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The Lifestyle Satisfaction Scale (LSS): Assessing individuals' satisfaction with residence, community setting, and associated services
Applied Research in Mental Retardation, Vol. 6, pp. 475-490, 1985 Printed in the USA. All rights reserved.
0270-3092/85 $3.00+ .00 Copyright © 1985 Pergamon Press Ltd.
The Lifestyle Satisfaction Scale (LSS): Assessing Individuals' Satisfaction with Residence, Community Setting, and Associated Services Laird W. Heal and lanis Chadsey-Rusch University of Illinois at Urbana-Champaign
Satisfaction o f mentally retarded persons with their quality o f life & an important outcome measure o f deinstitutionalization. The Lifestyle Satisfaction Scale (LSS) was developed to assess mentally retarded persons" satisfaction with their residence and its community setting and associated services. An acquiescencesubscale makes it possible to correct satisfaction scores for acquiescence bias. Empirical data indicate that this experimental version o f the LSS has internally consistent subscales and good test-retest and interrater reliabilities.
An assumption that has often been made by advocates of deinstitutionalization is that if they secure residential and day services for developmentally disabled individuals in the community, then the happiness of their clients is inevitable. This assumption, however, is not necessarily tenable. It seems likely that mentally retarded citizens themselves are capable of expressing a preference among alternatives that affect them. Furthermore, in the evaluation of deinstitutionalization outcomes it seems to be more basic to assess the citizen's preferences than to assess the "normalization," the expense, the skill development, or the "residential climate" of living alternatives. As Landesman-Dwyer (1981) asserted in her recommendation to the President's C o m mittee on Mental Retardation, quality of life variables need to be assessed from the personal viewpoint of the individual clients themselves. Yet, clients'
Address reprint requests to: Dr. Laird Heal, Dept. of Special Education, 1310 S. Sixth St., University of Illinois, Champaign, IL 61820. 475
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L. W. Heal and J. Chadsey-Rusch
satisfaction with their lives has been only minimally assessed in the research on community placement of mentally retarded individuals (Heal & Laidlaw, 1980). Happiness, or satisfaction, is an elusive construct that is probably best defined individually and measured subjectively. Several main elements of "what happiness is," however, appear in a number of philosophical works (Black, 1911; Cooksey, 1916; Russell, 1933), suggesting that the construct has some consensual bases. For example, Black (1911) related happiness to good health, enjoyable work, simplicity, intellectual stimulation, and affection. Cooksey (1916) also stressed friendship, affection, and industriousness. Interestingly enough, these facets of happiness resemble those mentioned by mentally retarded persons as being important [e.g., having friends and enjoyable things to do such as hobbies and recreational activities (Gollay, Wyngaarden, Freedman, & Kurtz, 1978)]. In several studies mentally retarded persons have been interviewed regarding their feelings about living in the community, particularly in contrast to living in institutions. For example, Schalock, Harper, and Carver (1981) assessed happiness or "quality of life" variables by interviewing 69 mentally retarded persons who had been residing in the community for 3 years. Although Schalock et al. assessed quality of life primarily from a frequencycount perspective (e.g., the number of hours spent in leisure activities, the number of times downtown shopping occurred), they also discussed quality of life variables from each client's point of view. During interviews, mentally retarded individuals reported they were "proud of their apartments and felt good about 'doing their own thing' but frequently indicated they would like to have more friends" (p. 175). Schalock et al. concluded that quality of life is reflected not only by skill functioning level, but also by the feelings and wishes of the clients themselves. The results from several other studies examining quality of life issues suggest that depending on their degree of independence, most mentally retarded persons prefer to live in the community rather than in institutions (e.g., Birenbaum & Re, 1979; Birenbaum & Seiffer, 1976; Edgerton, 1967; Edgerton & Bercovici, 1976; Gollay et al., 1978; Hull & Thompson, 1980; Scheerenberger & Felsenthal, 1977; Seltzer, 1981). In these studies, friends, family, and leisure time activities were all reported as the main ingredients of happiness. Assessing the happiness of mentally retarded persons poses several methodological problems. First, happiness is conceptually inexact: different labels and correspondingly different operations have been used to index it. Second, the procedures used to collect these data have ranged from yes-no questions, to either-or questions, to open-ended questions, to direct observation. These variations are especially troublesome in that Sigelman and her colleagues (Budd, Sigelman, & Sigelman, 1981; Sigelman, Budd, Spanhel, & Schoenrock,
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1981a, 1981b; Sigelman, Schoenrock, Spanhel, Hromas, Winer, Budd, & Martin, 1980) have found mentally retarded individuals to be prone to an acquiescence response bias, that is, the disposition to say "yes" to any question. In summarizing their research, Sigelman et al. (1981a) reported that acquiescence occurred at high rates, and that it became even higher as the IQ level of their subjects decreased. "Thus, the use of yes-no questions in interviewing mentally retarded persons is likely not only to distort the picture of a sample that emerges but also to obscure relationships between IQ and variables of substantive interest" (Sigelman et al., 1981a, p. 348). The purpose of the present study was to develop a reliable instrument to assess mentally retarded persons' satisfaction with their lives. In order to accomplish this goal, the Residential Satisfaction Scale (RSS), which had been used in a previous study by Novak, Heal, Pilewski, and Laidlaw (1980) was refined and re-named the Lifestyle Satisfaction Scale (LSS). The RSS had been developed to assess mentally retarded persons' satisfaction with their residence, their community setting, and their community services. Although used on a small sample (n = 17), Novak et al. (1980) reported that the RSS evinced good test-retest (r = .925) and interrater (r = .95) reliability. In light of these findings, and considering the importance of assessing mentally retarded persons' satisfaction with their lives, the psychometric properties of the RSS were further investigated with a larger sample of subjects. The resulting revised scale is called the Lifestyle Satisfaction Scale (LSS; Heal, Novak, ChadseyRusch, 1982; see the Appendix). METHOD Client volunteers from a rehabilitation facility located in a medium-size midwestern city were interviewed singly using a 50-item scale to evaluate their satisfaction with their residence and their associated community and services. Item test-retest reliabilities and item analysis procedures were used to identify the subscale structure of the satisfaction scale. Statistical procedures were developed to adjust for acquiescence bias. Subscale structure and reliability were cross-validated using a previous set of data.
Subjects In this investigation, 38 subjects volunteered from a sample of about 150 individuals from the sustaining care caseload of the rehabilitation agency located in a medium-sized midwestern city. "Sustaining care" is a state-financed, locally administered service that provides whatever supports are deemed necessary to keep developmentally disabled adults from being institutionalized or re-institutionalized. Two methods were used to obtain subjects. First, the investigators sent two mailings to individuals on the sustaining care
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caseload asking them to participate in the study. Because only eight individuals volunteered, sustaining care clients residing in a 58-bed intermediate care facility (ICFDD) were approached individually by their counselors, and 25 volunteered to be interviewed. In addition, five developmentally disabled clients, who were living in community apartments, were invited by their case workers to participate in the study. All five of these individuals consented to be interviewed. Thus, the final sample consisted of 25 subjects from the ICFDD, 12 subjects from apartments, and 1 mildly mentally retarded female from a nursing home. O f the 25 subjects living in the ICFDD, 13 were female and 12 were male. Ages ranged from 20 to 61 with a mean of 31. Seventeen of the subjects worked in the agency's sheltered workshop, 6 subjects held no job, and 2 subjects were being trained for competitive employment in janitorial services. Most recent IQ scores from subjects' files ranged from 22 to 72 with a mean of 47. The ages of subjects living in apartments ranged from 21 to 67 with a mean of 36. Six subjects were female and 6 were male. One subject worked in the sheltered workshop, 3 subjects had no job, and 8 subjects were competitively employed as food service laborers. One subject was married (to a competitively employed male), 3 subjects lived alone, and the remaining 8 subjects had r o o m m a t e s from the sustaining care caseload. IQ scores for 11 of these subjects ranged from 47 to 97 with a mean of 64. The IQ score of the 12th apartment dweller was not available. The Residential Satisfaction Scale (RSS)
The RSS, which had been used by Novak et al. (1980), was employed for the present study. The RSS consisted of 50 yes-no questions that probed subjects' satisfaction with their residence and its community setting and associated services. Subjects' scores on individual items could range from + 2, which represented an overwhelmingly favorable response, to - 2, which indicated an extremely negative response. A score of zero was recorded for ambivalent, neutral, or self-contradictory statements. Although all scale items required "yes-no" responses, seven items required examples before credit for a yes response was given. For example, one question (see question 7 in Appendix) asked subjects if they would prefer to live with someone else. If a subject answered "yes," they were then asked to name the person they would prefer to live with. If the subject named a person, they were given credit for a "yes" response. If they could not name a person, they were given a "no" score. A number of items were included in the scale to permit an assessment of response bias. Eight items were worded in such a way that a "no" answer indicated satisfaction, whereas a "yes" answer indicated dissatisfaction for eight parallel items (e.g., the last item on the scale "Would you like to move back
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9,, was paired with the next-to-last item "Do you like living
here?").
