1The Schedule for the Evaluation ofIndividual Quality of Life (SEIQoL)
Administration Manual
Department of Psychology
Medical School
Royal College of Surgeons in Ireland
Mercer Building
Mercer St
Dublin 2
Ireland

Ciarán A O'Boyle1 , Hannah M McGee1 , Anne Hickey1 ,C R B Joyce2 , John Browne1 , Kevin O'Malley3 , Beat
Hiltbrunner4 .
1. Department of Psychology, Medical School, Royal College of Surgeons in Ireland
2. University Psychiatric Policlinic, University of Bern, Switzerland
3. Department of Clinical Pharmacology, Medical School, Royal College of Surgeons in
Ireland
4. Clinical Research and Development, Ciba Ltd., Basle, Switzerland© Department of Psychology, Royal College of Surgeons in Ireland, 1993

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CONTENTS
Section 1: Introduction
1.1
The concept of quality of life in clinical research
1.2
The individual nature of quality of life
1.3
Judgment Analysis
1.4
The Schedule for the Evaluation of Individual Quality of Life (SEIQoL)
1.5
Appropriate respondents and applications

3
3
4
4
5

Section 2: SEIQoL Administration
2.1
Administration
2.2
Administration procedure
2.3
Potential problems in administration

6
6
9

Section 3: Scoring the SEIQoL
3.1
Recording scores
3.2
Multiple regression analysis: The Policy PC Programme
3.3
Using the Policy PC Programme
3.4
Deriving SEIQoL outcome data
3.5
Presenting data

10
10
11
12
13

Section 4: Reliability of the SEIQoL
4.1
Cue elicitation
4.2
Cue levels
4.3
Judgment analysis of weights
4.4
The SEIQoL index

13
14
14
15

Section 5: Validity of the SEIQoL
5.1
Content validity
5.2
Construct validity
5.3
Relationship with other measures

15
17
18

Section 6: Studies using the SEIQoL
6.1
Individually defined quality of life in a healthy adult sample
6.2
Psychometric properties of Judgment Analysis in a healthy adult sample
6.3
Individual quality of life in the healthy elderly
6.4
Individual quality of life in patients undergoing total hip replacement surgery
6.5
Individual quality of life in a gastroenterology unit sample

19
20
21
22
23

References.

26

Important Note:
In order to derive scores using the SEIQoL you will require a statistical programme
for conducting multiple-regression analysis. We have used the POLICY PC
Programme - Software for Judgment Analysis which derives judgment policies from
judgment analysis tasks. This, together with the reference manual, may be acquired
from Executive Decision Services, P.O. Box 9102, Albany, New York 12209.
Acknowledgements:
The development of the SEIQoL was made possible through the generous financial
support of Ciba Geigy Ltd., Basle, Switzerland and the Royal College of Surgeons in
Ireland. Specific studies were also funded by the Irish Health Research Board, The
Arthritis Foundation of Ireland and the British Geriatric Society. We acknowledge thecontributions of Mr Robert Coen for his valuable critique of the manual and wish to
thank Dr Nap Keeling, Prof Timothy O'Brien, Dr Timothy Dinan, Dr John Ryan andthose general practitioners who gave us access to their patients. Finally, we wish to
thank those individuals who agreed to allow us to measure their quality of life.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

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SECTION 1: INTRODUCTION
1.1

The concept of quality of life in clinical research
Advances in the clinical sciences this century have resulted in an impressive range of diagnostic
procedures, therapies, drugs and surgical techniques which have revolutionised the management ofheretofore fatal conditions. In addition to being concerned about life expectancy, people are also
concerned about the quality of their lives. Partly in response to the views of patients, assessment ofpatient Quality of Life (QoL) is becoming increasingly important in medicine, nursing and in the
behavioural sciences. It has already become an important outcome variable in assessing the impact
of disease, illness and treatment (Spilker, 1990; Walker and Rosser, 1993; Bowling 1991; O'Boyle,1992).
QoL is a multi-dimensional construct and there are various approaches to its evaluation. The
approach varies depending on the aims of the exercise. Health economists, for example, use
techniques such as the QALY (Quality Adjusted Life Year), standard gamble and time-trade-off
techniques in order to incorporate QoL measures into economic analysis and clinical trials. Clinicalresearch has utilised standardised and disease specific measures, usually in the form ofquestionnaires, in order to determine the impact of disease and treatment on patients' QoL. One ofthe problems of conducting research in this area is that there is no single agreed definition of QoL
nor is there a single 'gold standard' measurement technique. However, there is broad agreement thatstudies of health related QoL should include assessments of physical functioning, including somaticsensations such as physical symptoms and pain; psychological function including concentration andmood; social and sexual functioning and occupational status. Many researchers also assess patients'
global satisfaction and the economic impact of the condition.
While QoL scales and questionnaires, as well as the methods of rating and analysing them, havebeen developed by assessing the QoL of individuals, the specific items and the response categories
do not represent the free choice of individuals who are subsequently investigated using the scale.
Furthermore, the measures will often have been standardised in samples other than those currently
being assessed. Results are generally presented as group statistics and provide little or no data on the
QoL of individual patients.

1.2

The Individual Nature of Quality of Life'....... when it comes to saying in what happiness consists, opinions differ, andopinion of the wise take it to be something obvious and familiar, like pleasure ormoney or eminence and there are various other views and often the same person
actually changes his opinion. When he is ill he says it is his health, when he is
hard up he has that it is money.'
Aristotle (384-322BC) Ethica Nichomachea
A number of authors have highlighted the individual nature of QoL (O'Boyle et al., 1994). Cohen(1982) has proposed that persons are best viewed as lives lived with some degree of coherence; ahuman person is a life lived according to a human plan. It is the plan of life and the inter-related
purposes of a person that give his or her life the unity and meaning it has. When pushed to say who
we are, we reflect on our aims and upon the causes and principles with which we identify. We givean account of ourselves when we say what we did, are doing or intend to do with our lives.
Features of life can be judged by their effect on the life plan. Some are considered good while others
are considered less so. Intelligence, stamina, mobility and good health contribute to the realisationof human plans. Features of life such as the pursuit of one's vocation, the practice of one's art, theenjoyment of one's special pleasures and talents are evidence that the life plan is being advanced.
Some features of life, however, hinder or block the pursuit of a person's life plan: disease, illness,confinement to bed or to an institution, mental instability, fear and pain.

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A similar view expressed by Calman (1984) is that QoL is reflected in the differences between aperson's hopes and expectations, and their present experience. It is therefore dependent on theindividual's past experience, present life-style and his or her hopes and ambitions for the future. The
gap between hopes and reality may be narrowed in two ways. In medicine, firstly, the patient's
functioning can be improved through treatment such as surgery or drugs. Secondly, the patient may
be helped to achieve more realistic expectations through informed understanding of the limitationsof their situation and acceptance of the risks involved with treatment in relation to the expected
benefits.
Assessing the quality of an individual's life will involve attention to some elements that can bevalued by us all since they will tend to maximise the realisation of any life plan. However, since a
person's experiences, ambitions and plans are individual to him or her, some elements will be
important to a particular degree for a particular person. Most QoL questionnaires impose an external
value system on individuals by using standard formats, questions and weights of various pre-selectedcomponents of QoL derived from grouped data. The relevance of these standardised questionnaires tothe individual patient has not been addressed widely.
Specific goals or behaviours important to an individual's QoL are unlikely to be represented
adequately by broad questions about physical mobility or general health. Apparently similar
behaviours do not have the same significance for all individuals desiring to experience them, nor do
events or functions necessarily retain the same salience for a given individual with the passage oftime or indeed over the course of an illness. In assessing QoL, an individual should be given theopportunity to identify those areas which are important to him or her, indicate how well they are
doing in each particular area, and judge the relative importance of each area to their overall QoL.

1.3

Judgment Analysis
Judgment Analysis (JA), also known as policy capturing, is a research method which has been
widely used in studies of judgment and decision making. JA externalises the manner in which aperson makes a judgment or decision - their 'judgment policy'- by using statistical methods to derive
an algebraic model of the judgment process. The goal of JA is to quantify the relationships between
a person's judgment and the information, or 'cues', used to make that judgment. The theoreticalfoundations for JA lie in Brunswik's lens model (Brunswick, 1956) and in Social Judgment Theory
as developed by Hammond (Hammond et al., 1975; Brehmer and Joyce 1988). Therefore, JA differsfrom other methods of deriving algebraic judgment models such as multi-attribute utility theory, inthat it is the only method that is based on firm theoretical premises about how people cope withcomplex problems requiring judgment (Stewart, 1988a).
JA can be used, not only to model the judgment or decision process, but also as an aid to suchprocesses. It has been found particularly useful in externalising the basis for judgment when people
lack insight into the reasons for their judgments. This is often the case in expert judgment anddecision making.

1.4

The Schedule for the Evaluation of Individual Quality of Life(SEIQoL)
Components of QoL measured by the SEIQoL
The SEIQoL is designed to measure three elements of QoL:•

Those aspects of life considered by the individual to be crucial to his/her QoL are elicited bymeans of a structured interview.

•

Current functioning/satisfaction with each aspect is rated by the individual.

•

The relative importance of each aspect of QoL is measured by deriving the weight the individualassigns to each in judging overall QoL.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

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Propositions underlying the SEIQoL

1.5•

QoL is individual in nature. Those aspects of life which are important to one person may havelittle or no relevance for another. Therefore, the only valid means of assessing QoL is by selfreport.

•

An individual's judgment of their overall QoL is constructed from their assessment of theirlevel of functioning/satisfaction in discrete domains of life which they consider to be important.
Thus, a person's judgment of their QoL depends on their value system which, while generally
stable over time, may change. The relative importance which a person attaches to particular
aspects of life may change, for example, as they grow older, due to an illness or to some otherchange in their circumstances or their perception of their circumstances. The dynamic nature of
the individual's QoL is central to our understanding of the concept.

•

In judging QoL, a person evaluates each important aspect of his or her life in terms of its
relationship to worst and best possible states. This yardstick will also be specific to theindividual and will be influenced by a variety of factors including experience and expectations.

