Development of the

T
his article describes the process by which a new
assessment device, the Satisfaction with Perfor-

Satisfaction with mance Scaled Questionnaire (SPSQ), was cre-

ated and refined. The SPSQ was designed (a) to mea

Performance Scaled sure the degree of satisfaction that individuals experi-

ence while performing an array of independent liVing

Questionnaire (SPSQ) skills, (b) to be useful as both a clinical and a research

tool, and (c) to reflect how occupational therapists
value patients' self-determination.
Occupational therapy is concerned with how the
Elizabeth]. Yerxa, individual perceives his or her own performance of
Sandra Burnett-Beaulieu, occupations in comparison with professional "objec-
tive" assessments (AOTA, 1979; Sharrott, 1985-1986;
Sarah Stocking, Stanley P. Azen [Resolution 547-79, p. 782]). The phenomenology of
engagement in activity is related to central theoretical
constucts such as interests (Matsutsuyu, 1969), intrin-
Key Words: community health services.
sic motivation (Florey, 1969), choice (Yerxa, 1967),
independent living. test construction • goal directedness (King, 1978), and life satisfaction
tests, by title, Development of Satisfaction (Burnett & Yerxa, 1980). The American Occupational
with Performance Scaled Questionnaire Therapy Association's (1981) "Official Position
(SPSQ) Paper: Occupational Therapy's Role in Independent
or Alternative Living Situations" recognizes the
achievement of a satisfying and meaningful quality of
A new instrument, the Satisfaction with Perfor-
life as the "ultimate goal" of independent living.
mance Scaled Questionnaire (SPSQJ, was devel-
oped to measure individuals' satisfaction with their Thus, life satisfaction and its relationship to satisfac-
performance of independent living skills. The SPSQ tion with performance of daily liVing skills are impor-
was designed to be used for clinical assessment and tant components of treatment planning and research
research with community-based persons with dis- in occupational therapy However, the measurement
abilities. Split-hal[ reliability coefficients were 97 of satisfaction with performance is limited by a lack of
and .93 for the two scales, Home Management and valid, reliable instruments.
Social/Community Problem Solving, respectively
Preliminary findings provided support for construct
validity. The SPSQ appears promising as a measure Construction of the Original SPSQ
of the phenomenology of engagement in activities The need for the SPSQ grew out of a community-
related to independent living in the community
based independent liVing skills program for disabled
college students (Burnett & Yerxa, 1980; Burnett-
Beaulieu, 1984). The idea was to develop a self-report
instrument for students to assess their own needs for
developing independent living skills. On the basis of
Elizabeth J Yerxa, EdD, OTR, FAOTA, is Professor Emer- the results of a needs survey (Burnett & Yerxa, 1980),
ita and former Chair, Occupational Therapy Department, student interviews, and a literature review, it was de-
University of Southern California, Downey, California cided to measure three variables relevant to indepen-
90242 dent living skills self-perceived level of indepen-
Sandra Burnett-Beaulieu, MA, OTR, is Clinical Assistant dence, satisfaction with performance, and desire to
Professor of Occupational Therapy, University of Southern learn how to perform activities in a more satisfying
California, and Registered Occupational Therapist, Dis- way (see Figure 1)
abled Student Services, Santa Monica College, Santa Mon- The definition of satisfaction used was the sub-
ica, California. jective experience of being pleased or contented with
one's performance. This definition is similar to
Sarah Stocking, OTR, is a computer and statistical consul-
tant in private practice. Brophy's (1959) definition of satisfaction as "a sense
of well-being in one's subjective experience" (p.
Stanley P Azen, PhD, is Professor and Director of the Di 268) After revie\ving several psychological theories
vision of Biometry and Professor of Biomedical Engineer- of satisfaction, Brophy concluded that level of satis-
ing, School of Medicine, Departmenl of Preventive Medi-
faction is determined by an interaction between a
cine, University of Southern California, Los Angeles,
personal concept of what is desired and a related envi-
California
ronmentally focused concept of what the person re-