Interview Procedure After subjects consented to participate, they were contacted by the authors and scheduled for an interview. During the interview, the 50 items of the instrument were read to the subject. At any time that the subject appeared to have difficulty understanding a question, paraphrasing was substituted, and variations of the question were repeated until the subject appeared to understand. When a subject contradicted a previous response, the question was repeated. Each interview was conducted in private and took about 20 min to complete. After the 50 items had been completed, the interviewer(s) thanked the subject for participating and departed. Twenty-seven subjects were retested with 7 days' delay. One subject was retested after only 4 days, four after 14 days, two after 15 days and four at longer intervals, the longest of which was 29 days. Test-retest reliabilities were calculated using the scores from one rater for the first interview and the scores from a different rater for the second interview. Thus the retest reliabilities that are reported indicate simultaneous test-retest and interrater agreement; scores' stabilities were independent of both the time at which they were taken and the rater taking them.
Interviewers and Interviewer Training Of the 98 interviews used for data analysis, 31 were conducted by the first author, 32 by the second author, and the remaining 35 by three male and three female graduate students. All interviewers were trained in the following manner: (a) each interviewer read the RSS in its entirety; (b) each practiced giving the scale to another interviewer; (c) each observed a practiced interviewer giving the scale to a respondent from the target population and, at the same time as the practiced interviewer, scored the subject's responses; and (d) each person then conducted an interview in the presence of a trained interviewer.
Data Analysis A number of statistical analyses were completed in order to assess the psychometric properties of the 50 items on the RSS (Novak et al., 1980). The goal was to cull unreliable items and develop a new scale that had independent, meaningful subscales, including an acquiescence subscale to adjust for the increasing disposition of lower IQ subjects to say yes to any question asked of them (Sigelman et al., 1981a). This new scale, which included only 29 of the original 50 RSS items, was called the Lifestyle Satisfaction Scale (LSS).
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L. W. Heal and J. Chadsey-Rusch
The analyses involved in the development and evaluation of the LSS were as follows: (a) test-retest item reliabilities in order to eliminate unreliable items, (b) conventional item analyses, used to cluster the reliable items into internally consistent subscales that had conceptual integrity, (c) cross-validation of the current (1981) subscale structure using the Novak et al. (1980) 1979 data, (d) test-retest and interrater reliabilities on the new subscales computed for both the 1981 and 1979 data, (e) intercorrelations a m o n g subscales, and (f) an analysis of covariance to see if the LSS could discriminate between subjects living in the I C F D D and subjects living in apartments. RESULTS Item Test-Retest Reliabifities
Five items, which had test-retest reliabilities of less than .2, were rejected as unreliable. The eliminated interview questions probed subjects' satisfaction with their supervisor, their bus service, their church, places they go in the community, and what they were learning. Internal Consistency
The reliable LSS items were conceptually grouped to form the following four subscales: (a) Community Satisfaction (COMSAT), (b) Friends and Free Time Satisfaction (PALSAT), (c) Satisfaction with Services (SVCSAT), and (d) General Satisfaction (GENSAT). After several iterations of re-grouping items for the SPSS subprogram, R E L I A B I L I T Y (Hull & Nie, 1979), 16 items were dropped because they failed to add to the alpha reliability of any subscale. That is, they added no new information to the items that were retained. Table 1 illustrates the internal (alpha) consistency reliabilities from the four subscales individually and for the four subscales combined (Total Satisfaction). JOBSAT, the last "subscale" on Table 1, is a single item, which was retained on the LSS despite its low correlations with other items because of its high reliabilityand substantive importance. In addition to the mutually exclusive subscales, a shortened version of the scale (SHORTSAT) was formed from 13 items that had the greatest internal consistency. The new LSS subscales were then cross-validated with the 1979 data (Novak et al., 1980). Inspection of Table 1 reveals that, except for SVCSAT (r = - .04), 1979 alphas were only slightly smaller than those obtained for the 1981 data. Test-Retest Reliabilities
Test-retest reliabilities for 1981 and 1979 samples for all subscales and the total scale of the LSS are also presented in Table 1. The range of test-retest reliabilities for the 1981 data was from .44 (PALSAT) to .83 (COMSAT), with
481
Lifestyle Satisfaction TABLE 1. Reliability Estimates of Total Lifestyle Satisfaction Scale and Subscales ~Internal Consistency Reliability
Subscale COMSAT PALSAT SVCSAT GENSAT dTOTSAT SHORTSAT ACQUIESCENCE JOBSAT
No. of Items N
1981 98
9 6 7 5 27 9 16
.79 .66 .68 .67 .85 .81 .64 -
1
1979 22
bTest-Retest Reliability
blnterrater Reliability
1981 98
1979 22
1981 22
1979 c
.67 .56 - .04 .73 .82 .81 .64
.83 .44 .72 .63 .74 .74 .74
.90 .67 .41 .91 ,93 ,95 ,58
.93 .85 .97 .98 .95 .99 .82
.60 .83 .93 .94 .95 .90 .88
-
.49
.32
.46
.44
"Cronbach's (1951) alpha bReliability is for one rater or one occasion calculated using Winer's (1971, pp. 283-296) analysis of variance coefficient, which includes rater differences as unreliability. The Spearman Brown prophecy formula should be applied to estimate the reliability for two or more raters or occasions. ¢n = 6 sbs × 3 raters JOne Acquiescence item and JOBSAT bring the total number of items on the LSS to 29.
a .74 test-retest reliability for the total scale. These data were cross-validated with the 1979 data (Novak et al., 1980), which tended to show higher testretest reliabilities than those of the present data, presumably because there were only three raters in the earlier study, compared to eight in the current one.
Interrater Reliabilities Using the conservative intraclass coefficient (Winer, 1971) to estimate reliability, Table 1 shows that the interrater reliabilities for both 1981 and 1979 data are quite high. Overall interrater reliabilities for both years ranged from .60 (1979 COMSAT) to .98 (1981 GENSAT) with an interrater reliability estimate of .95 on the total scale (TOTSAT) in both samples.
Correlations Among Subscales The intercorrelations among the subscales of the LSS are shown in Table 2. The correlations among the four major subscales are too high to support any assertion that they are measuring greatly different constructs. Nevertheless, their intercorrelations fell far short of their reliabilities, suggesting that each has some uniqueness.
.015 .015 .048
-.090
.213 .077 .029 .232 -.037 .485* .114 .033 .415" .464* .410"
"FACILITY
-.009 -.021 .485* .478* .375* .278*
AKWYES
.430 -.010 .771 .649* .776*
COMSAT
.230 .463 .336* .715"
PALSAT
.290 .229 .475*
SVCSAT
.918" .891"
SHORTSAT
.810"
GENSAT
apoint biserial correlation of each subscale with residence at the ICFDD (score = 0; N = 27) or an apartment (score = 1; N = 11). bNeither SHORTSAT nor TOTSAT are corrected for spuriousness. *p <.05
bSHORTSAT GENSAT bTOTSAT
SVCSAT
FACILITY AKWYES COMSAT PALSAT
JOBSAT
TABLE2. IntercorrelationsAmongtheLSSSubscales
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Comparison o f Two Facility Types Table 3 shows the comparison of two facility types, apartments and the intermediate care facility for the developmentally disabled (ICFDD). Both with (Part R 2) and without (ta) statistical adjustments for acquiescence, the apartment dwellers were significantly more satisfied with their facility and community environment (COMSAT) and their general lifestyle (GENSAT, SHORTSAT, TOTSAT). They did not differ in their satisfaction with friends (PALSAT), community services (SVCSAT), their jobs (JOBSAT), or in their acquiescence (AKWYES).
