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Global Health and Well-being

Patient-Completed Health Outcome Measures

Global Health (complete one or both)

PROMIS 10 10 items

PROMIS 29 29 items

Well-being

Diener Satisfaction with Life Scale 5 items

Personal Well-Being Scale 8 items

Index of Well-Being 9 items

WHO-5 Well-being Index 5 items

Short Flourishing Scale 8 items

Do NOT take time to score the scales today. Scoring information is provided for reference.

PROMIS- Patient Reported Outcome Measurement Information System

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Global Health-
PROMIS Global Health (10) SF
Please respond to each item by marking Very
Excellent Good Fair Poor
one box per row good
Global In general, would you say your health is:
01 5 4 3 2 1
Global In general, would you say your quality of
02 life is: 5 4 3 2 1
Global In general, how would you rate your physical
03 health? 5 4 3 2 1
Global In general, how would you rate your mental
04
health, including your mood and your ability to
5 4 3 2 1
think?
Global In general, how would you rate your satisfaction
05
with your social activities and relationships? 5 4 3 2 1
Global In general, please rate how well you carry out
09
your usual social activities and roles. (This
includes activities at home, at work and in your
5 4 3 2 1
community, and responsibilities as a parent,
child, spouse, employee, friend, etc.)

A Not At
Completely Mostly Moderately
Little All
Global To what extent are you able to carry out your
06
everyday physical activities such as walking,
climbing stairs, carrying groceries, or moving a 5 4 3 2 1
chair?

In the past 7 days Never Rarely Sometimes Often Always

Global How often have you been bothered by
10 emotional problems such as feeling anxious,
5 4 3 2 1
depressed or irritable?
Very
None Mild Moderate Severe
Severe
Global How would you rate your fatigue on average?
08 5 4 3 2 1
Global How would you rate your pain on average?
07 0 1 2 3 4 5 6 7 8 9 10
No Worst
Pain Imaginable
Pain
Scoring:
Re-code Global07. The recoded score ranges from 1 to 5.
(0 No pain =5; 1, 2, or 3 =4; 4, 5, or 6 =3; 7, 8, or 9 =2; 10 worst pain imaginable =1)

After recoding, the

Global Physical Health score = SUM responses to G03 + G06 + G07 + G08.
Global Mental Health score = SUM G02 + G04 + G05 + Global10.

TOTALS Raw Score T-Score

Global Physical Health
Global Mental Health

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PROMIS GLOBAL SF (10)

Physical Mental
Short Form Conversion Table Short Form Conversion Table
Raw Score T Score SE* Raw Score T Score SE*
4 16.2 4.8 4 21.2 4.6
5 19.9 4.7 5 25.1 4.1
6 23.5 4.5 6 28.4 3.9
7 26.7 4.3 7 31.3 3.7
8 29.6 4.2 8 33.8 3.7
9 32.4 4.2 9 36.3 3.7
10 34.9 4.1 10 38.8 3.6
11 37.4 4.1 11 41.1 3.6
12 39.8 4.1 12 43.5 3.6
13 42.3 4.2 13 45.8 3.6
14 44.9 4.3 14 48.3 3.7
15 47.7 4.4 15 50.8 3.7
16 50.8 4.6 16 53.3 3.7
17 54.1 4.7 17 56.0 3.8
18 57.7 4.9 18 59.0 3.9
19 61.9 5.2 19 62.5 4.2
20 67.6 5.3
20 67.7 5.9

*SE = Standard Error *SE = Standard Error

Notes on PROMIS-10:

Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical
and mental health summary scores from the patient-reported outcomes measurement information
system (PROMIS) global items. Quality of Life Research, 18(7), 873-880.

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Global Health and Well-being

PROMIS 29 (optional)

Physical Function
With a With
Please respond to each item by marking Without any With some Unable to
little much
one box per row difficulty difficulty do
difficulty difficulty
PFA11 Are you able to do chores such as vacuuming
1
or yard work? 5 4 3 2 1
PFA21 Are you able to go up and down stairs at a
2
normal pace? 5 4 3 2 1
PFA23 Are you able to go for a walk of at least 15
3
minutes? 5 4 3 2 1
PFA53
4 Are you able to run errands and shop?
5 4 3 2 1

Anxiety
In the past 7 days Never Rarely Sometimes Often Always
EDAN
X015 I felt fearful
1 2 3 4 5
EDAN I found it hard to focus on anything other than
X406
my anxiety 1 2 3 4 5
EDAN
X417 My worries overwhelmed me
1 2 3 4 5
EDAN
X538 I felt uneasy
1 2 3 4 5