•

Only the individual can validly judge his or her QoL. Assessment of QoL in health has beendeveloped largely in the context of professional assessment of patients. Many measures ofhealth status such as the Karnofsky Index (Karnofsky and Burchenal, 1949) and the QL-Index(Spitzer et al., 1981) require the physician to rate the patient. Our perspective is that only theindividual concerned can provide a comprehensive account of his or her own QoL. Assessments
by others such as physicians or carers will be necessary in certain cases such as Alzheimer's
disease, mental retardation, vegetative states or in the case of young children. However, theseare proxy assessments and must not be confused with the individual's own assessment. Thisview is supported by studies documenting low levels of concordance between individuals'
ratings of their own QoL and the assessments of their QoL made by others including physicians(Jachuck et al., 1982; McCusker and Stoddard 1984; Magaziner et al., 1987; Pearlman andUhlmann, 1988; Slevin et al.,1990).

Appropriate Respondents and Applications
Most existing measures of quality of life are health related in that they have been designed toassess the impact of illness and treatment on the quality of life of patients, or significant
others related to the patient. They reflect a 'disease' model which is primarily concerned with themeasurement of health status and the health outcome of treatment interventions and care
(Spilker, 1990; Bowling, 1991). The SEIQoL, in contrast, is based on a phenomenologicalapproach to the measurement of quality of life, in which the terms of reference are determined
entirely by the individual. It may therefore be used for measuring the QoL of healthy
individuals (Section 6 - Studies to date) and should be free from cultural bias, although this has
not yet been investigated empirically.
The SEIQoL may be used with a variety of patient groups (see Section 6 - Studies to date) but
its applicability may be limited in illnesses which impair cognitive functioning or
motivational state. Successful completion of the SEIQoL requires, inter alia, insight into thefactors which determine one's QoL, the ability to think abstractly, the ability to makejudgments based on information presented in diagrammatic form, and the ability to provide
ratings using vertical and horizontal visual analogue scales. Therefore, its use with patient inwhom these abilities are impaired (Coen et al., 1993) may be problematic and may necessitate
modification of the standard form of the SEIQoL or use of another respondent (care-giver,'significant other'). In the latter case the estimate of QoL will be indirect and should bedesignated as such. A direct weighting technique derived from the SEIQoL has recently beenused to measure QoL in patients with HIV/AIDS (Hickey et al., 1993).
To date, the SEIQoL has been used with respondents ranging in age from early twenties to earlynineties. Johnson (1990) has shown that the elderly tend to use non-compensatory decision
strategies in completing tasks similar to JA. This might have been expected to reduce thereliability and validity of the weights.

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No such problems were encountered with healthy elderly respondents (Section 6.3). Given the
cognitive requirements of the task, as outlined above, the SEIQoL, in its present form, isunlikely to be suitable for children. We do not know what lower age limit applies, as the
SEIQoL has not yet been administered to children or to adolescents.
The SEIQoL has been specifically devised as an individual measure. It can therefore be used insingle-subject study designs and in within-subject study designs in which respondents act as theirown controls. This does not preclude its application in between-subject comparisons, but theindividual nature of the SEIQoL is necessarily compromised when data must be grouped,summarised or reduced to summary scores. For the purpose of group comparisons a global QoL
score can be calculated.

SECTION 2: SEIQoL ADMINISTRATION
2.1

Administration
The SEIQoL is administered in the form of a semi-structured interview. The interviewer firstelicits the five areas of life considered most important by the individual in determining their
QoL. The level of satisfaction /functioning in each area is next recorded followed by the JA task
which allows the interviewer to determine the relative importance of each QoL area.
The psychometric data presented in this manual was derived from studies in which the SEIQoL
was administered in exactly the manner described here. The following instructions should be
adhered to as closely as possible, with additional instructions given ONLY if absolutely
necessary, for example if the respondent does not understand the instructions as given.
In addition to this manual, you should have received the following templates:
•
•
•
•
•

Cue Definitions Record Form
Sample Cue Levels Record Form
Cue Levels Record Form
30 Hypothetical Case Forms (20 + 10 replicates)
Interview Record Form

You should make photocopies of these from the templates before commencing the interview. In
addition you will need two pens or pencils.

2.2

Administration Procedure
Step 1: Introduction
Read the following to the respondent:"For each of us, happiness and satisfaction in life depends on those parts or
areas of life which are important to us. When these important areas arepresent or are going well, we are generally happy but when they are absent
or are going badly we feel worried or unhappy. In other words, theseimportant areas of life determine the quality of our lives. What is considered
important varies from person to person. That which is most important toyou may not be so important to me or to yourhusband/wife/children/parents/friends (mention one or two of these groups as
appropriate)..and vice versa".
"I am interested in knowing what the most important areas of your life areat the moment. Most of us don't usually spend a lot of time thinking about
these things. Indeed, we often only notice that certain things are importantwhen something happens to change them.

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Sometimes it is easier to identify what is important by thinking about theareas of life that would (or do) cause us most concern when they are missing
or are going badly."

Step 2: Eliciting the five most important aspects of life (Cues)
Ask the respondent:"What are the five most important areas of your life at present - the things
which make your life a relatively happy or sad one at the moment......thethings that you feel determine the quality of your life?"
If the respondent does not understand what is required the question may be re-phrased in thefollowing ways :"What parts of your life are most important?../ What things are mostimportant?../ 'The most important things in my life are...'."•

elicit areas, NOT individuals, e.g. marriage, not wife. Do not give examples.

•

The meaning of each cue for the respondent must be documented at this stage on the Cue
Definitions Record Form. Establish what the respondent means by each quality of life area
named as being important. For example, if an individual were to name 'golf' as a cue, thismay relate primarily to leisure activity, but equally it may represent social activity, or
physical mobility. Similarly, if 'religion' were named as a cue it might relate to the
respondent's spiritual life, but might equally relate to being physically able to get tochurch, or to the social dimension of meeting one's friends at church. This is particularly
important for subsequent review of data, and of obvious relevance when respondents must
be re-assessed at some future date in order to ensure that the same cues are being considered.

•Having defined what the respondent means by the cue, it is important that the cue, aslabelled by the individual, be used by the interviewer and not the interviewer's
interpretation of what the respondent is saying.

•

Should the respondent volunteer cues which resemble 'quality of life' in meaning (e.g.
satisfaction, life quality), the interviewer should probe for more specific cues. Cues such as'happiness', 'attitude to life', 'morale' are acceptable.

•

If it is absolutely necessary to make some suggestions, then read the following list,
excluding any cues already mentioned - family, relationships, health, finances,living conditions, work, social life, leisure activities, religion/spiritual
life. This list is derived from our findings with a range of populations and represents thecues most commonly elicited, in descending order of frequency. It provides for consistency
across interviewers where such prompting is absolutely necessary.

Step 3: Determining levels
Say to respondent:"Now that you have named the five most important areas in your life, I am
going to ask you to rate how each of these areas are for you at the moment.
First I will show you an example of how the rating is done".
Place the Sample Cue Levels Record Form between you and the respondent so that the
respondent can clearly see how you carry out the rating.
"First look at this box (indicate). As you can see, there are spaces at thebottom in which I can write five important life areas of my life (indicate), andthere is a scale along the left hand side (indicate).

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

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The scale ranges from 'worst possible' on the bottom to 'best possible' on
the top, and passes through levels such as 'very bad' - 'bad' - 'neither goodnor bad' - 'good' - and 'very good' between the two extremes.
The first important area of my life is X (use a cue not already nominated by the
respondent and write it in the first space at the bottom of the rating box) and if this isgoing very well at the moment, I can show this by drawing a bar like this(draw a bar approx. 80mm high). I am using the scale (indicate) to decide how highmy bar should be. The nearer I draw the bar to the bottom line, the poorer
my rating of that area of my life and the nearer I draw it to the top line, thebetter my rating of that area of my life. A mark in the middle range would
indicate that I am rating life as neither good nor bad, but somewhere in
between."Now proceed with the ratings for the remaining cues :Second cue - "if X2 (use a cue not already nominated by the respondent and write it in thesecond space) is going as well as is possible, I would rate it by drawing a bar
like this"...(draw a bar 100mm high).
Third cue - "if X3 (use a cue not already nominated by the respondent and write it in the third
space) is going very badly, I would rate it like this"...(draw a bar approx. 15mmhigh).
Fourth cue - "if X4 (use a cue not already nominated by the respondent and write it in the
fourth space) is just all right, or 'fifty/fifty', I would rate it like this"...(draw a
bar approximately 50mm high).
Fifth cue - X5 (use a cue not already nominated by the respondent and write it in the fifth
space) - (draw a random rating).
"This provides a picture of life as I might think of it at the moment.
Thinking of my life in this way, I can now make a decision about theoverall quality of my life by marking on this line" (indicate the horizontal visual
analogue scale (VAS) below the recording box).
"This line ranges from 'the worst life imaginable' on the extreme left to 'thebest life imaginable' on the extreme right, passing through 'very bad' - 'bad'- 'neither good nor bad' - 'good' - and 'very good' between the two extremes.
If I make a mark in the middle of the line (indicate), it means that I am rating
the quality of this life as "neither good nor bad". If I mark it towards theextreme left, like this (indicate), it means that I am rating the quality of thislife as the worst I can imagine. A mark towards the extreme right (indicate)would mean rating the quality of this life is the best I can imagine. In otherwords, the nearer I make my mark to the extreme left, the poorer my ratingof that life, and the nearer I mark it to the extreme right, the better myrating of that life."
You should demonstrate to the respondent by marking the VAS at a number of different points.
Check with the respondent what he or she understands each mark to mean.

Step 4: Elicit rating of present life
Place the Cue Levels Record Form between you and the respondent. Write the respondent's fivecues in the appropriate spaces under the box. Give the respondent a pen or pencil.

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Say to respondent:"Now I want you to rate the five most important areas of your life, as you
see presented here (indicate). Firstly, draw a bar which represents how you
would rate yourself on each of these areas at the moment. As in the example
I've just shown you, the nearer you draw the bar to the bottom line, thepoorer you are rating that area of your life and the nearer you draw it to the
top line, the better your rating of that area of your life".
Have respondent draw bars.
"Now, thinking about these five areas of your life and how you have rated
them, please indicate on this scale (indicate the horizontal visual analogue) the pointthat best represents your overall quality of life at the moment".
Have respondent complete rating.