The Americanjournal oj Occupational Therapy 215

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 Figure 1 ploring career opportunities and going on a job inter-
Original Response Categories for the Satisfaction view). The agreement of two occupational therapists
with Performance Scaled Questionnaire
was the basis for grouping the items. Subjects were
Independence asked three questions about each item (see Figure 1).
Check one choice for each activity. Check whether you This 137-item instrument was assessed for reli-
- - Do the activity yourself
_ _ Have other people help you do it
ability by applying a split-half measure of internal
- - Do not do it at all consistency on data gathered from 24 physically dis-
Satisfaction abled adults Because of the divergence of the activi-
During the last six months, have you performed the following ties in the six activity clusters, it was decided to esti-
activity in such a way that you felt happy, pleased, or contented mate reliability for each cluster separately, using the
with what vou have done! In other words, how much of the time
have you f~lt satisfied with the way you have done these Spearman-Brown formula (Isaac & Michael, 1971).
activities' Check one choice for each activity. The following reliability coefficients were obtained
- - All of the time (100%) for "satisfaction with performance": Self-CarelADL,
- - Most of the time (75%)
- - Some of the time (50%) .84; Homemaking, .97; Community Mobility, .49;
- - Almost none of the time (25%) Cognitive Problem Solving, .97; Social/Recreational
- - None of the time (0%) Skills, .76; and School/Vocational Skills, .80. With the
Desire to Learn exception of the short (7-item) Community Mobility
Check whether or not you would like to learn how to do the
activity in a more satisfying way. Check only one choice. scale, all scales were considered sufficiently reliable
--Yes for further development of the SPSQ as a research
--No instrument.
At this stage of development, the only kind of
validity that was considered was content validity. The
ceives as feedback from the environment. Satisfaction items were generated from well-established research
is enhanced when the environment proVides for ful- and clinical instruments and interviews with disabled
fillment of the personal concept. The value of mea- persons. Although content validity is one of the
suring satisfaction with performance was supported weaker forms of validity, the overwhelming evidence
by King's (1978) view of occupational therapy as con- supporting occupational therapy's clinical concern
cerned with human adaptation, or the goodness-of-fit with these activities seemed ample support for their
between person and environment. inclusion in the SPSQ (Hopkins & Smith, 1978;
Items for the original questionnaire were se- Trombly & Scott, 1977).
lected from several sources. The items concerned To determine what, if any, relationship existed
with activities of daily living (ADL) were selected between self-perceived independence in an activity
from a variety of established medical rehabilitation and satisfaction with performance of that activity, cor-
tools, including Donaldson's unified ADL form relation coefficients were computed. The following
(Donaldson, Wagner, & Gresham, 1973), the Kenney statistically significant correlations between satisfac-
self-care status assessment (Schoening & Iversen, tion and independence were found: Self-CarelADL,
1968), the Katz and Barthel indices (Katz, Dorns, & r = .45, P < .05; Homemaking, r = .61, P < .01; Cog-
Cash, 1970; Mahoney & Barthel, 1965), and three ADL nitive Problem Solving, r = .64, p < .01; Social/Recre-
checklists in clinical use. Items concerning student ational Skills, r = .75, P < .001; School/Vocational
and community role behaviors were derived from in- Skills, r = .61, P < .01. Thus, in five of the six activity
terviews with disabled students as well as from the categories, moderately high, positive correlations be-
Burnett-Yerxa Needs Assessment Questionnaire tween satisfaction with an activity and self-perceived
(Burnett & Yerxa, 1980). Items concerning sexuality independence in performing it were found. The cor-
were based on information from the Massachusetts relation between satisfaction and independence for
Rehabilitation Hospital Guide (Neistadt & Baker, community mobility was not significant.
1978) and course materials from Pepperdine Univer-
sity, Malibu, California. Refinement of the SPSQ
The original SPSQ consisted of 137 items classi-
fied into six activity clusters, or scales: (a) Self-Carel A multidimensional health status index should meet
ADL (e.g., bathing, grooming, and dressing), (b) four criteria-practicality, simplicity, dependability,
Homemaking (e.g., meal preparation and cleaning), and usefulness (Miller, 1973). The SPSQ was refined
(c) Community Mobility (e.g., using public transpor- to meet these criteria. Length limited the SPSQ's prac-
tation), (d) Cognitive Problem Solving (e.g., money ticality, especially for persons with severe disabilities.
and time management skills), (e) Social/Recreational Also, responses were required for each item (inde-
Skills (e.g., meeting new people and eating at a res- pendence, satisfaction, and desire to learn), making
taurant), and (f) School/Vocational Skills (e.g., ex- the instrument difficult to score and problematic to

