Close
Home
Collections
Login
USC Login
Register
0
Selected
Invert selection
Deselect all
Deselect all
Click here to refresh results
Click here to refresh results
USC
/
Digital Library
/
University of Southern California Dissertations and Theses
/
A reliability and validity study of the meaningful activity participation assessment
(USC Thesis Other)
A reliability and validity study of the meaningful activity participation assessment
PDF
Download
Share
Open document
Flip pages
Contact Us
Contact Us
Copy asset link
Request this asset
Transcript (if available)
Content
A RELIABILITY AND VALIDITY STUDY OF THE MEANINGFUL ACTIVITY
PARTICIPATION ASSESSMENT
by
Aaron M. Eakman
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(OCCUPATIONAL SCIENCE)
August 2007
Copyright 2007 Aaron M. Eakman
ii
ACKNOWLEDGEMENTS
I would like to extend my appreciation to the following members of the USC New
Well Elderly research team, who provided conceptual and material support in the
undertaking of this study: Mike Carlson, Florence Clark, Deborah Mandel, Jeanne
Jackson, Jeanine Blanchard, Stan Azen, Carolyn Ervin, and Peng Zhao. The
contributions of the following Division of Occupational Science and Occupational
Therapy graduate students were also instrumental in completing this study: Patrick
Armstrong, Allison Chapman, Jenny Park, Ernest Santos, and Kathryn Sorenson.
Many thanks are extended to the Los Angeles area organizations, and especially to
their elders, who contributed their time and efforts to this study. I would also like to
acknowledge Paul Bailey for his assistance in formatting this manuscript. Finally,
this document would not have been possible without the love and support of my wife
Kathy.
iii
TABLE OF CONTENTS
Acknowledgements ii
List of Tables vi
List of Figures ix
Abstract x
Chapter One: Introduction and Statement of Problem 1
Chapter Two: Literature Review 9
Building Theoretical Support for the Meaningful Activity Participation
Assessment 9
Activity Theory 10
Continuity Theory 14
Life-Span Theories of Development 15
On the Nature of Meaningful Activity Participation 20
What does Meaningful Activity Mean in Social Gerontology? 21
Meaning and Purpose in Life and Meaningful Activity 29
The Nature of Meaning in Occupational Science
and Occupational Therapy 37
Theoretical Syntheses Relevant to the Meaning of Occupation 40
Positivistic Inquiry into the Meaning of Occupation 58
Naturalistic Inquiry into the Meaning of Occupation 62
The Here-and-Now Nature of Activity Meaning 63
The Meaning of Occupation from a Life History Perspective 66
Changes in the Meaning of Occupation over Time 68
A Synopsis of Meaning and Meaningful Activity 73
The General Construct of Activity Participation
in Social Gerontology 75
Measurement of Subjective Attributions of Activity 80
An Operational Definition of Meaningful Activity:
The Meaningful Activity Participation Assessment (MAPA) 88
Associations between Measures of
Meaningful Activity Participation 91
Associations between Meaningful Activity Participation and
Conceptually Related Constructs 96
Activity Participation and Life Satisfaction 98
Activity Participation and Health-Related Quality of Life 99
Activity Participation and Depression 101
A Tentative Causal Model 103
iv
Chapter Three: Methods 109
Overview of the Study Design 109
Participants 111
Participant Recruitment 112
Testing Procedures 113
Data Management 114
Instruments 116
Meaningful Activity Participation Assessment (MAPA) 116
MAPA Global 120
Criterion Variables 121
Engagement in Meaningful Activity Survey (EMAS) 121
Daily Occupation Experience Survey (DOES) 122
Life Satisfaction Index-Z (LSI-Z) 123
The Satisfaction with Life Scale (SWLS) 124
Center for Epidemiologic Studies
Depression Scale (CES-D) 125
The Purpose-in-Life Test (PIL) 126
SF-36 Version 2 (SF-36v2) 128
Data Analysis 130
Overview of the General Process of Data Analysis 130
Descriptive Statistics of the MAPA Scales 132
Principal Components Analysis of the MAPA Scales 133
Tests of the Study’s Main Hypotheses 135
Identification of MAPA Candidate Variables
in Predicting Criterion Variables 136
Comparison of MAPA-Frequency x Meaning
to Activity Frequency and Activity Diversity 139
Cluster Analysis 141
Path Analysis 143
Chapter Four: Results 147
Sample 147
Results of the MAPA Scales 147
Principal Components Analyses of the MAPA Scales 154
Tests of the Study’s Main Hypotheses 162
Identification of MAPA Candidate Variables
in Predicting Criterion Variables 172
Regression Models with MAPA-Frequency x Meaning
Predicting Criterion Variables 182
Testing the Contributions of MAPA-Global
in the Prediction of Criterion Variables 188
Comparison of MAPA-Frequency x Meaning
to Activity Frequency and Activity Diversity 194
v
Cluster Analysis 208
Path Analysis 215
Chapter Five: Discussion 219
Tests of the Study’s Main Hypotheses 220
Discussion of the Study’s Eight Research Questions 224
Cluster Analysis 235
Tentative Causal Path Model 238
Limitations of the Study 242
Suggestions for Future Research 246
References 249
Appendices
A. Meaningful Activity Participation Assessment (MAPA) – Frequency 271
B. MAPA – Meaning 274
C. MAPA – Health 280
D. MAPA – Reasons 284
E. MAPA – Global 291
F. Engagement in Meaningful Activity Survey 293
G. Daily Occupational Experience Survey 295
H. Purpose-in-Life Test 298
I. Life Satisfaction Index – Z 302
J. RAND 36-Item Short-Form Health Survey 304
K. Center for Epidemiological Studies Depression Inventory 313
L. Satisfaction with Life Scale 319
M. Background Variables 320
vi
LIST OF TABLES
Table 1: Summary of Differing Perspectives on Meaningful Activity 38
Table 2: Meaning of Occupation in Occupational Science
and Occupational Therapy 57
Table 3: Summary of Study Constructs and Criterion Indicators 131
Table 4: Summary of MAPA Derived Variables 134
Table 5: Summary of MAPA Derived Candidate Variables 140
Table 6: Demographic Characteristics 148
Table 7: MAPA – Frequency: Activity Participation by Type of Activity 149
Table 8: Zero-order Correlations between MAPA Derived Variables 153
Table 9: Principal Component Analysis of MAPA-Frequency Ratings 155
Table 10: Principal Component Analysis of MAPA-Meaning Ratings 157
Table 11: Principal Component Analysis of MAPA-Health Ratings 158
Table 12: Principal Component Analysis of
MAPA-Frequency x Meaning Ratings 159
Table 13: Principal Component Analysis of
MAPA-Frequency x Health Ratings 160
Table 14: Descriptive Statistics for Criterion Variables 163
Table 15: Zero-Order Correlations between Criterion Variables
and Activity Variables 165
Table 16: Comparison of MAPA Scale Structure Coefficients
in Relation to Criterion Variables 169
Table 17: Zero-Order Correlations between Criterion Variables
and MAPA – Frequency x Meaning Structure Coefficients 176
vii
Table 18: Zero-order Correlations of MAPA-Reasons Variables
with Criterion Variables 178
Table 19: MAPA Intra-Individual (II) Level Correlations
and Descriptive Statistics 181
Table 20: Zero-order Correlations of MAPA-Intra-Individual Variables
with Criterion Variables 183
Table 21: MAPA-F x M: Psychosocial Well-Being Regression Models 185
Table 22: MAPA-F x M: SF36v2 Mental Health Regression Models 186
Table 23: MAPA-F x M: SF36v2 Physical Health Regression Models 187
Table 24: MAPA-F x M and MAPA-Global: Psychosocial
Well-Being Regression Models 190
Table 25: MAPA-F x M and MAPA-Global: SF36v2
Mental Health Regression Models 191
Table 26: MAPA-F x M and MAPA-Global: SF36v2
Physical Health Regression Models 192
Table 27: Comparison of MAPA-F x M Models to MAPA-F x M
and MAPA-Global Models 193
Table 28: Comparison of Activity Measurement Approaches
in Prediction of Criterion Variables 195
Table 29: Improvements in Model R-Square and R-Square Change 198
Table 30: Regression Models Utilizing Stepwise Entry of Activity Variables 200
Table 31: Detailed Models Utilizing Stepwise Entry of Activity Variables 201
Table 32: Activity Diversity: Regression Models with
MAPA – Frequency x Meaning Entered Last 203
Table 33: Activity Frequency: Regression Models with
MAPA – Frequency x Meaning Entered Last 205
viii
Table 34: Comparison of R-Square Change
with MAPA-Frequency x Meaning Entered Last 207
Table 35: Scheffe Multiple Comparison of Clusters by
MAPA Activity Frequency Ratings 210
Table 36: Scheffe Multiple Comparisons of Clusters
by MAPA and Criterion Variables 212
Table 37: Partial Correlations between Tentative Causal Model Variables 215
Table 38: Test of PIL Mediation between MAPA and SF-36v2 Components 218
ix
LIST OF FIGURES
Figure 1: Tentative Causal Model with Study Constructs 8
Figure 2: Tentative Causal Model 143
Figure 3: Path Analysis of Causal Model 217
x
ABSTRACT
The discipline of occupational science was founded in response to the need for the
explication of the form, function and meaning of occupation (the day to day
activities that make up our lives). As a working assumption of occupational science,
our daily occupations are imbued with personal meanings that contribute to the
perception of purpose and meaning in our lives, ultimately influencing our health and
well-being. Further, meaningful activity participation holds a central place in
contemporary models and theories in social gerontology. Despite the importance of
meaningful activity participation, no instrument exists which has been shown to
validly tap the richness of this key construct. The present study addresses the
development and validation of the Meaningful Activity Participation Assessment
(MAPA), which is intended as a measure this vital conceptual domain.
The study began by utilizing focus groups and the input of the University of
Southern California Well Elderly II research team to derive the 28-item MAPA.
Data analyses were liberal in exploring the many facets of the MAPA scales,
including tests of six main study hypotheses utilizing a sample of 154 older adults:
1) Among community dwelling older adults there is a positive correlation between
the MAPA and the Purpose-in-Life test; 2) Among community dwelling older adults
there are positive associations between the MAPA scales and other scales of
meaningful activity participation; 3) Among community dwelling older adults there
are positive correlations between the MAPA and two measures of life satisfaction
xi
(i.e., LSI-Z and SWLS); 4) Among community dwelling older adults there is a
positive correlation between the MAPA and the four SF-36v2 Mental Health scales;
5) Among community dwelling older adults there is a positive correlation between
the MAPA and the four SF-36v2 Physical Health scales; and 6) Among community
dwelling older adults there is a negative correlation between the MAPA and the
CES-D.
Results from the statistical tests of these hypotheses were intended to provide
construct validity evidence for the MAPA. Zero-order correlation, multiple
regression analysis, principal component analysis, cluster analysis, and a tentative
causal model were employed as tests of the construct validity of the MAPA.
The results of these analysis offered nearly unequivocal support for the construct
validity of the MAPA. Each of the study’s main hypotheses was partially or fully
supported, as the MAPA achieved statistically significant theoretically anticipated
zero-order correlations with criterion measures. The MAPA was also found to hold
adequate test-retest and internal consistency reliability. Additionally, in multiple
regression models, the MAPA contributed to the prediction of every psychological
well-being indicator, and all but one measure of health-related quality of life.
Results of the cluster analysis found three clusters for which the members were
found to have low, medium or high MAPA scores respectively. Profiles of these
clusters discerned that, in general, low MAPA scores were associated with lesser
xii
psychological well-being and health-related quality of life. Results of the causal
model were mixed, though the MAPA was found to contribute directly to the
Purpose-in-Life test, whereas, together the MAPA and Purpose-in-Life test predicted
the mental health component of version 2 of the SF-36v2 Health Survey.
Discussion of the study findings related to the significance of the MAPA as a reliable
and valid measure of meaningful activity participation, in addition to the potential
role the MAPA could serve in informing contemporary life-span theories of aging.
Future research suggestions included the need for continued validation studies of the
MAPA, including larger more representative samples, as well as longitudinal and
experimental designs to consider the nature of change in the personal meaning of
activities in older adults.
1
CHAPTER ONE
INTRODUCTION AND STATEMENT OF PROBLEM
Occupational science and occupational therapy philosophy have their roots in the
notion that personally meaningful activity (or occupation) contributes substantially to
individual health and well-being (Clark, 1993; Reilly, 1969; Yerxa, 1993). As a
working assumption of occupational science, the personal meaning and importance
attributed to activity can influence the manner in which it is experienced and the
functions that is serves in a person’s life (Clark et al., 1996). Further, it has been
demonstrated that the health and quality of life of older adults may be positively
influenced through activity-based interventions (Clark et al., 1997), while dynamic
enhancements in one’s activities and their experienced meanings likely contribute to
long-standing health benefits (M. Carlson, Clark, & Young, 1998; Clark et al., 2001).
The above notions are underscored by the results of the USC Well Elderly Study
(Clark et al., 1997), which demonstrated that an activity-based intervention, called
life-style redesign, led to significant positive changes in the health and well-being of
older adults. A culturally diverse sample of community-living elders (N=361) were
randomized to either an occupational therapy treatment group who received the
lifestyle redesign intervention, a non-professionally led activity group (social
control) or a no-treatment control group. Greater psychological and perceived
2
physical health outcomes were evidenced by the occupational therapy group as
compared to the combined control groups. This result was robust and included the
outcome of life satisfaction as well as seven out of eight scales on the Rand SF-36
Health Status Survey (Ware & Sherbourne, 1992).
Clark et al. (1997) commented that the elders’ positive responses to the occupational
therapy treatment were likely due to its impacts in three key areas. First, the
occupational therapy program enabled the participants to construct daily routines of
health promoting and meaningful activities and embed them within the context of
their ongoing daily lives. Second, the program was individually tailored to the
unique circumstances of a person’s life, thereby increasing the likelihood that the
intervention resulted in personally feasible and sustainable changes. Third, the
occupational therapy intervention was designed to enable the elders to overcome
personal barriers to activity participation (Clark et al., 1997). However, although the
authors commented that enhanced meaningful activity participation played a direct
role in producing positive quality of life outcomes, the USC Well Elderly Study did
not employ an objective measure of meaningful activity participation, a key
construct suggested by the authors to be a mediating factor.
While the construct of meaningful activity participation is in itself not a new idea, no
empirically validated instrument currently exists by which it can be measured.
Streiner and Norman (2003) have posited that the need to develop a new instrument
3
exists when: (a) the construct is a new one and no existing scale measures it; or (b)
existing tools are unsatisfactory, and fail to capture some key aspect of the construct.
The purpose of the present study is to establish the psychometric properties of a new
instrument, the Meaningful Activity Participation Assessment (MAPA), which has
been designed to enable assessment of meaningful engagement in activity.
Justification for this study stems in part from the need for a measure of meaningful
activity participation as suggested from the USC Well-Elderly study. In further
support of the need for the study, I posit that existing instruments have not
adequately tapped into the phenomenological nature of meaningful activity
participation. Furthermore, the study will serve to provide evidence for the validity
of the MAPA as an instrument capable of reliably measuring this critical construct.
Guidance in the development of the MAPA has been gleaned from such theoretical
orientations as activity theory (Lemon, Bengston, & Peterson, 1972), continuity
theory (Atchley, 1989), and the model of selective optimization with compensation
(Baltes & Baltes, 1990a). As an example, a review of activity theory would suggest
that instruments intended to measure activity participation should include some scale
reflecting the frequency of activity participation. Furthermore, a review of the model
of selective optimization with compensation would suggest that the instrument
include some means for rating the value or meaning each activity holds for a person.
Based upon life-span models of human development, it will be argued that both
4
objective and subjective components are critical for a comprehensive approach to
measuring meaningful activity.
The review will detail relevant theoretical perspectives which may aid in answering
the question, “What does meaningful activity mean?” This review will highlight a
progression from concern with the more objective aspects of activity such as use of
time, to that of the subjective. Havinghurst (1961) was significant in this shift,
suggesting that questions should be asked about the quality of activities and what
they mean to the individual. The review will also extend into the existential, as
theories of meaning and purpose in life are introduced. Reker, Peacock, and Wong
(1987) have provided a rather concise definition of the construct of meaning and
purpose in life:
Meaning refers to making sense, order, or coherence out of one’s existence.
Purpose refers to intention, some function to be fulfilled, or goals to be
achieved. Having a sense of personal meaning means having a purpose and
striving toward a goal or goals (p. 44).
Other definitions of meaning and purpose in life tend approximate this one, while the
terms purpose in life and meaning in life may be used interchangeably. This
existential aspect of meaning is important to the present study since occupational
science scholars have posited that meaningful engagement in activity contributes to
viewing one’s life as purposeful and meaningful, ultimately influencing health and
well-being (Clark et al., 1991; Jackson, Carlson, Mandel, Zemke, & Clark, 1998;
Yerxa et al., 1989).
5
Contemporary approaches to activity measurement will also be reviewed. Critiques
will center on the general absence of measures of the subjective qualities of activity.