Step 5: Judgment Analysis: rating hypothetical cases
Place the first of the hypothetical cases before the respondent. Rather than having to write thefive cues under each of the 30 hypothetical cases, it is easier to write them, appropriately
spaced, on a 'post-it' type sticker. This can be applied and re-applied under each box.
Say to respondent:"So far we have talked about the way your life is at the moment. Now I
would like you to look at a series of pictures, or profiles, that show how
life could be for you. In each case I would like you to try to imagine whatlife would be like for you in such a situation. Then I want you to rate theoverall quality of life that you would have, in such a situation, using theline underneath (indicate). Once again, this line runs from 'the worst life
imaginable' to 'the best life imaginable' and you make your rating byplacing a mark on the line to show how good or bad you feel such a life
would be for you".
Should the respondent find it impossible to imagine a particular scenario as being relevant tohim or her, then you may orient him or her to the task by saying the following:"Remember that even though these are imaginary profiles some of them may
be situations that you could possibly find yourself in. Others may not be
specifically relevant to you but other people can be faced with them fromtime to time. How would you rate your quality of life if you were in thissituation?"
Have respondents complete ratings on all thirty hypothetical cases.

2.3

Potential problems in administration
The following are the problems most commonly encountered in SEIQoL administration.
- Determining cue levels
The respondent conceives the task as drawing bars in terms of their importance rather than interms of how these areas are for them at the moment.
Suggested solution: Remind the respondent that the task is to "rate how each of theseareas are for you at the moment".

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- Using the Visual Analogue Scales•

Respondent thinks that the task is to mark VAS underneath a particular cue(most important cue, least satisfactory cue, etc.).

•

Respondent thinks that only a mark at either end of the VAS is allowed.

•

Respondents thinks task is to make five separate judgments, one for each cue, on
the VAS.

Suggested solution: In each of these instances the respondent has not understoodthe nature of the task. Explain again in detail (Step 3).
•

Respondent confuses end-points of VAS and marks at end which seems inconsistent withverbal comments or earlier rating.

Suggested solution: Check with the respondent about the intention of the rating.
- Conceptualising Judgment Analysis Task•

Respondent compares cases with his or her own cue profile, and marks VAS
according to 'goodness of fit'.

•

Respondent thinks task is to judge how a case should look. For example if cue
levels are all low then respondent may mark towards 'best life imaginable'commenting that this case should be better.

Suggested solution: In each of these instances the respondent has not understoodthe nature of the task. Explain again in detail (Step 5).
•

Respondent views bar heights as representing importance rather than how theseareas are for them at the moment.

Suggested solution: Remind respondent that bar heights represent how these areas
are for them at the moment, and not their importance.

SECTION 3: SCORING THE SEIQoL
3.1

Recording Scores
Record on the Interview Record Form:
•
•
•
•
•

3.2

the length of time the respondent took to complete the task
the interviewer's rating of the respondent's understanding of the method
whether the interviewer felt that the respondent became fatigued or bored during the task
the interviewer's overall rating of the validity of the information obtained
scores on the Visual Analogue Scales for the thirty hypothetical cases.

Multiple-regression Analysis:
Derivation of cue weights involves determining by means of multiple regression analysis therelative importance of each cue to the overall VAS judgment of QoL. Various statisticalpackages can handle this type of data. However, a specific programme Policy PC has beendeveloped which makes the task somewhat easier. We have used this programme in al of our
SEIQoL studies to date.

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The Policy PC Programme
Policy PC is an interactive computer programme using multiple regression analysis andspecifically developed for analysing the results of judgment analysis techniques. A diskette andmanual for this programme are available from Executive Decision Services, P.O. Box 9102,
Albany, New York 12209, USA. The Policy PC manual explains data entry and analysis in a
stepwise fashion; it is easy to use and is designed specifically for users with no previous
computer experience. In addition to calculating cue weights, Policy PC also directly estimatesinternal validity (R2), a measure of the variance in QoL judgments explained by the five cues
used (Section 5 - Validity).

3.3

Using the Policy PC Programme
The steps involved in extracting judgment policies are explained in detail in the Policy PC manual.
Outlined below are the steps in the procedure required to use Policy PC specifically with the
SEIQoL.
Setting up Policy PC for the SEIQoL
Having loaded Policy PC according to the Manual instructions the following steps should be
followed; underlined phrases refer to programme instructions or questions:
1.
2.
3.
4.
5.
6.
7.
1.
8.

Select New Block (option 1) from the initial menu and name the New Block.
Number of cases to be judged = 30.
Number of cues = 5.
Unless using provided cues (Section 5.2), name the cues 1, 2, 3, 4 and 5.
Do you wish the cue values to be text? - NO.
The minimum, maximum, step values for each cue are 1,10,1.
Number of judges = number of respondents: in most cases there will be a single respondent =Name of Judge 1 may be any name unlikely to be used again or the study number assigned to
the respondent or the respondent's initials.
9. Judgment range is 0,100.
10. Select Old Block (option 2) from initial menu.
11. Type in name of block created in step 1.
12. Select Case Presentation (option 3) from initial menu.
13. Do you want to refine the cue set before judgments are entered? - NO.
14. Do you wish the judgments to come from an existing file? - NO.
15. Do you wish the cue values to be randomly generated? - NO.
16. Are cue values contained in an existing file? - NO.
17. Type name for new cue value set (e.g. SEIQoL30).
18. Cue values refer to the heights of the bars in the hypothetical cases and should be entered asfollows.
CASE 1 1,10,2,9,9
CASE 2 9,8,4,8,5
CASE 3 3,1,1,10,8
CASE 4 4,3,9,3,6
CASE 5 4,10,6,3,8
CASE 6 1,5,3,3,1
CASE 7 9,7,4,1,5
CASE 8 9,4,4,9,10
CASE 9 9,8,4,8,5
CASE 10 7,5,3,8,9

CASE 11CASE 12CASE 13CASE 14CASE 15CASE 16
CASE 17
CASE 18
CASE 19
CASE 20

7,5,7,6,10
6,9,1,5,5
10,2,9,8,1
10,1,1,5,6
7,9,5,8,7
9,6,5,10,8
9,2,10,10,8
6,2,10,9,2
6,1,7,6,5
1,5,3,3,1

CASE 21
CASE 22CASE 23
CASE 24
CASE 25
CASE 26
CASE 27
CASE 28
CASE 29
CASE 30

10,5,10,4,9
7,5,3,8,9
8,7,2,6,1
7,9,5,8,7
10,2,9,8,1
4,10,6,3,8
7,5,7,6,10
6,2,10,9,2
3,1,1,10,8
4,3,9,3,6© Department of Psychology, Royal College of Surgeons in Ireland, 1993

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3.4

Deriving SEIQoL outcome data
The problem of missing data should not arise when using the SEIQoL because the method isadministered by interview. However, in the event of it being a problem, for example if theinterviewer inadvertently skips a case, or a case has been omitted from the hypothetical cases,
then it is suggested that set of judgments be analysed separately, entering twenty-nine cases to
the Policy PC program rather than thirty. Any further missing data is likely to decreasesignificantly the variance explained. The SEIQoL yields the following outcome data :
(i)
(ii)
(iii)
(iv)
(v)
(vi)

Cue labels and their definitions
Cue levels
Cue weights
Internal validity
Internal reliability
The SEIQoL index(i) Cue Labels and their Definitions
During Step 2 (eliciting the five most important aspects of life), the meaning of each cue forthe respondent is summarised on the Cue Definitions Record Form, together with the label thatthe respondent used for each cue. For example, different respondents may use "religion" as a cuelabel, but it can have various meanings: a spiritual activity; a social activity (meeting friends atservices) or a physical activity reflecting mobility (being able to walk to services). The
definition is important for subsequent understanding of what was meant by the cue label. It isalso important in summarising cues from a number of respondents for grouped data
presentation.
(ii) Cue Levels
The cue levels are elicited during Step 3 when the respondent draws five bars on the Cue Levels
Record Form. Levels are scored by measuring the vertical height of each bar in millimetres.
This yields five scores which are independent continuous measurements, ranging from 0 to 100.
They can be analysed using parametric statistical methods.
(iii) Cue Weights
The cue weights are derived by entering into the Policy PC programme the respondent's global
QoL ratings on the visual analogue scales for the thirty hypothetical cases presented during
Step 5 (Judgment Analysis). For each hypothetical case use a ruler to measure the respondent's
QoL rating on the horizontal visual analogue line. Measure in millimetres from the left-handside and record each score on the Interview Record Form. Refer to the Policy PC reference
manual for use of this system. The weights always sum to 1.0 and are therefore not independent
for the purpose of statistical analysis.
Entering data

to Policy PC for individual

respondents.

1. Repeat steps 10-15 in Section 3.3 above.
2. Are cue values contained in an existing file? - YES.
3. Type name of cue value set created in Step 17 above.
4. Enter visual analogue scores for the 30 cases and save.
5. Select Extract (option 4) from initial menu to calculate weights.
6. Do you wish all function forms to be estimated quadratically? - YES.
7. Do you wish the quadratic term calculated by subtracting the cue mean? - YES.
8. No. of policies = 1
9. Judge number = 1.
10. Do you wish the analysis to be run automatically? = NO
11. Do you wish statistics displayed? = YES.
12. Press return three times and note the first R2 (internal validity) estimate from the bottom of thescreen.
13. Press return four times and note the first cue weight.
14. Press return for each of the subsequent cue weights.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

13(iv) Internal Validity
As previously described, Policy PC computes R2, a measure of the variance in QoL judgments
explained by the five cues used. This statistic provides an estimate of the internal validity of
judgment analysis. Caution should be exercised in interpreting judgment policies in which R2
is less than 0.7.
(v) Internal Reliability
The Policy PC programme does not calculate internal reliability and the administrator must do thisby calculating a Pearson correlation on the VAS scores for the 10 replicate cases. Calculate thePearson correlation on the global visual analogue scores for repeated cases as follows:
CASE 2 - CASE 9
CASE 3 - CASE 29
CASE 4 - CASE 30
CASE 5 - CASE 26
CASE 6 - CASE 20

CASE 10 - CASE 22
CASE 11 - CASE 27
CASE 13 - CASE 25
CASE 15 - CASE 24
CASE 18 - CASE 28(vi) The SEIQoL Index
The SEIQoL is intended primarily as an individual measure. Where group comparisons are
required, a global index can be calculated which may be used in within-subject or betweensubject study designs. As the index is a continuous measure ranging from 0 to 100 it can beanalysed using parametric statistical methods. Having obtained levels and weights for each of
the five cues, as described previously, the SEIQoL index is calculated as follows:•

For each cue multiply the level by the weight, then sum these products across the fivecues: SEIQoL Index =∑(levels x weights)

Care should always be taken in interpreting the index, as it is the sum of the products ofindividual cue levels by cue weights, each of which may vary independently. The index should
be interpreted in the context of the pattern of levels and weights generated for each respondent.