Depression
In the past 7 days Never Rarely Sometimes Often Always
EDDE
P049 I felt worthless
1 2 3 4 5
EDDE
P0610 I felt helpless
1 2 3 4 5
EDDE
P2911 I felt depressed
1 2 3 4 5
EDDE
4112 I felt hopeless
1 2 3 4 5

Fatigue
A little Quite a Very
During the past 7 days Not at all Somewhat
bit bit much
HI713 I feel fatigued
1 2 3 4 5
A314
I have trouble starting things because I am
tired 1 2 3 4 5
In the past 7 days
FATE
XP41 How run down did you feel on average?
15 1 2 3 4 5
FATE
XP40 How fatigued were you on average?
16 1 2 3 4 5

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Sleep Disturbance
In the past 7 days Very poor Poor Fair Good Very good
Sleep My sleep quality was
20927
5 4 3 2 1
A little Quite a Very
In the past 7 days Not at all Somewhat
bit bit much
Sleep My sleep was refreshing
11618
5 4 3 2 1
Sleep I had a problem with sleep
2019
1 2 3 4 5
Sleep I had difficulty falling asleep
4422
1 2 3 4 5

Satisfaction with Social Role

A little Quite a Very
In the past 7 days Not at all Somewhat
bit bit much
SRPS I am satisfied with how much work I can do
AT072
1 (include work at home) 1 2 3 4 5
SRPS I am satisfied with my ability to work (include
AT242
2 work at home) 1 2 3 4 5
SRPS I am satisfied with my ability to do regular
AT472
3 personal and household responsibilities 1 2 3 4 5
SRPS I am satisfied with my ability to perform my
AT492
4 daily routines 1 2 3 4 5

Pain Interference
A little Quite a Very
In the past 7 days Not at all Somewhat
bit bit much
PAINI How much did pain interfere with your day to
N925
day activities? 1 2 3 4 5
PAINI How much did pain interfere with work around
N2226
the house? 1 2 3 4 5
PAINI How much did pain interfere with your ability to
N3127
participate in social activities? 1 2 3 4 5
PAINI How much did pain interfere with your
N3428
household chores? 1 2 3 4 5

Pain Intensity

Global 0 1 2 3 4 5 6 7 8 9 10
0729 How would you rate your pain on average? No Worst
Pain Imaginable
Pain

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Scoring PROMIS 29

TOTALS Raw Score T-Score

Physical Function
Anxiety
Depression
Fatigue
Sleep Disturbance
Satisfaction with Social
Role
Pain Interference
Pain Intensity N/A

Note: The single pain intensity item is not scored but reported as its raw score (e.g., 0 to 10).

Notes on PROMIS-29:

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Subjective well-being-
Diener Satisfaction with Life Scale

Please respond to each item by marking Strongly Slightly Slightly Strongly

Disagree Mixed Agree
one box per row Disagree Disagree Agree Agree

1
In most ways, my life is close to my
ideal. 1 2 3 4 5 6 7
2 The conditions of my life are excellent.
1 2 3 4 5 6 7
3 I am satisfied with my life.
1 2 3 4 5 6 7
4
So far I have gotten the important
things I want in life. 1 2 3 4 5 6 7
5
If I could live my life over, I would
change almost nothing. 1 2 3 4 5 6 7

Scoring: Add the total of all 5 items (range: 5, 35). My total: __________
31 - 35 Extremely satisfied 26 - 30 Satisfied
21 - 25 Slightly satisfied 20 Neutral
15 - 19 Slightly dissatisfied 10 - 14 Dissatisfied
5 - 9 Extremely dissatisfied

Notes on SWL Scale:

Diener E, Emmons RA, Larsen RJ, Griffin S. The Satisfaction with Life Scale. J Personal Assess,
1985;49(1): 71

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Personal well-being Index (PWI)

For each question below, please note how

satisfied you are on a scale from 0 10

1 Your standard of living? 0 1 2 3 4 5 6 7 8 9 10

Dissatisfied Neutral Satisfied

2 Your health? 0 1 2 3 4 5 6 7 8 9 10
Dissatisfied Neutral Satisfied

What you are achieving in

3
life? 0 1 2 3 4 5 6 7 8 9 10
Dissatisfied Neutral Satisfied

Your personal
4
relationships? 0 1 2 3 4 5 6 7 8 9 10
Dissatisfied Neutral Satisfied

5 How safe you feel? 0 1 2 3 4 5 6 7 8 9 10

Dissatisfied Neutral Satisfied

Feeling part of your

6
community? 0 1 2 3 4 5 6 7 8 9 10
Dissatisfied Neutral Satisfied

7 Your future security 0 1 2 3 4 5 6 7 8 9 10

Dissatisfied Neutral Satisfied

Your spirituality or
8
religion? 0 1 2 3 4 5 6 7 8 9 10
Dissatisfied Neutral Satisfied

9
Optional: Your life as a
whole? 0 1 2 3 4 5 6 7 8 9 10
Dissatisfied Neutral Satisfied

Scoring: Take the average of the completed items and multiply by 100. Your score: ____
The normative range for Westerners is 70-80; for Asians, it is about 10 points lower.

