A picture perfect test of well-being: Graphic assessment tool tunes into life satisfaction

After working at it for the past decade, gerontologist and Dean of the Decker School of Nursing Sarah Gueldner has led a team of colleagues from institutions the world over in the development of a unique research tool to quantifiably measure almost anyone’s sense of well-being. Refined across four countries and three continents, with the help of more than 3,000 study participants, the instrument looks as if it was torn from the pages of a children’s coloring book and can be completed with a crayon.

If the tool sounds simplistic, Gueldner is just fine with that. Existing tools to measure people’s sense of well-being have tended to be far more erudite than hers and for some populations not worth the paper they were written on, Gueldner said.

“The usual tools that people give you to measure well-being ask questions like, ’ Do you feel more pragmatic or visionary…more finite or transcendent,’” she said. ” Can you imagine going into a nursing home and asking people that?

“Many people, particularly in older groups, which is what I’m interested in, have no research voice because they couldn’t respond to those kind of questions. But they can do mine.”

Gueldner is convinced, and early studies seem to confirm, that her admittedly simple, black-and-white pictorial tool –consisting of 10 pairs of line drawings of everyday images like a butterfly, balloons, sneakers, eyes, clouds, pencils, puzzle pieces, candles and water faucets– will soon be helping nurses and other health care and human service practitioners learn more about the sometimes silent populations that rely on their services.

The fact that the tool, known as the refined Index of Field Energy (IFE-R), can be completed in crayon was proven by at least one group of children with cerebral palsy who participated in field trials of the instrument. The pictorial survey presents oppositional image sets, such as a sharp pencil opposite a dull pencil, a turtle opposite a butterfly, a lion opposite a mouse. In the space between the oppositional images are seven unnumbered and conjoined boxes that comprise a scale along which participants are asked to mark the place on the scale that best describes how they feel.

For scoring purposes each box on each of the 10 sets of scales is assigned a number from 1 to 7, with 1 being the lowest and 7 being the highest. The numbers are not used on the tool as presented to participants to avoid biasing their responses. Possible scores on completed tests range from 10 to 70, with 70 indicating the respondent has a high sense of well-being and 10 indicating a low sense of well-being.

Based on the success of trials in Africa, Taiwan and Japan and its high correlation with other measures of well-being, Gueldner feels confident that the tool will hold up as perhaps the first international tool of its kind. Even more important is its potential to reach the broadest possible range of populations, including people who may not be able to see well, may have limited formal education or language skills, and who may be too sick or frail to respond to lengthier or more complex measures. Gueldner suspects the tool will even give a research voice to persons with mild to moderate cognitive impairment.

Well-being, Gueldner says, is recognized as “a relative sense of harmony and satisfaction in one’s life.” An effective tool for measuring well being is critical to measuring the success of interventions with those suffering from a low sense of well being, a state which almost certainly affects overall health, is likely linked to depression and certainly leads to general dissatisfaction with one’s life

In the Rogerian school of nursing theory to which Gueldner subscribes, well-being can be determined by measuring four things: energy, which is also known as frequency and is akin to life force; awareness of oneself as energy or an understanding that the body is only the shape the energy we represent happens to take; action, or the choice to do something whether physical or cognitive with that energy; and power, which essentially refers to whether or not you feel able to use and channel your energy toward getting what you need in life. Gueldner’s tool is designed to measure each of these aspects of an individual’s interface with his or her social and physical environment

Gueldner’s immediate goal is to learn more about what targeted populations such as the housebound elderly think of their well-being so that, when called for, simple interventions can be tried and tested. That could mean something as simple as getting people outside for regular walks or arranging to have a friend or family member call or stop by on a daily basis.

“People just need to have one good friend. They can manage the losses of old age, as long as they have somebody that they can see and talk to everyday, catch a meal with or something. It’s hard because if you live a long time, the price you pay for that is that your friends are gone.” she said.

Gueldner’s broader goal is to use the tool to collect research data that can begin to help redefine societal notions of wellness and spur human service and health care policy changes that will allow people to live more enriched lives, for all the days of their lives.

Her own parents set a good example of how to do that, she said. By being a part of a close community they were able not only to remain in their home until their deaths, but to experience a high-quality of life even when they were ill, she said.

“They lived to be 83 and 86, well beyond their life expectancies, and they did it right. They did it about as good as you can. They had awful, really major things wrong with them. But they never did lose their will to live, their will to live good.”

Nurturing the will to live well is what Gueldner and her tool are all about. By helping to discover people who have a low sense of well-being and providing a benchmark for progress as a result of simple interventions, she hopes that perfect health will no longer be the perceived requisite for living a good life.

“They say by the time we’re 50 everybody has some type of chronic illness,” Gueldner noted. “But it usually starts sooner than that. As we add years to life expectancy, very rapidly really, we just have to think of health in a different way. We have to begin to recognize that even with serious illness, there is always the chance for well being, for a good life. Otherwise, if the belief is that there is no longer any hope of well being just because you have some things wrong with you, it’s likely to be a really long and depressing life for many people.”