MANUAL
FOR THE
LIFE SITUATION SURVEY
Robert A. Chubon
R EH A B ILITA TIO N
P ROGRGRAM
COUNSELING
Department of Neuropsychiatry and Behavioral Science
School of Medicine
(1999 Revision)
Contents
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Instructions for Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Scoring and Interpreting the LSS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Development of the Life Situation Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Defining Q uality of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Quality of Life and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Disability and Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Instrument Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Reliability and Validity Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Revisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Additional Validity Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Appendix A
Group Norms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Demographics of Norm Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Appendix B
Scoring Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Copyright © 1990, 1995, 1999 by Robert A. Chubon, Ph.D., University of South Carolina, School of
Medicine, Department of Neuropsychiatry and Behavioral Science, Rehabilitation Counseling Program,
3555 Harden Street Ext., Columbia, SC 29203. All rights reserved. No portion of this manual may be
reproduced without written approval from the author/publisher.
i
Overview
tance to individuals who have reading, writing, and
comprehension problems. It has been administered
orally to persons who are mentally retarded and who
are blind, and reliability coefficients comparable to
self-administration have been obtained.
Description
The Life Situation Survey (LSS) is a 20-item
Likert-type rating scale designed to measure perceived life quality. The items were derived from
several quality of life indicator areas considered
applicable to the general population and other areas
determined to be especially relevant to persons with
chronic illnesses and permanent disabilities. Thus,
it is suitable for use with a broad spectrum of populations.
Most non-disabled persons can complete the
questionnaire in a few minutes, but since the Life
Situation Survey is not a "power test," protracted
administration sessions have not shown any effect on
reliability.
Uses
Scoring
The instrument initially was developed to
provide a measure for conducting quality of life
studies concerned with the comparative status of
disability and other disadva ntaged groups. However,
it can also serve as a tool to assist in assessing the
impact of social policies and programs, and intervention progra m effectiveness. The Life Situation
Survey has potential clinical uses, either as an individual progress measure or as a screening device for
identifying problem areas that might warrant attention.
The rating scale follows a Likert-type format, with item scores ranging from 1 to 7. The total
score is the sum of the individual item ratings, without need for weighting or other alteration.
Interpretation
Higher scores reflect higher life quality.
Norms are provided for several disabled and disadvantaged populations, as well a healthy college student group for comparison. Conceptually, the item
scores can be used to develop profiles or clusters that
may reflect more detailed group differences and associated areas of impact.
Administration
Ease of administration was a priority in developing the Life Situation Survey. Concern
stemmed from recognition that many potential target
populations have reading, writing, comprehension,
and other difficulties that interfere with even the
most basic pencil-paper operations. Additionally,
the number of items was limited to minimize the
possibility of overtaxing persons who are easily fatigued or who have limited attention spans. In essence, the LSS was designed for use with persons
varying extensively in aptitudes and abilities, and a
number of administration approaches can yield reliable and valid scores.
Because the reading level of the items is in
the elementary school range and the time required
for completion is nominal, the instrument can usually
be administered as a self-report questionnaire. However, the instructions allow for the provision of assis1
Instructions for Administration
to alleviate the likelihood of confusion and enhance
the validity of responses.
Although administration procedures can be
tailored to the specific needs of users, careful planning is essential to obtain the most reliable and
meaningful results. Effort should be taken to establish a relationship that will the motivate the
respondents to be conscientious when completing
the rating scale. After rapport is established, under
optimal circumstances, the Life Situation Survey can
be administered as an untimed, self-report instrument. Most unimpaired respondents are able to
complete the instrument in 15 to 20 minutes. The
basic instructions are contained on the rating scale.
A similar problem may exist with item 17
which refers to the individual's main life role now.
In addition to being ambiguous for persons in transition, others who fill or have filled multiple roles
may be uncertain as to what to use as their referent.
Again, a specific definition may be indicated by the
purpose of the study. If the study is focused on patient, student or some other particular status, that
can be spelled out at the onset to gain assurance that
the appropriate reference has been used, and to
diminish the need for respondents to deliberate over
the meaning or ask questions.
Although the administration procedure can
be adapted to accommodate the specific aptitudes
and abilities of the persons being surveyed, there are
some common questions that arise during
administration. Some forethought and development
of standardized supplemental instructions to deal
with these issues are essential to obtaining the most
reliable and valid data.