Studies incorporating subjective attributions of activity participation will also be
reviewed. It will be argued that evidence suggests that instruments which reflect the
subjective aspects of activity participation can provide for a greater understanding of
the relationship between activity and well-being (e.g., K. M. Everard, 1999;
Fernandez-Ballesteros, Zammarron, & Ruiz, 2001). While these studies have
assessed aspects of meaningful activity in relationship to positive affect and life
satisfaction, the number of studies have been quite limited, inconsistent findings are
evident (Pushkar, Arbuckle, Conway, Chaikelson, & Maag, 1997), and the
instruments themselves do not seem to be comprehensive enough to measure the
construct fully. Critiques will focus on how to improve upon the contemporary
approaches to measuring the subjective aspects of activity participation.
The Meaningful Activity Participation Assessment (MAPA) will be highlighted in
relative detail as the principal indicator of the construct of meaningful activity
participation. Briefly, the MAPA is a check-list type activity survey which contains
twenty-eight activity items. The MAPA is intended to assess the meaningfulness and
frequency of participation for each of the twenty-eight activity items. Three MAPA
scales with distinct characterizations of meaningfulness will be reviewed. Given the
exploratory nature of the present study, additional scales intended to tap the construct
of meaningful activity participation will be considered as sources for criterion-
6
related validity. One measure, the Engagement in Meaningful Activity Survey
(Goldberg, Brintnell, & Goldberg, 2002) is quite unique, and intimately tied to the
construct of meaningful activity participation.
As part of the process of construct validation it will be proposed that the MAPA be
evaluated in terms of its reliability and associations with related constructs of health
and well-being. The design of the present study may be interpreted best in relation
to two specific conceptual models. The first conceptual model is under investigation
at the University of Southern California as an NIH grant funded initiative entitled,
Health Mediating Effects of the Well Elderly Program (Clark, 2001). This model
had been developed to identify the mechanisms responsible for the positive outcomes
found by Clark et al. (2001; 1997) mentioned above. This model is intimately
related to the present study for two reasons. First, the MAPA is being proposed as
the study’s indicator for healthy activity. The validation of the MAPA as an
indicator of activity participation is therefore of paramount importance. Second, a
number of the outcome indicators from The Well Elderly model have been included
within the present study (e.g., the RAND SF-36 version 2 (Ware, Kosinski, &
Dewey, 2000), the Life Satisfaction Index-Z (Wood, Wylie, & Sheafor, 1969), and
the Center for Epidemiologic Studies Depressive Scale (Radloff, 1977)). Hence it
will be of significant consequence to substantiate the extent to which the MAPA may
predict variations within these outcome indicators.
7
The other conceptual model to be proposed for this study is supported by substantive
theory. It in part arises out of the need for instruments which are capable of reliably
and validly capturing the meaningfulness of activity participation in older adults
(Glass, Seeman, Herzog, Kahn, & Berkman, 1995). The model also reflects the
increasing interest in the construct of meaning and purpose in life as a contributing
factor to the both the mental and physical health of older adults (Ryff & Singer,
1998). A tentative causal model relating the constructs of 1) meaningful activity
participation, 2) meaning and purpose in life, 3) self-rated physical health and 4)
self-rated mental health, will be put forth. In this model, a direct causal influence
from a measure of meaningful activity participation to measures of self-rated
physical health and self-rated mental health is hypothesized. Meaningful activity
participation is also hypothesized to have a direct influence upon purpose and
meaning in life. Finally, both self-rated physical and mental health are hypothesized
to be indirectly influenced by meaningful activity participation via its role in
enhancing purpose and meaning in life, in addition to the direct influence of meaning
and purpose in life (see Figure 1).
Ultimately, the present study is guided by four key assumptions from the discipline
of occupational science. The first assumption is that occupation (or activity) can
have a healthful influence upon the individual. This position was ardently put forth
by Reilly (1962) in her declaration, “That man, through the use of his hands as they
are energized by mind and will, can influence the state of his own health” (p. 2). The
8
Figure 1. Tentative Causal Model with Study Constructs.
second assumption is that activity (or occupation) is imbued with meaning.
Individuals are constantly engaged in action, and in their cultural and social contexts
meanings are attached to activities that occupy their time (Jackson, 1996; Yerxa et
al., 1989). The third assumption is that occupation provides a source of meaning at
the higher symbolic or existential level of the human. Engagement in personally
valued and meaningful activity will contribute to an individual’s sense of meaning
and purpose in life (Clark et al., 1991). The final assumption, not explicit in
occupation science, suggests that personal subjective experience may be assessed
objectively. While subjective experience is intimately personal, indirect methods
may be used to establish them as empirical fact (Reker & Wong, 1988; Searle, 1992).
Physical Health
Mental Health
Purpose in Life
Meaningful
Activity
Participation
9
CHAPTER TWO
LITERATURE REVIEW
Building Theoretical Support for the Meaningful Activity Participation Assessment
The purpose of the Meaningful Activity Participation Assessment (MAPA) is to
enable quantitative assessment of the construct of meaningful activity participation.
However, how the construct of meaningful activity participation is operationally
defined in terms of its dimensions will depend on the theoretical orientation that
guides its development, as a given theoretical orientation will have a significant
impact upon the perception and definition of any specified construct (Hendricks &
Achenbaum, 1999; Kerlinger, 1986). To follow is a brief review to highlight a
number of theories of development and aging which have significant implications for
activity as a construct for empirical study. These theories include activity theory
(Lemon et al., 1972), continuity theory (Atchley, 1989), selective optimization with
compensation theory (Baltes & Baltes, 1990a), and Schultz and Heckhausen’s (1996)
lifespan model of development. Critiques, comparisons and contrasts among the
theories will be offered to highlight ideas relevant to the present study. The review
will also address how the measurement of activity in general, and meaningful
activity in particular, has been approached. The intention of the review will be to
10
present a theoretical framework which justifies the present design of the MAPA as a
potentially valid indicator of meaningful activity participation.
Activity Theory
Activity theory (e.g., Lemon et al., 1972) has greatly influenced our understanding of
activity in gerontological research. Although as a “grand theory” of aging
(Bengston, Rice, & Johnson, 1999) activity theory has lost a significant amount of its
initial prestige, some of its tenets continue to be influential in gerontological
research. The importance of activity, and more specifically activity that fulfills
social roles, was advocated by Havinghurst and Albrecht (1953). Lemon, Bengston
and Peterson (1972) then offered specific axiomatic statements regarding the
mechanisms through which activity was proposed to influence well-being in the
older adult. These authors defined activity as, “any regularized or patterned action or
pursuit which is regarded as beyond routine physical and personal maintenance” (p.
513). They further elucidated three specific types of activity in which older persons
were understood to be engaged: (1) informal activity which included social
interaction with relatives, friends and neighbors; (2) formal activity which included
social participation in formal voluntary organizations; and (3) solitary activity which
included pursuits such as watching television, reading, and hobbies performed alone
(Lemon et al., 1972).
11
Activity was theorized to enhance role supports necessary for reaffirming a person’s
self-concept. Additionally, the more intimate and more frequent the activity, the
greater the reinforcement of one’s social roles, positively influencing one’s self
concept, and thereby providing for higher life satisfaction (Lemon et al., 1972). The
frequency of each of the three activity types; formal and solitary, but especially
informal activity was hypothesized to enhance one’s life-satisfaction. However, only
informal activity with friends was found to predict life-satisfaction in their sample of
411 older adults, controlling for health, gender and age (Lemon et al., 1972). In
discussing the lack of full support for activity theory in their findings, the authors
suggested that the quality, as apposed to the mere frequency of one’s social activities
may be of greater importance in contributing to life satisfaction.
Studies undertaken with activity stratified into the three types proposed by Lemon et
al. (1972) have also resulted in mixed support for activity theory. For example,
Edwards and Klemmack (1973) utilized multiple regression analysis in a sample of
507 adults 45 years and older, controlling for such variables as age, socio-economic
status, marital status and health. They found that the frequency of informal social
activities predicted life satisfaction, while formal activity participation was
negatively associated with life satisfaction. Longino and Kart (1982) also found a
similar pattern in their large sample (N=1209) of older adults. One consistent
finding seems to be that more frequent informal social activity is related to positive
life satisfaction, while activities that are solitary in nature fail to predict life
12
satisfaction. From a brief review of these studies, there does not appear to be full
support for activity theory as outlined by Lemon et al. (1972).
A meta-analysis undertaken by Okun, Stock, Haring and Witter (1984) has helped to
clarify the diverse range of research findings conducted within an activity theory
frame. Their quantitative synthesis drew upon 556 sources which examined the
social activity and subjective well-being relationship. Activity was operationalized
as formal and informal social activities, in addition to general activities (which were
a mix of both formal and informal). The frequency of activity participation was
addressed in addition to the number or diversity of the activities. There was little
distinction between formal and informal social activity in terms of their effect sizes
upon life satisfaction, a finding contrary to the hypotheses proposed by Lemon et al.
(1972). While for first-order effect sizes (e.g., controlling for either: age, gender,
income, or marital status) formal activities were found to have higher mean effect
sizes upon life satisfaction than for informal activities. Additionally, while the
frequency of activity participation significantly predicted well-being, the diversity of
activities (i.e., the number of different activities within which persons were engaged)
predicted well-being to a greater extent than did activity frequency (Okun et al.,
1984).
The findings of the Okun, et al. (1984) study do not provide full support for activity
theory as outlined by Lemon et al. (1972). Informal social activity did not predict a
13
greater degree of subjective well-being when compared to formal activity. Overall
social activity only explained from 1% to 8% of the variance of subjective well-
being depending on the covariate. The Okun et al. (1984) study does however
provide strong support for including activity frequency as a component of
measurement in the activity/subjective well-being relationship; a central tenet from
activity theory. A means to account for the diversity of activity options for older
adults would also be warranted given these findings.
It appears that the a priori categorization of activity suggested by activity theory does
not provide for a sufficient amount of explanation in predicting well-being given the
potential contribution of a diverse array of activities. Additional criticisms of
activity theory suggest that it may support unrealistic expectations for aging
successfully, especially in the face of shifts in life space (Fry, 1992), and social
attachments (Carstenson, 1992; Tornstam, 1999). The relatively simplistic approach
suggested by activity theory may be limiting the prediction of life satisfaction given
the complex contributions of activity to the construction of an individual’s unique
contextualized life. Despite this, activity can be expected to share up to 10% of the
variance with subjective well-being measures (McNeil, Stones, & Kozma, 1986),
and therefore deserving of significant attention from researchers. But, as suggested
by Okun et al. (1984), efforts should be undertaken to better understand how
activities are interpreted by the individual, as well as identifying variables which
might interact with activity to determine subjective well-being.
14
Continuity Theory
Continuity theory (Atchley, 1989) represents a second prominent theoretical
approach that is germane to conceptualizing the role of meaningful activity. This
theory construes individuals as active participants in the construction, development,
and perpetuation of the structure and dynamics of the self. According to Atchley
(1999a) individuals set priorities and make selective investments that produce the
greatest possible benefit in terms of health and life satisfaction for their given
constraints. Continuity theory assumes that the primary goal of adult development is
adaptive change as opposed to homeostatic equilibrium. The theory is based upon an
evolutionary concept of continuity that stresses recurring themes and persistent
patterns in which details can change as long as basic patterns are maintained.
Four interacting elements are proposed in continuity theory for the aging adult:
internal patterns, external patterns, developmental goals, and adaptive capacity
(Atchley, 1999a). Most germane to the present study are the external patterns that
involve activities, relationships, living environments and geographic locations.
Continuity of activities is based upon an individual’s valued developmental goals
and is directed at maintaining a personally meaningful lifestyle, congruent with one’s
self-concept. In the face of age-related functional limitations, increased investment
in retaining personally meaningful activities has been linked to greater levels of
morale (Atchley, 1998). Stability of activity over time has also been found to be
15
related to happiness (Stones & Kozma, 1986). Furthermore, while overall activity
levels may decline, maintaining one’s patterns of activities is associated with greater
levels of life satisfaction and personal agency (Atchley, 1999b).
Continuity theory (Atchley, 1989) appears to provide a more dynamic model of
adaptation in the older adult when compared to activity theory (Lemon et al., 1972).
While activity theory’s central tenet is that activity levels should be maintained,
continuity theory suggests that a diversity of approaches may support activity
continuity in order to maximize life satisfaction. On the whole, activity theory may
be considered a more static theoretical orientation which may minimize
consideration of alternative approaches for meaningful adaptation in the older adult
(Fry, 1992; Sagy, Antonovsky, & Adler, 1990). In terms of an instrument to assess
activity participation, continuity theory suggests that a wide array of possible activity
options should be provided. The measure would need to be sensitive to change over
time to aid in identifying not only shifts in activity participation but also the
persistence or sustainability of activity patterns.
Life-Span Theories of Development
Baltes and Baltes (1990a) offer a third important perspective from which to view the
role activity could play in adult development. These authors have suggested that
successful adaptation can be considered as a process of “selective optimization with
16
compensation,” such that individuals choose to make the best use of certain
capacities and resources they still have, while finding ways to compensate for other
limitations. This process of adaptation may lead to accommodative strategies such
as rescaling goals (Brandtstädter, Wentura, & Greve, 1993) or compensating via
increased social interaction (Unger, McAvay, Bruce, Berkman, & Seeman, 1999) as
a means of maintaining perceived well-being when faced with chronic illness or
disability. To maximize the potential for successful aging, Baltes and Baltes (1990a)
have suggested the promotion of an activity lifestyle that minimizes the risk of
pathological aging conditions through strengthening reserve capacities.
The theory of selective optimization with compensation (SOC) is composed of three
interacting elements and processes (Baltes & Baltes, 1990a). The first is selection,
which relates to an increasing restriction of one’s life world to fewer domains of
functioning in response to age-related declines. A choice is made by the individual
to select activities which are of a high priority, given environmental demands and
individual motivation. According to the theory, the process of selection implies that
individual expectations are adjusted to allow for the subjective experience of
satisfaction and personal control. Optimization refers to the perspective that people
engage in activities so as to supplement their present capacities while maximizing
the quantity and/or quality of their activities. Finally, compensation results from
limitations in functional capacities which restrict one’s ability to engage in their
usual variety of activities. Compensation therefore involves modifications in ones
17
approach to his or her activities in order to support participation. In sum, the
adaptive task of the aging individual is to, “… select and concentrate on those
domains that are of high priority and that involve a convergence of environmental
demands and individual motivation, skills and biological capacity” (Baltes & Baltes,
1990a, p. 27).
Inherent within the continuity theory (Atchley, 1989, 1999a) and an explicit
component of the SOC (Baltes & Baltes, 1990a) theory of aging is an active practice
on the part of the individual to maximize health and life satisfaction through
processes of activity selection, activity investment (optimization), as well as activity
compensation. Schultz and Heckhausen (Heckhausen & Schultz, 1995; 1996) have
explicated these processes in articulating a comprehensive life course model of
developmental regulation, and suggest that they serve critical roles in aging
successfully.
Choice of a particular goal directed activity involves some expectation that
participation will result in a personally meaningful outcome for the individual.
Schultz and Heckhausen’s (1996) model proposes that it is through a sense of
primary control (i.e., achieving effects within the immediate environment) that an
individual is motivated to pursue their selected activities. However, the authors also
acknowledge the importance of other motivational forces such as autonomy and
relatedness with others (e.g., Deci & Ryan, 2002) as individuals choose to engage in
18
activity. A reciprocal aspect of their model involves secondary control, whereby
individuals shift their perceptions of their goal pursuits when faced with obstacles
that challenge their competencies. As an example of a secondary control strategy in
older adulthood, individuals might devalue the importance of an activity area in
which they are no longer capable of engaging (Brandtstädter & Rothermund, 1994).
Further, as individuals encounter functional losses in the face of increasing age-
related disability, secondary control strategies (e.g., disengagement from prior
activities and investment in alternative activities) may serve to enhance the personal
value of activities in which they are still capable of participating (Schultz &
Heckhausen, 1996).
Both continuity theory (Atchley, 1989) and SOC theory (Baltes & Baltes, 1990a)
underscore the dynamic developmental processes that adults undergo as they age.
Neither theory advocates for a specific formula of activity engagement as might be
suggested from activity theory (Lemon et al., 1972). Rather these theories offer
complementary perspectives within which to conceptualize the role of activity as
providing opportunities for maximizing health and life satisfaction. Implicit within
both continuity and selective optimization with compensation theories is an
understanding of the agentic nature by which the individual becomes meaningfully
occupied with the world. Both theories link active engagement to a sense of well-
being through self-systems, which actively structure and interpret experiences,
motivate engagement in activity, and provide a sense of continuity (E. R. Kaufman,
19
1986; Markus & Herzog, 1999). Schultz and Heckhausen’s (1996) model of primary
and secondary control serves to elucidate a mechanism by which age-related changes
in activity may occur. It further complements the continuity and selective
optimization with compensation theories by appreciating the adaptive nature of
individuals in shaping their life course.
The preceding discussion suggests the following considerations concerning the
development of an instrument intended as a measure of meaningful activity
participation in older adults. As proposed from the review of activity theory (Lemon
et al., 1972), a measure of activity should reflect the frequency of activity
participation, as this aspect of activity has been shown to be related to well-being.
From continuity theory (Atchley, 1989) the instrument should allow for
measurement of a diversity of activity options, while being capable of discerning
shifting patterns of activity engagement over time. When the theory of selective
optimization with compensation (Baltes & Baltes, 1990a) and the model of primary
and secondary control (Schultz & Heckhausen, 1996) are incorporated as theoretical
guides, aspects of subjective attributions specific to each activity would be
warranted; as a individuals’ perceptions of their activity choices over time may, for
example, influence their decisions to select or remain engaged in activities seen as
meaningful. While distinctions have been made regarding the manner by which each
theoretical position would suggest particular features for a measure of meaningful
20
activity participation, these divisions primarily serve a heuristic purpose given the
relative congruence of these theories (Markus & Herzog, 1999).