3.5

Presenting Data
The data from each individual respondent can be presented in tabular form giving the elicitedcues, the levels, the weights and internal reliability (r) and internal validity (R2). For grouping
data SEIQoL Index scores may be presented (cf. McGee et al., 1991, O'Boyle et al., 1992).

SECTION 4: RELIABILITY OF THE SEIQoL
4.1

Cue Elicitation
Individually defined QoL can change in a number of ways. The areas which are considered
important by the individual may change, their levels may change and/or the relative importanceof cues to each other may change. The stability of elicited cues over time was examined by
calculating the mean number of cue changes for the samples in whom no intervention occurred
between interviews. The important question is whether individuals nominate the same cues after
an elapsed period of time.
For a healthy adult sample (Study 6.4: control group), the mean number of cue changes was
1.1 (sd: 0.94; range = 0-3) over 7.5 months and 1.3 (sd: 0.83; range = 0-3) over 24 months.
For a healthy elderly sample (Study 6.3) the mean number of cue changes was 1.1 (sd: 0.76;
range = 0-3) over 12 months.
These results indicate that the domains which individuals judge to be important to their QoL arelikely to remain relatively constant over periods as long as two years.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

14

However, they may change and, consequently, if the SEIQoL is being used in a repeatedmeasures design it will be necessary to decide in advance whether to elicit cues again on
repeated testing or to require respondents to rate the previously elicited cues. We suggest thatboth should be done. The full SEIQoL should be administered at the repeat testing and if newcues are found these should be rated. Following this, the JA task can be re-presented using cues
from the first test time.
As the cues elicited are easily remembered over a short period of time, measures of inter-rater
agreement by serial elicitation of cues is precluded. At present, no research has been completed
on inter-rater reliability for cue elicitation. Test-retest reliability of cue elicitation over shortperiods is also precluded by recall effects.

4.2

Cue Levels(i) Test-retest Reliability: before and after JA
In study 6.3, elderly respondents were required to rate their cue levels before and after JA, inorder to assess the reliability of these ratings. This procedure was carried out at baseline and 12
months later. Correlations between levels at different times cannot be calculated due to thesmall number of levels (five) to be correlated. The mean absolute difference between cue levels
before and after JA was calculated for each respondent and then averaged across respondents togive the mean distance between ratings for a sample. At baseline, the average mean difference
between cue levels before and after JA was 7.0 (sd: 5.2; range = 0-21). At 12 months theaverage mean difference was 10.7 (sd: 6.2; range = 0-24.2).
(ii) Stability over longer periods
In study 6.4, a control sample of healthy adults received no intervention and cue levels for thesame cues were measured at baseline, 7.5 months and 24 months. The average mean differencein cue levels was 12.9 (sd: 6.3; range = 4-26) from baseline to 7.5 months and 12.2 (sd: 4.8;
range = 5-22) from baseline to 24 months.

4.3

Judgment Analysis of Weights(i) Internal reliability
Table 1. Internal reliability of judgment analysis in studies to dateStudy No. Sample

Mean r

6.1

Healthy adults (n=42)

0.74

6.2

Healthy adults (n=40)

0.73 (baseline)
0.75 (7-10 days)

6.3

Healthy elderly community residents(n=56)

0.66 (baseline)
0.73 (12 months)

6.4

Osteoarthritis patients undergoing
total hip replacement (n=20)0.64 (pre-op)
0.49 (7.5 months)
0.62 (24 months)

Healthy matched adult controls(n=20) for the hip replacement
sample0.71 (baseline)
0.62 (7.5 months)
0.66 (24 months)

Irritable Bowel Syndrome patients (n=28)
Peptic Ulcer Disease patients (n=28)

0.62
0.70

6.5

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

15

Standard 30-case Judgment Analysis contains ten repeat cases which allow calculation of theinternal reliability of the procedure. Mean Pearson's r correlations for these ten repeat cases arepresented in table 1 for the various samples studied to date.
(ii) Test-retest Reliability of JA weights
In study 6.2 a sample of healthy adults provided weights for the same cues at baseline and 7-10
days later. The average mean change in JA weights over this period was 8.44 (sd: 3.8; range =1.6-16.8).
(iii) Stability of JA weights over time
In study 6.4, a sample of healthy adults received no intervention and provided weights for thesame cues at baseline, 7.5 months and 24 months later. Because the Policy PC programme
constrains the weights to sum to a total of 1.0, the relative weights cannot be considered as
independent observations for the purposes of statistical analysis. Thus the same procedure used
to estimate the stability of cue levels was performed. Average mean difference in weights was
10.3 (sd: 5.2; range: 3.6-22.8) from baseline to 7.5 months and 8.0 (sd: 4.0; range: 3.0-16.8)
from baseline to 24 months.

4.4.

The SEIQoL Index
The SEIQoL is designed to measure QoL at a particular point in time and should therefore be
responsive to change. One would expect that QoL is a state type construct which should varyover time. Changes were examined by correlating SEIQoL Index scores recorded over time inpopulations receiving no intervention. For a healthy adult population (study 6.4), Pearson's r =0.33 between scores at baseline and at 7.5 months later. For the same population, Pearson's r= 0.18 between QoL scores at baseline and QoL scores 24 months later. For a healthy aged
population, (study 6.3) Pearson's r = 0.45 between QoL scores at baseline and 12 months later.
These findings indicate that the scores do fluctuate with time in normal healthy populations aswould be expected.

SECTION 5: VALIDITY OF THE SEIQoL
The key concern in assessing the validity of a measure is whether it measures what it purports
to measure - in this case individual QoL. According to Anastasi (1988 p.164) the 'validation
process begins with the formulation of detailed trait or construct definitions, derived frompsychological theory, prior research or systematic observation and analysis of the relevant
behaviour domain' We have outlined the assumptions underlying our definition of QoL in
section 1.3 above.

5.1

Content Validity
Does the SEIQoL include a representative sample of the behaviour domain under measurement
and exclude irrelevant factors? The structure of the SEIQoL is such that individuals themselves
generate the sample of items (cues) for inclusion in the QoL assessment.
The number of cues to be elicited was set at five for a number of reasons. Firstly, research
indicates that most individuals experience difficulty in making judgments requiring the
combination of information from a large number of cues and studies of decision making havemade use of relatively few cues (Stewart, 1988b). The number of cases which the individual
must judge increases in direct proportion to the number of cues on which the judgments must
be made. Ten cases are required for three cues and a further 5 cases for each additional cue(Policy PC Manual) thus giving a requirement of 20 cases for 5 cues. In the SEIQoL, 10
replicates are also included to calculate internal reliability. This gives a total requirement of 30
cases.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

16

A variety of cues has been elicited in SEIQoL studies to date. Table 2 outlines the generalnature of cues obtained from a sample of healthy young adults (study 6.1) and a sample of thehealthy elderly subjects (study 6.3). The particular cues elicited from participants have beenarranged in broad categories for the purposes of summarising results. However, the actual cuesand range of combinations of cues are many. For example, only two of forty-two healthy adults
in study 6.1 named five similar cues.
Table 2. Percentage of healthy elderly and healthy young adults nominating particular cues as relevant totheir quality of life.
___% Healthy% Healthy
Elderly (n=56)
young adults (n=42)
Cue Category

Baseline

12 months

89
95
91
80
75
16
25
18
5
5

89
59
87
89
84
14
43
21
7
5

___
FamilySocial and leisure activities
HealthLiving conditions
ReligionIndependence
Finances
Relationships
Work
Happiness

62**
38*
83
21**
7**
19
60*
86**
38**
48**

___
p < 0.05 for chi-square comparisons between healthy young adults and the elderly sample atbaseline.
** p < 0.05 for chi-square comparisons indicating differences between the young adults and theelderly at both baseline and also at 12 months.
*

Internal Validity
The extent to which judgment policies derived from JA explain the overall judgments of QoL
made by the individual may be assessed from the variance (R2) estimate provided by Policy
PC. Higher variance scores indicate that the combination of cues elicited is in fact that usedby the individual in making overall QoL judgments. All but one of the study samples haveprovided acceptable mean internal validity scores exceeding 0.70 (Table 3). In the case ofpatients with osteoarthritis, R2 was somewhat lower.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

17

Table 3. Internal validity (R2) of judgment analysis in SEIQoL studies to date.
_Study No. Sample

Mean R2_

6.1

Healthy adults (n=42)

0.75

6.2

Healthy adults (n=40)

0.78 (baseline)
0.79 (7-10 days)

6.3

Healthy elderly community residents(n=56)

0.72 (baseline)
0.78 (12 months)

6.4

Osteoarthritis patients undergoing
total hip replacement (n=20)

0.62 (pre-op)
0.65 (7.5 months)
0.64 (24 months)

Healthy matched adult controls(n=20) for the hip replacement sample

0.76 (baseline)
0.72 (7.5 months)
0.71 (24 months)

6.5

Irritable Bowel Syndrome patients (n=28)
Peptic Ulcer Disease patients (n=28)