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 interpret. Therefore, the scoring needed to be simpli- to perform a factor analysis to determine what, if any,
fied. It was not known whether the original six cate- mutually exclusive groupings, or minimum number
gories of activity were truly discrete because they had of factors, could explain the variability in scores
been formulated logically, a priori, before any statisti- among the 50 subjects.
cal analysis was concluded. Further, reliability had Fourth, an unrotated factor analysis was first per-
only been estimated for the six a priori categories. formed to exclude all items loaded below .30 (Ker-
Therefore, the dependability of the SPSQ was un- linger, 1967) This operation reduced the number of
known. It was possible that categories were not really items from 115 to 99.
mutually exclusive or meaningful. Finally, the SPSQ Fifth, a varimax rotation was performed on the
needed to be made more useful as a clinical device for remaining items to exaggerate any differences that
determining both treatment goals and program devel- might reveal theoretically and clinically meaningful
opment within the time constraints imposed on a dimensions of activities of daily living. Two factors
busy occupational therapist. accounted for 57% of the variance. Factor I (40%)
Five refinements were made. First, the response seemed to be made up of items dealing with satisfac-
categories of independence and desire to learn how tion with home management, such as "scrape/stack
to do the activity in a more satisfying way were elimi- dishes" and "wash pots and pans"; this factor was
nated, leaving only the question of how much of the called Home Management. Factor II (17%) consisted
time the respondent felt satisfied with performance. of items dealing with social and community problem
The major reason for this change was to reflect the solving, including "socialize with other persons" and
philosophy of independent living, which emphasizes "go on an interview"; this factor was named Social!
individuals' perspectives of the quality of their own Community Problem Solving. Items with a factor
performance. This change also seemed justified be- loading of less than 5 or loaded at 5 or above on
cause independence and satisfaction had been shown more than one factor were eliminated, reducing the
to be moderately correlated in the first phase of this total number of items to 46 (see Table 1)
study. Clinically, satisfaction seemed a more useful Thus, from an original 137-item instrument con-
criterion for establishing treatment goals than desire sisting of six a priori categories of activity and three
to learn because a patient might not be aware of all categories of response, the SPSQ was revised to in-
possibilities that could be achieved with occupational clude 46 items categorized into two scales, Home
therapy. Satisfaction was already scaled to permit five Management (24 items) and Social/Community
gradations of response, providing more information Problem Solving (22 items), requiring only one cate-
than the simple yes or no answer required for desire gory of response, satisfaction with performance. The
to learn. refined SPSQ is displayed in Figure 2.
Second, another refinement was accomplished Because it was desired that scores be summated,
by an item analysis of the revised instrument on data items were also assessed for equal weighting. Using a
gathered from an expanded subject pool of 50 dis- scoring coefficient matrix, it was found that the items
abled subjects prior to occupational therapy interven- were of suffiCiently equal weight to justify summing
tion. The sample, although small, was representative them for scale scores and an overall satisfaction score.
of a wide array of disabilities, as follows: acquired Limitations of the procedures used in refining the
brain injury (n = 11), cerebral palsy (n = 11); learn- instrument should be kept in mind. The small sample
ing disability (n = 9); mental retardation (educable) size (N = 50) used in the factor analysis and the de-
(n = 8); chronic disability, diagnosis unknown (n = limitation of that sample to a single geographic area
3); neurological disability (adult onset) (n = 2); spi- might limit the ability to generalize these results. The
nal cord injury (n = 2); psychiatric disability (n = 2); effects of the small sample size were mitigated by
severe vision loss (n = 1); postpoliomyelitis (n = ]) holding the criteria used in the factor analysis to the
The majority of subjects had severe disabilities that most stringent levels (Rogers, Weinstein, Figone, &
had a major impact on their daily actiVities. In this Azen, 1980).
sample, 22 of the items had low variability and miss-
ing data. These items were eliminated from the Reliability and Validity of the Refined SPSQ
questionnaire.
Third, a scalogram or correlation matrix was con- To determine the reliability of the SPSQ, a split-half
structed to determine to what extent the six a priori procedure was llsed on each of the two scales (N =
categories were mutually exclusive. This operation 50). The reliabilities estimated were 97 for the Home
used the Likert method of summated ratings corrected Management scale and .93 for the Social/Community
for overlap (Likert, 1932) It was found that the origi- Problem SolVing scale. These coefficients provide
nal six scales did not fall into discrete categories, that support for the reliability of the SPSQ as both a re-
is, were not mutually exclusive. Thus, it was decided search and a clinical instrument.