It has been reported that a few respondents
have raised questions about the m eaning of services
provided by the government as contained in item 15.
This item is intended to be widely encompassing,
including, but not limited to services such as police,
mail delivery, health care, welfare, street maintenance, and public utilities. When questions regarding the meaning of this item arise, the broad nature
of the referent should be stressed.
First, the instructions contained on the LSS
indicate that responses should be made on the basis
of reference to one's present life situation. Although
this is a clear referent for persons in many ordinary
life situations, those who are undergoing a change
in their situation or recently made a significant life
transition are sometimes confused regarding the
reference period. In other instances, individuals
may not have identified with their new situation, and
respond erroneously using a past period as their
referent. For example, individuals who have been
recently admitted to an institution may interpret the
instructions as referring to their pre-institutionalized
status.
If there is uncertainty as to how the target
population might interpret these aspects of the instructions, it may be useful to conduct a pilot study
in which administration is followed by a debriefing
interview. Respondents can be questioned directly
regarding the referent they used and whether the
items were ambiguous.
When it is apparent that there are a significant number of persons in the target population
whose situation may be unclear, it is essential that
a consistent explanation be given at administration.
If, for example, the purpose of administering the
Life Situation Survey is to determine how individuals are faring within the context of an institutional
environment, that should be made clear by providing
them with a specific definition of present life situation reflecting that referent. Such explanations help
2
Scoring and Interpreting the LSS
Thus, the temporal proximity of comparison scores
must be carefully considered when interpreting comparison group differences.
Scoring
A scoring key is contained in appendix B.
The item scores range from 1 to 7. The midpoint
rating of 4 has been omitted to provide a means for
dealing with missing data. Items for which no response has been made can be assigned this value (4)
in accordance with a procedure described by
Kerlinger (1973). Other approaches to dealing with
missing data can be used; however, all results reported in this manual were obtained using the using
the above procedure. The total score is calculated
by adding the rating values of the 20 items on the
LSS. The possible range of scores is from 20 to
140, with the lower end of the scoring continuum
representing poorer life quality. No weightings or
other adjustments are required.
When statistically supported differences
based on total scores are found and the time-difference factor can be discounted as a probable cause,
it may be reasonable to conclude that a group difference has been detected. However, if comparison
groups produce similar total scores, it cannot be
assumed conclusively that the life quality of the
groups does not differ. The response patterns or
item score profiles of the groups must be determined
to be comparable before it can be concluded that
they are truly similar. It is reasonable to expect that
different factors vary in impact on groups that result
in different item score patterns, although the overall
impact may be of similar intensity. Such differences
are not revealed by total scores alone.
Interpreting the Results
Generally, scores of 100 or more reflect perception of a very good life quality. Scores in the
80's and lower are associated with a relatively poor
quality of life. These interpretations are reflected by
the norm group scores reported in the appendices.
Before interpreta tion of scores is undertaken,
it is recommended that the reliability be established
by calculating Cronbach's alpha or other appropriate
reliability coefficient. This is especially critical
when the target population is of questionable competency. Some individuals, for example, frail elderly, mentally retarded, and sedated persons, may
have judgmental or other cognitive limitations that
diminish reliability.
Results obtained with translated versions of
the LSS must be treated ca utiously. Reliability
could adversely be affected if the language level of
the translation exceeds that of the English version
or if the meaning of the items is altered. It is
essential that the reliability coefficient be determined for altered forms. Additionally, comparing
scores obtained in different countries presents problems. For example, socio-economic factors could
account for score differences rather than disability
or chronic illness.
Appendix A contains scores and other data
obtained from a num ber of different populations that
can serve as a basis for com parative studies. However, interpreting the findings from comparative
studies should be cautiously approached. Longitudinal studies using the LSS indicate that there are
notable undulations in the outlook of the population
as a whole that are attributable to major social influences such as economic downturns. Consequently,
comparison scores may differ because of the time
frames when they were obtained rather than group
characteristics or other variables under study. For
example, samples of university graduate students
consistently scored in the 105 to 107 range in the
mid-1980s. In the mid-1990s, comparable groups
have typically scored in the 101 to 103 range.