On the Nature of Meaningful Activity Participation
As mentioned at the beginning of this review, the purpose of this study will be to
provide evidence of the psychometric properties of the Meaningful Activity
Participation Assessment (MAPA). However, validation begins with a grounded
blueprint and the development of the instrument in accord with a credible conceptual
framework. Benson (1998) has outlined an approach to measurement validation
typified by the prominent role theory plays in validation. According to Benson, the
substantive stage of construct validation entails an operational definition of the
observed variable(s) reflecting the theoretical domain of a construct. Consistent with
the approach of Benson, Pedhazur and Schmelkin (1991) advocate methods for
construct validation which will serve in part as a guide for the present discussion.
According to these authors, logical analysis involves defining the construct of
interest, and is an essential aspect of construct validation. Support for the definition
of a construct may be drawn from relevant theories and research findings.
21
What does Meaningful Activity Mean in Social Gerontology?
Throughout this review I will present aspects of the conceptual framework that
justify the construction of the MAPA. The intention of the review to follow is to
introduce a variety of perspectives from which to answer the following question,
“What does meaningful activity mean?” Studies will also be reviewed that have
operationalized some aspect of activity meaning, and explored the relationship
between more subjective aspects of activity meaning, health, and well-being.
Finally, the MAPA will be proffered as an operational definition of the construct of
meaningful activity participation. The review will serve to highlight key aspects of
what might constitute meaningful activity, so as to offer supportive theoretical
evidence for the construct validity of activity meaning in the present study.
Engagement in meaningful activity has been a key construct in gerontological studies
for decades. The study of leisure time use was given early attention in exploring
activity meaning in older adults. For example, in the opening chapter of a book
entitled Aging and Leisure, Kleemeier (1961a) noted that the significance of time use
was its potential to serve as an indicator with which to determine the value that
individuals placed upon their activities, stating: “Thus it is that basic to this entire
book is the significance for older person of time usage and the meaning of activity”
(p. 8). Contributors throughout the text considered activity meaning in terms of time
spent in such diverse areas as family contexts, formal activity participation,
22
commercial entertainment, and a variety of leisure activities (Kleemeier, 1961b).
While time use was purported to constitute one reflection of activity meaning, other
objective descriptors of activity (e.g., family activities and commercial
entertainment) were seen as an additional perspective from which to assert an
activity’s meaningfulness.
Havinghurst (1957; 1961) by contrast directed his inquiry toward the personal
experience and subjective characteristics of leisure time use, stating:
But for a study of significance of leisure it is necessary to go beyond
questions of sheer quantity. A variety of questions must be asked
about the quality of leisure activities, what they mean to the
individual, what place they have in his life” (p. 153).
As part of in-depth interviews in the Kansas City Study of Adult Life (Havinghurst,
1957) study participants were asked to list a few of the activities that they liked the
most; and a list of 11 activity areas was identified. A set of “significance variables”
was generated based upon the interviews, sociological writings and collegial review.
The significance variables included a list of 19 semantically distinct concepts (e.g.,
autonomy versus other-directed, enjoyment versus time-killer, gregarious versus
solitary and new experience versus repetition). These variables were applied by the
author to each individual’s leisure activities based upon readings of their personal
interview. Findings indicated that a given activity had a variety of significance
ratings depending on the person, and that different leisure activities could have the
same significance for a given individual. The following was summarized by
23
Havinghurst (1957) in consideration of the relationship between personality and
socioeconomic variables with significance ratings:
Generally speaking, good personal adjustment, complex life-style,
and higher socioeconomic status are correlated with the following
characteristics of leisure activity: autonomy, creativity, enjoyment,
prestige-giving, novelty, vitality, expansion of interests (p. 161).
Lawton (1993) reviewed the status of the meaning of leisure activities in older
adults, and suggested that relatively little in the way of empirical study had been
done since Havinghurst (1961). Drawing from the work of Osgood, Lawton made a
distinction between two types of activity meanings: “denotative meaning” which
refers to the more objective physical characteristics and uses of activities, and
“connotative meaning” referring to the personally subjective or affective aspects of
activity involvement as (p. 26). Lawton posited that to ask the question, “What does
the activity do for me?” (p. 28) may best approximate the nature of connotative
meaning. In terms of denotative meaning, Lawton evaluated studies which had
categorized diverse activities upon either an a priori basis (e.g., Lemon et al., 1972),
or by a factor analysis of frequency of participation data and concluded that little had
been gained in advancing an understanding of the connotative meanings of leisure
activity.
From his literature review Lawton (1993) provided an initial categorization of
connotative meanings of leisure activities. Three large classes of connotative
meanings were outlined entitled experiential, developmental and social leisure.
24
Experiential leisure meanings included four aspects: intrinsic satisfaction,
exemplified by the flow concept from Csikszentmihalyi (1975), in addition to
solitude, diversion, and relaxation. Experiential leisure meanings reflected activities
performed for their own sake rather than for its consequences. Developmental
leisure meanings shared the characteristic that the activity was not only enjoyed but
assisted an individual to change in some way. Five aspects of developmental leisure
were suggested including: intellectual challenge, personal competence, health,
expression and personal development, and creativity. The final class of leisure
meaning, social leisure, was identified by Lawton (1993) as a dimension found
within virtually every classification of connotative leisure meanings. The three
aspects of social leisure included: social interaction, social status, and service to
others. Kelly, Steinkamp, and Kelly (1986) derived five clusters of activity
meanings in their sample of adults aged 40 to 70+, including: companionship in the
activity, strengthening primary relationships, competence and skill development,
expression and personal development, and health and exercise. Their results
suggested that the environments, forms and meanings of leisure activities changed as
a part of life transitions. However, “…there is considerable consistency in both the
core of engagements and the central meanings of leisure through the life course” (p.
536).
Lawton (1993) echoed the conclusion reached by Havinghurst (1957), and suggested
that any single activity, in denotative terms, may take on a great variety of
25
connotative meanings across persons. Lawton (1993) offered the term
“mulitplexity” to suggest this aspect of activity meaning (p.33). Another property of
multiplexity involved the idea that activity meanings may vary within the same
person across different contexts or across time periods. Rather than seen as a
difficulty with the conceptualization of activity meaning, the property of multiplexity
as suggested by Lawton (1993) fits well within the theory of selective optimization
with compensation (Baltes & Baltes, 1990b). As choices are made to relinquish an
activity in the face of age-related changes, the activity may be attributed a lesser
degree of meaning, or be less important than are activities which are maintained.
Support for this position may be found in a study conducted by Pushkar, Arbuckle,
Conway, Chaikelson, and Maag (1997). Older adults (N=198) completed surveys in
which they indicated the frequency of their engagement in 26 activities, as well as
the importance of each activity. The mean-rated importance of the activities which
declined in frequency of participation over time was less than the importance ratings
of the activities which remained the same or increased in frequency. Further, the
loss a sense of perceived control in a particular goal domain (e.g., physical fitness,
family security) appears to be less detrimental when it occurs in a domain that has
been devalued by the older adult (Brandtstädter & Rothermund, 1994).
Kaufman’s (1986) concept of “themes of meaning” can potentially facilitate the
conceptualization of the dynamic nature of activity meanings. Themes of meaning,
“… identify the personal, idiosyncratic ways of experiencing and communicating
26
meaning in the individual life – the ways in which people interpret experience so as
to give unique internal continuity and structure to the self” (p. 115). Themes imply
that there is substantial variability between persons in terms of the content and
intensity of meaning they draw from any given activity. Themes represent a means
by which the older adult continually creates the self through an ongoing
interpretation of past experience, present commitments, values and current contexts.
Within her qualitative investigation of older adults, Kaufman (1986) identified
present activity in daily routines, family and friends as structural components of
themes, and found that an individual’s personal values were critical in shaping
themes about these components. Values such as achievement, success, productivity,
work, progress, social usefulness, independence, self-reliance, and individual
initiative were found in her sample of 60 older adults. However, according to
Kaufman (1986; 1993) the individual is capable of reinterpreting experiences such
that lifelong values: 1) take on new meanings in old age, 2) promote a sense of
continuity of self, and 3) contribute to an integrated and salient account of the life
course.
Also utilizing qualitative methodologies, Jackson (1996) found a significant degree
of congruence between individuals’ themes of meaning and their engagement in
meaningful activity. For older adults living successfully with disabilities, symbolic
themes of meaning involved: productivity, generosity, generativity, creative
expression, caregiving, affective familial bonds and independence. The themes
27
served to provide a framework within which activity goals were formulated and
enacted. The dynamic nature of themes was suggested as individuals adapted to
disability-related activity losses through integrating themes of meaning into their
present daily and weekly rounds of activity. The work of Kaufman (1986) and
Jackson (1996) suggests that activities are imbued with meaning as a ongoing
process of a self-construction. Activity and the self are mutually constituted as
individual action is organized and integrated within the self, and the self then serves
to construct or provide meaning and coherence to a person’s experience (Herzog &
Markus, 1999).
Baumeister (1991) has conceptualized meaning as occurring in contextualized
networks of associations, structured as a web of ideas and relationships which serve
to regulate emotions and guide behavior. Baumeister’s definition of meaning states
that, “…meaning is shared mental representations of possible relationships among
things, events, and relationships” (p. 15). Personal meanings are situated within an
historical socio-cultural milieu, and consist of multiple interacting levels. Any event
– or activity – can engender different meanings depending upon contexts, levels, and
relationships with other meanings. This view of meaning is consistent with socio-
culturally contextualized theories of embodied meaning (Overton, 1994).
Baumeister (1991) suggests that persons have an “appetite” or need for meaning,
such that the degree to which persons satisfy these needs contributes to their sense of
28
a meaningful life. Four needs were outlined including: 1) purposiveness – the need
to see one’s activities as oriented toward a purpose, 2) value (justification) – peoples
motivation to feel that their actions are right and good and justifiable, 3) Efficacy –
people’s need to achieve control (or experience control) within the events of their
daily lives, and 4) self-worth – the need to make sense of their lives that enables
them to feel they have positive value (Baumeister, 1991; Sommer & Baumeister,
1998). Interestingly, these needs for meaning are compatible with Deci and Ryan’s
(2002) motivations for autonomy, efficacy and connectedness, and Schultz and
Heckhausen’s (1996) motivation for control.
Within this conceptualization, Baumeister (1991) has acknowledged the interpretive
and adaptive capacity of the individual. Finding happiness and satisfaction in life is
related not just to ones external circumstances and events, but to a greater degree
relies on the person’s perceptions of these circumstances in conjunction with the
expectations or standards with which the person compares one’s circumstances.
Difficult life transitions, such as activity loss from age-related declines, may restrict
an individual’s access to their sources of meaning, creating a “meaning vacuum” (p.
315). Adaptation to difficult life transitions may be facilitated through “stretching”
one’s remaining sources of meaning to make up for the deficit, and/or to find new
replacement sources of meaning. Further, the continuity of themes of meaning
throughout persons’ lives helps individuals cope with change and loss. Ultimately,
according to Baumeister (1991), an individual is actively engaged in constructing
29
and negotiating meanings in order to support the need for meaning; and, “Without
the gift of meaning we could never fully appreciate the gift of life” (p. 370).
Meaning and Purpose in Life and Meaningful Activity
The work of Viktor Frankl has been credited with spurring philosophical and
scientific inquiry into the concept of purpose and life meaning (Wong & Fry, 1998).
A substantial increase in the study of purpose and meaning in life has occurred, in
part, because of the strong empirical relationships which have emerged between life
meaning and various indicators such as measures of physical and mental health,
psychological well-being, and life satisfaction (Reker & Chamberlain, 2000). For
example, in a classic article Zika and Chamberlain (1992) reported significant
positive relationships between measures of life satisfaction, well-being, and meaning
and purpose in life in adults aged 60 years and older. In a review of theoretical and
empirical evidence, Wong (1988) suggested that personal meaning represents a new
perspective on the promotion of well-being of the elderly. Personal meaning was
suggested to be a major source of life satisfaction and a buffer against stress, while
the discovery and creation of meaning may represent an essential component of
successful aging.
The construct of meaning and purpose in life has been defined by Reker, Peacock,
and Wong (1987) as follows:
30
Meaning refers to making sense, order, or coherence out of one’s existence.
Purpose refers to intention, some function to be fulfilled, or goals to be
achieved. Having a sense of personal meaning means having a purpose and
striving toward a goal or goals (p. 44).
Terms such as purpose in life, meaning in life and meaning and purpose in life may
be used interchangeably by different authors throughout this review. Presently,
empirical evidence addressing the factorial nature of diverse measures of meaning
and purpose in life suggest that these concepts actually constitute one coherent
construct (Reker & Fry, 2003). So while authors may differ somewhat in their
terminology, for the purpose of the present review these terms should be understood
to reflect the general construct of meaning and purpose in life.
According to Reker and Wong (1988) personal meaning can be defined as the degree
of self-transcendence that is realized among four interacting levels of personal
meaning. The lowest level is identified by a self-preoccupation with hedonistic
pleasure and comfort. The second level is related to the personal devotion of time
and energy towards personal goals and self-actualization. In the third level the
individual moves beyond self-interest to the service of others, and dedication to a
larger societal cause. The forth level is purported to involve values that transcend
the individual, to encompass cosmic meaning and ultimate purpose. In agreement
with Baumeister (1991), personally held values and meanings (e.g. personal
relationships, personal growth, altruism) serve as sources for personal meaning, with
31
the degree of personal meaning in life being composed of the total amount of
meaning derived from available sources (Reker & Wong, 1988).
A personal meaning system is an integrated complex of relationships between levels
of meaning, consisting of individuals’ valued sources from their past history, their
present endeavors, and future expectations (Reker & Wong, 1988). While the
personal meaning system is seen to involve the interaction of its multiple levels, it is
also supported by the diversity of its meaning sources. Reker and Wong postulated a
breadth hypothesis which suggests that an individual’s degree of personal meaning
will increase in proportion to the diversification of personal sources of meaning.
Most relevant to the present study is the contribution of what the authors describe as
“present meaning,” which is primarily based upon an individual’s ongoing
commitments, activities, and pursuits. According to the authors, the development of
life meaning is consistent with life course perspectives of aging, such that, “We
create meaning through choices and actions as we move through life, but we also
discover meaning from many ‘happenings’ that come our way” (Reker & Wong,
1988).
Purpose in life has been identified as an essential component of psychological well-
being, and has been defined by Ryff and Singer (1995) as the belief that one’s life is
purposeful and meaningful. Evidence has been provided by Zika and Chamberlain
(1992) that purpose in life is highly correlated with measures of life satisfaction and
32
positive affect in older adults. The authors suggested that meaning in life may be
one of the critical factors in obtaining and maintaining a strong sense of well-being.
Fry (2001) investigated the role of personal meaning in a sample of older adults who
had lost their spouses to death. Personal meaning was found to predict well-being in
this sample while controlling for demographic factors, social support and health
problems. Fry concluded that existential factors such as life meaning may serve a
role in supporting coping in the face of devastating losses. Further, measures of
purpose and meaning in life have been shown to be factorially distinct from
measures of depression, while they offer the potential to predict depression in older
adults beyond that of traditional measures (Reker, 1997).
Ryff and Singer (1998) have proposed that as a central component of positive mental
health, the construct of purpose and meaning in life has direct consequences for
physical health. Some evidence in support of this position has been proffered by
Reker, Peacock, and Wong (1987) in a sample of young, middle-aged, and older
adults. Utilizing measures of life meaning, perceived psychological and physical
well-being, the authors found that lower levels of life purpose and meaning were
predictive of greater perceived psychological and physical discomforts. However,
given the cross-sectional design of the study the direction of influence could not be
substantiated. In a study employing path analytic methodology, Smith and Zautra
(2000) examined the contribution of purpose in life to coping in older adults
recovering from knee surgery. They concluded that purpose in life was directly
33
related to better mental health and indirectly related, through active coping, to better
physical health.
It is important that a link be drawn between purpose and meaning in life, and the
manner by which persons are occupied in daily activities. A number of existential
authors provide some understanding toward how this tie may be recognized. Frankl
(1959/1984) has suggested that the specific meanings we attribute to our lives result
from our personal day to day experiences. Meaning is ultimately discovered as we:
1) create a work or do a deed, 2) experience something or encounter someone, and 3)
choose the attitude we take toward suffering. Further, Frankl and Yolam (1980)
agree that a sense of purpose in life is not realized through passivity; rather, it may
be understood as emanating from a personal state of tension as an individual
continues to strive toward personally meaningful goals. Activity that is devoid of
engagement and purposive commitment may have less to do with a meaningful life,
and more to do with a passing of the hours, days, and years.
Occupational science is an academic discipline with the purpose of explicating the
complex factors constituting the mundane activities of human day to day existence.
