more trouble than it ordinarily does. Items on a menu don’t look as appetizing after a chemotherapy treatment. Medical problems impact a person’s life in manifold and often unpredictable ways.

Unfortunately, medicine is not equipped to deal with the many unseen parts that factor into the human being standing before them. Medicine is much better at dividing that same human being into separate parts, and then working on each part by itself. Doctors have learned that ear aches are best treated by people who spend all of their time and training looking at ears, and not by someone who has been distracted by bones and neurons and skin. Doctors are trained how to do one thing really well. This is called specialization. Specialization is why it is not uncommon to visit the dentist for tooth pain and be referred to a neurologist. The neurologist examines the problem and makes a referral to the pain specialist. The pain specialist makes a referral to the psychiatrist, who makes a referral to the social worker who recommends a dentist. 

The inventory that follows, the Quality of Life (QOL) inventory, is a measure designed to bring all of these disparate parts of the human being back together again. QOL provides the whole picture, taking into consideration a person’s physical health, their psychological health, their relationships, and their environment. The interrelationship of these five factors is shown in Figure 2.1, below. 

Figure 2.1: Interrelation of Health Factors in Quality of Life (Brief Version)

 

Instead of inspecting any one aspect of a patient’s health such as their blood pressure or temperature, the QOL inventory asks after a patient’s entire existence. “Basically,” writes a QOL scholar Ventegodt, “quality of life it is a product of being of value to self, other people and the surrounding world” (p. 418).

By recognizing the relationship between these four areas of life (to which autonomy and spirituality could be added as fifth and sixth components), healthcare providers see the entire person, and are therefore more capable of diagnosing the underlying problem and making a prognosis that fits in with everything else in a patient’s life.

Overlapping Factors in QOL: Environment and Relationships

If you are not already in a committed romantic relationship, then imagine that you are. See if you can identify how the following environmental factors might effect the quality of your relationship with your significant other. Here are the questions that ask after the quality of a patient’s environment:

How Safe Do You Feel in Your Daily Life? 

“Safety needs” are listed second on the hierarchy of human needs developed by psychologist Abraham Maslow. Maslow observed that humans were incapable of building relationships or worrying about their own happiness if they felt like their life was at risk. Social needs and self-esteem needs must wait on the satisfaction of safety needs.

If you feel safe and secure every day, then you will be free to open yourself up to new opportunities and possibilities. You will be more present and aware, for example, when eating out at a restaurant with your special person. You will be more attentive to what they have to say, and you will be more vulnerable. If, on the other hand, you feel unsafe, then you will be closed off, suspicious, and defensive.

How Satisfied Are You with the Condition of Your Living Place?

When I was just out of college, I was embarrassed about my living conditions. This was pretty common for people who graduated in 2008, which was when the housing market collapsed and unemployment exploded. I was renting a single bedroom in a three-bedroom house. I had two roommates. All three of us had college degrees, but could only find part-time gigs. I hated being in the house when anybody else was home, so I would get up and immediately leave to go to a coffee shop or library or out for a run. Needless to say I wasn’t interested in bringing anybody home with me. 

Though I didn’t identify with my living arrangements at that time, it was hard to separate them from my identity. I wished that I had owned my own place, or least could afford to rent a decent apartment in the city. In reality, I was living in fantasy land: I could not afford a nicer place, because that wasn’t where I was at that time financially. That would come later. In other words, my dissatisfaction with my living place was evidence of my dissatisfaction with myself: I was disappointed in who I was and what I had accomplished. My dating life reflected this. I was intensely critical of everyone that I met, wondering why they weren’t better or more successful or more integrated than they were. As you can see, I made terrible company.

And so on. Those five circles, each representing a significant component of who you are, overlap. We have examined only two of these circles, and only two ways in which they are related. These same two circles overlap with all the others, too. That is a lot of interconnections. The QOL inventory is not perfect, but it is a glimpse at the global impact that these five factors have in your life—your existential health, if you will.

The QOL Inventory

The World Health Organization (WHO) publishes a 100-item inventory that assesses global QOL. That is a lot of questions, which would require a lot of computing on your end. The WHO also publishes a shortened version, which they call the QOL BREF.

The original 100-item QOL inventory was tested on thousands of individuals and across 15 culturally diverse medical centers around the world. During these tests, the 300 items were winnowed down to 100 items. Based on tests of item and construct validity, 26 of these items were selected for the BREF version, which is the version given below.

Completing the QOL Inventory

For each question, select the number that most closely corresponds to your answer. For example, with the question “How satisfied are you with the condition of your living place?” you are given the following options: 1) Very dissatisfied; 2) Dissatisfied; 3) Neither satisfied nor dissatisfied; 4) Satisfied; 5) Very satisfied. Choose the best answer and record your score.

Scoring the QOL Inventory

Once you have answered all of the questions, the next step is to calculate your score. There are six scores you can calculate. The first is your global QOL score. Unfortunately the calculation of your global QOL score is not as easy as adding up all of the numbers you selected. There are two adjustments you will need to make.

Adjustment one: Converting Negatively Scored Items 

A handful of questions in the QOL-BREF are negatively scored. This means that a score of 1 actually means a score of 5; a 2 actually means a 4; and so on. In the inventory, the following items must be scored negatively: 3, 4, and 15. 