Scoring Adjustments for Acquiescence* The B regression coefficient column of Table 3 indicates that there was significant correlation between SVCSAT, GENSAT, TOTSAT, and the Short Form (SHORTSAT) with acquiescence. Thus, it is important to take acquiescence into account in determining the absolute level of satisfaction regarding these variables. The equation for adjusting these scores is:
~=X~-B(A~-A)
(1)
Where Yi = the "new" subscale score for individual; Xi= the original subscale score for individual; B = Bx,Aco from Table 3, the nonstandardized regression coefficient of X on satisfaction acquiescence; Ai = the acquiescence score for the ith individual; A -- the mean acquiescence score for the sample. (If a mean score is not available from the sample from which the ith subject was drawn, the mean scores for our ICFDD or apartment sample, on Table 3, may be used as an approximate mean acquiescence score.) DISCUSSION The evaluation of deinstitutionalization is presumably incomplete without the assessment of the happiness or satisfaction of mentally retarded persons themselves. The LSS, which assesses satisfaction with respect to residence, community environment, friends, and services, not only addresses some of the dimensions of satisfaction but also evinces internal consistency regarding their measurement.
*Scoring tables based on the 1981 sample of data are available from the authors.
4~.
.58 - .80 5.13 4.07 7.83 13.83 4.00 5.56
Mean
SD 5.58 4.77 4.92 5.70 14.61 23.46 3.49 8.47
IC F DD N=27
bAdj. - .58 - .80 5.08 4.92 7.22 13.55 5.54
mean 5.35 .45 5.45 9.09 20.35 33.13 3.75 .91
Mean
APARTMENT N=ll
2.89 5.87 3.49 1.64 9.18 8.75 2.20 13.00
SD
bAdj. 5.36 .45 5.58 9.23 20.62 33.81 .95
mean - .017 - .028 .698* .776* 1.463" 3.735* .221
aBX,AC Q
.235* - .013 .001 .215" .168" .172" _ .045
r2
.004
.236* .013 .003 .228* .176" .188"
cPart r 2
'~Unstandardized Partial Regression Coefficient relating AKWYES (acquiescence) to each row variable; facility type has been partialed out. bMeans adjusted for group differences in acquiescence. CThe squared part point-biserial correlation between the row score and the binary facility variable with acquiescence partialed out statistically. dOvetail acquiescense was significantly above zero, t(36)= 7.71. *p< .05
COMSAT PALSAT SVCSAT GENSAT TOTSAT SHORTSAT AKWYES JOBSTAT (one item)
Score (X)
TABLE 3. Comparison of the ICFDD and Apartments: Means, Standard Deviation, Adjusted Means, Unstandardized Regression Coefficients, Correlations and Part Correlations
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With the mentally retarded population it is not enough to define happiness; one must also devise a valid procedure to assess happiness, particularly if one relies on verbal responses. Yes-No questions, although easy to answer, lend themselves to considerable acquiescence bias, particularly as IQ level decreases (Sigelman et al., 1980). To combat this problem, Sigelman et al. (1981a) studied the use of either-or questions or pictures. Although either-or questions were found to yield more valid responses, they were also slightly harder to answer and generated a small bias toward the latter of two options named. In the same study, Sigelman et al. (1981a) found that pictures made either-or questions easier to answer and reduced the bias toward the latter choice, but did not significantly increase valid responding. Although both either-or questions and pictures deserve further evaluation as a format to use when interviewing mentally retarded persons, another option to consider is controlling acquiescence bias by statistical procedures. Regression of each LSS subscale on the acquiescence subscale neutralizes any detectable acquiescence bias. Evidence for the construct validity of the LSS lay in its ability to discriminate between two criterion groups. In this study, subjects were from two very different points on the restrictiveness continuum: Apartments and an ICFDD. Our presumption in comparing these two facility types was that the less deviant one's residential facility from the standard(s) of society at large, the more pleased the residents will be with their styles of life. Although residents in apartments varied greatly in their ability and disposition to explore the limits of the community, all were in control of their daily decisions. On the other hand, residents in the ICFDD had a very regimented schedule of sleeping, eating, and other activities. The higher LSS scores by the apartment dwellers are consistent with the hypothesis that satisfaction is correlated with less restrictive settings. The present study also demonstrated that the LSS had moderately high test-retest and interrater reliabilities and satisfactory cross-validation results. These results, however, must be interpreted with caution due to the small heterogeneous sample and sample selection process. In particular, subjects used in the present study threaten the generality of the results in at least two ways. First, it is possible that only happy subjects would volunteer for an interview with university people about their home and community. This argument is not particularly credible, however, in that volunteers were easiest to obtain at the ICFDD, where they were least happy. Second, it is possible that only stable subjects (consistently happy or consistently unhappy) would volunteer to talk about their homes and community. This second possibility also seems f a r - f e t c h e d - i t is much more reasonable to assume that volunteer bias has little affect on the stability or consistency of scores, and that these features are primarily influenced by items and procedures rather than examinees. Thus, although the sample was far from ideal, it is likely that similar reliability estimates would result from other developmentally disabled respondents.
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L. W. Heal a n d J. Chadsey-Rusch
F u t u r e r e s e a r c h r e g a r d i n g p s y c h o m e t r i c p r o p e r t i e s o f t h e L S S will n e e d t o i n c o r p o r a t e a l a r g e r s a m p l e t h a t is d i v e r s e w i t h r e s p e c t t o r e s i d e n t i a l p l a c e m e n t a n d c l i e n t f u n c t i o n i n g level. R e g a r d l e s s o f t h i s l i m i t a t i o n , h o w e v e r , t h i s e x p e r i m e n t a l v e r s i o n o f t h e L S S is, t o o u r k n o w l e d g e , t h e o n l y r e l i a b l e int e r v i e w i n s t r u m e n t a v a i l a b l e t o m e a s u r e h a p p i n e s s a n d q u a l i t y o f life v a r i a b l e s from the perspective of mentally retarded persons themselves.
Acknowledgements--The authors extend their thanks to the personnel and clients of Developmental Services Center for their willingness to participate in this study. Special thanks are also extended to Frank Rusch for his careful reading of this manuscript.
REFERENCES Birenbaum, A., & Re, M. A. (1979). Resettling mentally retarded adults in the communityAlmost 4 years later. American Journal o f Mental Deficiency, 83, 323-329. Birenbaum, A., & Seiffer, S. (1976). Resettling retarded adults in a managed community. New York: Praeger Special Studies. Black, H. Happiness. (1911). Chicago: Fleming H. Revell. Budd, E., Sigelman, C. K., & Sigelman, L. (1981). Exploring the outer limits of response bias. Sociological Focus, 14, 297-307. Cooksey, N. B. (1916). Helps to happiness. Olney, IL: Cooksey. Edgerton, R. (1967). The cloak o f competence: Stigma in the lives o f the mentally retarded. Berkeley, CA: University of California Press. Edgerton, R. B., & Bercovici, S. M. (1967). The cloak of competence: Ten years later. American Journal o f Mental Deficiency, 80, 485-497. Gollay, E., Wyngaarden, M., Freedman, R., Kurtz, C. (1978). Coming home. Boston: Apt. Associates. Heal, L. W., & Laidlaw, T. J. (1980). Evaluation of residential alternatives. In A, R. Novak & L. W. Heal (Eds.), Integration o f developmentally disabled individuals into the community. Baltimore, MD: Paul H. Brookes. Heal, L. W., Novak, A. R., Chadsey-Rusch, J. (1981). Lifestyle satisfaction scale. (k. W. Heal, Department of Special Education, University of Illinois, 1310 South Sixth Street, Champaign, IL, 61820). Hull, C. H., & Nie, N. H. (1979). SPSS update: New procedures and facilities f o r releases 7 and 8. New York: McGraw-Hill. Hull, J. T., & Thompson, J. C. (1980). Predicting adaptive functioning of mentally retarded persons in community settings. American Journal o f Mental Deficiency, 85, 253-261. Landesman-Dwyer, S. (1981). Living in the community. American Journal o f MentaIDeficiency, 86, 223-234. Novak, A. R., Heal, L. W., Pilewski, M. B., & Laidlaw, T. (1980). Independent apartment settings f o r developmentally disabled adults: A n empirical analysis. Paper presented at the annual meeting of the American Association on Mental Deficiency. San Francisco, CA, May 1980. Russell, B. (1933). The conquest o f happiness. New York: Garden City. Schalock, R. L., Harper, R. S., & Carver, G. (1981). Independent living placement: Five years later. American Journal o f Mental Deficiency, 86, 170-177.