Existential themes are present within the tenets of occupational science, and provide
further support for the notion that there is a crucial relationship between meaningful
activity and a meaningful life. Of interest are two specific levels of the USC model
of human subsystems (Clark et al., 1991). This model, employing general systems
34
theory, is conceptualized as a hierarchical nesting of six lower to higher-order
subsystems: the physical, biological, information processing, sociocultural,
symbolic-evaluative, and transcendental subsystems. The model serves to highlight
the relative interdependence of each of the six levels, while attempts to explain
occupational behavior (or activity) should take into consideration at least two levels
simultaneously. The symbolic-evaluative subsystem is of interest as it is purported
to account for the symbolic meanings individuals confer upon their activity. The
transcendental subsystem represents the next higher-order level of the model and
refers to the meanings persons ascribe to their life experiences. Ultimately it is
believed that an individual’s health, sense of life satisfaction and purpose in life is
directly influenced through engagement in meaningful occupation (Clark et al.,
1991).
While substantial empirical support may be found for the positive relationships
between activity involvement and life satisfaction in older adults, relatively few
studies have explored the contributions of meaningful activity towards the
fulfillments of life purpose and meaning for older adults. When compared to
qualitative investigations (Ahern, 1996; Jackson, 1996; E. R. Kaufman, 1986),
quantitative studies have provided much less in the way of improving our
understanding of this relationship. This may in part be due to the complexity of both
constructs, as well as the limited availability of sufficient measures to tap their
35
phenomenological and contextual subtleties. Despite this, a number of investigators
who have employed quantitative methodologies have shed some light on this area.
Most notable has been the work of Edward Prager, who developed an instrument
called the Sources of Meaning Profile (SOMP) (Prager, 1996). The SOMP is a
sixteen-item measure that includes a combination of activity categories, values, and
interest, and subjects are instructed to indicate each item’s relative degree of
importance within their lives. Prager’s position is consistent with that of Reker and
Wong’s (1988) breadth hypothesis, which suggests that a greater diversity of one’s
sources of meaning contributes to enhanced meaning in life. Fifty percent of the
SOMP’s items were directly reflective of activity involvement, including:
participating in leisure activities, meeting everyday needs, taking part in creative
activities, engaging in personal relationships with family and/or friends, taking part
in religious activities, being of service to others, and participation in “hedonistic”
activities (e.g., gambling, parties). In a large age-stratified Canadian sample
(N=461) Prager found age-invariant stability in eight of the nine categories (1996).
This finding suggests the relative continuity in the importance of these activities as a
sources of meaning well into later life. Unfortunately, Prager had not directly
assessed the relationship between these sources of meaning with a separate measure
of life meaning.
36
Only three studies involving older adults were found that explicitly investigated
activity as a source of meaning and its relationship to purpose and meaning in life.
Weinstein, Xie, and Cleanthouse (1995) utilized the Purpose-in-Life Test
(Crumbaugh & Maholick, 1969) as a measure of life meaning in a sample of older
adults (N=40). Subjects who engaged in volunteer activities on average more than
ten hours a week were found to have statistically significantly higher scores on the
Purpose-in-Life Test than those who volunteered less than ten hours per week.
Gerwood (1995) also utilized the Purpose-in-Life Test in his sample of adults aged
65 and older (N=130). Work and volunteering were classified together and coded as
a categorical variable, that is, only the presence or absence of this activity category
could be discerned rather than the frequency or duration of activity participation.
Work/volunteering was not found to have a significant correlation with life meaning,
and as could be expected it did not contribute to the prediction of Purpose-in-Life.
Finally, as part of a study of religion and purpose in life in older adults’ attitudes
toward death, Ardelt (2003) found a moderately high positive correlation (r = .44)
between spiritual activities and the Purpose-in-Life Test. And while Purpose-in-Life
helped to predict life satisfaction in a regression model, shared spiritual activities
failed to do so.
The findings from these quantitative studies indicate that meaningful activity is often
correlated with meaning and purpose in life. Though each of the above studies relied
on only one type of activity, Prager’s (1996) work suggests that by measuring a
37
greater number of activities as sources of meaning, more definitive statements can be
made regarding this relationship. Ultimately, longitudinal and experimental designs
will be required to provide substantial evidence in support of the proposition that
meaningful activities contribute to purpose and life meaning. Nonetheless, there is a
definite need to further explicate the relationships and contributions that meaningful
activity can make towards the experience of a meaningful life.
Therefore, the inclusion of a measure of meaning and purpose in life in the present
study can be supported from a few positions. First, personal meaning has been
implicated as an important resource in the promotion of health and successful aging
(Wong, 1989). Second, evidence suggests a decline of purpose in life with
advancing age and disability (Pinquart, 2002; Ryff, 1989), rendering the issue highly
salient in the lives of older adults. Lastly, participation in daily activities has been
identified as an essential source of personal meaning for the older adult (Prager,
1996; Reker, 1994). See Table 1 for a summary of differing aspects on meaning.
The Nature of Meaning in Occupational Science and Occupational Therapy
The discipline of occupational science arose from a need to elucidate the form,
function and meaning of occupation, and to understand how occupation contributes
to human health (Yerxa et al., 1989; Zemke & Clark, 1996). To achieve this goal it
is vital that we increase our understanding of both the experience and the personal
38
Table 1
Summary of Differing Perspectives on Meaningful Activity
Author(s) Perspectives on Meaningful
Activity
Kleemeier (1961a) Time Use
Havinghurst (1957; 1961) Personal Significance
Lawton (1993) Connotative/Denotative Meaning
Kaufman (1986), Jackson (1996) Themes of Meaning
Baumeister (1991) Needs for Meaning
Frankl (1959/1984); Reker, Peacock &
Wong (1987); Ryff & Singer (1995)
Meaning and Purpose in Life
Reker & Wong (1988); Prager (1996) Sources of Meaning
and symbolic meanings related to engagement in occupation (Clark & Jackson,
1989; Yerxa et al., 1989). This understanding may in turn facilitate our ability to
explain the processes which relate personally meaningful occupation to a higher
order sense of life purpose and meaning ultimately contributing to health and well-
being (Clark et al., 1991).
As occupational science and occupational therapy have considered multiple
definitions of occupation (AOTA, 1995; Dunn & Hocking, 2001), different
perspectives on the meaning of occupation have also emerged. The importance of
meaning has been repeatedly substantiated in a variety of models of occupation
39
within both fields. Meaning has been invoked as a key element in constructing
therapeutic occupations for the restoration of health. It has further been advocated
that the experience of meaning is the premier aspect of occupation (Hasselkus,
2002). Despite this history of apparent consensus regarding the central place of
meaning to occupation, there lies a significant record of definitional and conceptual
ambiguity.
The intent of this aspect of the review is to provide a conceptual landscape upon
which guideposts of understanding might be placed for future inquiry into the
meaning of occupation. In order to make this task manageable for the purpose at
hand, relevant articles covering the last decade were retrieved primarily from the
American Journal of Occupational Therapy and The Journal of Occupational
Science, though highly relevant articles from other journals were also included. The
review is organized into three sections reflecting three general approaches to
knowledge generation: theoretical syntheses, quantitative inquiry, and qualitative
inquiry. The first section will provide information on theoretical models and
propositions related to the meaning of occupation. The following two sections will
focus on empirical research from both positivistic (quantitative) and naturalistic
(qualitative) perspectives (DePoy & Gitlin, 2005). This aspect of the review will
serve three general ends: 1) to relate evidence which can substantiate or refute the
propositions and conceptualizations of meaning identified via theoretical syntheses,
2) to illuminate empirical evidence of phenomena relevant to these
40
conceptualizations of meaning, and 3) to introduce additional theoretical
propositions pertinent to the meaning of occupation.
Theoretical Syntheses Relevant to the Meaning of Occupation
Nelson (1996) defined meaning as, “The person’s entire interpretive process when
encountering an occupational form, including perceptual, symbolic, and affective
experience” (pg. 776). Meaning, according to Nelson, occurs in the relationship
between occupational form (objective physical and sociocultural circumstances
external to an individual) and occupational performance (voluntary doing by that
individual). As an individual encounters an occupational form, meaning is
instantiated as a function of the person’s developmental structure, defined by Nelson
as, “The present nature of the person as a holistic being with sensorimotor, cognitive,
and psychosocial characteristics”. The meaning ascribed to an occupational form in
turn imbues the occupational performance with purpose, defined by Nelson as, “The
experience of wanting an outcome from an anticipated occupational performance”.
Finally, occupational performance has the capacity to impact or modify the
occupational form, concurrently a sense of purpose may lead to changes in the
individual’s developmental structure. Nelson’s (1996) conceptual model suggests an
intimate relationship between a person’s ascription of meaning to an occupational
form and the purpose this affords to a persons doing. Further, the purpose for
41
engaging in an occupation combined with the doing of that occupation can lead to a
change in the very nature of the person (developmental structure); likely leading to
differences in meaning when the person engages in future occupational forms.
Trombly (1995) considers meaning and purpose as two principal aspects of a
therapeutic use of occupation within a practice model for persons with physical
dysfunction: occupation-as-means and occupation-as-end. According to Trombly,
occupation-as-means refers to occupations which are both purposeful and
meaningful and are intended to remediate impaired abilities or capacities. The
meanings of these occupations are derived from the “value” of their accomplishment;
as well as from emotional content, familiarity to the person, the capacity to arouse
associations in the person, garner approval from others and their perceived
contributions to recovery. Trombly is explicit in noting that occupation-as-means
perceived as meaningful will also be viewed as purposeful, though the reverse is not
necessarily so. In clarifying this position, she states that, “The purpose is the goal,
the expected end result,” such that an occupation with purpose (a clear goal) may
have no inherent meaning for the individual.
Occupation-as-ends are defined as occupations to be learned as part of the
therapeutic process, and are personally meaningful and purposeful (Trombly, 1995).
The meaning to the individual of occupation-as-ends is related to a personal
interpretation of the occupation as being important, valued and offering experiences
42
of success or pleasure leading to enhanced life-satisfaction. Though no clear
definition of purpose for occupation-as-ends is offered by Trombly, it was proffered
that these occupations are “purposeful by definition” in that persons envision an end
goal in relationship to engagement in the occupation. It was further hypothesized
that the meaning of an occupation serves to motivate, while purpose serves to
organize occupational engagement.
The conceptual models offered by Nelson (1996) and Trombly (1995) are similar in
their regard for the importance of meaning and purpose as essential aspects of an
occupational experience. Both authors differentiate meaning and purpose as distinct
concepts relevant to the performance of occupation. Nonetheless, the authors appear
to differ with regard to the definitions of, and relationship between, these concepts.
Nelson’s definition of purpose relates to a person’s experience of wanting some
outcome from engagement in occupation; a subjective appreciation that could
motivate (or hinder) action toward a goal. Meaning may therefore be understood as
enabling a sense of telos necessary for a person’s doing. By contrast, Trombly
appears to define purpose as an objective end product to be achieved through
engagement in occupation. Meaning does not necessarily give rise to or inform
purpose, in fact purpose can even be absent of personal meaning.
The distinctions between these authors’ definitions of purpose have direct
implications for their descriptions of the meaning of occupation. Trombly (1995)
43
has suggested that a purposeful occupation is not inherently meaningful. Her
description of meaningful occupation is premised on occupation being valued and
experienced as important or offering positive benefits to the individual. Defining the
meaning of occupation solely in positive or salutary terms may detract from a full
understanding of the nature of meaning. Given this, Trombly’s position may limit
theoretical exposition on the meaning of occupation. Nelson (1996), on the other
hand, identifies meaning as an interpretive process necessary for persons to ascribe a
purpose to their doing. Occupational engagement and its inherent purpose impact
and augment a person’s developmental structure, making it likely for differences in
future ascriptions of personal meaning. Nelson’s definition appears to leave room
for a more comprehensive understanding of occupational meaning, offering a
conceptual structure which could guide inquiry related to how the meaning of
occupation might change over time.
Fisher (1998), in turn, has suggested that the purpose and meaning of an occupation
are inextricably linked and mutually influencing. According to Fisher, the meaning
of an occupation pertains to its “personal significance” and this meaning serves as a
source of motivation. The purpose of an occupation pertains to a person’s,
“…personal aim, reason for doing, or intended goal” (pg. 511), and serves to
organize occupational performance. Fisher is in agreement with Nelson (1996)
suggesting that the purpose for engaging in an occupation is derived from personal
meaning. However, she extends this position by explicitly indicating that personal
44
meaning can be derived from one’s purpose for engaging in the occupation.
Occupations thereby serve as a source for increasing both motivation (meaning) and
a sense of purpose. Fisher (1998) seems to have incorporated both Nelson’s (1996)
and Trombly’s (1996) definitions of occupational purpose within her own model,
though she appears to have preferred Trombly’s concept of personal meaning.
It seems apparent that the above three scholars of occupation have not come to a
consensus on the definitions of meaning and purpose, or the manner by which these
concepts might interact. Hammell (2004) has argued that occupational therapy
theory development has been hampered by a poor differentiation between meaning
and purpose in the study of occupation, and that these terms have often been used
interchangeably. One example relevant to this concern can be found in the position
statement of the American Occupational Therapy Association regarding the
therapeutic use of occupation. According to Hinojosa and Kramer (1997) the
therapeutic use of occupation is founded upon the use of purposeful activity, defined
as, “…goal-directed behavior or tasks…that the individual considers meaningful”
(pg. 865). The goal-directed quality of an occupation was purported to relate to
achieving some outcome, which may meet personal goals or needs. Unfortunately
no definition was submitted for what a person might consider to be “meaningful”,
leaving limited guidance for the therapist towards developing therapeutic purposeful
activities. It therefore appears that only marginal progress had been achieved in
45
developing clear definitions of these concepts which are relevant to understanding
occupational meaning.
Subsequently, the concept of personal identity has served as a context in which the
meaning of occupation has been positioned (e.g., C. H. Christiansen, 1999; Crabtree,
1998). In doing so, a somewhat richer and more diverse appreciation of occupational
meaning has emerged. Crabtree (1998) refers to meaning as embodied action, and
posits that human beings in their ideal state are meaning makers (Bruner, 1990),
creating and expressing personal meaning through engagement in occupation. He
proposes that meaning making involves the idea of having in mind or intention,
stating, “I make no critical distinction among having in mind, meaning, and
intention. When we perform, we express what we have in mind, what we intend to
do, and what we mean” (pg. 206). This proposition is unique in relation to those
reviewed above as Crabtree makes no clear reference to the role of purpose in
organizing action; rather, meaning as intending is inherently purposeful.
According to Crabtree (1998), personal identity is developed and shaped through the
meaning making process intrinsic to occupational performance. Engagement in
occupation is hypothesized to be driven by intrinsic motivation which depicts
personal meaning and shapes identity. In turn, action or occupation congruent with
one’s personal identity captivates attention, motivates doing, enhances well-being
and situates the person in a community of others. Finally, Crabtree notes that the
46
meaning of an occupation is contextually dependent, and will vary across the life
course.
Identity and meaning are also intimately linked within Christiansen’s (1999) view of
occupation. Four propositions related to personal identity, occupation and meaning
are outlined: 1) Identity is an overarching concept that shapes and is shaped by our
relationship with others; 2) Identities are closely tied to what we do and our
interpretations of those actions in the context of our relationships with others; 3)
Identities provide an important central figure in a self-narrative or life story that
provides coherence and meaning for everyday events and life itself; and 4) Because
life meaning is derived in the context of identity, it is an essential element in
promoting well-being and life-satisfaction. Christiansen’s focus on meaning is
primarily related to a sense of meaning and purpose in life founded upon the
expression of personal identity through occupation. This perspective on meaning
differs substantially from those espoused by the above authors (i.e., Crabtree, 1998;
Fisher, 1998; Nelson, 1996; Trombly, 1995). Christiansen (1999) does provide a
description of two different levels of meaning. On one level, the meaning of
occupation is briefly referred to as having personal significance and is afforded
symbolical meaning when performed within a social context. On another level the
creation of life meaning relates to the fulfillment of the needs of purpose, efficacy,
value and self-worth (Sommer & Baumeister, 1998). Identity is consequently
47
developed and expressed by the pursuit of personal goals which engender possible
future selves, enable social approval and competent performance.
By embracing personal identity as an integral part of occupation, these authors have
afforded additional possibilities for framing the concept of meaning. With a focus
on “self” as constituted of past action and future potentiality, action motivation and
the importance of the social relatedness of the individual may be brought to the
foreground as critical factors for understanding the meaning of occupation
(Baumeister, 1992). Crabtree’s exposition is notable because it relates the creation
and expression of meaning though personal action. He intuits a perspective that
embraces meaning as both guiding and motivating the pursuit of occupation (Frankl,
1959/1984). Also, the importance of the social nature of human occupation is
addressed by a focus on identity. Our social interrelatedness can be appreciated as a
core aspect of personal meaning, apposed to a mere contextual consideration.
Finally, Christiansen (1999) had suggested that meaning may not be related solely to
engagement in specific occupations. Rather, personal meaning may be nested or
hierarchical in nature, such that occupations which afford experiences of efficacy
and self-worth may contribute to a personal sense of life meaning (Baumeister,
1991).
Jackson, Carlson, Mandel, Zemke and Clark (1998) have also utilized the concept of
identity (or self) in relation to the meaningfulness of occupation. They had proposed
48
that the ability to find and experience meaning through occupation was a key aspect
of successful aging. Meaning was conceptualized as the “significance” of an
occupation, and according to the authors this significance, “…derives from the
person’s beliefs, identities, experiences, goals, and life narratives” (pg. 328). The
experience of meaning related by the authors was directly related to opportunities for
flow (Csikszentmihalyi, 1990), connections to the life course, enhanced meaning in
daily routines and experiences of perceived control. Further, global themes of
meaning were discussed as a process which mediated the ascription of meaning to
occupation (Jackson et al., 1998). Global themes of meaning represent a means by
which the older adult continually creates the self through an interpretation of past
experience, present commitments, values and current contexts (E. R. Kaufman,
1986). Themes of meaning may guide how occupations are chosen, serve to
organize occupational patterns, and provide a framework for how they are
experienced (Jackson et al., 1998). Themes of meaning are also understood to be
malleable, suggesting that the choice of occupations and their experienced meanings
will likely shift across the life course.