0.73
0.79
_

5.2

Construct Validity
Does the measure assess the theoretical construct of individual QoL? Two fundamental aspectsof the measure; individual cue generation and individual weighting of cues can be assessed.
(i) Evidence of need for an individual approach: cues
Most traditional measures purporting to measure QoL provide the individual with a predetermined list of items which are previously weighted on the basis of grouped data. Our studies
show that, while a number of cues frequently assessed by such instruments were often elicitedusing the SEIQoL (e.g. health, family and work), other cues such as religion, finance andeducation were also nominated. Cues unique to a single study participant (e.g. politics,
aesthetics) were also elicited regularly.
Can cues be provided?
In a number of studies we have provided participants with cues derived from more traditional
health status questionnaires. QoL assessment using these cues was possible and provided
acceptable internal validity scores, e.g. R2 = 0.79 in a sample of healthy adults (Study 6.1) andR 2 = 0.74 in a sample of patients undergoing hip replacement (Study 6.1). However, thecorrelation between elicited cues QoL and provided cues QoL was moderate (Pearson r = 0.49)
for the healthy adult sample. SEIQoL index scores based on provided cues were not sensitive tosurgical intervention. Scores did not show significant improvement following total hip
replacement (change from 66.1 to 70.6 over 7.5 months; n.s.) while SEIQoL index scoresderived using an elicited cues format were sensitive to the surgery (change from 61.6 to 70.7
over 7.5 months; p<0.02).
Does age have an effect?
Different cues might be expected to be important to individuals at different stages in the lifecycle. A comparison of a healthy younger and older adults (Studies 6.1 and 6.3, respectively)
showed that areas such as religion and social and leisure activities were nominated significantly
more often by the older group (Table 2). Areas such as work and relationships (as distinct fromfamily) were more often identified by the younger group.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

18

These differences are what might be expected in Western society and are consistent withtheoretical models of the life-cycle such as that proposed by Erikson (1963).
SEIQoL in health and disease.
QoL as defined by SEIQoL is not equivalent to health status. Health was not the mostcommonly nominated cue in most studies to date, including studies where the sample wasdefined on the basis of health problems and interviewed in a medical context (e.g. hip
replacement, irritable bowel syndrome, peptic ulcer disease).
In patients with severe osteoarthritis, (Study 6.4) for example, health was not nominated as animportant cue by all participants. In fact, only 10/20 patients and 14/20 controls respectively,
mentioned health. Patients with osteoarthritis accorded lower weights on average to the provided
cue 'general health' than did controls (Table 6).
(ii) Evidence of need for individual approach: weights
Weights may change over time. For example, patients who had received a hip replacement 7.5
months previously gave significantly greater weighting to the 'general health' cue postoperatively while controls did not change their weighting as a group (table 6). Average weights
for the provided cue 'physical functioning', ‘emotional functioning’, ‘social functioning’ and‘living conditions’ did not change with time.
Table 4. Average weights assigned by patients and controls to the provided cue 'General
health'.
_Baseline
7.5 months post-op
Mean (sd)Mean (sd)_Hip replacement patientsControls

0.28 (0.10)
0.33 (0.13)

0.35 (0.13) (p < 0.01)
0.35 (0.14) (ns)_

Respondents are also able to recognise weighting policies that have been captured through JA,
establishing the criterion validity of the procedure. In study 6.2 a sample of healthy adults
provided a weighting policy (5 weights summing to 1.0) for five elicited cues via JA. 7-10 days
later they were presented with 10 weighting policies for the five elicited cues, and asked to rankorder them in terms of how well they fitted their own current policy for those cues. Unknown
to the subjects, one of the weighting policies was the JA policy they had previously provided.
The mean rank given to their own policy was 2.87, with 62.5% of subjects placing their policy
within the first three ranks, and all subjects placing it within the first five.
In patients with gastrointestinal disorders (Study 6.5), the SEIQoL index was more sensitive todifferences between the groups than a summary score based on mean cue levels alone. Whenpatients with irritable bowel syndrome (IBS) were compared with those who had peptic ulcer
disease (PUD) the differences between the groups were just significant for scores based on meanlevels alone. However, Index scores incorporating weights clearly discriminated between thegroups. Incorporating weights dramatically changed individual scores. Paired t-tests between
SEIQoL index scores and scores based solely on mean cue levels showed highly significant
differences for the two groups (p<.001 for PUD and p<.0004 for IBS).

5.3

Relationship with other Measures
QoL, as measured by SEIQoL, is related to health measures in the expected direction but is not
sufficiently similar to any measure yet assessed to negate its unique contribution to themeasurement of QoL.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

19(i) Hip Replacement Study (6.4)
This study compared global SEIQoL scores with those derived from a general measure ofhealth status: the McMaster Health Index Questionnaire (MHIQ; Chambers et al., 1982). The
MHIQ is derived from the World Health Organisation definition of health as comprisingphysical, social and emotional well-being. The questionnaire comprises three subscales
corresponding to these 3 components of well-being. The correlation between SEIQoL index
scores and total MHIQ scores was r = 0.21. Both measures were sensitive to hip replacement
surgery but the sensitivity of the MHIQ reflected changes only on the physical functioning
subscale.
The SEIQoL was also compared with the Arthritis Impact Measurement Scales (AIMS; Meenan
et al., 1980) a disease-specific measure of QoL for arthritis. SEIQoL index scores correlated
only moderately (r = -0.25; p < 0.05) with those of the AIMS.
The mean correlation between the SEIQoL index scores and the Harris Hip Rating, a physicalfunctioning scale (Harris, 1969) was r = 0.12. This indicates that the SEIQoL is measuringsomething other than physical functioning.

SECTION 6: STUDIES USING THE SEIQoL
6.1

Individually Defined Quality of Life in a Healthy Adult
Sample.
FOCUS:
Initial psychometric evaluation of the SEIQoL methodology.
STRUCTURE:
Sample of healthy adults.
TIME FRAME: Single interview.
SAMPLE SELECTION: Consecutive attendees at the International Immunisation Clinic of theRoyal College of Surgeons in Ireland for inoculation/vaccination before travel abroad. The sample
comprised 42 individuals (20m/ 22f). Mean age was 28.8 (range = 19-51). All participants could
complete the SEIQoL.
SEIQoL CUE PARAMETERS:(a) elicited cues.
(b) provided cues: 5 cues provided from general QoL research (physical, social and emotional
functioning, living conditions and general health) presented after the elicited cue task.
STUDY RESULTS:
Features of life elicited as important to QoL by individuals are outlined in table 2. Some cues suchas family were common to many individuals. However, some cues such as religion or education
were nominated by only a few individuals. Not all subjects mentioned health as an important aspectof their QoL. Of the 35 who did, there was considerable variability in the weight attached to it. JA
weights for health ranged from 0.03 to 0.59 of a maximum possible 1.0. This illustrates thevariability in individual definitions of QoL.
Table 5. Study results of young healthy adult study.
_
Elicited cues

SEIQoL index
Internal reliability
Internal validity

Provided cues

Mean

sd

Range

Mean

sd

Range

77.4
0.74
0.75

9.5
0.07
0.13

52.0-95.3
0.15-0.95
0.46-0.94

80.0
0.69
0.79

7.0
0.18
0.11

_
61.5-96.0
0.13-0.95
0.47-0.93_© Department of Psychology, Royal College of Surgeons in Ireland, 1993

20

Table 6. Range of weights attributed to five provided cues in judgment decisions on QoL using
the SEIQoL.
_
Mean weight
Range_
Physical functioning
0.22
0.03-0.38
Social functioning
0.14
0.05-0.44
Emotional functioning
0.24
0.02-0.46
Living conditions
0.14
0.02-0.30
General health
0.26
0.09-0.54_
The relationship between SEIQoL Index scores based on elicited and provided cues was
significant (Pearson r = 0.49, p < 0.001) but accounted for less than 25% of the common
variance. Thus, the measures are not interchangeable. The mean index scores from the two
measures do not differ significantly (Table 5).
Examination of cue weights in the provided cue version of the SEIQoL (table 6) illustrates thevariability in cue weights which occur in a healthy sample. The SEIQoL is one of the few QoL
measures which measures the weight attached to a particular aspect of Qol by respondents.
This initial study illustrated the individual and phenomenological nature of QoL. Different cues
were nominated and the relative importance of the same cues also varied from person to person.
The ability of all participants to complete the SEIQoL and the resultant levels of internalreliability and validity which were high, justified further exploration of the measure withpatient populations.

6.2

Psychometric Properties of Judgment Analysis in a
Healthy Adult Sample.
FOCUS:

Test-retest reliability and criterion validity of judgment
analysis.
STRUCTURE:
Repeated measures study in a sample of healthy adults.
TIME FRAME: Interviews at baseline, 7-10 days and 14-20 days.
SAMPLE SELECTION: Staff members of a medical college and postgraduate research
students of a psychology department. The sample comprised 40 individuals (15m/ 25f). Meanage = 31.2 (range = 20-53). All could complete Judgment Analysis.
SEIQoL CUE PARAMETERS: elicited cues.
PROCEDURE:
At baseline (t1) five cues were elicited. Judgment analysis was carried out
using these cues at baseline and 7-10 days (t2) in order to establish test-retest reliability. A
further 7 to 10 days later (t3) subjects received a questionnaire by post containing ten weighting
policies for the five cues. A policy refers to five weights that sum to 1.0. Of these ten policies,
one was the JA policy provided by the subject concerned at t2. Unaware of this, subjects wererequested to rank order the policies in terms of how closely they resembled their own current
policy for the cues. These ranks were then used as a measure of criterion validity. The aim wasto determine whether subjects could select from a range of alternatives their particular judgment
policy (Reilly and Doherty, 1989).
STUDY RESULTS:© Department of Psychology, Royal College of Surgeons in Ireland, 1993

21

Table 7. Internal reliability and validity of JA at time 1 and time 2.
___________________________________
Time 1Time 2_______________
Mean sdrange
Mean sdrange___________________________________
Internal reliability
0.73
0.2
0.29-0.90
0.75
0.2
0.35-0.93
Internal validity
0.78
0.1
0.58-0.93
0.79
0.1
0.37-0.94___________________________________
The average mean difference between JA weights at t1 and t2 was 8.44 (sd: 3.8; range = 1.616.8).
Recognition of JA Policies.
Seven subjects (17.5%) gave their first rank to the JA policy most closely resembling theircurrent policy, 10 (25%) ranked the appropriate JA policy second, 12 (30%) ranked it third, 3(7.5%) ranked it fourth and 8 (20%) ranked it fifth. The mean rank for JA policies was 2.87
(range 1-5) from a possible 10. Therefore, 62.5 % of respondents placed their own judgment
policy within the first three ranks and all subjects placed it within the first five.
These findings indicate that, in general, policies derived from JA closely resembled those which
subjects felt were their own policies.