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Scheerenberger, R. C., & Felsenthal, D. (1977). Community settings for mentally retarded persons: Satisfaction and activities. Mental Retardation, 15, 3-7. Seltzer, G. (1981). Community residential adjustment: The relationship among environment, performance, and satisfaction. American Journal of Mental Deficiency, 85, 624-630. Sigelman, C. K., Budd, E. C., Spanhel, C. L., & Schoenrock, C. J. (1981a). Asking questions of retarded persons: A comparison of yes-no and either-or formats. Applied Research in Mental Retardation, 2, 347-357. Sigelman, C. K., Budd, E. C., Spanhel, C. L., & Schoenrock, C. J. (1981b). When in doubt, say yes: Acquiescence in interviews with mentally retarded persons. Mental Retardation, 19, 53-58. Sigelman, C. K., Schoenrock, C. J., Spanhel, C. L., Hromas, S. G., Winer, J. L., Budd, E. C., & Martin, P. W. (1980). Surveyingmentally retarded persons: Responsivenessand response validity in three samples. American Journal of Mental Deficiency, 84, 479-486. Winer, B. J. (1971). Statisticalprinciples in experimental design (2nd ed.). New York: McGrawHill.
APPENDIX L i f e t i m e S a t i s f a c t i o n Scale
The Lifestyle Satisfaction Scale (LSS) measures manifest satisfaction of an individual with their life space, including their residence and its associated features, their friends, their community, and their opportunities. Be conscious of the possibilities for scoring errors, and be continually vigilant in the matter of avoiding them. In cases of uncertainty, examiners should ask themselves,"What did the respondent really intend to communicate here?" E.g., did the respondent really not care, or did they express a preference for their present neighborhood? While it is important to be objective, an examiner should not "bend over backwards" to ignore information not directly elicited. Always record your best estimate o f the respondent's true score. Reverse Scoring The LSS measures respondents' satisfaction with their living arrangement. However, many items are worded so that a "no" answer indicates satisfaction and a "yes" indicates dissatisfaction. In order to simplify the examiner's task, all items should be scored + f o r "yes" responses or - , f o r "no" responses. The scoring formulas (below) perform reverse scoring automatically. There are two exceptions: Questions 22 and 23 have possible "no branches"i I f these "no branches" are used, then the responses to their follow-up questions miast be r6verse-scored. (E.g., if a respondent answers "no" to questibn 23, "Do you have a job?" and then responds yes to the question "'Do you Wish you had a job?" this item should be scored " - "). There is an instructional note with each item. All other reverse scoring is done with the scoring formula. Scoring Formulas The RSS has four subscales, each of which is scaled to vary from - 20 to + 20. The total scale, the Sum of these subscales, varies from - 80 to + 80. Zero is a psychological neutral point in every case. In the scoring formulae below the numbers are
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L. W. Heal and J. Chadsey-Rusch
item numbers and the signs indicate whether the item score is to be added or subtracted in the calculation of the subscale total. For example, the friends and free time subscale (PALSAT) is calculated by subtracting the score of Items 12, 14, and 15 from the score of Items 11, 13, and 16, and then multiplying this difference by 5/3. For example, if a male respondent gave an unenthusiastic "yes" to Items 11 thru 13 and an enthusiastic "no" to Items 14 thru 16, his P A L S A T score would be 5/3 ( ( + l ) - ( + l ) ( + l ) - ( - 1 ) - ( - 1 ) + ( + l ) ) o r
5/3 (4) or 6.67.
The scoring formulas are as follows: 1. General satisfaction with one's community (COMSAT)= 10/9 (91 - 2 - 3 + 4 - 5 + 6 - 7 + 8 9) 2. Friends and free time ( P A L S A T ) = 5 / 3 (+ 1 1 - 12+ 1 3 - 1 4 - 15+ 16) 3. Services (SVCSAT)+ 10/7 (18+ 1 9 + 2 0 + 2 1 + 2 2 + 2 4 + 2 7 ) 4. General satisfaction (GENSA T) + 2(10 + 17 + 25 + 26 + 28) 5. Total (TOTSA T) = COMSAT + P U L S A T + SVCSAT + GENSAT In addition to the four mutually exclusive subscales, three ancillary scales may be scored. JOBSA T consists of a single item, #23, which was retained from the fieldtest version of the LSS scale although it did not correlate with any subscale; SHORTSA T, a 13-item version of the LSS, whose reliability is as good as that of TOTSAT; and ACQUIESCENCE, composed of three pairs of items, one member of each pair requiring a "yes" to indicate satisfaction, and the other member requiring a "no" to indicate satisfaction. A significantly positive score on acquiescence implies either that the subject is disposed to say "yes" or that the examiner is inclined to recognize "yes" more easily than "no." 6. Job satisfaction (JOBSAT)= 10(23) 7. Short form (SHORTSTA T) = 10/13 ( 1 - 2 + 3 - 4 + 6 - 7 + 8 - 1 5 + 1 6 + 1 7 + 2 5 + 2 6 + 2 8 ) 8. ACQUIESCENCE~Leniency + 5(10 + 12 + 13 + 14 + 28 + 29) RESPONDENT DATE RATER LIFESTYLE SATISFACTION SCALE Laird W. Heal, Janis Chadsey-Rusch, and Angela R. Novak 1982
Informed Consent Instructions I want to ask you some questions about how you usually feel about where you live. You don't have to answer any question that you don't want to, and we'll stop anytime you want to. Okay? We want to know how people feel about where they live. We're not going to tell your supervisor or anyone else what you say, and we can't do anything to change where you live. There are no right or wrong answers. We only want to know how you usually feel. Okay? P R O C E E D ONLY IF TH E R E S P O N D E N T CONSENTS, AND TERMINATE THE INTERVIEW IF THE RESPONDENT ASKS TO DO SO. 1.(cl)
How do you like living here?
OR
Lifestyle Satisfaction
"2.(c2) "3.(c3) 4.(c4) "5.(c5)
6.(c6)
"7.(c7)
8.(c8) "9.(c9)
lO.(gl) 11.(191) * 12. (192)
489
How do you like your home where you live? Can you think of a better place to live? Where would that be? SCORE "NO" FOR A VAGUE RESPONSE. Where did you live before you lived here? Did you like it better there ( + ) or here ( - ) ? Do you like the food here? Can you think of a place to live where the food would be better? Where would that be? SCORE "NO" FOR A VAGUE RESPONSE. Whom do you live with here? Do you like living with (Name of roommate or spouse)? OR Do you like living alone? Would you like living with someone (else) better? Who would that be? SCORE "NO" FOR A VAGUE RESPONSE Do you like the neighborhood here? Can you think of a neighborhood that you would like better? Where would that be? SCORE "NO" FOR A VAGUE RESPONSE. ***What do you do in your free time? Are you happy with what you do in your free time? Do you have enough things to do in your free time? Do you wish you could enjoy your free time more? OR (OPTIONAL) Do you wish you could have more fun in your free time?
***Who are your friends here? 13.(193) Do you have enough friends? * 14. (194) Do you wish you had more friends? "15.(195) Can you think of a place to live where you would have more friends? Where would that be? SCORE "NO" FOR A VAGUE RESPONSE. 16.(196) Do you get to see enough of your friends? ***Who is your supervisor here? (PROBE IF NECESSARY) IF THE RESPONDENT USES A DIFFERENT LABEL, SUCH AS "CASEWORKER," APPLY THAT LABEL TO QUESTIONS 17. 17.(g2) Do you like your supervisor? OR How do you like not having a supervisor? ***Now I'm going to ask you about some things we call services. 18.(S1) How do you like your dentist? 19.($2) How do you like your laundry facilities? 20.($3) How do you like your taxi service? 21.($4) How do you like your grocery store and other stores around here? *Item must be reversed scored.
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L. W. Heal and J. Chadsey-Rusch
22.($5)
***Do you take any classes? 1F "YES": Do you like your classes?
OR a
IF "NO": Is there a class that you wish you could take? What would that be? aNOTE: IF THE NO BRANCH IS USED, SCORE + FOR "NO" AND FOR "YES"
23.(J1)
***Do you have a job? IF "YES": Do you like your job?
OR a IF "NO": Do you wish you had a job? aNOTE: IF THE NO BRANCH IS USED, SCORE + FOR "NO" AND - FOR "YES." 24.($6) All these things we've talked about, like the doctor, the bus, the stores, and other things, are called services. Do you like all these services?
***What are the rules here? Does your (landlord) have any rules? Does (name of supervisor) have any rules? (AS S O O N A S T H E R E S P O N D E N T M E N T I O N S A RULE, ASK): 26.(g4) Do you like that rule? 27.($7) Can you think of another rule? Do you like that rule? 28.(g5) Do you like living here? "29.(al) Would you like to go back to (USE RESPONSE FROM QUESTION 3)
0270-3092/85 $3.00+ .00 Copyright © 1985 Pergamon Press Ltd.