A different perspective for conceptualizing occupation and meaning has been
strongly influenced by theories of complexity. Jackson, et al. (1998) had referred to
dynamic systems theory (McLaughlin Grey, Kennedy, & Zemke, 1996) as a means
for interpreting patterns of change and stability in occupational repertoires. Other
authors have extended the use of complexity theories to focus more directly on
49
occupational meaning. Ikuigi (2005) has proposed that the meaningfulness of
occupations serve as an attractor which determines engagement in occupation across
the life course or occupational-life-trajectory. Life goals, values, and personal
interests were posited to underlie or support (i.e., a basin of attraction for) the
experience of meaning in occupation. Ikuigi offered initial empirical evidence in
support of his model by reviewing a study in which nine university students
indicated their reasons for engaging in their most important activities. Participants
perceived their most “important” activities as being supported by at least one of the
following five qualities: enjoyable, supportive of life goals, valued by others,
offering a sense of accomplishment and having a therapeutic nature. These reasons
were interpreted as variables constituting the basin of attraction for the
meaningfulness of the activities (Ikiugu, 2005).
Persson, Erlandsson, Eklun and Iwarsson (2001) proposed a tri-level model of
occupation and meaning which integrates a complexity theory perspective. The
macro-level of occupation entails personal identity and life history, such that the
meaning of any given occupation can only be appreciated in relation to the lived
experiences of the individual. Occupational repertoires or the full contingent of
personal occupational engagement across the life course best represent the
conceptualization of occupation at this level. The next lower level is the meso-level
of occupation. From this perspective, smaller aspects of an individual’s occupational
repertoire, such as the occupations taken on within a given day, are considered.
50
Finally, the micro-level of occupation addresses specific actions such as drinking
coffee, or the motoric operations of grasping and lifting a cup. According to Persson
et al. (2001) occupations at the micro level are relatively absent of personal meaning
as they may lack reference to the meso- and macro-levels. The interactions of these
three levels of occupation are asserted to infuse any specific activity with personal
meaning.
Specific occupations also take on concrete, symbolic and self-reward value as a
prerequisite for personal attributions of occupational meaning (Persson et al., 2001).
Concrete value refers to the visible features of occupation, such as the development
of capacities and acquired skills. Occupations are also understood to be imbued
with symbolic value, which refers to an interaction of personal, cultural and
universal significance. The social environment is proposed to play a critical role in
the ascription of symbolic meaning as feedback from social sources is communicated
or reflected back to the individual. Lastly, self-reward value refers to the immediate
experiences offered to the individual via engagement in occupation. Experiences of
flow (Csikszentmihalyi, 1990) and enjoyment were related as best constituting this
aspect of occupational value or meaning.
Summarizing these positions, two concepts relevant to the meaning of occupation
have garnered support from a number of the scholars. Personal identity appears to
serve an essential role in mediating the experience of occupation as it calls for us to
51
reflect on meaning in relation to personal life history (C. H. Christiansen, 1999;
Crabtree, 1998; Ikiugu, 2005; Jackson et al., 1998; Persson et al., 2001). Identity
also introduced personal narrative as a tool for accessing the multifaceted nature of
life history and the meaning of occupation. Narratives link personal past, present
and future into a coherent story, affording possibilities for experiencing the meaning
of occupation in relation to the self. The importance of human social interaction has
also been raised as critical to our understanding of meaning (e.g., C. H. Christiansen,
1999; Persson et al., 2001). We negotiate our lives within social worlds rich in
symbolic meaning which serves to shape our choice of activities and to influence our
experience of occupation. This suggests that the meaning of occupation be
considered as intimately related to a lived social world.
The adoption of complexity metaphors has inculcated the interaction of key variables
into an understanding of occupation and meaning. Jackson et al. (1998) indicated
that stable patterns of occupations can be achieved despite the complexity inherent in
establishing a balance of personally significant occupations. Furthermore, small
shifts in one component of this system may result in unpredictable system changes.
Persson et al. (2001) support this perspective and further proposed that the values
attached to a personal repertoire of activities shapes the personal experience of
meaning. These authors give support to the idea that the personal meaning of any
given occupation must be considered in the context of past, present and future
occupational pursuits. However, Ikuigi’s (2004) application of complexity is
52
somewhat unique. A different system dynamic is emphasized which calls attention
to the experience of occupations (e.g., their being enjoyable, supportive of life goals,
valued by others and offering a sense of accomplishment) as constituting a basin of
attraction for occupational meaningfulness. This system focus suggests that the
interaction among the variables might further inform an understanding of
occupational meaning.
This review had begun with an emphasis on the relationship between meaning and
purpose as one perspective relevant to our understanding of occupation and meaning.
The nature of meaning in occupation was further expanded by addressing identity as
a mediating construct intimately related to personal social worlds. Complexity
metaphors were also introduced as an epistemic tool with the potential to explain
occupational meaning as consisting of highly interrelated and interacting variables.
I would like to extend this review by outlining two viewpoints that add to an
understanding of the meaning of occupation. These perspectives are congruent with
the propositions and conceptualizations reviewed above, and afford additional
concepts relevant for describing the nature of occupational meaning.
Hammell (2004) offers a sound critique of occupational therapy’s focus on purpose
as a concept for directing therapeutic interventions and guiding theoretical
development. She argues that occupational therapy has privileged goal-oriented,
purposeful occupations despite a lack of substantive evidence supporting the efficacy
53
of this perspective. Hammell expresses a belief that occupations imbued with a
sense of purpose are a basic human need, though she places and emphasis on
meaning as the source of personal attributions of purpose. She further proposes that
human needs fulfillment is essential for persons to experience a life as worth living.
Experiencing occupations as meaningful and affording a sense of purpose are two
needs which are explicitly related. Additional needs include opportunities for choice
and control, experiences of self worth and opportunities for engaging in occupations,
as they necessarily substantiate personal needs fulfillment.
Adopting Wilcock’s (1998) perspective on occupation, Hammell (2004) has
emphasized four concepts essential to appreciating occupational meaning: doing,
being, belonging, and becoming. These four dimensions of meaning are posited to
best represent universal human needs, essential for a fulfilled existence, mutually
inclusive and necessary for occupational meaning. First, meaning is discovered
through “doing”; via engagement in purposeful goal-directed action. Second,
“being” relates to our experiencing of our occupations, self-contemplation or
understanding, and appreciating the offerings of life. Third, a need for “belonging”
refers to the contributions of social interaction, mutual support, friendship, and being
included. Finally, “becoming” involves the capacity for envisioning a future self,
and exploring ideas of what one may wish to become. Disruptions, such as those
arising from disability, have the capacity to alter our perception of occupational
meaning. A change or loss in one’s way of engaging with the world shifts the
54
manner in which one perceives the significance of his or her actions (perspective
transformation) and the self.
King (2004) describes a developmental, process-oriented meta-model that outlines
the fundamental ways people acquire and create meaning in life through their
everyday activities. The model posits three interrelated concepts (belonging, doing,
and understanding self and world) garnered from over 30 theories in the fields of
psychology, social work, nursing and occupational therapy. The three irreducible
concepts were consistently found within theories which addressed intrapersonal,
interpersonal or environmental levels of analysis. According to King, belonging,
doing, and understanding are three universal modes for acquiring meaning that
operate at three levels: 1) the micro level of experience or perception, 2) the middle
level at which persons experience everyday events (the phenomenological level), and
3) the macro level of meaning in life. For example, Maslow’s (1970) perspective on
fundamental human needs: affiliation (love, belongingness), achievement, and self-
actualization are representative of the micro level of experience. Whereas at the
middle level, Antonovsky’s (1987) sense of coherence constructs of emotional sense
(meaningfulness), manageability, and comprehensibility are also reflected in King’s
tripartite model.
Five main principles or assumptions guide an understanding of occupation’s capacity
to engender meaning (King, 2004). First, the three aspects of meaning are
55
intertwined and emanate from all levels, such that an overall experience of meaning
in life happens simultaneously. Secondly, there is indeterminacy of cause and effect
in that no one aspect of meaning exists prior to or causes another. The three
concepts of meaning are multi-causal and reciprocal in their mutual influence.
Thirdly, there are individual differences in preferred ways of engaging with the
world. One individual may derive meaning primarily through connectedness with
others, while another may find that life tasks or goals contribute most substantially to
a meaningful life. Next, the model proposes that a commitment to intrinsic life goals
is necessary for maximizing life meaning. Engagement or commitment ensures that
people feel connected, motivates action and effort, and facilitates an understanding
of self and world. Finally, the model holds that changes in meaning occur across the
life course. Whether via onset of disability or significant changes in life roles,
people will make choices which reflect changes in underlying beliefs or values.
Personal goals or commitments may be relinquished or modified as persons face
shifts in their life circumstances.
Congruence between Hammell’s (2004) needs for doing, being, belonging and
becoming and King’s (2004) concepts of belonging, doing, and understanding is
clearly evident, specifically in relation to doing and belonging. Interestingly,
Hammell relied substantially on qualitative evidence to support the four concepts she
had espoused. Conversely, King structured her model from a positivistic
perspective, though partly informed by qualitative evidence. It is encouraging to see
56
that despite the epistemological differences, substantial parity exists between these
viewpoints on meaning and occupation. However, discrepancy between these
models does lie in the use of ‘being’ and ‘becoming’ offered by Hammell and that of
‘understanding’ offered by King. This difference might be rectified by invoking
personal identity or self systems (Herzog & Markus, 1999; Markus & Herzog, 1991)
as mediating constructs given that self-understanding is the main aspect of “being”
as described by Hammell, and relatively synonymous with King’s “understanding.”
Nonetheless, Hammell also posited that “being” relates to experiences of enjoyment
or pleasure from occupation. These concepts are not clearly evident in King’s
model, yet they could conceivably be constructed from her concepts and underlying
assumptions. Alternatively, Hammell’s concept of “being” could serve to influence
the underlying assumptions and dynamics of King’s model given sufficient empirical
evidence. Table 2 provides a brief overview of the aspects of meaning reviewed
above by scholars in occupational science and occupational therapy.
The remainder of this review on meaning in occupational science and occupational
therapy will focus on empirical research from both positivistic (quantitative) and
naturalistic (qualitative) perspectives (DePoy & Gitlin, 2005). This aspect of the
review will serve three general ends: 1) to relate evidence which can substantiate or
refute the propositions and conceptualizations of meaning related above, 2) to
illuminate empirical evidence of phenomena relevant to previous conceptualizations
57
Table 2
Meaning of Occupation in Occupational Science and Occupational Therapy
Author(s) Perspectives on the Meaning of Occupation
Christiansen
(1999)
Having personal significance and symbolic meaning when
performed within a social context.
Crabtree (1998) Embodied action.
Fisher (1998) Personal significance.
Ikuigi (2005) Life goals, values, and personal interests.
Jackson, Carlson,
Mandel, Zemke
and Clark (1998)
Personal beliefs, identities, experiences, goals, and life
narratives; opportunities for flow, connections to the life
course, enhanced meaning in daily routines, experiences of
perceived control, and themes of meaning.
King (2004) Belonging, doing, and understanding self and world.
Nelson (1996) The person’s entire interpretive process when encountering an
occupational form, including perceptual, symbolic, and
affective experience.
Persson et al.
(2001)
Concrete, symbolic and self-reward value.
Trombly (1995) Personal value, emotional content, familiarity to the person,
the capacity to arouse associations in the person, garner
approval from others and their perceived contributions to
recovery; perceived as important, valued and offering
experiences of success or pleasure leading to enhanced life-
satisfaction.
Hammell (2004),
Wilcock (1998)
Doing, being, belonging, and becoming.
58
of meaning, and 3) to introduce additional theoretical propositions pertinent to the
meaning of occupation. Given the large number of potentially related research
studies, a select group from the past decade will be highlighted which best serve to
fulfill the purpose of the review.
Positivistic Inquiry into the Meaning of Occupation
Ferguson and Trombly (1997) employed Nelson’s (1988) conceptual model of
occupation in an experimental design to discern the differential effects of meaning
and purpose in the acquisition of motor skills. Participants (N=20) learned specific
finger movements in an added-purpose (playing a tune on a piano) and rote motor
learning of finger patterns condition; these two conditions constituted manipulations
of purpose. Meaning was operationalized by participants indicating the
meaningfulness of the two motor learning tasks (not meaningful to very meaningful)
on a ten-point scale. The added-purpose condition led to fewer errors in learning the
motor patterns. Whereas ascribed meaning was not significantly rated to error rates,
though greater meaning was related to fewer errors. The authors suggested that the
findings offered empirical support for the contribution of purpose to motor learning,
proposing further that meaning did not contribute to purpose. It was argued that
having a clear outcome (learning a tune) was responsible for the significant findings
(Ferguson & Trombly, 1997). Nonetheless, higher ascribed meaning was related to
fewer errors and the small sample size may have elevated the risk of Type II error.
59
This would suggest that a distinct separation of meaning and purpose is equivocal
(especially given the relatively contrived nature of the research design), and further
study is warranted.
Murphy, Trombly, Tickle-Degnen and Jacobs (1999) studied the effect having an
end-product in terms of engagement in activity, operationalized as intrinsic
motivation. In a counterbalanced designed study, participants (N=50) worked on
their choice of four craft activities which they could keep or not keep. The
participants also rated their level of intrinsic motivation for the performance of these
tasks in terms of self-determination and competence. Participants were found to
work significantly longer and reported higher levels of intrinsic motivation on the
activities which they were able to keep. The authors concluded that people may
work longer and be more motivated if choices are provided, and if they are allowed
to keep an end product. This study offers empirical evidence for the idea that choice
and keeping the product of one’s efforts affords persons some aspect of meaning
(intrinsic motivation), influencing engagement in occupation.
Christiansen, Backman, Little and Nguyen (1999) explored the relationship between
occupation and subjective well-being (SWB) in a correlational-design study in a
sample of adults (N=120). Personal projects analysis (Palys & Little, 1983) was
employed which involved participants rating their current goal-directed pursuits in
terms of an array of 17 dimensions or characteristics. A meaning factor, consisting
60
of three items reflecting enjoyment, identity, and absorption in goal pursuit, was
positively associated with SWB. A positive association was also found between
perceptions of self as efficacious in terms of their goal pursuit. A regression model
failed to substantiate the role of meaning in predicting SWB when all 17 of the
appraisals were included. The authors concluded that the findings offered empirical
support for the assumption that occupations provide a means for expression of self
and, therefore, contribute to the formation and maintenance of personal identity (C.
H. Christiansen et al., 1999). Additionally, this study offers empirical support for a
positive relationship between activity meaning and SWB.
Baker, Jacobs and Tickle-Degnen (2003) provided an example of quantifying the
meaning of work based upon the Meaning of Working Survey (MOWS). This
previously validated scale assessed meaning as composed of three separate but
interconnected constructs: 1) worker centrality (the degree of importance work has
for the individual), 2) work beliefs (normative expectations and definitions of work),
and 3) valued work outcomes (expected benefits of work, i.e., social support,
comfort, personal expressiveness and promotion / power). A sample of 246
telecommunications employees were organized into five distinct groups based upon
cluster analysis of the MOWS, with each group representative of a unique
configuration of seven MOWS factors (or aspects of meaning). As an example,
members of group 1 viewed working as a means for promotion / power and liked the
work to be convenient, comfortable and secure. Whereas group 5 highly regarded
61
work centrality and obligation, holding work as a central aspect of their life that
sustained a sense of duty as a worker over personal rights. Results of the cluster
analysis support the interconnected nature of the MOWS components, while
highlighting the variety of patterns of meanings associated with working.
Lastly, Goldberg, Britnell and Goldberg (2002) hypothesized that engagement in
meaningful activities was positively associated with quality of life. The Engagement
in Meaningful Activities Survey (EMAS) was employed as a measure of global
activity meaning. That is, persons indicated the extent to which they perceived their
overall activity engagement based upon 12 items reflecting conceptualizations of the
meaning of activity found within occupational therapy literature. According to the
authors, these meanings were best represented by three themes: congruence with
values / needs, competence / mastery, and value in social groups. Examples of items
included: reflection of self, expression of creativity, sense of accomplishment,
competence and pleasure, personal satisfaction, and helping others. Persons with
persistent mental illness (N=32) completed the EMAS and positive associations were
found with measures of quality of life, a negative relationship was established with a
measure of depression. When regression analysis was employed, however, the
EMAS failed to predict quality of life when controlling for depression.
The empirical evidence related to occupational meaning garnered from these
quantitative studies offers mixed support for a number of the propositions reviewed
62
earlier. Notably, the relationship between meaning and purpose remains equivocal in
terms of its impact on occupational performance (Ferguson & Trombly, 1997).
Unfortunately, the paucity of quantitative evidence generated over the past decade
exploring occupational meaning and purpose, especially in terms of “real-world”
contexts, has dire consequences for theory development (Hammell, 2004). In the
absence of substantial empirical evidence, disagreement between scholars on the
conceptual definitions and operationalization of these constructs will likely persist.
