Development of a simple non-language based measure of well-being: a personal journey.
Article Type: Editorial
Author: Gueldner, Sarah Hall
Pub Date: 01/01/2011
Publication: Name: Visions: The Journal of Rogerian Nursing Science Publisher: Society of Rogerian Scholars Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Society of Rogerian Scholars ISSN: 1072-4532
Issue: Date: Jan, 2011 Source Volume: 18 Source Issue: 1
Persons: Named Person: Gueldner, Sarah Hall
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 272167863
Full Text: Unlike many of the terms used by Rogerian Scholars, well-being is a term that is generally understood in everyday language. It denotes a sense of being well, and is presumed to be the ultimate goal of virtually every person and of society in general. But because the term conveys different images to different people, sense of well-being is not easy to measure. Addressing that goal, my colleagues (some were students at the time) and I began the daunting task of developing a non-language based paper and pencil pictorial scale that could measure general sense of well-being in persons around the world. That goal required several years of developing simple one inch line-drawn black and white pictures that depict opposite ends of a well-being scale (i.e., the sun out bright or behind clouds; eyes open or closed; a candle lit or not lit; a lion or a mouse). We sketched the pictures ourselves at first, but on the advice of our wise and well-meaning peers, a student artist was eventually hired to draw the simple coloring book style pictures that portray universally recognizable simple images perceived to represent positive or negative sense of well-being.

The images were taken to national and international nursing meetings over a two year time period, and participants were invited to judge whether each item represented a positive or negative view of well-being (or neither). Only the strongest items were retained and posted as positive versus negative well-being picture pairs, separated by a line with 7 selection options. As before, participants at national and international nursing meetings were invited to review the paired pictures and indicate those items that they felt best represented a strong versus weak pairing of items. The scale was also tested at international conferences to confirm which items had universal recognition. An 18-item test was developed first, but as it was administered to groups it became apparent that some items were stronger than others, and the scale was eventually reduced to 14 then 10 items (which is the present version of the scale). It is interesting to note that over time some items became out of date or otherwise inappropriate. For instance, a drawing of the first space shuttle on the launch pad represented a highly positive icon at the beginning of the tool development, and was included on the original 18-item scale because it generated a highly positive sense of well-being. However, it had to be removed from the scale after the space shuttle exploded on takeoff, because at that point it had came to portray a tragic and thus negative image to participants.

The present 10-item scale has been administered to several thousand participants in the USA, Canada, Taiwan, Japan, Egypt, and most recently Africa, and the psychometric properties continue to remain strong in both national and international samples. It has also been used to measure sense of well-being in both community and nursing home dwelling elders, and in other groups who may have compromising circumstances. The five picture pairs that have emerged to be the most consistent items across all samples are: 1) puzzle pieces together and separated, 2) balloons inflated and deflated, 3) sun behind a cloud and without a cloud(all three representing the concept of awareness); 4) eyes open and closed (representing frequency), and 5) the lion and the mouse (representing power). A children's version of the instrument has recently been developed by Susan Terwilliger (2008) for use in her doctoral research.

In summary, the WPS was developed with intent to provide a simple measure of well-being for all persons, including those who can not read or speak English, who have difficulty seeing, or who may be too weak or otherwise unable to respond to more complex or lengthy measures of well-being. I am so pleased that the findings of three studies using the WPS are reported in this issue of Visions, and it especially pleases me to learn that one of the studies was conducted by an author (Jabrenta Hubbard) who is a not a nurse. To my knowledge, this is the first time that the WPS has been used as a research measure in a discipline other than nursing, fueling my hope that it will become a tool that is used across disciplines.

The developers and I greatly appreciate those who helped develop and have used the WPS as a measure in their research, and we encourage others to use it in their studies, as well. A copy may be obtained without charge by emailing me at

By Sarah Hall Gueldner, DSN, RN, FAAN, the Arline H. and Curtis F. Garvin Professor of Nursing at the Frances Payne Bolton School of Nursing, Case Western Reserve University
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.