The Lifestyle Satisfaction Scale (LSS): Assessing Individuals' Satisfaction with Residence, Community Setting, and Associated Services Laird W. Heal and lanis Chadsey-Rusch University of Illinois at Urbana-Champaign
Satisfaction o f mentally retarded persons with their quality o f life & an important outcome measure o f deinstitutionalization. The Lifestyle Satisfaction Scale (LSS) was developed to assess mentally retarded persons" satisfaction with their residence and its community setting and associated services. An acquiescencesubscale makes it possible to correct satisfaction scores for acquiescence bias. Empirical data indicate that this experimental version o f the LSS has internally consistent subscales and good test-retest and interrater reliabilities.
An assumption that has often been made by advocates of deinstitutionalization is that if they secure residential and day services for developmentally disabled individuals in the community, then the happiness of their clients is inevitable. This assumption, however, is not necessarily tenable. It seems likely that mentally retarded citizens themselves are capable of expressing a preference among alternatives that affect them. Furthermore, in the evaluation of deinstitutionalization outcomes it seems to be more basic to assess the citizen's preferences than to assess the "normalization," the expense, the skill development, or the "residential climate" of living alternatives. As Landesman-Dwyer (1981) asserted in her recommendation to the President's C o m mittee on Mental Retardation, quality of life variables need to be assessed from the personal viewpoint of the individual clients themselves. Yet, clients'
Address reprint requests to: Dr. Laird Heal, Dept. of Special Education, 1310 S. Sixth St., University of Illinois, Champaign, IL 61820. 475
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L. W. Heal and J. Chadsey-Rusch
satisfaction with their lives has been only minimally assessed in the research on community placement of mentally retarded individuals (Heal & Laidlaw, 1980). Happiness, or satisfaction, is an elusive construct that is probably best defined individually and measured subjectively. Several main elements of "what happiness is," however, appear in a number of philosophical works (Black, 1911; Cooksey, 1916; Russell, 1933), suggesting that the construct has some consensual bases. For example, Black (1911) related happiness to good health, enjoyable work, simplicity, intellectual stimulation, and affection. Cooksey (1916) also stressed friendship, affection, and industriousness. Interestingly enough, these facets of happiness resemble those mentioned by mentally retarded persons as being important [e.g., having friends and enjoyable things to do such as hobbies and recreational activities (Gollay, Wyngaarden, Freedman, & Kurtz, 1978)]. In several studies mentally retarded persons have been interviewed regarding their feelings about living in the community, particularly in contrast to living in institutions. For example, Schalock, Harper, and Carver (1981) assessed happiness or "quality of life" variables by interviewing 69 mentally retarded persons who had been residing in the community for 3 years. Although Schalock et al. assessed quality of life primarily from a frequencycount perspective (e.g., the number of hours spent in leisure activities, the number of times downtown shopping occurred), they also discussed quality of life variables from each client's point of view. During interviews, mentally retarded individuals reported they were "proud of their apartments and felt good about 'doing their own thing' but frequently indicated they would like to have more friends" (p. 175). Schalock et al. concluded that quality of life is reflected not only by skill functioning level, but also by the feelings and wishes of the clients themselves. The results from several other studies examining quality of life issues suggest that depending on their degree of independence, most mentally retarded persons prefer to live in the community rather than in institutions (e.g., Birenbaum & Re, 1979; Birenbaum & Seiffer, 1976; Edgerton, 1967; Edgerton & Bercovici, 1976; Gollay et al., 1978; Hull & Thompson, 1980; Scheerenberger & Felsenthal, 1977; Seltzer, 1981). In these studies, friends, family, and leisure time activities were all reported as the main ingredients of happiness. Assessing the happiness of mentally retarded persons poses several methodological problems. First, happiness is conceptually inexact: different labels and correspondingly different operations have been used to index it. Second, the procedures used to collect these data have ranged from yes-no questions, to either-or questions, to open-ended questions, to direct observation. These variations are especially troublesome in that Sigelman and her colleagues (Budd, Sigelman, & Sigelman, 1981; Sigelman, Budd, Spanhel, & Schoenrock,
Lifestyle Satisfaction
477
1981a, 1981b; Sigelman, Schoenrock, Spanhel, Hromas, Winer, Budd, & Martin, 1980) have found mentally retarded individuals to be prone to an acquiescence response bias, that is, the disposition to say "yes" to any question. In summarizing their research, Sigelman et al. (1981a) reported that acquiescence occurred at high rates, and that it became even higher as the IQ level of their subjects decreased. "Thus, the use of yes-no questions in interviewing mentally retarded persons is likely not only to distort the picture of a sample that emerges but also to obscure relationships between IQ and variables of substantive interest" (Sigelman et al., 1981a, p. 348). The purpose of the present study was to develop a reliable instrument to assess mentally retarded persons' satisfaction with their lives. In order to accomplish this goal, the Residential Satisfaction Scale (RSS), which had been used in a previous study by Novak, Heal, Pilewski, and Laidlaw (1980) was refined and re-named the Lifestyle Satisfaction Scale (LSS). The RSS had been developed to assess mentally retarded persons' satisfaction with their residence, their community setting, and their community services. Although used on a small sample (n = 17), Novak et al. (1980) reported that the RSS evinced good test-retest (r = .925) and interrater (r = .95) reliability. In light of these findings, and considering the importance of assessing mentally retarded persons' satisfaction with their lives, the psychometric properties of the RSS were further investigated with a larger sample of subjects. The resulting revised scale is called the Lifestyle Satisfaction Scale (LSS; Heal, Novak, ChadseyRusch, 1982; see the Appendix). METHOD Client volunteers from a rehabilitation facility located in a medium-size midwestern city were interviewed singly using a 50-item scale to evaluate their satisfaction with their residence and their associated community and services. Item test-retest reliabilities and item analysis procedures were used to identify the subscale structure of the satisfaction scale. Statistical procedures were developed to adjust for acquiescence bias. Subscale structure and reliability were cross-validated using a previous set of data.
Subjects In this investigation, 38 subjects volunteered from a sample of about 150 individuals from the sustaining care caseload of the rehabilitation agency located in a medium-sized midwestern city. "Sustaining care" is a state-financed, locally administered service that provides whatever supports are deemed necessary to keep developmentally disabled adults from being institutionalized or re-institutionalized. Two methods were used to obtain subjects. First, the investigators sent two mailings to individuals on the sustaining care
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L. W. Heal and J. Chadsey-Rusch
caseload asking them to participate in the study. Because only eight individuals volunteered, sustaining care clients residing in a 58-bed intermediate care facility (ICFDD) were approached individually by their counselors, and 25 volunteered to be interviewed. In addition, five developmentally disabled clients, who were living in community apartments, were invited by their case workers to participate in the study. All five of these individuals consented to be interviewed. Thus, the final sample consisted of 25 subjects from the ICFDD, 12 subjects from apartments, and 1 mildly mentally retarded female from a nursing home. O f the 25 subjects living in the ICFDD, 13 were female and 12 were male. Ages ranged from 20 to 61 with a mean of 31. Seventeen of the subjects worked in the agency's sheltered workshop, 6 subjects held no job, and 2 subjects were being trained for competitive employment in janitorial services. Most recent IQ scores from subjects' files ranged from 22 to 72 with a mean of 47. The ages of subjects living in apartments ranged from 21 to 67 with a mean of 36. Six subjects were female and 6 were male. One subject worked in the sheltered workshop, 3 subjects had no job, and 8 subjects were competitively employed as food service laborers. One subject was married (to a competitively employed male), 3 subjects lived alone, and the remaining 8 subjects had r o o m m a t e s from the sustaining care caseload. IQ scores for 11 of these subjects ranged from 47 to 97 with a mean of 64. The IQ score of the 12th apartment dweller was not available. The Residential Satisfaction Scale (RSS)
The RSS, which had been used by Novak et al. (1980), was employed for the present study. The RSS consisted of 50 yes-no questions that probed subjects' satisfaction with their residence and its community setting and associated services. Subjects' scores on individual items could range from + 2, which represented an overwhelmingly favorable response, to - 2, which indicated an extremely negative response. A score of zero was recorded for ambivalent, neutral, or self-contradictory statements. Although all scale items required "yes-no" responses, seven items required examples before credit for a yes response was given. For example, one question (see question 7 in Appendix) asked subjects if they would prefer to live with someone else. If a subject answered "yes," they were then asked to name the person they would prefer to live with. If the subject named a person, they were given credit for a "yes" response. If they could not name a person, they were given a "no" score. A number of items were included in the scale to permit an assessment of response bias. Eight items were worded in such a way that a "no" answer indicated satisfaction, whereas a "yes" answer indicated dissatisfaction for eight parallel items (e.g., the last item on the scale "Would you like to move back
Lifestyle Satisfaction to
479
9,, was paired with the next-to-last item "Do you like living
here?").