Naturalistic Inquiry into the Meaning of Occupation
The use of qualitative methods has resulted in a plethora of interpretations of the
meaning of occupation. These differences in part reflect the diverse approaches
taken to understand the phenomenon of occupation and meaning (e.g. narrative
analysis, grounded-theory, ethnography and semi-structured interview, etc.). Rather
than focusing on the qualitative methods employed, this review will attempt to
highlight how these qualitative methods offer insight into the complex nature of
meaning. Three general ways of understanding the meaning of occupation arouse by
considering the studies in this light. First, occupational meaning was found to be
reflected in a static manner. The qualitative methods within this approach generally
involved a single interview / observation and addressed meaning primarily from a
here-and-now perspective. The second way meaning was reported related to
personal life-worlds. Again, only one interview was employed, but the results
63
suggested personal life histories with changes in occupational performance or
meanings. The final methodological aspect involved a longitudinal component
wherein multiple interviews/observations were conducted over an extended period of
time. In general, these approaches resulted in findings sensitive to shifts in
occupations and their meanings as they evolved throughout the course of
respondents’ lives.
The Here-and-Now Nature of Activity Meaning
The impact of physical limitations upon occupation and meaning can be found
within two studies. Specht, King, Brown and Foris (2002) interviewed persons with
congenital physical disabilities regarding their leisure occupations, emphasizing
“turning points” in their lives that facilitated adaptation. Their findings indicated
that leisure occupations offered mental and physical benefits, were enjoyable to the
participants, reflected a sense of self-worth and competence, and facilitated social
connectedness. Borell, Lilja, Svidén and Sadlo (2001) employed interview and
observation in a sample of older adults with physical impairments. The main theme
of meaning reported by participants was that they engaged in occupations which they
liked or wanted to do. The findings also indicated a tendency for the participants to
withdraw from occupation because of their impairments; these limitations led to a
reduction in hope that impeded their pursuit of valued activities. Interestingly,
occupational capacities (or limitations) framed the way in which persons viewed
64
their lives, rather than being viewed in terms of their physical frailties. For example,
a person would indicate what occupations were lost from their lives because of a
visual impairment instead of highlighting their reduction in sight.
Food related occupations were also explored as a source of understanding the
meaning of occupation. Bundegaard (2005) utilized semi-structured interviews and
ethnography to explore the experiences of daily meals in specialized long-term care
living units. Four significant themes arouse from the data including: a home-like
atmosphere, a sense of community, autonomy as an expression of the self, and an
environment for valued occupations. These themes were rich with sub-themes
related to autonomy in doing as enabling a positive sense of self, expressing care for
and sharing activities with others, and connecting the present experiences to a past
self. Sheerer, Cahill, Kirby and Lane (2004) proffered a tentative theory of meaning
and motivation based on their exploration of cake decorating in women. Meaning
was interpreted with themes of activity satisfaction, flow experiences and health
benefits from the occupation. The significant motivational components of cake
decorating included compliments from others and expressing caring for others.
Their model implied that the meanings of the occupation serve to engage
performance whereas the motivational components contribute to continued
occupational engagment. Other studies of food related occupations investigated
making and consuming tea (Hannam, 1997) and cooking or “recipe work” (Hocking,
Wright-St. Clair, & Bunrayong, 2002). Both studies highlighted the social
65
significance of these occupations to their participants. These social meanings were
evidenced in sharing with and caring for others, in addition to the memories of
significant others these occupations engendered. Furthermore, the occupations and
the symbolic characteristics of the materials employed within doing provided an
essential aspect of personal continuity.
These qualitative studies represent the more static approach to investigating
occupational meanings, and the results have a substantial degree of congruence with
the main constituents of the models and propositions of occupational meaning
offered above. Social meanings were a consistent theme within food related
occupations. These occupations provided venues for sharing and caring for others,
as well as linking persons symbolically to important social experiences from their
life course. Occupations also afforded a sense of competence and autonomy,
reflecting a positive sense of self back onto the participants. Alternately, the loss of
doing was related to sadness and a reduction of hope for future occupational
endeavors. Another consistent theme involved the nature with which occupations
afforded a sense of person continuity with the life course. Occupations were viewed
as meaningful because of their capacity to bind present doing with valued life
experiences. Continuity through occupational engagement was evidenced primarily
in terms of social connectedness and personal competency. Occupations were also
imbued with meaning because of their capacity to afford positive experiences such as
66
enjoyment, liking and experiences of flow. These constituents of meaning may in
turn have the capacity to motivate and sustain engagement.
The Meaning of Occupation from a Life History Perspective
The second aspect of qualitative inquiry into the meaning of occupation incorporates
studies which gathered data from a single point in time (Johansson & Tham, 2006;
Miller, Bunch-Harrison, Braumbaugh, Kutty, & FitzGerald, 2005). These studies
again reflect aspects of meaning reviewed above, though affording some perspective
into how meanings may blend together and evolve. The evoked personal life
histories offer a glimpse into the potential for change in meanings and occupations
over time. Miller, Bunch-Harrison, Braumbaugh, Kutty and FitzGerald (2005)
employed semi-structured interviews to discover the meaning of computer use of
persons who were homeless participating in a work readiness program. Exposure to
computers as part of the program appeared to enhance the importance of computer
use for the participants. The program enabled participants to identify new computer
relevant goals and afforded knowledge and skills necessary for the pursuit of these
new-found goals. Further, participants expressed increased self-efficacy and self
confidence in their computer skills which in turn facilitated a growing sense of
connection to society. The program appeared to have increased skills and self-
efficacy affording a telos for future endeavors and re-establishing social connections,
positively changing the “perceptions of self”.
67
Utilizing open-ended questions, Johansson and Tham (2006) described the diverse
manner by which the meaning of working had changed for persons with traumatic
brain injuries. Four general themes emerged representing the experiences of the
participants: 1) work had taken on a new place in their life, 2) the social dimension
of work had taken on an expanded meaning, 3) the person’s perceived competence
and work identity had been altered, and 4) work afforded a means to strive for
normality. Work appeared to be less important in the participants’ lives as other
aspects of their occupations increased in meaning following the brain injury. Work
was less valued and perceived as less pleasurable, in part because of restrictions in
personal choice and autonomy. Alternately, daily activities and social occupations
took on a greater level of personal value. Expanding social qualities of work
included the increasingly important role of colleagues inside and outside of work, as
well as the positive influences work afforded for belonging within the home.
Participants also expressed an evolving sense of personal identity which was
reflected in decreased work competences and difficulties in self-appraisal subsequent
to their brain injuries. However, self understanding also evolved positively as
persons began to adapt to and honor their present skills and competencies. They
began to value themselves as persons rather than solely as workers.
68
Changes in the Meaning of Occupation over Time
The final aspect of qualitative inquiry into occupation and meaning involves
longitudinally designed methodologies. Again, components of meaning previously
identified are evident, though a broader understanding is offered by emphasizing
change processes. Given this, the evolution of meaning and occupation, and the
dynamic nature by which the two are mutually constituted over time will be
highlighted. A phenomenological approach was employed to investigate the
meaning of work in supported employment for persons with long-term mental illness
(Gahnström-Strandqvist, Liukko, & Tham, 2003). The authors suggested that a
normalizing life-world served as a higher ordered theme of meaning for the
participants’ experiences. Underlying this theme were three phases of meaning
change: 1) from unsatisfying to satisfying occupational context, 2) meeting
occupational and social needs, and 3) deciding to stay or leave supported
employment. The first phase was highlighted by a change from passive and
withdrawn lifestyles to that of increased activity and socialization. A desire to
alleviate passivity and the value of work and hope for something better motivated
participants to seek assistance. After some time in the cooperative the satisfactions
derived from meeting occupational and social needs motivated continued
participation. This context enabled feelings of contributing to the work cooperative,
along with a sense of personal accomplishment and belonging that bolstered well-
being. The participants’ engagement also fostered a sense of acceptance and social
69
camaraderie that extended beyond the cooperative’s boundaries. Furthermore, a
more positive sense of personal identity was developed as skills and social
competencies were expanded. The final theme involved participants’ decisions to
remain or leave the cooperative. For some, the cooperative was a staging ground
that could be relinquished in pursuit of newly identified personal goals. Others
deferred leaving the cooperative, concerned that the lack of a supportive
environment would result in their return to a less satisfying life.
Strong (1998) also studied supportive work for persons with mental illnesses
utilizing participant observation, in-depth interviews and focus groups. Her findings
emphasized the contributions of changes in meaning and occupation that contributed
to clients’ sense of self-efficacy and self concept as a part of their recovery.
Participants initially reported their experiences of living with a label of mental illness
as limiting choices and opportunities. Despite this, self perceptions were modified
over time as small day-to-day goals were achieved creating hope for larger goals in
the future. Persons felt more in control of their lives, gained autonomy and
independence as knowledge and skills were acquired. Belonging experiences also
evolved as participants noted feeling a sense of place, establishing significant
relationships, in addition to feelings of usefulness and life purpose. A significant
finding related to how perceptions of work shifted as a function of particular frames
of meaning (Strong, 1998). When ‘’living with a label of mental illness’ was a
prominent theme, work served as a buffer for dealing with societal attitudes. The
70
frame of a ‘person as capable and with a future’ enabled work to be perceived as a
means for garnering concrete evidence of self-efficacy; work inspired hope and
future possibilities. When a theme of ‘belonging’ was brought to bear, work served
to foster a sense of self-worth and purpose, or the meaning of work was related to a
place to belong and feel accepted.
The last two articles highlight change processes in the meanings of occupations over
time for older adults. Using grounded-theory methodology, Dublouloz, Laporte,
Hall, Ashe and Smith (2004) studied changes in meaning perspectives for persons
with arthritis receiving occupational therapy services. According to the authors,
meaning perspectives are constituted by personal values, beliefs, feelings and
knowledge and serve to guide daily action, similar in many respects to personal
themes of meaning (Jackson et al., 1998; E. R. Kaufman, 1986). At the initiation of
therapeutic interventions participants shared three core meaning perspectives
experienced as self-defining values: independence, activity and altruism. Over time
the nature of these core meaning perspectives began to shift. Persons became more
flexible in their personal definition of independence, such as allowing help from
others. Personally relevant activities remained relatively constant over time.
However, the function and meaning of these activities did change as persons
developed personal compensation strategies and redefined their mode of engagement
(e.g. perceiving the need to engage in activity ‘all the time’ to ‘within my means’).
Altruistic occupations held a deep meaning to participants as they valued their role in
71
contributing to the needs of others. Later in therapy, the personal relevance of this
core value decreased. This decrease was found to be directly related to the
emergence of two new meaning perspectives: self-caring and self-respect.
This transformation of meaning perspectives may be viewed as a process of
deconstruction and reconstruction guided by the emergence of a new meaning
perspective of self-value (Dublouloz et al., 2004). Early in therapy the values of
staunch independence, constant activity, and self-less altruism served to guide
occupational choices and influence experienced meanings. Later in the therapeutic
process, the emergent meaning perspective of self-respect served to reorganize the
participants’ personal value system. An increased focus on self-needs minimized the
valence of activity and altruism as core values. Independence was reinterpreted and
expanded to allow for instrumental and social support. Self-caring became more
acceptable and desirable and grew as a new meaning perspective, yet personal
continuity was preserved as core values were transformed and reintegrated.
Finally, Jonsson, Borell, & Sadlo (2000) employed grounded-theory methodology in
their study of adults transitioning into retirement. They found a change in the
structure and temporal flow of occupations which in turn influenced the meanings
the occupations held for the participants. Work no longer served to structure daily
activities as it had prior to retirement. As a result, day to day occupations were
lengthened in the absence of the press work had previously imposed. Activities such
72
as breakfast and reading the newspaper took on new meaning as they extended in
time within the morning. This new temporal and occupational structure changed the
meaning of occupations. As an example, one retiree had longed for a weekend get-
away to his cabin for a much needed respite following a busy work week. Following
retirement, the feelings of being at the cabin changed in the presence of a new
occupational structure. The authors had concluded that the temporal and structural
relationship between occupations created a context for changes in the experienced
meanings of occupations.
The studies that employed naturalistic methodologies appear to be rich with multiple
perspectives on the nature of the meaning of occupation (activity), and play a central
role in explicating the character of occupation (Carlson & Clark, 1991). The unique
strength of naturalistic approaches to studying the meaning of occupation relates to
their capacity to explicate the constituents and dynamics of contextualized personal
experience. Though not all of the respondents were older adults, the findings of
these studies relate directly to the human experience of meaning, and are therefore
relevant to this review. Furthermore, these studies offer a rich basis of data that
inform our understanding of how the meaning of activity arises and changes over the
course of time.
73
A Synopsis of Meaning and Meaningful Activity
The above review was intended to highlight aspects of the meaning of activity in
older adults. What should be evident is that an answer to the question, “What does
meaningful activity mean?” is neither simple nor straightforward. From the
perspective of social gerontology, activity can be meaningful for a multitude of
reasons, viewed from a number of differing perspectives. Activities may be
understood as being meaningful because of the time one commits to their endeavors
(Kleemeier, 1961a). On the other hand, the contribution of activity participation to
the creation of a meaningful life may have more to do with the degree to which the
activity is imbued with personal themes of meaning (Jackson, 1996) or is congruent
with a sense of self (Herzog & Markus, 1999). Activities may also be seen as
meaningful to the extent they allow an individual to explore and fulfill their needs
for meaning (Baumeister, 1991; Deci & Ryan, 2002; Schultz & Heckhausen, 1996),
or to achieve progress towards valued goals (Emmons, 1986; Riediger, Freund, &
Baltes, 2005). Further, activities may be deemed meaningful simply because the
person enjoys engaging in them (Bonder & Martin, 2000; K. Everard, 1995;
Havinghurst, 1957; Lawton, 1993). Furthermore, engagement in personally
meaningful activities can provide a source of “present meaning,” which in turn may
contribute to one’s sense of purpose and meaning in life (Reker & Wong, 1988).
74
Occupational science and occupational therapy have given the human experience of
meaning a central place in the study of occupation (e.g., Clark et al., 1998; Hasselkus
2002). Despite ambiguity in explicating this construct, scholars of occupation
continue to delve into its varied aspects. The meaning of occupation has been related
to its personal significance (Fischer, 1998), personal life goals, values and personal
interests (Ikuigi, 2005), and as an expression of embodied action (Crabtree, 1998).
Furthermore, it has been suggested that the meaning of occupation must be
appreciated within personal life histories (e.g., Jackson, Carlson, Mandel, Zemke and
Clark, 1998; Persson et al., 2001) and it is intimately linked to personal identity
(Christiansen, 1999). Fortunately, conceptual models are arising that may inform the
future study of activity meaning (King, 2004; Wilcock, 1998). It also appears that
naturalistic methodologies will contribute considerably to this process. Notably,
these methods are well suited to exploring the contexts and dynamics of occupation,
as well as changes in the experience of occupational meaning over time.
The above perspectives in no way represent an exhaustive review of what “meaning”
may mean. To pursue this line of inquiry would be well beyond the scope of this
paper. Rather, these perspectives allow for a reasoned appreciation of the potential
complexity and dynamics of adult meaning making. Further, the intent of this
review was to provide theoretical perspectives within which to situate the primary
construct of concern for the present study, meaningful activity participation.
75
The next portion of the review will briefly address attributes common to the
quantitative study of activity, primarily from the perspective of social gerontology.
It will be argued that a need exists for the development of validated measurement
approaches that combine both objective and subjective aspects of activity
participation. The review will proceed by demonstrating how quantitative studies
have operationalized subjective attributions of activity. This will provide a ground
upon which to view meaningful activity participation with empirical studies of the
same ilk. At the conclusion of this section I will present the Meaningful Activity
Participation Assessment as a viable indicator of meaningful activity participation.
The General Construct of Activity Participation in Social Gerontology
Activity participation refers to a person’s expenditure of time in a variety of specific
types of activity. Studies of activity in social gerontology have tended to focus on
leisure activities, which has been defined as activities that are chosen to occupy a
persons free-time, but do not involve those of basic self maintenance (e.g., Caplan,
1961). Activity theory had refined activity into categories such as formal and
informal social, and solitary activities (Lemon et al., 1972) in hopes of explaining
their influence upon life satisfaction. Unfortunately, this a priori approach to the
categorization of activity has been met with some skepticism, in part due to
inconsistencies in predicting well-being. Current studies have concentrated on
specific types or categories of activity such as religious (Koenig, Kvale, & Ferral,
76
2001), volunteering (Van Willigen, 2000), physical (Brown & Frankel, 1993),
productive (Herzog, Kahn, Morgan, Jackson, & Antonucci, 1989), and cognitive
(Wilson, Barnes, & Bennett, 2003), with the intention of explicating the differential
benefits these types of activities might incur upon the elderly in terms of life
satisfaction, health, cognition, or longevity, in addition to supporting a particular
theoretical position.
Dimensions of activity participation have also been categorized through a process of
factor analysis of frequency ratings of diverse activities resulting in a plethora of
categories across studies. These approaches have been intended in part to
concentrate the variance of activity participation frequency or diversity into
manageable clusters for discerning their relationships with the studies outcomes of
interest; while the clusters also served to provide groupings of activities so as to
enhance the interpretability of findings. For example, Harlow and Cantor (1996)
defined the eight categories that emerged from their factors as: social activities,
community service activities, mass communication use, building knowledge, home
activities and hobbies, creative activities, activities outside the home, and games.