3
Development of the Life Situation Survey
It is now accepted that quality of life is a
complex, multi-faceted concept. Not only are there
numerous domains to be considered, there are variants that emanate from human development stages
(Weisgerber, 1991). Others have pointed out that
who is considering quality of life issues and the
purpose of examination are integral to influencing
what form the concept takes (Mukherjee, 1989).
Recently, Lawton (1991) has attempted to integr ate
several of these factors by constructing a multidimensional model that incorporates psychological
well-being, behavioral competence, perceived life
quality, and environmental factors. Others have
come to view the construct or term as having taken
on so much "excessive baggage" that it has become
useless and should be abandoned (Wolfensberger,
1994, p. 286). However, that point of view does not
appear to be widespread.
Defining Q uality of Life
In his discussion of quality of life assessment
issues, Scheer (1980) has stated that it is the quality
of life which makes us feel that life is worth living.
This matter-of-fact comment underscores the relatedness of quality of life to disability and health care
issues. Insufficient life quality is an often expressed
reason for denying, refusing, or failing to pursue
treatment. In other instances, disability and chronic
illness may result in an arduous existence replete
with stressors that contribute to further deterioration.
Strauss (1975) has chronicled the plight of
persons with chronic and terminal illness and provides insight into the manner in which the combinations of symptoms, treatment demands and side effects, and the person's life situation in general interact to reduce life quality to the point where it is no
longer considered worth continuing. Paradoxically,
it is noted that individuals who may not be willing
to comply with treatment to prolong their life may
actively seek out and accept treatment directed toward easing them into death, e.g., hospice care and
assisted suicide. Although these cases are extreme,
they suggest that acquiring a broad perspective of
the person's situation may be critical to understanding compliance and other behavioral issues. The use
of life quality assessment concepts may help to provide this perspective.
Quality of Life and Health
Although health has been one of the most
prominent and universally accepted quality of life
constituents, development of qualitative indicators
in this area has lagged (Berg, 1975). Often, consideration has been limited to factors such as the presence or absence of disease, life expectancies, and
morbidity rates, without concern for extent of the
impact of illness or disability on the individual's life.
However, relatively recent advancements in medical
technology, for example, dialysis and artificial heart
implants, have resulted in increased concern with
such qualitative issues within the health care community (Dimond & Jones, 1983), and seem to be
giving impetus to developmental activities.
Quality of life assessment has evolved from
a number of diverse fields, notably the social sciences (e.g., see Liu, 1978) and public administration
(Schneider, 1976). Although originally focused on
objective, gross indicators of well-being such as
economic status, it quickly became recognized that
there is also a subjective domain. It includes perceived needs and satisfaction with living conditions
(Campbell, 1976). This subjective domain derives
from a tendency to compare our life condition with
that of others to whom we are exposed, and then to
make some judgement as to how we are faring. Although these two domains are interrelated, the latter
seems most closely linked to individual actions or
behaviors, and therefore, may be especially helpful
to understanding response to treatment.
Examples of efforts involving life quality
measurement concepts in health care include Blau's
(1977) demonstrated the use of quality of life indicators as the basis for evaluating treatment impact on
psychiatric patients. Also, Padilla et al. (1983) have
undertaken the developm ent of a disease specific
instrument for use with cancer patients.
Disability and Rehabilitation
Notable interest in quality of life assessment
4
Instrument Development
has emerged in the field of rehabilitation (e.g., see
Anderson, 1982). There has been a call for expanding traditional indices of rehabilitation impact beyond changes in functional level or readily identifiable monetary benefits related to returning persons
with disabling conditions back to the work force
(Cardus, Fuhrer, & Thrall, 1981; Alexander & Willems, 1981). This need for expanding rehabilitation
indicators stems from recognition that many nonmonetary, non-objective benefits accrue from
rehabilitation, such as enhanced personal dignity
and self-esteem (Kottke, 1982; Freed, 1984). Consequently, there is a need to assess the impact of
rehabilitation services in a more comprehensive
manner.
Because of the cited limitations in available
instruments for use in life quality assessment, effort
was directed toward development of a measure
which would be sensitive to factors related to a spectrum of chronic illnesses and disabilities. The approach used was to build upon generally accepted
quality of life measurement concepts and foci to
ensure that the instrument would be suitable for use
with the general population, as well as the described
sub-populations. The idea was to develop a broadbased instrument that would enable a wide range of
comparative studies.