6.3

Individual Quality of Life in the Healthy Elderly.
FOCUS:
Normative study of quality of life in the healthy elderly.
STRUCTURE:
Longitudinal study of a cohort of healthy elderly.
TIME FRAME: Sample interviewed at baseline and 12 months later.
SAMPLE SELECTION: Randomly selected general practitioners in urban Dublin area were
contacted and asked to participate in study. Sixty seven healthy respondents were randomly selectedfrom general practitioner files, and were interviewed at baseline. Health criteria were: (a) not onprescribed medication, (b) not on a waiting list for medical treatment, (c) no chronic disorder, (d) no
acute disorder requiring prescribed medication within previous six months. Seven (9.6%) wereunable to understand the SEIQoL. Of the 60 respondents who had completed the SEIQoL atbaseline, 2 had died and 2 were incapacitated by ill-health at 12 months. Thus, the study sample
comprised 56 healthy aged community residents (22m/ 34f) of mean age = 73.7 years (range - 6590).
SEIQoL CUE PARAMETERS:General life area cues elicited at time 1 and time 2.

OTHER MEASURES: Other measures used were: (a) Self Evaluation of Life Functioning scale(SELF) , adapted to measure physical, social and psychological functioning in aged samples (Linn and
Linn, 1985); (b) Mini- Mental State Examination, a brief measure of cognitive impairment (Folstein
et al., 1975); (c) Life Satisfaction Index, a measure of successful ageing (Neugarten et al., 1961);(d) Life Experiences Survey, a measure of the number and perceived impact of life changes occurringin the previous 12 months (Sarason et al., 1978).
STUDY RESULTS:
SEIQoL Index scores and psychometric indicators derived from SEIQoL are shown in table 12.
SEIQoL Index scores were correlated with psychosocial measures at baseline and 12 months as shownin Table 9.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

22

Table 8. Mean, SD and range of overall QoL scores, internal reliability and internal validity
co-efficients for a healthy elderly cohort.
___________________________________
Baseline
12 months
Mean sdrange
Mean sdrange
SEIQoL index
82.1
12.2
47.3-100
80.06 11.2
51.9-100
Internal reliability
0.66
0.24
0.01-0.94
0.73
0.18
0.36-0.98
Internal validity
0.72
0.15
0.30-0.92
0.78
0.12
0.41-0.97___________________________________
Table 9.Pearson r correlations between SEIQoL Index scores and a range of psychosocial
measures at baseline and at 12 months for a healthy elderly cohort.
___________________________________MEASURE
Correlation with SEIQoL Index
Baseline
12 months
Self Evaluation of Life Functioning
Symptoms of ageing
Self-esteem
Social satisfaction
Depression
Personal control

-0.07
-0.15
-0.22
-0.13
0.12

-0.43*
0.03
0.03
-0.27
-0.34*

Mini-Mental State Examination

0.13

-0.24

Life Experiences Survey
Number of life events
Mean overall impact of life events

0.10
0.06

0.08
0.005

Life Satisfaction Index

0.17_______________

0.29____________________* p < 0.01

6.4

Individual Quality of Life in Patients undergoing Total Hip
Replacement Surgery.
FOCUS: Prospective longitudinal study to determine the sensitivity of the SEIQoL to change
following a surgical intervention. Comparison of SEIQoL using cues elicited from therespondents with SEIQoL in which cues were provided by the investigator. Comparison of the
SEIQoL with disease-specific health-status measures.
STRUCTURE: Patients undergoing total hip replacement (THR) surgery compared withmatched community controls.
TIME FRAME: 6 weeks before, 7.5 months after and 2 years after THR surgery for patientsand equivalent time for controls.
SAMPLE SELECTION: Consecutive patients with unilateral osteoarthritis of the hip andscheduled for THR at one centre were interviewed to achieve a sample of 20 (7m/13f). Mean ageof the patient sample was 65.2 (range = 45-80). Controls were healthy adults selected from one
general practice register and matched with patients by age, sex and social class. Mean age of thecontrol sample was 63.4 (range = 43-78).
SEIQoL CUE PARAMETERS:a) Elicited cues: Patients were asked to nominate their 5 most important cues pre-operatively.
Following surgery the SEIQoL was administered using these previously nominated cues. In
addition, cues were again elicited in order to determine the proportion of patients in whom thenominated cues changed.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

23(b) 'Provided' cues: 5 general cues (i.e. physical, social and emotional functioning, living
conditions and general health) reflecting areas normally included in health status measures were
provided and the SEIQoL completed using these cues.
STUDY RESULTS:
Table 10a: Study results for elicited cues.
___________________________________

THR patientsControls

Mean

SD

Range
Mean SD
Range___________________________________

61.6
0.64
0.62

18.8
0.30
0.19

27.4-96.0
0.08-0.95
0.25-0.97

60.7
0.71
0.76

9.4
0.24
0.14

37.2-73.2
0.10-0.96
0.25-0.94

7.5 months post-operative
SEIQoL Index
70.7
Internal reliability
0.49Internal validity
0.65

11.2
0.22
0.16

50.0-86.7
0.01-0.96
0.33-0.94

59.8
0.62
0.72

15.6
0.34
0.13

24.8-83.3
0.03-0.96
0.42-0.88

24 months post-operative
SEIQoL Index
69.3
Internal reliability
0.62Internal validity
0.64

10.2
0.26
0.17

39.9-91.3
61.3
9.0
44.7-73.3
0.02-0.86
0.66
0.27
0.15-0.96
0.39-0.88
0.71
0.23
0.40-0.91___________________________________

Baseline
SEIQoL Index
Internal reliability
Internal validity

Using elicited cues, the SEIQoL was sensitive to changes in quality of life following hip
replacement surgery. SEIQoL Index scores were positively, although not strongly, correlated withthose of the McMaster Health Index questionnaire and the Arthritis Impact Measurement Scales (cf.
Section 5.3 of this manual). SEIQoL Index scores derived from cues provided by the investigator
were insensitive to the change in quality of life following surgery.
Table 10b. Study results for provided cues.
___________________________________

THR patientsControls

Mean

SD

Range
Mean SD
Range___________________________________

66.1
0.68
0.74

12.5
0.22
0.14

41.0-87.4
0.12-0.90
0.43-0.90

65.6
0.64
0.72

14.3
0.28
0.14

28.9-83.4
0.04-0.94
0.31-0.91

7.5 months post-operative
SEIQoL Index
70.6
Internal reliability
0.46Internal validity
0.76

8.5
0.29
0.13

55.6-88.4
0.04-0.97
0.46-0.93

65.9
0.73
0.82

13.9
0.14
0.19

28.3-90.2
0.47-0.95
0.65-0.93

24 months post-opeative
SEIQoL Index
70.7
Internal reliability
0.58Internal validity
0.66

12.2
0.26
0.15

43.3-98.0
65.0
11.2
33.1-78.4
0.05-0.90
0.56
0.26
0.02-0.89
0.28-0.91
0.71
0.15
0.26-0.91___________________________________

Baseline
SEIQoL Index
Internal reliability
Internal validity

The data from this study support the validity of the SEIQoL since the measure is sensitive tochange, is related, but not strongly, to measures of functional status, and is more sensitive tochange if the patients' own cues are used.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

24

6.5

Individual Quality of Life in a Gastroentorology Unit
Sample.
FOCUS: Description of quality of life for two distinct patient groups and comparison of
SEIQoL results with those of health and functional status measures.
STRUCTURE: Patients attending an out-patient clinic for treatment of irritable bowel
syndrome (IBS) or peptic ulcer disease (PUD).
TIME FRAME: Cross-sectional single interview.
SAMPLE SELECTION: 28 patients (12m/ 16f) with irritable bowel syndrome (IBS) and28 patients (16m/ 12f) with peptic ulcer disease (PUD). Patients were consecutive out-patient
attendees at a gastroenterology unit. Mean age of the IBS sample was 33.2 (range = 17-64) andmean age of the PUD sample was 35.9 (range = 19-72). All patients were able to complete the
SEIQoL.
SEIQoL CUE PARAMETERS: elicited cues.
OTHER MEASURES: The Gastrointestinal Symptom Rating Scale (GSRS) (Svedlund etal, 1988), a 15-item symptom scale designed for use with IBS and PUD populations, wascompleted by the attending physician. Illness-related QoL was assessed using the Psychosocial
Adjustment to Illness Scale (PAIS) (Derogatis, 1986), a self-report measure designed tomeasure patient adjustment to illness on seven domains: health care orientation, vocational
environment, domestic environment, sexual relationships, extended family relationships, social
environment and psychological distress. Health status was assessed by means of theNottingham Health Profile (NHP) (Hunt et al, 1986). This measure comprises two parts. Part I
consists of statements describing health problems in six domains: energy, pain, emotional
reactions, sleep, social isolation and mobility. Part 2 lists 7 likely problem areas (job,household management, social life, family life, sex life, interests and hobbies and holidays).
Respondents indicate if their present state of health is causing problems with any of these areas.
STUDY RESULTS:
Table 11. Mean, SD and range of overall QoL scores, internal reliability and internal validity
co-efficients for IBS and PUD samples.
___________________________________IBS
PUD_______________
Mean sdrange
Mean sdrange___________________________________
SEIQoL Index
62.9
17.4
25.8-95.4
72.6
12.6
50.9-93.8
Internal reliability
0.62
0.33
-0.69-0.95
0.70
0.26
-0.21-0.96
Internal validity
0.73
0.15
0.23-0.90
0.79
0.10
0.54-0.92___________________________________The dimensions of life considered important for QoL and the frequency with which they are
mentioned by both groups are illustrated in table 11. Health was nominated less frequently by
the PUD group than by the IBS group or healthy sample. This finding indicates that thepresumption that health is automatically an important component of patients' perceived qualityof life may not be warranted. Health may be viewed by patients as facilitating other important
aspects of their lives rather than something to be valued in isolation.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