Only the first three activity clusters were found to predict life satisfaction. Warr,
Butcher, and Robertson (2004) identified six factors of activities classified as:
family/social, church/charity, home and garden, reflective learning, music and
drama, and sports from their initial list of 20 activities. In a sample of older adults
(N=1167) the authors reported positive associations with affective well-being in only
77
two of six activity groupings; and activity participation was positively associated
with life-satisfaction in three of the activity groupings. Despite inconsistent
associations between activity participation and well-being, activity profiles
suggestive of the activity canalization proposed by the SOC model (Baltes & Baltes,
1990b) were discerned. The authors suggested that an exploration of personal
motivations for activity choices was required in order to enhance the explanatory
nature of existing life-course models of gerontology (Warr et al., 2004).
From this brief review, two general orientations appear to be commonly represented
in activity research in social gerontology: 1) theoretically derived a priori
categorizations of activity; and 2) activity categorization using factor analytic
methodologies. In terms of the first orientation, the strengths inherent in this
approach include theoretic guidance in activity categorization as well as the
likelihood of minimizing extraneous variance of the scale score in terms of outcome
variables. A weakness related to the first orientation involves inconsistent
relationships between or prediction of criterion variables from the activity categories.
A further weakness is the absence of subjective ascriptions to the activities, an
approach likely to improve the explanatory ability of the gerontological theories
(Van Willigen, 2000; Warr et al., 2004). The second orientation, the use of factor
analytic methodologies, appears to have the strength of maximizing interpretability
of measures with diverse activity choices. Unfortunately, this approach also has
been limited in its explanatory ability because of an inability to consistently predict
78
criterion variables. Furthermore, little has been gained towards understanding the
connotative (personally subjective) dimensions of these scales as researchers have
tended to assign ad-hoc ‘meanings’ to their factors; see Lawton (1993) for a review.
Glass et al. (1995) have advocated for the inclusion of subjective indicators that
reflect the value and significance of activity participation when researchers explore
the contributions of activity to the health and well-being of older adults.
Unfortunately, relatively little attention has been given to this area of concern,
considering the overall interest in the study of activity participation in older adults.
From the perspective of occupational science, the meanings that persons attribute to
their individual activities are believed to mediate the experience of those activities
(Clark et al., 1996; Jackson, 1996). Further, personal meanings are derived from an
individual’s day-to-day decision and actions (Maddi, 1998). Exploring the ways in
which health and well-being are influenced by the personal attributions of meaning
to activity participation therefore represents an important area of scientific inquiry.
From the perspective of social gerontology, especially given present life-span
theories of development, the subjective aspects of life are critical in explicating the
processes of change in the life course. Baltes and Baltes (1990) have posited that
successful aging is related to interindividual variability and intraindividual plasticity
with advancing age, and that these two factors are the cornerstone of a
developmental theory of human adaptation. They further argue that both subjective
79
and objective indicators are required to support the validity of any explanatory
framework of human development. It is evident from Lawton’s (1993) review that
both subjective (connotative) and objective (denotative) components are inherent in
describing activity. Subjective and objective indicators will therefore be necessary
for any comprehensive approach to activity measurement.
Incorporating personally subjective attributes of activity participation into the study
of activity has been advocated by social scientists for four decades. Kleemeier’s
(1961b) text and the contribution from Havinghurst (1961) are examples of work
from early proponents. The work of Kelly (1978; Kelly, 1993) has consistently
challenged researches to explore the role leisure activity, and activity in general,
plays in the lives of older adults. His work has explored approaches to measuring
activity meaning, and he has suggested that multiple indicators are necessary to
capture the diversity of subjective experience. Furthermore, recent research
interpreted within a life-course perspective has demonstrated that the beneficial
effects of activity participation change as a function of age. For example, Van
Willigen (2000) studied the effects of volunteering in middle-aged and older adults,
and found greater physical and mental health benefits for the older adults as a
function of hours of volunteering. These findings support the idea that activities
have differential meanings given the life-context of the individual, and that these
meanings may have salutary effects for the individual. This interpretation is
consistent with a life-course perspective, and it is in agreement with other authors
80
who have concluded that activity influences health and longevity via psychosocial
pathways (Glass, Mendes de Leon, Marottoli, & Berkman, 1999; Glass et al., 1995).
As reviewed above, the common approaches to activity measurement have their
weakness in failing to address the subjective aspects of activity participation. To aid
our understanding of human development, approaches to the measurement of activity
will require incorporating both subjective and objective components. Further, it is
critical that measures are developed that are both reliable and valid in their ability to
tap the construct of meaningful activity participation. The following review will
focus on studies that have incorporated an approach to measuring the subjective
aspects of activity participation. Finally, the methodology of measuring activity
meaning will be critiqued and potential remedies suggested.
Measurement of Subjective Attributions of Activity
One of the more common subjective activity attributions has involved satisfaction
with leisure activity. In a sample of 507 Spanish adults over the age of 65,
Fernandez-Ballesteros, Zammarron, and Ruiz (2001) assessed the degree of
satisfaction persons held toward their participation in a list of 15 leisure activities.
Activity satisfaction for each of the 15 activities was assessed by asking: “How much
do you enjoy the following activities?” on a four-point scale. Exploratory factor
analysis of the study’s construct indicators generated a higher-order satisfaction
81
factor, upon which activity satisfaction was significantly loaded (.598) in addition to
satisfaction with life, age satisfaction and perceived health. A causal model
suggested that activity satisfaction helped to explain a significant amount of the
effects social activity had upon life satisfaction. Lomranz et al. (1988) studied the
degree to which satisfaction with leisure contributed to psychological measures of
well-being in a sample of older adults in Israel (N=103). A two-item indicator of
leisure satisfaction was found to mediate the contributions of outdoor activities to
well-being in men, while this measure did not contribute to the prediction of well-
being in women.
Mancini and Orthner (1980) also used a two-item measure of leisure satisfaction in
their sample of older adults (N=104). The indicator of leisure satisfaction was
moderately correlated with morale (r = .38), while it helped to explain an additional
4% of the variance in this outcome variable. Finally, Brown and Frankel (1993)
incorporated a 12-item measure of leisure satisfaction which addressed subjective
activity attributions such as: challenge, social interaction, effects on health,
relaxation, and pleasure. They found a moderate degree of correlation between
leisure satisfaction and life satisfaction (r = .44) in their sample of adults. Physical
activity participation was reported to have both a direct effect on life satisfaction, in
addition to an indirect effect through leisure satisfaction. The degree of satisfaction
with one’s activity, a subjective attribute of meaning, appears to mediate the activity-
life satisfaction relationship across the three studies.
82
Some studies of activity participation in older adults have also explored how the
reasons one chooses to engage in activity help to explain well-being. In a sample of
147 older adults, Everard (1999) found that persons reported engaging in their
activities for the following reasons: fun, mental stimulation, social participation, to
pass the time, because of obligation, and to be physically involved. The reasons for
activity participation contributed 5% of the unique variance to the prediction of well-
being beyond the number of activities, activity frequency, and perceived heath.
Activities chosen for their ability to connect persons socially were positively
associated with well-being and provided the greatest amount of unique variance in
predicting well-being from the reason categories. Furthermore, Everard (1999)
reported that activities which served to “pass the time,” were negatively associated
with well-being.
Steinkamp and Kelly (1987) asked their sample of older adults (N=400) to list their
reasons for participating in their two most favored activities. Some of these reasons
included: “I’m expected to by my family,” I like developing a skill,” and “I enjoy the
companions;” the reasons were coded then factor analyzed resulting in 5 factors of
reasons. While total leisure activity participation contributed significantly to life
satisfaction within the entire sample, older adults (>75 years) were engaged in
activities for reasons of perceived competence and health to a lesser degree than
were the younger cohorts. Lastly, Bevil, O'Connor, and Mattoon (1993) assessed the
level of participation of older adults (N=32) in 36 different activities. Subjects were
83
also asked to report the type and number of benefits (e.g., physiological,
psychological, sociocultural, developmental, and spiritual) they obtained from their
involvement in each of the activities. Both the frequency and breadth (i.e., the
number of different activities) of activity involvement were found to be positively
associated with well-being, as was the number of different reasons a subject gave for
activity participation.
Studies have also investigated how an individual’s commitment to an activity or the
degree of importance attributed to their activities has related to measures of health
and well-being. Ray and Heppe (1986) surveyed a sample of older adults (N=120) in
terms of activity frequency, breadth, and perceived commitment (“not at all” to
“heavily committed”). Their findings suggested that both activity frequency and
activity commitment were associated with happiness to a greater degree than was
activity breadth. Further, the degree to which individuals were committed to their
activities was highly correlated with their frequency of activity participation.
Pushkar, et al. (1997) used importance (“not at all” to “extremely”) and difficulty
(“not at all” to “extremely”) as qualitative indicators of activity participation in
addition to a measure of activity frequency across a list of 25 diverse activities. In
their adult sample (N=98) aged 60-87 years, women reported greater mean levels of
activity difficulty and lesser mean levels of activity importance when compared to
their male counterparts. Further, subjects with poorer self-rated health tended to
assign greater importance to their activities. When these instruments were used in a
84
different sample of older adults (N=198), it was the men who assigned a lesser
degree of importance to their activities (Pushkar et al., 1997). However, greater
perceived activity difficulty predicted poorer subjective health for both genders
studied. Finally, as mentioned above it was found that the mean importance ratings
of activities in which participation was increased or remained the same was greater
than the importance ratings of activities which were relinquished.
Gregory (1983) incorporated a summative measure of activity meaningfulness as a
qualitative indicator of activity participation in older adults. The scale was
composed of three distinct components: enjoyment (“Enjoy Doing it Very Much” to
“Do Not Enjoy It at All”), autonomy (“Want to Do It” and “Have to Do It”), and
competence (“Do It Very Well” to “Do Not Do It Well”). Activity participation on a
23-item checklist was rated in terms of frequency of participation, while subjects
also rated the meaningfulness of each of the 23 activities. In the sample of adults
aged 65 to 90 years (N=111) both activity frequency (r = .43) and activity
meaningfulness (r = .29) were significantly positively correlated with life
satisfaction. A similar approach was undertaken by Smith, Kielhofner, and Watts
(1986) as they assessed the subjective aspects of activity categorized as work, daily
living tasks, recreation, and rest. Subjects aged 65 to 99 years (N=30) rated their
participation in these activity categories in terms of their perceived: competence,
importance and enjoyment. Results indicated significant positive associations
85
between life satisfaction and all three measures of meaning: competence (r = .39),
importance (r = .40) and enjoyment (r = .26).
Finally, Lawton et al. (1999) assessed both quantitative and qualitative components
of activity participation in their diverse sample of older adults (N=602) residing
either independently in the community or within an extended care facility. Subjects
rated the diversity of their activity involvement within a 20-item activity survey. A
measure reflecting one’s judgment of overall quality of time use, in addition to the
perceived quality of contact with family and friends served as the subjective
indicators of activity participation. The clearest pattern of results from the study
confirmed that activity involvement was positively related to both health and
psychological well-being. Furthermore, the amount of activity participation was
related to positive affect by both a direct path and an indirect path through time
quality. The authors suggested that in general more activity is better, but that
positive affect may be enhanced by greater time quality (Lawton et al., 1999).
In sum, the findings from these studies provide converging lines of evidence in
support of incorporating subjective measures of activity participation within the
instrument that has been developed for this study. Measures of activity satisfaction
and reasons for activity engagement have demonstrated unique contributions in
explaining the variance in subjective well-being beyond that of activity frequency.
Further, measures such as activity importance and difficulty have been shown to vary
86
according to gender, self-rated health, and changes in activity participation levels,
suggesting the potential to enhance the sensitivity by which activity frequency
predicts well-being. Finally, measures of self-perceived competence and activity
reasons have been linked to chronological age, offering further potential to discern
how meaning may mediate age-related shifts in activity participation. While the
cross-sectional designs of these studies limit the degree to which one may assert the
usefulness of activity meanings in terms of intra-individual change, the overall
consistency of findings provides strong evidence for the expectation of a connection
of multiple dimensions of meaning to the outcome of well-being.
These findings support the development of a measure of meaningful activity
participation. However, the instruments used in these studies have two general areas
in need of improvement: reliability/validity, and global versus activity specific
attributes of meaning. The development if a measurement tool requires that aspects
of reliability such as test-retest and internal consistency have been established in
order to make judgments regarding the validity of the instrument (Kerlinger, 1986).
Of particular concern is the lack of reliability and validity data, and most studies
have little data regarding the reliability of their measures. Arbuckle et al., (1997)
and Lawton (1999) are notable exceptions. The Meaningful Activity Participation
Assessment (MAPA) tested in this study is intended to alleviate these shortcomings
via two key avenues. First, the study has been designed to investigate essential
psychometric properties of the scale. Second, the MAPA scaling is inteded to allow
87
for a more ground-level assessment of activity meaning (i.e., personal judgments of
meaning for each of a diverse array of activities is possible), as apposed to a global
evaluation of overall activity meaningfulness.
Although this literature supports the value of including the construct of meaningful
activity in social gerontology research, difficulties exist in current procedures for
assessing it. What are arguably missed by the approaches reviewed above are the
transactions between specific activities and their personally relevant meanings. For
example, although some studies evaluated satisfaction with activities or use of time
(e.g., Fernandez-Ballesteros et al., 2001; Lawton et al., 1999), most measures were
general reflections of activity satisfaction consisting of a just a couple of items.
These measures failed to evaluate the subjective qualities of each activity. This
critique may be extended to studies which assessed the reasons for activity
participation. Steinkamp and Kelly (1987) looked at the reason for just one activity
per participant, the most important activity; and Everard (1999) reported a sum of
differing reasons for activity participation, irrespective of the specific activity-reason
relationship. Finally, typically only the average value for meaningfulness or
frequency is considered, without attending to subjects’ involvement in personally
unique arrays of activities. To promote more sensitive analyses, measures of activity
should strive to account for the likely association between meaning and frequency
inherent within an individual’s repertoire of activity choices. The MAPA has been
designed so as to provide a potential remedy for these concerns.
88
An Operational Definition of Meaningful Activity:
The Meaningful Activity Participation Assessment (MAPA)
The Meaningful Activity Participation Assessment (MAPA) is the primary
assessment of interest in the present study, and its specifications have largely been
derived from the literature reviewed above to serve as an operational definition of the
construct of meaningful activity participation. The MAPA is an activity survey
check-list which contains twenty-eight activity items common to older urban
American adults. The MAPA includes a frequency measure (MAPA-Frequency: 1 –
“Not at all” to 7 – “Every day”) for each of the twenty-eight activities (see Appendix
A), in addition to three measures of subjective attribution, or meaning. The
frequency scaling is intended to be more sensitive to change when compared to
frequency ratings such as rarely, often, frequently, or constantly (Lennartsson &
Silverstein, 2001; Litwin, 2000; Lomranz et al., 1988).
The first meaning category, MAPA-Meaning, was intended to reflect an overall or
general attribution of meaning. This approach is in agreement with the
recommendation made by Lawton (1985) for conceptualizing the many varieties of
activity meanings. In his review Lawton had suggested that a general term of
activity meaning (or meaningfulness) be used to represent both the cognitive and
affective qualities of activity participation. Given this, subjects were provided with
the following instructional wording, “Please rate each activity according to how
89
meaningful it is to you. That is, how much it matters or is personally fulfilling to
you.” (see Appendix B). Given the broad diversity of meanings reviewed above, the
intent of this wording was to cast a broad net so as to allow individuals to apply their
own attributes of meaning to each of the twenty-eight activities (1 – “Not at all
meaningful” to 5 – “Extremely meaningful”).
The second attribute of meaning, MAPA-Health (see Appendix C), was intended to
reflect the degree to which individuals believed participation in a given activity was
healthful. Individuals completing MAPA-Health were to indicate the extent to
which each activity contributed to their physical and mental health (1 – “Extremely
unhealthy” to 5 – “Extremely healthy”). This more specific component of meaning,
health, was chosen because of its congruence with a focus area of activity-based
interventions in the elderly (Clark et al., 1997). Furthermore, individual health has
commonly been identified as an area of concern for older adults (Bowling et al.,
2003; Clark et al., 1996; K. Everard, 1995; Kelly et al., 1986; Lawton, 1993),
therefore it is likely that activity participation is imbued with this aspect of meaning.
The above scales were intended to reflect: 1) the frequency of activity participation
(MAPA-Frequency, 2) the general meaningfulness of activity participation (MAPA-
Meaning), and 3) the more specific health-related meaning of activity participation
(MAPA-Health). In order to achieve indicators of the construct of meaningful
activity participation, the MAPA meaning and health scales are weighted by the
90
frequency of activity participation for all of the twenty-eight activities. This
approach is consistent with the practice of combining multiple ratings of a task or
activity into single indices (Kane, Kingsbury, Colton, & Estes, 1989; Raymond,
2001). The two indices to be formed are intended to reflect a general
conceptualization of meaningful activity (MAPA-Frequency x Meaning) and a more
specific health-related conception of meaningful activity (MAPA-Frequency x
Health). Please refer to the Methods section for more specific details regarding
scoring procedures and the combining of the scales.