Traditional areas of measurement were
gleaned from existing instruments, such as that developed by Blau (1977). Additional areas for measurement were sought through the use of a critical
incidents technique (Flanagan, 1954) based on mail
surveys and personal interviews of persons with
chronic illness or disabling conditions, including
cancer, diabetes mellitus, heart disease, m ultiple
sclerosis, spinal cord injury, muscular dystrophy,
epilepsy, and blindness. The participants were
asked questions pertaining to difficulties experienced as a result of their condition, and what actions
could be taken to improve the quality of their life.
Both institutionalized and non-institutionalized persons contributed. One hundred and sixty-eight pertinent responses were sorted into 17 different categories (impact areas) for consideration by the
researcher (Table 1).
Some researchers (e.g., Trudel, Fabia, &
Bouchard, 1984, and Baird, Adams, Ausman, &
Diaz, 1985) have approached quality of life assessment by surveying functional limitations, using instruments such as the Level of Rehabilitation Scale
(Carey & Posavac, 1978) and the Sickness Impact
Profile (Bergner, Bobbitt, Pollard, M artin, & Gilson,
1976). Although these studies support the utility of
quality of life assessment concepts in researching
some rehabilitation-relevant issues, the instrum ents
are limited in the range of applications either because they are disease specific or because they are
concerned only with objective indicators, that is,
functional deficits.
The meaning of the functional deficits to the
persons who manifest them must be based on inference or imagination, and this is risky without some
verification and a means by which to establish relevance to the total life situation. This is a serious
shortcoming insofar as treatment compliance and
other behavioral issues are concerned because, as
has been previously noted, the subjective aspect of
life quality may be more critical to understanding
response to treatment and overall impact. Thus,
there seemed sufficient need and rationale for
developing a research instrument to explore a variety of rehabilitation and health care related issues,
which includes the subjective life quality assessment
domain, and which can be used with a variety of
populations.
It is noted that all of these categories have
been reported in one or more previous studies in the
literature reviewed for the project. These impact
areas provided the content foci for measurement
items, together with ten categories considered to be
"traditional" based on their widespread use and acceptance.
Several pilot testings were conducted using
a variety of item forms. A Likert-type format was
subsequently chosen for use because of the reported
clarity of the response procedure and ease of completion by the vast majority of participants in the
pilot studies.
Items were altered or eliminated on the basis
5
The positive and negative items are randomly interspersed to diminish the likelihood of response pattern bias. The midpoint of the item scales was omitted and reserved for assignment of scores when no
response is recorded in accordance with a procedure
described by Kerlinger (1973). The possible total
score range is from 20 to 140. Special attention was
given to maximizing the readability of the scale
items, and findings from several reading level
measures suggest that it is in the fourth to fifth grade
range. Instructions include provisions for using
assistance in completing the instrument, if required.
Approximately 20 minutes are required to complete
the rating scale.
of item analyses. Items which consistently produced
low item-total correlations or more than a 10% nonresponse rate were eliminated. Twenty items were
retained for a final item analysis, which was based
on responses obtained from a relatively heterogeneous volunteer sample comprised of 166 adult weekend patrons of a large enclosed metropolitan shopping mall located in a southeastern U.S. city. Itemtotal correlations ranged from .26 to .71 and were
highly significant (p < .001).
The twenty-item, self-administered instrument utilizes a 7 rating interval format. Half the
items are phrased positively and half negatively.
Impact Areas for Inclusion in Rating Scale
Derived from
Previous Studies
Derived Through Critical
Incidents Technique
Retained
Rejected
Work
Security
Parenting
Leisure
Public Support
Discrimination
Nutrition
Stress
Spirituality
Sleep
Mobility
Purposefulness
Social Nuturance
Autonomy
Comfort/Pain
Earnings
Energy Level
Personal Expression
Health
Social Support
Love/Affection
Mood/Affect
Environment
Outlook
Self-esteem
Egalitarianism
School*
*Incorporated into item with work
Table 1
6
reported in Table 2..
Reliability and Validity Studies
Results of t-Tests Used to Compare the Scores
of the University Student Group with
Others in the Validation Studies
The Life Situation Survey rating scale has
undergone several reliability and validity studies.
Test-retest reliability for a one-week interval based
on data obtained from 23 graduate level university
students was .91.