The reason negatively scored items are included is to increase the reliability of the test. Some people, when completing surveys, tend to be more agreeable. For whatever reason, they are more like to say “I am satisfied” than they are to say “I am not dissatisfied.” The negatively scored test items account for this positivity bias. The same goes for any negativity bias.

Adjustment Two: Adjust for the Range of Possible Scores

 Because there are 26 questions in the QOL-BREF, and the highest score for each question is 5, this means that the highest QOL-BREF score is 26 x 5 = 130. You might reasonably assume that a score of 65, which is half of 130, is right in the middle. But this would fail to take into consideration that the lowest possible score is 26. In order to calculate the absolute median possible score, you would have to find the middle of the range of possible scores. For the overall score, you would do this by subtracting 26 from 130, which would give you 104. Half of 104 is 52. When you add the lowest possible score to 52, you get 78. The median possible QOL-BREF score is 78.

The same range adjustment will have to be made for each subsection of the QOL inventory, too. The ranges are listed in Table 2.1.

 

Table 2.1: Domain Ranges for QOL-BREF

 

Domains	Raw Domain Score	Domain Range
General QOL	2-10	8
Physical	7-35	28
Psychological	6-30	24
Social Relationships	3-15	12
Environment	8-40	32

 

Questions in the QOL-BREF, which is at the end of this chapter, have been organized by domain. This will help when it comes to scoring.

You may not care to see what each domain score is, but the domain break-down will help you identify which areas contribute to your quality of life, and which areas hurt it. You might find, for example, that you have excellent physical and psychological health, but that your relationships are what really keep you from thriving.

 

QOL-BREF Inventory 

(Adapted from WHO, 1996)

 

1.     How would you rate the quality of your life?

1                2                      3                      4                      5

Very poor                                                              very good

 

 

2.     How satisfied are you with your health?

1                2                      3                      4                      5

Very dissatisfied                                       very satisfied

 

 

 

3.     To what extent do you feel that physical pain prevents you from doing what you need to do?

1                2                      3                      4                      5

Not at all                                                     An extreme amount

 

4.     How much do you need any medical treatment to function in your daily life?

1                2                      3                      4                      5

Not at all                                                       An extreme amount

 

5.     Do you have enough energy for everyday life?

1                2                      3                      4                      5

Not at all                                                                   Completely

 

6.     How well are you able to get around?

1                2                      3                      4                      5

Very Poor                                                                   Very Well

 

 

7.     How satisfied are you with your sleep?

1                2                      3                      4                      5

Very dissatisfied                                                   Very satisfied

 

 

8.     How satisfied are you with your ability to perform you daily living activities?

1                2                      3                      4                      5

Very dissatisfied                                                    Very satisfied                                           

 

 

9.     How satisfied are you with your capacity for work?

1                2                      3                      4                      5

Very dissatisfied                                                    Very satisfied

 

 

10.  How much do you enjoy life?

1                2                      3                      4                      5

Not at all                                                            An extreme 

         amount

 

 

11.  To what extent do you feel your life to be meaningful?

1                2                      3                      4                      5

Not at all                                                                   An extreme

          amount

 

 

12.  How well are you able to concentrate?

1                2                      3                      4                      5

Not at all                                                                   An extreme 

          amount

 

 

13.  Are you able to accept your bodily appearance?

1                  2                      3                      4                      5

Not at all                                                                   Completely

 

 

14.  How satisfied are you with yourself?

1                2                      3                      4                      5

Very dissatisfied                                                   Very satisfied

 

 

15.  How often do you have negative feelings such as blue mood, despair, anxiety, depression?

1                2                      3                      4                      5

Never                                                                              Always

 

 

16.  How satisfied are you with your personal relationships?

1                2                      3                      4                      5

Very dissatisfied                                                    Very satisfied

 

 

17.  How satisfied are you with your sex life?

1                2                      3                      4                      5

Very dissatisfied                                                   Very satisfied

 

 

18.  How satisfied are you with the support you get from your friends?

1                2                      3                      4                      5

Very dissatisfied                                                    Very satisfied

 

 

19.  How safe do you feel in your daily life?

1                2                      3                      4                      5

Not at all                                                                     Extremely

 

 

20.  How healthy is your physical environment?

1                2                      3                      4                      5

Not at all                                                                     Extremely

 

 

21.  Have you enough money to meet your needs?

1                2                      3                      4                      5

Not at all                                                                   Completely

 

 

22.  How available to you is the information that you need in your day-to-day life?

1                2                      3                      4                      5

Not at all                                                                   Completely

 

 

23.  To what extent do you have the opportunity for leisure activities?

1                2                      3                      4                      5

Not at all                                                                   Completely

 

 

24.  How satisfied are you with the condition of your living place?

1                2                      3                      4                      5

Very dissatisfied                                                   Very satisfied

 

 

25.  How satisfied are you with your access to health services?

1                2                      3                      4                      5

Very dissatisfied                                                   Very satisfied

 

 

26.  How satisfied are you with your transportation?

1                2                      3                      4                      5

Very dissatisfied                                                   Very satisfied