The American Journal of Occupational Therapy 217

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 Table 1
Satisfaction with Performance Scaled Questionnaire: Factor Loading of Individual Items
With the Varimax Rotation Method (N = 50)
Factor
Item 11

FACTOR I, HOME MANAGEMENT

Horn 33 Scrape/stack dishes 94 05
Hom 35 Wash pots and pans 90 .08
Hom 37 Remove/put away utensils/dishes in cupboards 88 .14
over sink/counters
Hom 32 Set/clear table .88 .05
Hom 40 Load/unload washing machine .87 .03
Hom 51 Dust high su rfaces 86 12
Hom 38 Remove/put away utensils/dishes in cupboards .84 17
under sink/counters
Hom 48 Use a floor mop .81 15
Hom 47 Make a bed 79 14
Hom 8 Use stove top elements 79 .10
Hom41 Put clothes on hangers 78 .14
Horn 50 Clean a bathtub/shower 76 19
Hom 13 Reach high cupboards .76 .32
Hom 24 Dispose of garbage 76 .27
Hom 39 Son clothes for washing 76 .17
Hom 11 Open screw-top lids .75 .20
Hom 42 Put clothes away in drawers/closet rod 75 .04
Hom 29 Handle a milk canon 74 -.03
Hom 55 Use a vacuum cleaner 73 17
Hom 25 Clean up counter/couking surfaces 73 .25
Hom 60 Get objects off top store shelves 71 .12
Hom 15 Clean vegetables 68 15
Hom 36 Carry hot foods to table 66 .23
Hom 18 Stir against resistance in a bowl .63 20

FACTOR II, SOCIAL/COMMUNITY PROBLEM SOLVING

Schl 18 Socialize with other persons 10 .82
Soc 9 Have friends 09 .81
Schl 6 Explore training reqUirements 19 81
Soc 12 Assen your thoughts and feelings with others 15 76
Schl9 Go on an interview 19 76
Cog 15 Find and use social activities -.001 75
Cug 14 Find and use financial assistance programs .04 .74
Soc 8 Meet new people -05 .73
Cog 17 Find and use educational programs 29 .72
Soc 3 Talk with panner about sex and problems .01 72
Hom 58 Get the most for your money 30 67
Schl8 Find a job 16 67
Schl19 Understand class material 02 66
Cog 12 Make decisions .07 65
Schl 19 Talk with teacher about class problems 23 65
Cog 4 Pay bills and balance account 13 .62
Cog 5 Plan for future savings/expenses .24 .61
Cog 3 Budget your income .10 56
Soc 10 Take a trip/sightsee 29 56
Schl16 Talk and panicipate in class 01 .56
Soc 6 Plan recreational activities .15 .55
Cog 13 find resou rces/he Ip 18 54
Note Cog = Cognitive. Hom = Home Schl = School. Soc = Social.

Evidence for construct validity of the SPSQ was these findings are suggestive rather than confirma-
obtained in a separate study comparing 15 commu- tory, awaiting replication in additional studies.
nity-based subjects with spinal cord injuries with 12
nondisabled cohorts matched for age, sex, ethnicity, Usefulness as a Research and Clinical Tool
and community of residence (Yerxa & Baum, 1986).
The subjects with spinal cord injuries scored signifi- The SPSQ, although developed for use with commu-
cantly lower than the nondisabled cohorts on both nity college students who were disabled and enrolled
scales (p <00l). Because of the small sample size, in independent living skills training, may also be use-

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 Figure 2
The Revised Satisfaction with Performance Scaled Questionnaire
Sandra Burnett-Beaulieu, Elizabeth J. Yerxa, Sarah Stocking, Stanley P Azen

Name: _ During the last six months have you performed the following activity in such a way that you
have felt happy, pleased. or contented with what you have done' In other words, how much
Date: of the time have you felt sa!isfied with the way you have done these activities'

Almas! none
I. HOME MANAGEMENT ALL (100%) Mos! (75%) Some (50%) (25%) of None (0%)
This item does nO[ apply to me (check) of Ihe lime of the time of the time the lime of the time

1 Scrape/stack dishes
2. Wash pots and pans

3 Remove/put away utensils/dishes in

cupboards over sink/counters
4. SCI/clear table
':i Load/unload washing machine
6 Dust high surfaces
7, Remove/put away utensils/dishes in
cupboards under sink/counters
8. Use a floor mop

9 Make a bed --- - - _ ..

10 Usc stove top elements -_.
-
11. PUt clothes on hangers
12. Clean a bathtub/shower
13 Reach high cupboards
14 Dispose of garbage I
15 Sort clothes for washing
16. Open screw· tOp lids
- -
17. Put clothes away in drawers/closet rod
18 Handle a milk canon
19 Use a vacuum cleaner
20. Clean up counter/cooking surfaces
21 Get objects off wp SlOre shelves
22 Clean vegetables
-
23 Carry hot foods to table
24 Stir against resistance in a bowl
Almas! none
II. SOCIAL/COMMUNITY PROBLEM SOLVING ALl (100%) Mosl (7':i%) Some (50%) (25%) of None (0%)
This item does not apply to me (check) of the time of the time of the time the time of the time
1. Socialize with other persons
2. Have friends