However, since the area of measurem ent is
situation dependent and retest reliability is expected
to diminish substantially with time, inter-item
consistency is a more appropriate measure of reliability. During initial development, coefficients
(Cronbach's alpha) ranging from .74 to .95 were
obtained for a variety of groups, including prison
inmates, hospital patients, university students, and
rehabilitated spinal cord injured adults. In sum, the
findings from the studies indicated an acceptable
degree of reliability with diverse populations.
Validity derives, in part, from the construction procedure which was designed to gather data
relevant to the target populations. This is supplemented by the instrument's demonstrated a bility to
discriminate between populations in accordance
with hypothesized differences. Because the Life
Situation Survey evolved from the premise that
health and non-health factors are synergistic in
terms of impact on life quality, studies were conducted to demonstrate its discriminant validity in
both areas.
Group
N
Mean
SD
t
Students
50
107.34 11.21
Prison Inmates
44
74.27 14.87
12.66*
ESRD Patients
27
83.15 14.07
8.25*
Persons with
Back Problems
22
81.14 20.88
5.55*
Persons with
SCI
16
87.88 26.37
2.87*
Note: Because the variances of the groups
cannot be assumed equal, an approximated t is
given instead of Student's t
*p < .01, one-tailed.
Table 2
In a successive study, it was predicted that a
group of 17 otherwise healthy, middleclass, stress
management workshop enrollees would score lower
than the students but higher than the prison group.
A mean of 96.06 and a standard deviation of 12.47
were calculated for the stress management group,
and the three groups were compared using the general linear models procedure (SAS Institute, 1982)
analysis of variance (Table 3). Scheffe's test was
used to establish the locus of the highly significant
difference, and all means differed from one another
(p < .05).
The first series of comparative studies was
undertaken to demonstrate the instrument's sensitivity to non-health related factors. It is noted that in
these studies, health sta tus was confirmed by selfreport through an item on a general information
questionnaire provided with the Life Situation Survey rating scale. The initial comparative study was
conducted with a group of 50 healthy, graduate level
counseling students at a southeastern U.S. university, which was predicted to be a high scoring group,
and a group of 44 healthy prison inmates in a medium security prison described in the courts as outdated, overcrowded, and having intolerably harsh
conditions. The latter group was considered to have
an extremely poor life quality. Analysis of the data
revealed a mean score of 107.34 for the student
group, and a mean of 74.27 for the inmate group.
T-test results for this and other related studies are
A related study was subsequently conducted
in which it was predicted that the instrument would
discriminate between the previously described prison population and a group of 23 inmates in a minimum custody prison where conditions were considerably better in terms of space, freedom to move
about, recreational activities, visitation privileges,
and work opportunities. Although the significance
7
A similar study was conducted using persons
who were hospitalized and undergoing treatment for
chronic back pain. The mean for this sample is
81.14, which is significantly lower than that of the
comparison group, and provides additional support
for the hypothesis. This study has been reported in
detail elsewhere (Chubon, 1985). Findings from an
additional study, which was also recorded in Table
2, indicated that a group of rehabilitated spinal cord
injured persons also scored lower on the Life Situation Survey than did the university students. Although these findings are somewhat tentative because of the compromised hypothesis and use of
convenience samples, their consistency and number
provide considerable evidence that the Life Situation
Survey is sensitive to the impact of severe chronic
illness and disability.
level (p< .08, one-tailed) established with Student's
t-test did not reach the acceptable criterion (p< .05),
the mean of 80.00 is in the expected direction, and
failure of the test may be an artifact of the small
group size. In sum, this series of studies indicated
that the Life Situation Survey does discrim inate between groups experiencing non-health related life
quality differences.
Analysis of Variance of Life Situation
Survey Scores for the University
Student, Medium Security Prison
Inmate, and Stress Management
Workshop Groups
Source of
Variation
SS
MS
df
F
Between
25844.46 129221.43
Within
18150.89
168.06 108
Total
43995.75
110
To further ascertain the instrument's sensitivity to manifestations of severe chronic disease and
disability, and treatment, a pre- and post-treatment
study was conducted. The underlying hypothesis
was that if the instrument does measure the impact
of these problems, it should be sensitive to changes,
i.e., improvement, brought about by treatment. The
pre-post paradigm was developed around an intensive, 25 day inpatient pain treatment program. The
Life Situation Survey was administered to 70 patients who were consecutively admitted to a pain
therapy center for treatment during the fall of 1985.