25

Table 12. Elicited cues for the PUD and IBS groups and for the healthy young adult group(Study 6.1). Data show the percentage of respondents who nominated each cue.
___________________________________Cue Category% Healthy
% IBS
% PUD
___________________________________
Relationships
86
36*‡
50‡
Health83
89*
61‡
Family62
100*‡
93‡Finance60
57*
39‡Happiness
48
14‡
7‡
Work
38
61‡
57‡
Social and Leisure
38
82‡
75‡
Living conditions
21
29*
50‡
Education
19
4‡
11
Independence
19
4‡
11
Religion
7
7
14
Misc.
17
18*
32‡
___________________________________* Significantly (at least p<0.05 for chi-square test) from PUD group.
‡ Significantly (at least p<0.05 for chi-square test) from healthy group.
The GSRS scale indicated that patients with IBS suffered higher levels of symptomatology than
did the PUD group (Table 12). SEIQoL Index scores but not PAIS or NHP scores significantly
distinguished the two groups, indicating that IBS patients as a group had significantly lower
QoL than the PUD patients. The mean QoL of the IBS group, but not the PUD group, wasalso significantly lower than that of the young healthy sample (mean 77.4; sd: 9.5; t = -3.3, p< 0.01; Study 6.1). This finding is supported by research and by clinical perceptions that IBS
disrupts QoL to a greater degree than does PUD (e.g. Whitehead et al, 1982; Guthrie et al,1987).
Table 13. Mean symptom ratings (sd.), SEIQoL Index scores and summary scores on the NHP
and PAIS for PUD and IBS groups.
___________________________________
MeasureIBS
PUD___________________________________
Gastrointestinal Symptom Rating Scale
17.7 ( 5.3)
14.1 ( 6.5) *SEIQoL Index
62.9 (17.4)
72.6 (12.6) **PAIS Total Score
37.9 (14.0)
32.3 (16.2)
NHP Part 2 Total score
2.3 ( 1.8)
1.9 ( 2.0)___________________________________* p < 0.05; **p < 0.01 for comparisons between groups.
Although IBS patients were ambulatory, living in the community and continuing withactivities of daily living such as employment, they were more likely to perceive that their QoL
was impaired by their condition. On the health status measures IBS patients scored significantly
lower than PUD patients only on the psychological distress scale of the PAIS and on the social
isolation scale of the NHP.
Relationships among measures
There were no significant relationships between the SEIQoL Index scores and either PAIS
subscale or total scores. Neither was there a relationship between SEIQoL Index scores andscores on Part 2 of the NHP. SEIQoL scores were significantly related to 2 of 6 subscales ofPart 1 of the NHP: sleep (r = 0.38, p < 0.01) and social isolation (r = -0.29, p < 0.05). Total
scores on the PAIS and the NHP (Part 2) were significantly related (r = 0.69, p < 0.001).
SEIQoL scores did not correlate with the medical severity rating on the GSRS. The GSRS was
not significantly correlated with the PAIS total score but showed a modest relationship with the
NHP (part 2) summary score (r = 0.33, p < 0.05). Low correlations between medically-rated
symptomatology on the GSRS and patient-rated measures of QoL indicated that quality of life
was not directly proportional to severity of medical symptoms in this sample. The results
suggest that clinical assumptions about patient QoL, if based solely on levels of
symptomatology, may not relate to patients' own perceptions of their QoL.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

26

This study illustrated that the SEIQoL could be completed by medical populations. It was moresensitive to the health status differences between the groups than were the traditional healthrelated QoL measures.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

27

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Hickey, A., Bury, G., O'Boyle, C.A., O'Kelly, F.D., Bradley F. and Shannon W. (1993).
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© Department of Psychology, Royal College of Surgeons in Ireland, 1993

1

The Schedule for the Evaluation ofIndividual Quality of Life (SEIQoL):a Direct Weighting procedure for Qualityof Life Domains (SEIQoL-DW)

Administration Manual

Department of Psychology
Medical School
Royal College of Surgeons in Ireland
Mercer Building
Mercer St
Dublin 2
Ireland

Ciarán A O'Boyle1 , John Browne1, Anne Hickey1 , Hannah M
McGee1, C R B Joyce21.
2.

Department of Psychology, Medical School, Royal College of Surgeons in Ireland.
University Psychiatric Policlinic, University of Bern, Switzerland.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

2

CONTENTS
1.0 Introduction

3

2.0 SEIQoL-DW Administration

3

2.1 Administration Procedure4

2.2 Potential Problems in Administration

6

3.0 Scoring the SEIQoL

7

3.1

Recording Scores7

3.2

Deriving SEIQoL Outcome Data7

3.3

Presenting Data8

3.4 Using SEIQoL-DW in Prospective Study Designs

4.0 References

8

9

Acknowledgements:
The development of the SEIQoL was made possible through thefinancial support of CIBA Geigy Ltd, Basle, Switzerland and the Royal
College of Surgeons in Ireland. Specific studies were also funded by
the Irish Health Research Board, The Arthritis Foundation of Ireland,
the British Geriatric Society and the HIV Primary Care Research
Project.
© Department of Psychology, Royal College of Surgeons in Ireland, 1993

3

SCHEDULE FOR THE EVALUATION OF QUALITY OF LIFE
(SEIQoL):A Direct Weighting Procedure for Quality of Life Domains
C. A. O’Boyle, J. Browne, A. Hickey, H. M. McGee, C. R. B. Joyce.
Department of Psychology, Royal College of Surgeons in Ireland, Mercer Building, Mercer
Street Lower, Dublin 2, Ireland.

1.0

Introduction

The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) is an interviewbased instrument for the assessment of quality of life (QoL) of the individual. Theinterview procedure associated with the full version of the SEIQoL (McGee et al, 1991;
O’Boyle et al, 1992) requires considerable time to complete (10-30 minutes) and thus may
be primarily suitable for research settings or clinical situations where the instrument is being
used as part of the process of having the individual consider a range of options or outcomesin evaluating QoL. The SEIQoL has been used with a variety of patient groups, but its
applicability may be limited in illnesses which impair cognitive functioning or motivational
state. Successful completion of the SEIQoL requires, inter alia, insight into the factors
which determine one’s quality of life, the ability to think abstractly and the ability to makejudgments based on information presented in diagrammatic form. Therefore, its use withpatients in whom these abilities are impaired may be problematic (Coen et al, 1993).
A direct weighting procedure for QoL domains that is more suitable for routine clinical use
than Judgment Analysis (JA) and that may impose fewer demands on individuals with
reduced cognitive function has been developed for the SEIQoL (Hickey et al., 1996).
Psychometric information on the procedure has been obtained from a healthy adult
population (Browne et al, 1997).
The procedure for administering the method is as follows:

Administration of SEIQoL using the Direct Weighting (DW)
Procedure
2.0

Administration
The SEIQoL and SEIQoL-DW is administered in the form of a semi-structured
interview. The interviewer first elicits the five areas of life considered mostimportant by the individual in determining his/her QoL. The level ofsatisfaction/functioning in each area is next recorded followed by the SEIQoL-DW
task which allows the interviewer to determine the relative importance of each QoL
area using the disk provided.
A SEIQoL interview form, SEIQoL-DW disk, pen and non-permanent marker pen
are required for the interview.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

4

2.1

Administration Procedure
Step 1: Introduction
Read the following to the respondent:“For each of us, happiness and satisfaction in life depends on those parts or
areas of life which are important to us. When these important areas arepresent or are going well, we are generally happy but when they are absent
or going badly we feel worried or unhappy. In other words, these important
areas of life determine the quality of our lives. What is considered
important varies from person to person. That which is most important toyou may not be so important to me or to yourhusband/wife/children/parents/friends (mention one or two of these groups as
appropriate) … and vice versa”.
“I am interested in knowing what the most important areas of your life areat the moment. Most of us don’t usually spend a lot of time thinking about
these things. Indeed, we often only notice that certain things are importantwhen something happens to change them. Sometimes it is easier to identify
what is important by thinking about the areas of life that would (or do)cause us most concern when they are missing or going badly”.
Step 2: Eliciting the Five Most Important Aspects of Life (Cues)
Ask the respondent:“What are the five most important areas of your life at present – the things
which make your life a relatively happy or sad one at the moment …. thethings that you feel determine the quality of your life?”.
If the respondent does not understand what is required the question may be rephrased in the following ways:“What parts of your life are most important? …/ What things are mostimportant? …/ ‘The most important things in my life are …’.”•

Elicit areas NOT individuals, eg. marriage, not wife. Do not give examples.

•

The meaning of each cue for the respondent must be documented at this stage
on the Cue Definitions Record Form. Establish what the respondent meansby each quality of life area named as being important. For example, if an
individual were to name ‘golf’ as a cue, this may relate primarily to leisureactivity, but equally it may represent social activity, or physical mobility.
Similarly, if ‘religion’ were named as a cue it might relate to the respondent’s
spiritual life, but might equally relate to being physically able to get to church,or to the social dimension of meeting one’s friends at church. This isparticularly important for subsequent review of data, and of obvious relevancewhen respondents must be re-assessed at some future date in order to ensurethat the same cues are being considered.

•Having defined what the respondent means by the cue, it is important that thecue, as labeled by the individual, be used by the interviewer and not theinterviewer’s interpretation of what the respondent is saying.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

5•

Should the respondent volunteer cues which resemble ‘quality of life’ inmeaning (eg satisfaction, life quality), the interviewer should probe for more
specific cues. Cues such as ‘happiness’, ‘attitude to life’, ‘morale’ areacceptable.

•

If it is absolutely necessary to make some suggestions, then read the following
list, excluding any cues already mentioned – family, relationships, health,finances, living conditions, work, social life, leisure activities,
religion/spiritual life. This list is derived from our findings with a range of
populations and represents the cues most commonly elicited, in descendingorder of frequency. It provides for consistency across the interviewers wheresuch prompting is absolutely necessary.