3 Explore training requirements

4. Assen your thoughts and feelings with
others

5 Go on an interview
6 Find and use social activities
7. Find and use financial assistance
programs
8. Meet new people

9 Find and use educational programs

(Figure conlinues on next page)

The American Journal of Occupational Therapy 219

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 Figure 2 (Continued)
Almost none
II. SOCIAL/COMMUNITY PROrlLEM SOI.VING All (100%) Most (75%) Some (50%) (25%) of None (0%)
This item does not apply to me (check) of the time of the time of the time the time of the time
10 Talk with partner abom sex and
problems
11 Get the most for your money
12. Find a job
13 Understand class material
14. Make decisions
15 Talk with teacher about class problems
16 Pay bills and balance account
17. Plan for future savings/expenses
18 Budget your income
19. Take a trip/sightsee
20 Talk and participate in class
21. Plan recreational activities
22. Find resources/help
Note. Scoring: Each item is scored 1 to 5 points: None (0%) = 1, and All (100%) = 5. Factor I has 120 possible points; Factor II has 110 possible
points.

fu I with other populations. Increasing numbers of oc- scores and traditional "objective" measures of daily
cupational therapists are working to improve patients' liVing skills in community-based samples of people
skills in community liVing in such settings as out pa- who are disabled. Outcomes of occupational therapy
tient hospital programs, independent liVing centers, programs based on contractual versus prescriptive
schools, and home health care agencies. The SPSQ treatment approaches could also be compared. Fi-
provides information that can be valuable in planning nally, additional studies might explore the relation-
individual occupational therapy programs and mea- ships between satisfaction with performance, as mea-
suring progress toward achievement of treatment sured by the SPSQ, and overall life satisfaction among
goals. Because data gathered from the SPSQ empha- various populations for whom occupational therapists
size the subject'S satisfaction with his or her own per- provide service (e.g., patients who have chronic phys-
formance, the questionnaire should facilitate patients' ical, emotional, or developmental challenges to their
involvement in setting their own goals and help occu- independence in community living skills). Data col-
pational therapists to tap into patients' intrinsic moti- lected on a sample of community-based subjects with
vation for developing independence. The SPSQ spinal cord injuries have provided preliminary sup-
would be useful in creating a contractual rather than port for a correlation between SPSQ scores and over-
prescriptive basis for treatment planning, encourag- all life satisfaction scores (Yerxa & Baum, 1986) but
ing patients to take more responsibility for both treat- additional studies are needed to replicate and further
ment planning and outcome (Burnett-Beaulieu, explore this relationship.
1984). The instrument was not, however, designed to The Satisfaction with Performance Scaled Ques-
be a criterion for diagnosis or prediction of adaptive tionnaire is an attempt to operationalize the concept
potential. of satisfaction experienced in performance of inde-
pendent living skills. The questionnaire appears to
In research, the SPSQ could be used to describe
hold promise for clinical and research use, partiCU-
and compare the characteristics of various popula-
larly in community-based occupational therapy pro-
tions, to develop intervention strategies, and to test
grams. Additional research is needed to validate the
the effects of different occupational therapy ap-
instrument further and assess its usefulness in testing
proaches on satisfaction with performance of inde-
hypotheses generated from occupational therapy
pendent living skills. Because professionals often as-
theories.
sume that self-determination of satisfaction in the per-
formance of daily liVing skills is a necessary but not Acknowledgments
sufficient measure of patients' progress, it could be We express our deepest appreciation to Judy Schwartz, PhD,
valuable to study the relationship between SPSQ Fran Neumann, MA, and Chuck Havard, MA, for their assis-

220 April 1988, Volume 42, Number 4

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 tance with various stages of the testing and to Linda Tickle, Kerlinger, F. (1967) Foundations of behavioral re-
MA, OTR, for statistical analyses during the initial stages of search. New York: Holt, Reinhart and Winston.
development of the SPSQ. King, L. J. (1978). Toward a science of adaptive re-
This research was partially supported by the American sponse. American journal of Occupational Tberapy, 32,
Occupational Therapy Foundation through a research grant. 429-437
Likert, R. (1932). A technique for the measurement of
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The American journal 0/ Occupational Therapy 221

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