Approximately 90% of the participants reported
their primary problem to be chronic back pain, with
the remainder seeking treatment of chronic headaches or lower extremity pain. Treatment was provided by an interdisciplinary team of professionals,
emphasizing a nonsurgical, behavioral approach to
remediation. Specific treatments included, but were
not limited to, instruction in body mechanics and
relaxation, cognitive restructuring, group psychotherapy, and a graded conditioning program. Upon
completion of the highly structured treatment program, the Life Situation Survey was re-administered
in conjunction with other discharge checkout procedures. Most patients com pleted the questionnaire
prior to leaving the facility, but for convenience
several were permitted to take theirs with them with
the stipulation that they be returned within a few
days.
2 76.89 *
*p < .001
Table 3
A second series of studies was designed to
determine if the instrument would discriminate between persons who were healthy and those who
manifest serious illness or disabilities. Ideally, the
strongest evidence of this capability would have
been obtained by comparing college student and
prison inmate populations in similar circumstances
to those used in the above studies also manifesting
serious illness or disability, with the prediction that
those with illness or disability would score lower
than the respective healthy groups. However, because such groups were not available for study, it
was hypothesized that groups in general with serious
illness or disability would score lower than the healthy university student group. To test this compromise hypothesis, a group of 27 persons with endstage renal disease (ESRD) was administered the
instrument. Data analysis yielded a mean of 83.15,
which lies in the predicted direction and is statistically significant (Table 2). Other details of this
study are contained in a published report (Chubon,
1986).
Fifty-five of the persons who completed the
8
Further, a number of users reported a problem with item 17 on the original version of the LSS,
which read, "I am satisfied with my employment (or
school if you are primarily a student)." The problem
was that the item resulted in a high number of nonresponses when the Life Situation Survey was administered to some populations, particularly those
including older persons who were retired. Additionally, homemakers frequently did not recognize the
item as being applicable to their situation and did
not respond.
pre-treatment questionnaire subsequently completed
the 25 day program. Of the remainder, six were
terminated early on recommendation of the staff,
and nine dropped out on their own accord. Pre- and
post-treatment data were obtained from 37 (67%) of
the 55 persons who completed the entire 25 day
program, and their respective means were found to
be 83.87 and 91.16. A paired t-test was performed
to test the hypothesis that there would be a significant increase in scores on the Life Situation Survey.
The results indicated a highly significant difference
between the pre- and post-treatment scores (t = 2.54,
df = 36, p < .01, one-tailed). Comparison of the pretest data from this group with scores from those who
completed the program but did not return their posttreatment questionnaire revealed no differences.
A number of alternative items were formulated and tested in an effort to develop one that
would more clearly reflect the intended, broa dly
encompassing meaning. Ultimately, a somewhat
lengthy replacement item was selected which reads,
"I am satisfied with my main life role now (for example, as a worker, student, homemaker, retiree, or
patient)."
However, when the pre-test data from those
who dropped out of the program on their own accord was examined, their scores appeared to be
lower, having a mean of 77.20 in comparison to a
mean of 83.87 calculated from the pre-test scores of
those who completed the program. Additionally, the
dropouts reported an a verage of 2.1 trips out of their
place of residence in the week preceding admission
compared to an average of 4.2 reported by the completion group. It is emphasized, however, that these
are only apparent differences, because the sma ll
number (9) in the dropout group precluded meaningful statistical testing. Nevertheless, these serendipitous findings underscore the potential applicability of the quality of life assessment approach to
compliance issues. In total, the findings from this
study are consistent in supporting the discriminant
properties of the Life Situation Survey. Additionally, these studies confirmed its suitability for use
with a spectrum of chronically ill and disabled
populations.
Concurrent administration of both the original and revised items to a group of 19 graduate students in a counselor education course was carried
out. Correlation of the ratings for item 5 produced
a coefficient of 1.00, indicating that the items were
virtually identical in meaning to the persons who
were all U.S. citizens. The correlation between the
original and revised forms of item 17 was .74. This
reflects substantial similarity of the two versions of
the item, but there appears to be some difference.
In a post administration debriefing of the respondents, there was near consensus that the revised
version was more clearly understood and that there
was much more certainty about the correctness of
response. It was concluded that the revised item
would yield more reliable and valid responses than
the original.