Interview Procedure After subjects consented to participate, they were contacted by the authors and scheduled for an interview. During the interview, the 50 items of the instrument were read to the subject. At any time that the subject appeared to have difficulty understanding a question, paraphrasing was substituted, and variations of the question were repeated until the subject appeared to understand. When a subject contradicted a previous response, the question was repeated. Each interview was conducted in private and took about 20 min to complete. After the 50 items had been completed, the interviewer(s) thanked the subject for participating and departed. Twenty-seven subjects were retested with 7 days' delay. One subject was retested after only 4 days, four after 14 days, two after 15 days and four at longer intervals, the longest of which was 29 days. Test-retest reliabilities were calculated using the scores from one rater for the first interview and the scores from a different rater for the second interview. Thus the retest reliabilities that are reported indicate simultaneous test-retest and interrater agreement; scores' stabilities were independent of both the time at which they were taken and the rater taking them.
Interviewers and Interviewer Training Of the 98 interviews used for data analysis, 31 were conducted by the first author, 32 by the second author, and the remaining 35 by three male and three female graduate students. All interviewers were trained in the following manner: (a) each interviewer read the RSS in its entirety; (b) each practiced giving the scale to another interviewer; (c) each observed a practiced interviewer giving the scale to a respondent from the target population and, at the same time as the practiced interviewer, scored the subject's responses; and (d) each person then conducted an interview in the presence of a trained interviewer.
Data Analysis A number of statistical analyses were completed in order to assess the psychometric properties of the 50 items on the RSS (Novak et al., 1980). The goal was to cull unreliable items and develop a new scale that had independent, meaningful subscales, including an acquiescence subscale to adjust for the increasing disposition of lower IQ subjects to say yes to any question asked of them (Sigelman et al., 1981a). This new scale, which included only 29 of the original 50 RSS items, was called the Lifestyle Satisfaction Scale (LSS).
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L. W. Heal and J. Chadsey-Rusch
The analyses involved in the development and evaluation of the LSS were as follows: (a) test-retest item reliabilities in order to eliminate unreliable items, (b) conventional item analyses, used to cluster the reliable items into internally consistent subscales that had conceptual integrity, (c) cross-validation of the current (1981) subscale structure using the Novak et al. (1980) 1979 data, (d) test-retest and interrater reliabilities on the new subscales computed for both the 1981 and 1979 data, (e) intercorrelations a m o n g subscales, and (f) an analysis of covariance to see if the LSS could discriminate between subjects living in the I C F D D and subjects living in apartments. RESULTS Item Test-Retest Reliabifities
Five items, which had test-retest reliabilities of less than .2, were rejected as unreliable. The eliminated interview questions probed subjects' satisfaction with their supervisor, their bus service, their church, places they go in the community, and what they were learning. Internal Consistency
The reliable LSS items were conceptually grouped to form the following four subscales: (a) Community Satisfaction (COMSAT), (b) Friends and Free Time Satisfaction (PALSAT), (c) Satisfaction with Services (SVCSAT), and (d) General Satisfaction (GENSAT). After several iterations of re-grouping items for the SPSS subprogram, R E L I A B I L I T Y (Hull & Nie, 1979), 16 items were dropped because they failed to add to the alpha reliability of any subscale. That is, they added no new information to the items that were retained. Table 1 illustrates the internal (alpha) consistency reliabilities from the four subscales individually and for the four subscales combined (Total Satisfaction). JOBSAT, the last "subscale" on Table 1, is a single item, which was retained on the LSS despite its low correlations with other items because of its high reliabilityand substantive importance. In addition to the mutually exclusive subscales, a shortened version of the scale (SHORTSAT) was formed from 13 items that had the greatest internal consistency. The new LSS subscales were then cross-validated with the 1979 data (Novak et al., 1980). Inspection of Table 1 reveals that, except for SVCSAT (r = - .04), 1979 alphas were only slightly smaller than those obtained for the 1981 data. Test-Retest Reliabilities
Test-retest reliabilities for 1981 and 1979 samples for all subscales and the total scale of the LSS are also presented in Table 1. The range of test-retest reliabilities for the 1981 data was from .44 (PALSAT) to .83 (COMSAT), with
481
Lifestyle Satisfaction TABLE 1. Reliability Estimates of Total Lifestyle Satisfaction Scale and Subscales ~Internal Consistency Reliability
Subscale COMSAT PALSAT SVCSAT GENSAT dTOTSAT SHORTSAT ACQUIESCENCE JOBSAT
No. of Items N
1981 98
9 6 7 5 27 9 16
.79 .66 .68 .67 .85 .81 .64 -
1
1979 22
bTest-Retest Reliability
blnterrater Reliability
1981 98
1979 22
1981 22
1979 c
.67 .56 - .04 .73 .82 .81 .64
.83 .44 .72 .63 .74 .74 .74
.90 .67 .41 .91 ,93 ,95 ,58
.93 .85 .97 .98 .95 .99 .82
.60 .83 .93 .94 .95 .90 .88
-
.49
.32
.46
.44
"Cronbach's (1951) alpha bReliability is for one rater or one occasion calculated using Winer's (1971, pp. 283-296) analysis of variance coefficient, which includes rater differences as unreliability. The Spearman Brown prophecy formula should be applied to estimate the reliability for two or more raters or occasions. ¢n = 6 sbs × 3 raters JOne Acquiescence item and JOBSAT bring the total number of items on the LSS to 29.
a .74 test-retest reliability for the total scale. These data were cross-validated with the 1979 data (Novak et al., 1980), which tended to show higher testretest reliabilities than those of the present data, presumably because there were only three raters in the earlier study, compared to eight in the current one.
Interrater Reliabilities Using the conservative intraclass coefficient (Winer, 1971) to estimate reliability, Table 1 shows that the interrater reliabilities for both 1981 and 1979 data are quite high. Overall interrater reliabilities for both years ranged from .60 (1979 COMSAT) to .98 (1981 GENSAT) with an interrater reliability estimate of .95 on the total scale (TOTSAT) in both samples.
Correlations Among Subscales The intercorrelations among the subscales of the LSS are shown in Table 2. The correlations among the four major subscales are too high to support any assertion that they are measuring greatly different constructs. Nevertheless, their intercorrelations fell far short of their reliabilities, suggesting that each has some uniqueness.
.015 .015 .048
-.090
.213 .077 .029 .232 -.037 .485* .114 .033 .415" .464* .410"
"FACILITY
-.009 -.021 .485* .478* .375* .278*
AKWYES
.430 -.010 .771 .649* .776*
COMSAT
.230 .463 .336* .715"
PALSAT
.290 .229 .475*
SVCSAT
.918" .891"
SHORTSAT
.810"
GENSAT
apoint biserial correlation of each subscale with residence at the ICFDD (score = 0; N = 27) or an apartment (score = 1; N = 11). bNeither SHORTSAT nor TOTSAT are corrected for spuriousness. *p <.05
bSHORTSAT GENSAT bTOTSAT
SVCSAT
FACILITY AKWYES COMSAT PALSAT
JOBSAT
TABLE2. IntercorrelationsAmongtheLSSSubscales
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483
Comparison o f Two Facility Types Table 3 shows the comparison of two facility types, apartments and the intermediate care facility for the developmentally disabled (ICFDD). Both with (Part R 2) and without (ta) statistical adjustments for acquiescence, the apartment dwellers were significantly more satisfied with their facility and community environment (COMSAT) and their general lifestyle (GENSAT, SHORTSAT, TOTSAT). They did not differ in their satisfaction with friends (PALSAT), community services (SVCSAT), their jobs (JOBSAT), or in their acquiescence (AKWYES).