Notes on the PWI:

th
Personal Well-being Index (PWI-Adult); English, 4 edition, International Well-being Group. 2006

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Index of Well-Being

Below are words and phrases we would like

you to use to describe how you feel about
your present life.

IWB1 My present life is: 0 1 2 3 4 5 6 7

Boring Interesting

IWB2 My present life is: 7 6 5 4 3 2 1 0

Enjoyable Miserable

IWB3 My present life is: 0 1 2 3 4 5 6 7

Useless Worthless

IWB4 My present life is: 0 1 2 3 4 5 6 7

Lonely Friendly

IWB5 My present life is: 7 6 5 4 3 2 1 0

Full Empty

IWB6 My present life is: 0 1 2 3 4 5 6 7

Discouraging Hopeful

IWB7 My present life is: 7 6 5 4 3 2 1 0

Rewarding Disappointing

0 1 2 3 4 5 6 7
IWB8 My present life is: Doesnt Brings out
give much the best
chance in me

IWB9
In thinking about my 0 1 2 3 4 5 6 7
life as a whole, I am: Completely Completely
Dissatisfied Satisfied

Scoring: Add the responses varying from 0-7 for all nine items giving a range from 0-63. A higher score
represents greater wellbeing.

My score: ____

Notes on Index of Well-being:

Campbell, A., Converse, P. E., & Rodgers, W. L. (1976). The quality of American life: Perceptions,
evaluations, and satisfactions (Vol. 3508). Russell Sage Foundation.

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Overall Well-being
WHO-5 Well-being Index

Please respond to each item by Most More Less Some

All of At no
marking one box per row, regarding of the than half than half of the
the time time
how you felt in the last two weeks. time the time the time time
WHO
1 I have felt cheerful in good spirits.
5 4 3 2 1 0
WHO
2 I have felt calm and relaxed.
5 4 3 2 1 0
WHO
3 I have felt active and vigorous.
5 4 3 2 1 0
WHO
4 I woke up feeling fresh and rested.
5 4 3 2 1 0
WHO My daily life has been filled with
5
things that interest me. 5 4 3 2 1 0

Scoring:
The raw score is calculated by totaling the figures of the five answers. The raw score ranges from 0 to 25,
0 representing worst possible and 25 representing best possible quality of life.

To obtain a percentage score ranging from 0 to 100, the raw score is multiplied by 4. A percentage score
of 0 represents worst possible, whereas a score of 100 represents best possible quality of life.

Notes on WHO-5 Well-being Index:

Regional Office for Europe WHO. Use of Well-Being Measures in Primary Health
Care - The DepCare Project. Health for All, Target 12, 1998 [http://www.who.dk/document/e60246.pdf]

Bech P. Measuring the dimensions of psychological general well-being by the WHO-5. QoL Newsletter
2004; 32: 15-16.

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Short Flourishing scale

Please respond to each item by Strongly Slightly Slightly Strongly

Disagree Mixed Agree
marking one box per row Disagree Disagree Agree Agree

1
I lead a purposeful and meaningful
life 1 2 3 4 5 6 7
2
My social relationships are supportive
and rewarding 1 2 3 4 5 6 7
3
I am engaged and interested in my
daily activities 1 2 3 4 5 6 7
4
I actively contribute to the happiness
and well-being of others 1 2 3 4 5 6 7
5
I am competent and capable in the
activities that are important to me 1 2 3 4 5 6 7
6
I am a good person and live a good
life 1 2 3 4 5 6 7
7 I am optimistic about my future
1 2 3 4 5 6 7
8 People respect me
1 2 3 4 5 6 7

Scoring: Add the responses varying from 1-7 for all seven items giving a range from 8-56. A higher score
represents a person with more psychological resources and strengths.

My score: ____

Notes on Flourishing Scale:

Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D. W., Oishi, S., & Biswas-Diener, R. (2010). New
well-being measures: Short scales to assess flourishing and positive and negative feelings. Social
Indicators Research, 97(2), 143-156.

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