In addition to the item comparisons described above, two additional studies were carried out to
establish equivalence of the original and revised
versions of the complete 20-item rating scale. In a
study involving repeated administration of the revised version of the Life Situation Survey to 24
graduate students enrolled in a counselor education
course, test-retest reliability over a two week interval was determined to be .84 (Pearson correlation
coefficient). The inter-item consistency (Cronbach's
alpha) was found to be .84 based on the pre-test
Revisions
As a result of relatively extensive use of the
Life Situation Survey and feedback from users during the three ye ars following development, late in
1988 two of the 20 items were revised. To accommodate international users, item 5, which originally
stated, "I am better off than most people in the U.
S.," was reworded to read, "I am better off than most
people in this country."
9
ers, 1976) were administered in randomly ordered
sets to 41 university graduate students. Pearson
product moment correlation coefficients were calculated for the scores from the three measures. The
results are contained in Table 4.
data.
A second study was conducted on a similar
group of 18 gradua te counseling students in which
the revised version of the LSS was administered as
a pre-test, and the original version was administered
on a post-test basis two weeks later. The Pearson
correlation coefficient derived from the items was
found to be .84. The inter-item consistency for the
revised form of the LSS was determined to be .86,
and the Cronbach's alpha coefficient for the original
version (post-test) was found to be .89
Correlations Between the Life Situation
Survey, Life Satisfaction Index - A,
and the Index of Well-Being
LSS
LSIA
These studies provide evidence that the revised version of the Life Situation Survey is virtually
equivalent to the original form used in the earlier
developmental studies.
LSIA
.77
IWB
.65
.69
Table 4
Additional Validity Studies
It is apparent that there is a relationship between the LSS and the other two instruments. However, the moderate correlations are suggestive of
significant difference. The finding is consistent with
expectations. Although both instruments were designed to measure life satisfaction, the LSIA was
developed for persons 65 years of age or older and
the Index of Well-being was developed for the general population without particular regard for the
impact of disability and illness. It can be concluded
that some items contained in the LSIA are not relevant or appropriate for non-elderly populations, and
that those that underlie the IWB do not as adequately address disability relevant factors. Thus,
the limited correlations.
A study was conducted to establish the construct validity of the LSS. In the first study, the
instrument was adm inistered to forty students enrolled in a graduate level counseling class. Based
on self-reports, none had a significant disability or
chronic illness. In addition to the LSS, the students
were also administered the Beck Depression Inventory (Beck & Steer, 1987), and the Crowne-Marlowe
Social Desirability Scale (Crowne & Marlowe,
1964). The respective correlations with the LSS
were -.61, and .13. Only the -.61 correlation between the LSS and Beck Depression Inventory was
significant (p < .001).
These findings suggest that there is a notable
relationship between LSS scores and the affective
state of individuals. One would ordinarily expect a
higher prevalence of depression among individuals
who perceive their life quality to be relatively poor.
Finally, items on the Life Situation Survey do not
appear to induce individuals to give responses that
they feel are socially desirable or acceptable.
Rather, they are apparently comfortable in making
ratings consistent with their true feelings.
Conclusion
The reliability and validity of the Life Situation Survey have been supported by a series of
purposefully designed studies. The internal consistency of the rating scale items falls at acceptable
levels with diverse populations. The studies reflect
substantial discriminant validity, with sensitivity to
both health and non-health factors affecting perceived life quality. It appears to be effective in discriminating between groups, as well as measuring
treatment impact. A noteworthy serendipitous finding occurred when it was discovered that a small
group of dropouts from a treatment program scored
lower than their compliant counterparts in the most
A second study was implemented to establish
concurrent validity. The Life Situation Survey, Life
Satisfaction Index - A (LSIA) Adams, 1969;
Neugarten, Havinghurst, & Tobin, (1961) and the
Index of Well-Being (Campbell, Converse,& Rog10
recent study. The finding underscores the instrument's potential use in exploring compliance issues.
At this point, the instrument seems adequately developed to justify its use in a broad spectrum of health care related research. Because it has
apparent sensitivity to treatment related change, it
may be useful as a progress measure.