Scoring Adjustments for Acquiescence* The B regression coefficient column of Table 3 indicates that there was significant correlation between SVCSAT, GENSAT, TOTSAT, and the Short Form (SHORTSAT) with acquiescence. Thus, it is important to take acquiescence into account in determining the absolute level of satisfaction regarding these variables. The equation for adjusting these scores is:
~=X~-B(A~-A)
(1)
Where Yi = the "new" subscale score for individual; Xi= the original subscale score for individual; B = Bx,Aco from Table 3, the nonstandardized regression coefficient of X on satisfaction acquiescence; Ai = the acquiescence score for the ith individual; A -- the mean acquiescence score for the sample. (If a mean score is not available from the sample from which the ith subject was drawn, the mean scores for our ICFDD or apartment sample, on Table 3, may be used as an approximate mean acquiescence score.) DISCUSSION The evaluation of deinstitutionalization is presumably incomplete without the assessment of the happiness or satisfaction of mentally retarded persons themselves. The LSS, which assesses satisfaction with respect to residence, community environment, friends, and services, not only addresses some of the dimensions of satisfaction but also evinces internal consistency regarding their measurement.
*Scoring tables based on the 1981 sample of data are available from the authors.
4~.
.58 - .80 5.13 4.07 7.83 13.83 4.00 5.56
Mean
SD 5.58 4.77 4.92 5.70 14.61 23.46 3.49 8.47
IC F DD N=27
bAdj. - .58 - .80 5.08 4.92 7.22 13.55 5.54
mean 5.35 .45 5.45 9.09 20.35 33.13 3.75 .91
Mean
APARTMENT N=ll
2.89 5.87 3.49 1.64 9.18 8.75 2.20 13.00
SD
bAdj. 5.36 .45 5.58 9.23 20.62 33.81 .95
mean - .017 - .028 .698* .776* 1.463" 3.735* .221
aBX,AC Q
.235* - .013 .001 .215" .168" .172" _ .045
r2
.004
.236* .013 .003 .228* .176" .188"
cPart r 2
'~Unstandardized Partial Regression Coefficient relating AKWYES (acquiescence) to each row variable; facility type has been partialed out. bMeans adjusted for group differences in acquiescence. CThe squared part point-biserial correlation between the row score and the binary facility variable with acquiescence partialed out statistically. dOvetail acquiescense was significantly above zero, t(36)= 7.71. *p< .05
COMSAT PALSAT SVCSAT GENSAT TOTSAT SHORTSAT AKWYES JOBSTAT (one item)
Score (X)
TABLE 3. Comparison of the ICFDD and Apartments: Means, Standard Deviation, Adjusted Means, Unstandardized Regression Coefficients, Correlations and Part Correlations
Lifestyle Satisfaction
485
With the mentally retarded population it is not enough to define happiness; one must also devise a valid procedure to assess happiness, particularly if one relies on verbal responses. Yes-No questions, although easy to answer, lend themselves to considerable acquiescence bias, particularly as IQ level decreases (Sigelman et al., 1980). To combat this problem, Sigelman et al. (1981a) studied the use of either-or questions or pictures. Although either-or questions were found to yield more valid responses, they were also slightly harder to answer and generated a small bias toward the latter of two options named. In the same study, Sigelman et al. (1981a) found that pictures made either-or questions easier to answer and reduced the bias toward the latter choice, but did not significantly increase valid responding. Although both either-or questions and pictures deserve further evaluation as a format to use when interviewing mentally retarded persons, another option to consider is controlling acquiescence bias by statistical procedures. Regression of each LSS subscale on the acquiescence subscale neutralizes any detectable acquiescence bias. Evidence for the construct validity of the LSS lay in its ability to discriminate between two criterion groups. In this study, subjects were from two very different points on the restrictiveness continuum: Apartments and an ICFDD. Our presumption in comparing these two facility types was that the less deviant one's residential facility from the standard(s) of society at large, the more pleased the residents will be with their styles of life. Although residents in apartments varied greatly in their ability and disposition to explore the limits of the community, all were in control of their daily decisions. On the other hand, residents in the ICFDD had a very regimented schedule of sleeping, eating, and other activities. The higher LSS scores by the apartment dwellers are consistent with the hypothesis that satisfaction is correlated with less restrictive settings. The present study also demonstrated that the LSS had moderately high test-retest and interrater reliabilities and satisfactory cross-validation results. These results, however, must be interpreted with caution due to the small heterogeneous sample and sample selection process. In particular, subjects used in the present study threaten the generality of the results in at least two ways. First, it is possible that only happy subjects would volunteer for an interview with university people about their home and community. This argument is not particularly credible, however, in that volunteers were easiest to obtain at the ICFDD, where they were least happy. Second, it is possible that only stable subjects (consistently happy or consistently unhappy) would volunteer to talk about their homes and community. This second possibility also seems f a r - f e t c h e d - i t is much more reasonable to assume that volunteer bias has little affect on the stability or consistency of scores, and that these features are primarily influenced by items and procedures rather than examinees. Thus, although the sample was far from ideal, it is likely that similar reliability estimates would result from other developmentally disabled respondents.
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L. W. Heal a n d J. Chadsey-Rusch
F u t u r e r e s e a r c h r e g a r d i n g p s y c h o m e t r i c p r o p e r t i e s o f t h e L S S will n e e d t o i n c o r p o r a t e a l a r g e r s a m p l e t h a t is d i v e r s e w i t h r e s p e c t t o r e s i d e n t i a l p l a c e m e n t a n d c l i e n t f u n c t i o n i n g level. R e g a r d l e s s o f t h i s l i m i t a t i o n , h o w e v e r , t h i s e x p e r i m e n t a l v e r s i o n o f t h e L S S is, t o o u r k n o w l e d g e , t h e o n l y r e l i a b l e int e r v i e w i n s t r u m e n t a v a i l a b l e t o m e a s u r e h a p p i n e s s a n d q u a l i t y o f life v a r i a b l e s from the perspective of mentally retarded persons themselves.
Acknowledgements--The authors extend their thanks to the personnel and clients of Developmental Services Center for their willingness to participate in this study. Special thanks are also extended to Frank Rusch for his careful reading of this manuscript.
REFERENCES Birenbaum, A., & Re, M. A. (1979). Resettling mentally retarded adults in the communityAlmost 4 years later. American Journal o f Mental Deficiency, 83, 323-329. Birenbaum, A., & Seiffer, S. (1976). Resettling retarded adults in a managed community. New York: Praeger Special Studies. Black, H. Happiness. (1911). Chicago: Fleming H. Revell. Budd, E., Sigelman, C. K., & Sigelman, L. (1981). Exploring the outer limits of response bias. Sociological Focus, 14, 297-307. Cooksey, N. B. (1916). Helps to happiness. Olney, IL: Cooksey. Edgerton, R. (1967). The cloak o f competence: Stigma in the lives o f the mentally retarded. Berkeley, CA: University of California Press. Edgerton, R. B., & Bercovici, S. M. (1967). The cloak of competence: Ten years later. American Journal o f Mental Deficiency, 80, 485-497. Gollay, E., Wyngaarden, M., Freedman, R., Kurtz, C. (1978). Coming home. Boston: Apt. Associates. Heal, L. W., & Laidlaw, T. J. (1980). Evaluation of residential alternatives. In A, R. Novak & L. W. Heal (Eds.), Integration o f developmentally disabled individuals into the community. Baltimore, MD: Paul H. Brookes. Heal, L. W., Novak, A. R., Chadsey-Rusch, J. (1981). Lifestyle satisfaction scale. (k. W. Heal, Department of Special Education, University of Illinois, 1310 South Sixth Street, Champaign, IL, 61820). Hull, C. H., & Nie, N. H. (1979). SPSS update: New procedures and facilities f o r releases 7 and 8. New York: McGraw-Hill. Hull, J. T., & Thompson, J. C. (1980). Predicting adaptive functioning of mentally retarded persons in community settings. American Journal o f Mental Deficiency, 85, 253-261. Landesman-Dwyer, S. (1981). Living in the community. American Journal o f MentaIDeficiency, 86, 223-234. Novak, A. R., Heal, L. W., Pilewski, M. B., & Laidlaw, T. (1980). Independent apartment settings f o r developmentally disabled adults: A n empirical analysis. Paper presented at the annual meeting of the American Association on Mental Deficiency. San Francisco, CA, May 1980. Russell, B. (1933). The conquest o f happiness. New York: Garden City. Schalock, R. L., Harper, R. S., & Carver, G. (1981). Independent living placement: Five years later. American Journal o f Mental Deficiency, 86, 170-177.