Step 3: Determining Levels
Say to respondent:“Now that you have named the five most important areas in your life, I am
going to ask you to rate how each of these areas are for you at the moment.
First I will show you an example of how the rating is done”.
Place the Sample Cue Levels Record Form between you and the respondent so thatthe respondent can clearly see how you carry out the rating.
“First look at this box (indicate). As you can see, there are spaces at thebottom in which I can write the five important areas of my life (indicate), andthere is a scale along the left hand side (indicate). The scale ranges from‘worst possible’ on the bottom to ‘best possible’ on the top, and passes
through levels such as ‘very bad’ – ‘bad’ – ‘neither good nor bad’ – ‘good’ –and ‘very good’ between the two extremes.
The first important area of my life is X (use a cue not already nominated by the
respondent and write it in the first space at the bottom of the rating box) and if thisis going very well at the moment, I can show this by drawing a bar like this(draw a bar approx. 80mm high). I am using the scale (indicate) to decide howhigh my bar should be. The nearer I draw the bar to the bottom line, thepoorer my rating of that area of my life and the nearer I draw it to the top
line, the better my rating of that area of my life. A mark in the middle
range would indicate that I am rating life as neither good nor bad, butsomewhere in between”.
Now proceed with the ratings for the remaining cues:
Second cue – “if X2 (use a cue not already nominated by the respondent and write itin the second space) is going as well as is possible, I would rate it by drawing
a bar like this …” (draw a bar 100mm high).
Third cue – “if X3 (use a cue not already nominated by the respondent and write itin the third space) is going very badly, I would rate it like this …” (draw a bar
approx. 15mm high).
Fourth cue – “if X4 (use a cue not already nominated by the respondent and write itin the fourth space) is just all right, or ‘fifty/fifty’, I would rate it like this …”(draw a bar approximately 50mm high).

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

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Fifth cue – X5 (use a cue not already nominated by the respondent and write it in thefifth space) – (draw a random rating).
“This provides a picture of life as I might think of it at the moment”.
Step 4: Elicit Rating of Present Life
Place the Cue Levels Record Form between you and the respondent. Write therespondent’s five cues in the appropriate spaces under the box. Give the respondenta pen or pencil.
Say to the respondent:“Now I want you to rate the five most important areas of your life, as you see
presented here (indicate). Firstly, draw a bar which represents how you
would rate yourself on each of these areas at the moment. As in the example
I’ve just shown you, the nearer you draw the bar to the bottom line, thepoorer you are rating that area of your life and the nearer you draw it to the
top line, the better you are”.
Have respondent draw bars.
Step 5: Direct Weighting Procedure
Say to respondent:“I would like you to show me how important the five areas of life you havenominated are in relation to each other, by using this disk (indicate SEIQoLDW). People often value some areas in life as more important than others.
This disk allows you to show me how important each area in your life is bygiving the more important areas a larger area of the disk, and the lessimportant areas a smaller area of the disk. In my life, for example, X (namecue not already chosen by respondent) is about this important (manipulate diskso that X represents 30% of space available). X2 however is less important thanX, so it has only this much of the pie (manipulate disk so that X2 represents 20%of the space available). X3 on the other hand is more important than X, so it
has this much of the pie (manipulate DWP so that X3 represents 40% of space
available). Finally, X4 and X5 are the least important areas of life for me, andI value them about the same (manipulate disk so that X4 and X5 represent 5%
each of space available). Now thinking about the five areas of life you havementioned (write the name of each cue along the cut edge of one of the 5 coloured
disks with a non-permanent marker [disks may also be marked with stick-on ‘postit’ labels indicating the cues if preferred]). I would like you to show me how
important these areas are in relation to each other by moving the disks
around until their relative size represents your view of their importance”.

2.2

Potential Problems in Administration
The following are the problems most commonly encountered in SEIQoL-DW
administration.

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Nominating Important Life Areas:•

The respondent cannot think of 5 cues.
Suggested Solution: use prompt list provided.
Determining Cue Levels:•

The respondent conceives the task as drawing bars in terms of theirimportance rather than in terms of how these areas are for them at the moment.
Suggested Solution: Remind the respondent that the task is to “rate howeach of these areas are for you at the moment”.
Determining Cue Weighting:•

The respondent conceives the task as dividing up the pie diagram in terms ofcurrent functioning in that area.
Suggested Solution: Remind the respondent that the task is to indicate how
important each of the 5 areas are at present relative to each other.

3.0

Scoring the SEIQoL

3.1

Recording Scores
Record on the Interview Record Form:
The length of time the respondent took to complete the task
The interviewer’s rating of the respondent’s understanding of the method
Whether the interviewer felt that the respondent become fatigued/boredduring the task
The interviewer’s overall rating of the validity of the information obtained
Scores of the weights assigned to SEIQoL-DW for each cue

•
•
•
•
•

3.2

Deriving SEIQoL Outcome Data
(i)
(ii)
(iii)
(iv)

Cue labels and their definitions
Cue levels
Cue weights
The SEIQoL Index(i)

Cue Labels and their Definitions

During Step 2 (eliciting the five most important aspects of life), the meaning of eachcue for the respondent is summarized on the Cue Definitions Record Form, together
with the label that the respondent used for each cue. For example, different
respondents may use “religion” as a cue label, but it can have various meanings: aspiritual activity; a social activity (meeting friends at services) or a physical activity
reflecting mobility (being able to walk to services).
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The definition is important for subsequent understanding of what was meant by thecue label. It is also important in summarising cues from a number of respondents
for grouped data presentation.
(ii) Cue Levels
The cue levels are elicited during Step 3 when the respondent draws five bars on the
Cue Levels Record Form. Levels are scored by measuring the vertical height ofeach bar in millimetres. This yields five scores which are independent continuous
measurements, ranging from 0 to 100. They can be analysed using parametricstatistical methods.
(iii) Cue Weights
To calculate weights from SEIQoL-DW, align edge of green disk tab with the ‘0’(zero) gradation and note the weight (0-100) given to each of the 5 life areas byreading the amount of disk space assigned against the gradation on the outer edge ofthe disk. Divide each weight by 100 since the weights when calculating the SEIQoL
Index range from 0.00-1.00 in order that the overall Index (levels X weights) sumfrom 0-100.
(iv) The SEIQoL Index
The SEIQoL is intended primarily as an individual measure. Where groupcomparisons are required, a global index can be calculated which may be used inwithin-subject or between-subject study designs. As the index is a continuous
measure ranging from 0 to 100 it can be analysed using parametric statisticalmethods. Having obtained levels and weights for each of the five cues, as described
previously, the SEIQoL Index is calculated as follows:•

For each cue multiply the level by the weight, then sum these products acrossthe five cues: SEIQoL Index = ∑ (levels x weights)

Care should always be taken in interpreting the index, as it is the sum of the
products of individual cue levels by cue weights, each of which may vary
independently. The index should be interpreted in the context of the pattern oflevels and weights generated for each respondent.

3.3

Presenting Data
The data from each individual respondent can be presented in tabular form giving
the elicited cues, the levels and the weights. For grouping data SEIQoL Indexscores may be presented (cf. McGee et al., 1991, O’Boyle et al., 1992).

3.4

Using SEIQoL-DW in Prospective Study Designs
In prospective study designs, or in situations where SEIQoL-DW is employed overtime to evaluate an intervention, recommended practice is that new cues are elicited ateach assessment. Cues nominated at the initial assessment should then be provided
to the individual and the SEIQoL-DW procedure gone through again, in order tofacilitate direct comparison between initial and subsequent assessments.

© Department of Psychology, Royal College of Surgeons in Ireland, 1993

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References
O’Boyle C A, McGee H M, Hickey A, Joyce C R B, Browne J, O’Malley K,
Hiltbrunner B. The Schedule for the Evaluation of Individual Quality of Life(SEIQoL): Administration Manual. Dublin: Royal College of Surgeons in Ireland,(1993).
McGee H M, O’Boyle C A, Hickey A, O’Malley K and Joyce C R B. Assessing thequality of life of the individual: the SEIQoL with a healthy and a gastroenterology unit
population. Psychological Medicine 1991;21:749-59.
O’Boyle C A, McGee H M, Hickey A, O’Malley K and Joyce C R B. Individual quality oflife in patients undergoing hip replacement. Lancet 1992;339:1088-91
O’Boyle C A. Assessment of Quality of Life in Surgery. British Journal of Surgery
1992;79:395-398
Coen R F, O’Mahony D, O’Boyle C A, Joyce C R B, Hiltbrunner B, Walsh J B and
Coakley D. Measuring the quality of life of dementia patients using the Schedule for the
Evaluation of Individual Quality of Life. Irish Journal of Psychology, (Special Issue on the
Elderly) 1993;14:154-63
O’Boyle C A. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL).
International Journal of Mental Health 1994;23:3-23
Browne J P, O’Boyle C A, McGee H M, Joyce C R B, McDonald N J, O’Malley K,
Hiltbrunner B. Individual quality of life in the healthy elderly. Quality of Life Research.
1994;2:235-44
Joyce C R B. How can we measure individual quality of life? Schweizerische Medizinische
Wochenschrift 1994;124: 1921-6
O’Boyle C A, McGee H M, Joyce C R B. Quality of life: assessing the individual. In G
Albrecht and R Fitzpatrick (eds.) Quality of Life in Health Care. New York:JAI Press(1994).
Hickey A M, Bury G, O’Boyle C A, Bradley F, O’Reilly F D, Shannon W. (1996) A new
short-form individual quality of life measure (SEIQoL-DW): application in a cohort ofindividuals with HIV/AIDS. British Medical Journal 313:29-33
Browne JP, O’Boyle CA, McGee HM, McDonald NJ, Joyce CRB. Development of adirect weighting procedure for quality of life domains. Quality of Life Research 1997;
6:301-309.

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CUE DEFINITIONS RECORD FORMDESCRIPTION OF CUE

CUE LABEL

1.

____________

2.

____________

3.

____________

4.

____________

5.

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CUE LEVELS RECORD FORM
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INTERVIEW RECORD FORM

1. TIME TAKEN

2. UNDERSTANDING OF METHOD•

Not Understood•

Poor/Uncertain
Understanding•

Understood

3. FATIGUE/BOREDOM
•

None

/

•

Some

/

•

A Lot

/

4. OVERALL VALIDITY OF INFORMATION (in light of 2 & 3 above)
Definitely Invalid
Uncertain
Valid

5. WEIGHTS ASSIGNED TO CUES
Cue 1: Weight (%)
Cue 2: Weight (%)
Cue 3: Weight (%)
Cue 4: Weight (%)
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HYPOTHETICAL CASE FORMS

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