Although the empirical evidence is impressive
insofar as consistency in findings and the number of
supporting studies are concerned, the instrument's
greatest strength may lie in the manner in which the
items were derived, that is, from information obtained from target populations, and in its focus on
measuring perceived status or life condition. Developmentally and conceptually, the Life Situation
Survey has evolved with a strong person-centered
emphasis. It has been approached from the premise
that those who have been affected by illness and disability are likely to be most knowledgeable or aware
of the problems imposed by these conditions, as well
as the best source from which to acquire understanding of the meaning of their condition. Although going to the patient for answers seems to be commonsensical, personal experience, as well as reviews of
published research dealing with compliance and
other health care issues such as program and treatment evaluation, suggest that the approach is exceptional.
11
Appendix A
12
Population
1
1
Reliability
N
Mean
SD
Nursing home residents
20
90.50
10.51
.67
Suicidal psychiatric hospital patients
50
88.06
19.52
.87
Graduate counseling students
41
101.32
15.00
.89
Mentally retarded adults
120
85.57
6.51
.70
Spinal cord injured persons
100
89.51
15.05
.85
Chronbach's alpha
Group Norms
Nursing Home Residents: Data were collected in 1988. Half the individuals required skilled care and the
others, intermediate. All individuals were oriented and able to communicate. Additional information is
contained in Hulsman and Chubon (1989).
Suicidal Psychiatric Hospital Patients: Data were collected in 1988. These were consecutive admissions to
a South Carolina state psychiatric facilities who were institutionalized because of an attempt or threatened
attempt to commit suicide. The LSS was administered by a counselor as part of the initial assessment
procedures within 48 hours following admission.
Graduate Counseling Students: Data were collected in January, 1992. Administration was carried out at the
onset of regularly scheduled classes by instructors at the University of South Carolina. Questionnaires were
returned anonymously. Based on self-report, none of the students had a significant disability or illness.
Mentally Retarded Adults: Data were collected in June 1991. This was a stratified sam ple of persons receiving
services from the South Carolina Department of Mental Retardation. They represented all IQ levels and
residential options provided by the system. Details are contained in Vandergriff and Chubon (1994).
Spinal Cord Injured Persons: Data were collected between June 1990 and June 1991. The sample was
comprised of South Carolinians whose injury was severe enough to necessitate wheelchair use and who were
at least two years post injury. Details are contained in Clayton and Chubon (1994).
13
Age Education
Population
N
M
M
Sex
Race
Male Female
White Af-Am
Income
Other
M
Nursing home residents
20
75
6.8
2
18
17
3
NA
Suicidal psychiatric
hospital patients
50
49
11.4
28
22
40
10
14367
Graduate counseling
students
41
31
19.9
13
28
38
2
1
32757
Mentally retarded
adults
120
42
NA
62
58
NA
NA
NA
NA
Spinal cord injured
persons
100
34
12.6
80
20
60
36
4
17000
Demographics of Norm Groups
14
Appendix B
15
LIFE SITUATION SURVEY
Scoring Key
1. I feel safe and secure.
7
6
5
3
2
1
2. My health is good.
7
6
5
3
2
1
3. I have too few friends who I can count on.
1
2
3
5
6
7
4. I like myself the way I am.
7
6
5
3
2
1
5. I am better off than m ost people in this country.
7
6
5
3
2
1
6. I feel constantly under pressure.
1
2
3
5
6
7
7. I don't eat very well.
1
2
3
5
6
7
8. My future is hopeless.
1
2
3
5
6
7
9. I am a happy person.
7
6
5
3
2
1
10. There are always people willing to help me
when I really need it.
7
6
5
3
2
1
11. My income is a constant source of worry.
1
2
3
5
6
7
12. My sleep is restful and refreshing.
7
6
5
3
2
1
13. I don't get the love and affection I need.
1
2
3
5
6
7
14. I don't have any fun or relaxation.
1
2
3
5
6
7
15. Services provided by the government and other
public agencies meet my needs.
7
6
5
3
2
1
16. I am able to go when and where I need to go.
7
6
5
3
2
1
17. I am satisfied with my main life role now. (for example,
as a worker, student, homemaker, retiree, or patient)
7
6
5
3
2
1
18. There is little that I am able to enjoy in my
community and surroundings.
1
2
3
5
6
7
19. I am exhausted well before the end of the day.
1
2
3
5
6
7
20. I have too little control over m y life.
1
2
3
5
6
7
16
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20