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Scheerenberger, R. C., & Felsenthal, D. (1977). Community settings for mentally retarded persons: Satisfaction and activities. Mental Retardation, 15, 3-7. Seltzer, G. (1981). Community residential adjustment: The relationship among environment, performance, and satisfaction. American Journal of Mental Deficiency, 85, 624-630. Sigelman, C. K., Budd, E. C., Spanhel, C. L., & Schoenrock, C. J. (1981a). Asking questions of retarded persons: A comparison of yes-no and either-or formats. Applied Research in Mental Retardation, 2, 347-357. Sigelman, C. K., Budd, E. C., Spanhel, C. L., & Schoenrock, C. J. (1981b). When in doubt, say yes: Acquiescence in interviews with mentally retarded persons. Mental Retardation, 19, 53-58. Sigelman, C. K., Schoenrock, C. J., Spanhel, C. L., Hromas, S. G., Winer, J. L., Budd, E. C., & Martin, P. W. (1980). Surveyingmentally retarded persons: Responsivenessand response validity in three samples. American Journal of Mental Deficiency, 84, 479-486. Winer, B. J. (1971). Statisticalprinciples in experimental design (2nd ed.). New York: McGrawHill.
APPENDIX L i f e t i m e S a t i s f a c t i o n Scale
The Lifestyle Satisfaction Scale (LSS) measures manifest satisfaction of an individual with their life space, including their residence and its associated features, their friends, their community, and their opportunities. Be conscious of the possibilities for scoring errors, and be continually vigilant in the matter of avoiding them. In cases of uncertainty, examiners should ask themselves,"What did the respondent really intend to communicate here?" E.g., did the respondent really not care, or did they express a preference for their present neighborhood? While it is important to be objective, an examiner should not "bend over backwards" to ignore information not directly elicited. Always record your best estimate o f the respondent's true score. Reverse Scoring The LSS measures respondents' satisfaction with their living arrangement. However, many items are worded so that a "no" answer indicates satisfaction and a "yes" indicates dissatisfaction. In order to simplify the examiner's task, all items should be scored + f o r "yes" responses or - , f o r "no" responses. The scoring formulas (below) perform reverse scoring automatically. There are two exceptions: Questions 22 and 23 have possible "no branches"i I f these "no branches" are used, then the responses to their follow-up questions miast be r6verse-scored. (E.g., if a respondent answers "no" to questibn 23, "Do you have a job?" and then responds yes to the question "'Do you Wish you had a job?" this item should be scored " - "). There is an instructional note with each item. All other reverse scoring is done with the scoring formula. Scoring Formulas The RSS has four subscales, each of which is scaled to vary from - 20 to + 20. The total scale, the Sum of these subscales, varies from - 80 to + 80. Zero is a psychological neutral point in every case. In the scoring formulae below the numbers are
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item numbers and the signs indicate whether the item score is to be added or subtracted in the calculation of the subscale total. For example, the friends and free time subscale (PALSAT) is calculated by subtracting the score of Items 12, 14, and 15 from the score of Items 11, 13, and 16, and then multiplying this difference by 5/3. For example, if a male respondent gave an unenthusiastic "yes" to Items 11 thru 13 and an enthusiastic "no" to Items 14 thru 16, his P A L S A T score would be 5/3 ( ( + l ) - ( + l ) ( + l ) - ( - 1 ) - ( - 1 ) + ( + l ) ) o r
5/3 (4) or 6.67.
The scoring formulas are as follows: 1. General satisfaction with one's community (COMSAT)= 10/9 (91 - 2 - 3 + 4 - 5 + 6 - 7 + 8 9) 2. Friends and free time ( P A L S A T ) = 5 / 3 (+ 1 1 - 12+ 1 3 - 1 4 - 15+ 16) 3. Services (SVCSAT)+ 10/7 (18+ 1 9 + 2 0 + 2 1 + 2 2 + 2 4 + 2 7 ) 4. General satisfaction (GENSA T) + 2(10 + 17 + 25 + 26 + 28) 5. Total (TOTSA T) = COMSAT + P U L S A T + SVCSAT + GENSAT In addition to the four mutually exclusive subscales, three ancillary scales may be scored. JOBSA T consists of a single item, #23, which was retained from the fieldtest version of the LSS scale although it did not correlate with any subscale; SHORTSA T, a 13-item version of the LSS, whose reliability is as good as that of TOTSAT; and ACQUIESCENCE, composed of three pairs of items, one member of each pair requiring a "yes" to indicate satisfaction, and the other member requiring a "no" to indicate satisfaction. A significantly positive score on acquiescence implies either that the subject is disposed to say "yes" or that the examiner is inclined to recognize "yes" more easily than "no." 6. Job satisfaction (JOBSAT)= 10(23) 7. Short form (SHORTSTA T) = 10/13 ( 1 - 2 + 3 - 4 + 6 - 7 + 8 - 1 5 + 1 6 + 1 7 + 2 5 + 2 6 + 2 8 ) 8. ACQUIESCENCE~Leniency + 5(10 + 12 + 13 + 14 + 28 + 29) RESPONDENT DATE RATER LIFESTYLE SATISFACTION SCALE Laird W. Heal, Janis Chadsey-Rusch, and Angela R. Novak 1982
Informed Consent Instructions I want to ask you some questions about how you usually feel about where you live. You don't have to answer any question that you don't want to, and we'll stop anytime you want to. Okay? We want to know how people feel about where they live. We're not going to tell your supervisor or anyone else what you say, and we can't do anything to change where you live. There are no right or wrong answers. We only want to know how you usually feel. Okay? P R O C E E D ONLY IF TH E R E S P O N D E N T CONSENTS, AND TERMINATE THE INTERVIEW IF THE RESPONDENT ASKS TO DO SO. 1.(cl)
How do you like living here?
OR
Lifestyle Satisfaction
"2.(c2) "3.(c3) 4.(c4) "5.(c5)
6.(c6)
"7.(c7)
8.(c8) "9.(c9)
lO.(gl) 11.(191) * 12. (192)
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How do you like your home where you live? Can you think of a better place to live? Where would that be? SCORE "NO" FOR A VAGUE RESPONSE. Where did you live before you lived here? Did you like it better there ( + ) or here ( - ) ? Do you like the food here? Can you think of a place to live where the food would be better? Where would that be? SCORE "NO" FOR A VAGUE RESPONSE. Whom do you live with here? Do you like living with (Name of roommate or spouse)? OR Do you like living alone? Would you like living with someone (else) better? Who would that be? SCORE "NO" FOR A VAGUE RESPONSE Do you like the neighborhood here? Can you think of a neighborhood that you would like better? Where would that be? SCORE "NO" FOR A VAGUE RESPONSE. ***What do you do in your free time? Are you happy with what you do in your free time? Do you have enough things to do in your free time? Do you wish you could enjoy your free time more? OR (OPTIONAL) Do you wish you could have more fun in your free time?
***Who are your friends here? 13.(193) Do you have enough friends? * 14. (194) Do you wish you had more friends? "15.(195) Can you think of a place to live where you would have more friends? Where would that be? SCORE "NO" FOR A VAGUE RESPONSE. 16.(196) Do you get to see enough of your friends? ***Who is your supervisor here? (PROBE IF NECESSARY) IF THE RESPONDENT USES A DIFFERENT LABEL, SUCH AS "CASEWORKER," APPLY THAT LABEL TO QUESTIONS 17. 17.(g2) Do you like your supervisor? OR How do you like not having a supervisor? ***Now I'm going to ask you about some things we call services. 18.(S1) How do you like your dentist? 19.($2) How do you like your laundry facilities? 20.($3) How do you like your taxi service? 21.($4) How do you like your grocery store and other stores around here? *Item must be reversed scored.
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22.($5)
***Do you take any classes? 1F "YES": Do you like your classes?
OR a
IF "NO": Is there a class that you wish you could take? What would that be? aNOTE: IF THE NO BRANCH IS USED, SCORE + FOR "NO" AND FOR "YES"
23.(J1)
***Do you have a job? IF "YES": Do you like your job?
OR a IF "NO": Do you wish you had a job? aNOTE: IF THE NO BRANCH IS USED, SCORE + FOR "NO" AND - FOR "YES." 24.($6) All these things we've talked about, like the doctor, the bus, the stores, and other things, are called services. Do you like all these services?
***What are the rules here? Does your (landlord) have any rules? Does (name of supervisor) have any rules? (AS S O O N A S T H E R E S P O N D E N T M E N T I O N S A RULE, ASK): 26.(g4) Do you like that rule? 27.($7) Can you think of another rule? Do you like that rule? 28.(g5) Do you like living here? "29.(al) Would you like to go back to (USE RESPONSE FROM QUESTION 3)