The third meaning scale, MAPA-Reasons, corresponds to the final included meaning
dimension that is rated for each of the 28 activity items (see Appendix D). Within
MAPA-Reasons, participants are asked to indicate the primary reason for their
activity engagement. This scale was in part modeled after studies which have
incorporated reasons for activity participation as a subjective attribute of activity
(Bevil et al., 1993; K. M. Everard, 1999; Kelly et al., 1986). On the MAPA,
participants are directed to indicate one reason that best reflects why they choose to
engage in the activity. Four reason categories were available including: 1) Need or
have to do this, 2) For new experiences, 3) Connect with people, and 4) Sense of
accomplishment.
As a group, these three indices, MAPA-Frequency x Meaning, MAPA-Frequency x
Health, and MAPA-Reasons are aspects of the MAPA which reflect participants’
91
subjective attributions of meaning to each of the 28 activity items. A notable
improvement over other activity instruments is gained by employing this type of
approach to measuring activity. Addressing more diverse subjective attributes of
activity participation may offer a remedy to the concerns noted by social
gerontologists. Additionally, a means by which to quantify the value or significance
of activity to the older adult provides an additional tool with which to explore
activities’ contribution to health and well-being (Glass et al., 1995). Furthermore,
activity measures utilizing varied subjective attributions of meaning may help to
improve the explanatory nature of present gerontological models of development
which emphasize control (Brandtstädter & Rothermund, 1994), adaptation (Atchley,
1999a), and the processes of selective optimization with compensation (Baltes &
Baltes, 1990a).
Associations between Measures of Meaningful Activity Participation
To this point, the discussion has focused primarily upon outlining the substantive
stage (Benson, 1989) of meaningful activity participation. This process is analogous
to the process of logical analysis (Pedhazur & Schmelkin, 1991), and is an essential
component in the process of construct validation whereby empirical data and
theoretical perspectives are utilized to support the proposed construct. Details
regarding the indicator of the construct at hand, meaningful activity participation,
have been delineated above.
92
The final aspect of construct validation is called the external stage, which involves
studying the relations among the construct of interest and two or more theoretically
or empirically related constructs (Benson, 1989). The purpose of this approach is to
assess the degree to which the indicator of the construct is seen to relate to the others
in a hypothesized manner. Pedhazur and Schmelkin (1991) have referred to this
process as cross-structure analysis. The idea of a “nomological network” was
offered by Cronbach and Meehl (1955) as a means in which to define the intended
relationships between the constructs and their indicators. Such a network should
include a theoretical framework in which to suggest relationships between the
constructs, an empirical framework for how to measure it, and a specification of the
linkages among and between these two frameworks.
The process of construct validation should follow relevant theoretical and empirical
guide posts. In support of this position the present study has incorporated measures
that on strong theoretical grounds are expected to reflect the construct of meaningful
activity participation in order to test the criterion-related validity of the MAPA.
Given that, three measures will serve as additional indicators of the construct of
meaningful activity participation. The first measure for this purpose is called
MAPA-Global. It is an eight-item scale designed as a summative measure of the
activity meanings included in the present study (see Appendix E). MAPA-Global
includes items which were intended to tap the phenomenological experience of the
respondents’ activity participation in areas more directly related to the MAPA scales
93
reviewed above. Within MAPA-Global, items address the extent to which
participants believe their activities in a general sense contribute to their mental and
physical health, contribute to their satisfaction and contentment with their present
round of daily activities, and are personally meaningful.
The Engagement in Meaningful Activity Survey (Goldberg et al., 2002) is the second
measure intended to tap the domain of meaningful activity participation. The EMAS
is a twelve-item measure proposed to reflect the extent to which persons ascribe
meaningfulness to their overall activity routines (Appendix F). Items in the scale are
worded to address twelve types of meaning attributable to participation in daily
activities. In general, the scale reflects an individual’s beliefs that his or her daily
activities: a) provide congruence with one’s value system and needs, 2) provide
evidence of competence and mastery, and 3) are valued in one’s social/cultural
group.
The Daily Occupational Experience Survey (DOES) was conceptualized by Erna
Blanche as a means for exploring play experiences in the daily activities of adults
(Blanche, 1999, 2002); and is included to represent a third measure of meaningful
activity participation. The original instrument included thirteen items reflecting
experiential characteristics of play that had been identified in the literature.
Examples of item content in the DOES include the experience of spontaneity, arousal
seeking, physical or mental activity, fantasy, and pleasure associated with one’s
94
activities. A modified version of the DOES serves as a source of data within the
present study. The revised DOES consists of seventeen items; thirteen items reflect
the characteristics of play experiences identified in the literature by Blanche (1999),
and the four additional items are derived from the process-oriented experiences of
Blanche’s conceptual map (refer to Appendix G).
An assessment intimately related to the construct of meaningful activity participation
is the Purpose-In-Life Test. The Purpose-in-Life Test (PIL) was developed by
Crumbaugh and Maholick (1964; 1969) as a measure of Victor Frankl’s concept of
“existential vacuum.” Frankl (1959/1984) had theorized that the essence of human
motivation was in the pursuit of life meaning or “will to meaning”. The PIL is
therefore concurrently considered an instrument intended to operationalize the
existential concept of purpose and meaning in life. The PIL is a twenty item scale
designed to evoke responses believed to be related to the degree to which the
individual experienced “purpose in life” (Crumbaugh & Maholick, 1964).
While the PIL is not overtly a measure of the construct of meaningful activity
participation, it can be substantiated as a measure which supports the external stage
of the construct validation process for the present study. Benson (1998) has
contended that in an initial process of construct validation, “…it is best to define the
theoretical domain as broadly as possible to include all the dimensions and subtleties
of the construct” (p. 12). An important aspect of the three MAPA scales (MAPA-
95
Frequency x Meaning, MAPA-Frequency x Health, and MAPA-Reasons) is their
conceptual relationship to present theories of meaning and purpose in life. Reker
and Wong (Reker, 2000; 1987) have theorized that individuals’ phenomenological
experience of their activities and pursuits, referred to as “present meaning”,
constitute a critical aspect of their personal meaning system. An individual’s valued
activities, as a source of present meaning, contribute to the person’s more global
experience of meaning and purpose in life. According to their breadth hypothesis,
sources of present meaning are expected to be causally related to the level of
meaning and purpose in life. Empirical evidence reviewed by Reker (1994) lends
support to this position in older adult samples. Unfortunately only one instrument,
the Source of Meaning Profile (SOMP), had been used as a measure of present
meaning in his review. The MAPA therefore provides another approach for
quantifying sources of present meaning; an important capacity given the need to
develop instruments capable of validly reflecting this major existential concept
(Prager, Bar-Tur, & Abramowici, 1997; Reker, 2000).
As noted above, in addition to the three MAPA-derived scales, three measures were
proposed as indicators of the construct of meaningful activity participation: MAPA-
Global, Engagement in Meaningful Activity Survey, Daily Occupational Experience
Survey. Additionally, the Purpose-In-Life Test has been included as an indicator of
the construct of meaning and purpose in life. These theoretically derived measures
may provide an empirical base upon which to substantiate the relatively new
96
conceptual domain of meaningful activity participation. Most notably, the Purpose-
In-Life test is a well established instrument capable of reliably and validly tapping
existential themes, while it has strong theoretical links to the MAPA based upon the
work of Reker and Wong (1987). The Engagement in Meaningful Activity Survey is
also supported by a diverse theoretical base, with sound psychometric properties and
a history of construct validity. Though the Daily Occupational Experience Survey
and the MAPA-Global are not established empirically, they are moored strongly to
the MAPA with theoretic and content related ties. The first two research hypotheses
to be offered may be drawn from the present review:
1. Among older adults there are positive correlations between the three principal
MAPA scales and the Purpose-In-Life Test.
2. Among older adults there are positive correlations between the three principal
MAPA scales and the other scales of meaningful activity participation.
Associations between Meaningful Activity Participation and Conceptually Related
Constructs
This section will provide an overview of constructs and their indicators which are
either theoretically or empirically related to meaningful activity participation to
expand the nomological network for validating the MAPA. The rationale for
selecting the other constructs with which the MAPA will be validated will be
97
established. Hypotheses will be introduced regarding the expected relationships
between these indicators and the construct measured on the MAPA. For the sake of
parsimony, only four additional hypotheses will be proposed.
Though gains have been made in understanding how activity relates to such
constructs as health and life-satisfaction, these varied groupings and classifications
of activities have made it challenging to compare findings across studies (Kozma &
Stones, 1978; McNeil et al., 1986; Menec, 2003). The review will not attempt to
disentangle all of the complex and inconsistent results, but should serve instead to
outline the generally consistent findings. The following empirical findings will
provide the basis from which the hypotheses for the present study can be generated.
Additionally, the conceptual model posited by the occupational science and
occupational therapy department at the University of Southern California (USC) will
serve to frame the expected hypothesized relationships. To review, this model is
intimately related to the present study for a number of key reasons. The MAPA is
being proposed as the indicator for meaningful activity suggested by the USC
conceptual model. Enhancing meaningful activity participation in older adults has
been theorized to effect positive changes in the criterion indicators included within
the present study. The RAND SF-36 version 2 (Ware et al., 2000) is included as a
measure of perceived physical health and mental health. Additional measures of
psychosocial well-being shared between the two studies include the Center for
98
Epidemiologic Studies Depression Scale (Radloff, 1977), the Life Satisfaction Index-
Z (Wood et al., 1969). Hence it will be of significant consequence to substantiate the
extent to which the MAPA may predict variations within these outcome indicators.
Activity Participation and Life Satisfaction
The relationship between activity participation and life satisfaction has received
substantial attention in the gerontological literature. Life satisfaction is understood
to be a construct within the higher-order factor of subjective well-being (Stock,
Okun, & Benin, 1986), and involves individuals’ interpretation of their affective and
cognitive evaluations of their lives (Diener, 1984). The Life Satisfaction Index-Z
(LSI-Z) (Wood et al., 1969) and the Satisfaction with Life Scale (Diener, Emmons,
Larsen, & Griffen(1985), 1985) are well accepted tools for measuring this construct,
and will be employed in this study. Meta-analytic evidence has suggested that social
activity is moderately positively correlated with well-being (Okun et al., 1984),
while differing categorizations of activity have been shown to be positively
correlated with measures of life satisfaction (Brown & Frankel, 1993; Harlow &
Cantor, 1996; Menec & Chipperfield, 1997; Sagy et al., 1990). In terms of specific
activity clusters, engagement in activity is positively correlated with the LSI-Z for
both men and women in terms of social, solitary and productive activity (Menec,
2003), as well as customary physical activity (Morgan et al., 1991). As a result of
this review it seems reasonable to formulate the following hypothesis:
99
3. Among older adults there are positive correlations between the LSI-Z, the
SWLS and the three principal MAPA scales.
Activity Participation and Health-Related Quality of Life
Health-related quality of life is an abstract construct with definitions that may vary
based upon underlying values and approaches to measurement. While difficult to
define, health-related quality of life (HRQL) may be thought of as, “…those aspects
of self-perceived well-being that are related to or affected by the presence of disease
or treatment.” (Ebrahim, 1995, p. 1384), and typically involves individuals’
evaluation of their functioning across multiple domains such as physical,
psychological, and social engagement (Anderson & Meyers, 2000). Version 2 of the
RAND SF-36 Health Survey (SF-36v2) (Ware et al., 2000) was used as a indicator
of this construct in the present study; more specifically, the two higher-order factors
reflecting physical health and mental health. Dijkers (1999) has suggested that
profile approaches to assessing quality of life, such as that employed in the SF-36v2,
represent a relatively more objective indicator as compared to measures which
primarily address measures of life satisfaction or negative and positive affect.
Furthermore, Spiro III and Bossé (2000) have demonstrated that measures of HQRL
and well-being represent distinct constructs, and that HRQL measures are important
for improving our understanding of health and well-being among older persons.
100
Activity participation has typically been studied in relationship to self-rated health
using measures of significantly smaller breadth than the SF-36v2. In these studies,
self-rated health has served as a primary outcome variable, or as a control variable in
predicting the relationships between activity participation and psychological well-
being in older adults. Utilizing a single-item scale of health satisfaction, Ritchey,
Ritchey, and Dietz (2001) found a positive association between activity frequency
and self-rated health. Van Willigen (2000) and Luoh and Herzog (2002) have found
that levels of activity (specifically volunteer work) were statistically significant
predictors of self-rated health. While Warr, Butcher and Roberston (2004) reported
that health-related activity restrictions moderated the degree to which the frequency
of activity participation predicted life satisfaction. Finally, in a meta-analysis of 86
studies, Pinquart (2001) examined measures of either activities of daily living or
instrumental activities of daily living (e.g., housekeeping, cooking, shopping,
managing finances). A moderate positive relationship was found between
instrumental activities and measures of objective health.
There is evidence to suggest that the SF-36v2 may demonstrate significant positive
relationships with activity. The SF-36 has been shown to distinguish between those
older adults with and without physical disability (Lyons, Perry, & Littlepage, 1994),
and those of differing disease severity (McHorney, Ware, & Raczek, 1993), factors
which likely limit the frequency and diversity of activity participation. The findings
of Clark et al. (1997) are relevant to the present study in that older adults who
101
received an activity-based occupational therapy program (i.e., Lifestyle Redesign ®)
demonstrated significant improvements on seven of the eight scales of the SF-36
compared to controls. Jenkins, Pienta, and Horgas (2002) studied the relationship
between activities and the SF-36 scores on a sample (N=167) of independent living
and assisted living residents in the Midwest. Activity participation was classified
into four levels of increasing intensity of involvement. Greater activity involvement
was found to be positively associated with seven of the eight scales from the SF-36,
while negative association was found for persons who were classified as inactive
(e.g., more time spent doing nothing). Therefore, the following study hypotheses are
suggested from this review:
4. Among older adults there is a positive correlation between the SF-36v2-
Mental and the three principal MAPA scales.
5. Among older adults there is a positive correlation between the SF-36v2-
Physical and the three principal MAPA scales.
Activity Participation and Depression
The next construct against which the MAPA will be validated is depression, given
substantial empirical support for this association. Depression is typically defined by
the extent or pattern of the symptoms which indicate its presence, such as depressed
mood, anhedonia, social isolation, or poor appetite (Blazer, 2004). For the present
102
study the Center for Epidemiologic Studies Depressive Scale (CES-D) will serve as
the indicator of this construct; higher CES-D scores are reflective of greater
depressive symptomatology (Radloff, 1977). While a causal association between
depression and activity participation has not been directly established, longitudinal
evidence suggests that the relationship is likely reciprocal, though depression in
older adults tends to be preceded by the loss of activity (Ormel, Rijsdijk, Sullivan,
van Sonderen, & Kempen, 2002). A unique perspective on this relationship has been
undertaken by Williamson and Schulz (1992), whose Activity Restriction Scale
measures the loss of activities. They have found moderate positive relationships
between the loss of activity and depression as measured by the CES-D.
Typically measures of activity frequency or diversity display low to moderate
negative relationships with measures of depressive symptomology (Adams, Sanders,
& Auth, 2004; Morrow-Howell, Hinterlong, Rozario, & Tang, 2003). This pattern is
also apparent when the CES-D has been used in association with measures of
activity. Utz, et al., (2002) reported low negative correlations between the CES-D
and measures of informal and formal social activity. Low moderate correlations
were also reported between the CES-D and frequency of leisure activities (Herzog,
Franks, Markus, & Holmberg, 1998). Therefore, the following hypothesis is being
proposed:
103
6. Among older adults there are negative correlations between the CES-D and
the three principal MAPA scales.
A Tentative Causal Model
The final aspect of the construct validation process for the present study will be to
test a causal model relating the construct of meaningful activity participation to two
theoretically relevant constructs, health related quality of life and purpose and
meaning in life. The importance of this model is founded upon the need to generate
knowledge related to the form, function, and meaning of occupation or activity
(Zemke & Clark, 1996). As described earlier in this review, the construct of
meaningful activity participation represents not just the objective realm of activity
engagement, but is also intended to reflect personal phenomenological qualities of
activity meaning. Occupational science scholars have posited that meaningful
engagement in activity contributes to viewing one’s life as purposeful and
meaningful, ultimately influencing health and well-being (Clark et al., 1991; Jackson
et al., 1998; Yerxa et al., 1989).
It is from this vantage point that the following tentative model will be offered. In the
model, a direct causal influence from the construct of meaningful activity
participation to the constructs of self-rated physical and mental health is
hypothesized. Meaningful activity participation is also hypothesized to have a direct
104
influence upon the construct of purpose and meaning in life. Finally, self-rated
physical and mental health are hypothesized to be indirectly influenced by
meaningful activity participation via its role in enhancing purpose and meaning in
life, in addition to the direct influence of meaning and purpose in life (See Figure 1).
The relationship of meaningful activity participation to HRQL has been argued based
upon the empirical findings reviewed immediately above. A causal association is
suggested by the work of Clark et al. (2001; 1997) whereby randomly assigned
community-dwelling older adults receiving activity-based interventions (lifestyle
redesign) demonstrated long-term benefits in 7 of the 8 scales of the RAND-SF36.
Furthermore, Rejeski and Mihalko (2001) presented a critical review of literature in
which they found support for the notion that the value or meaning of activities likely
moderate the relationship between activity and well-being. Further, the studies of
Van Willigen (2000) and Luoh and Herzog (2002) suggested that levels of activity
predict self-rated health. Finally, meta-analytic evidence strongly supports this
posited relationship (Pinquart, 2001). Currently gerontologists are interested in
explicating the mechanisms which mediate this relationship (Menec, 2003).
The relationship between meaningful activity participation and meaning and purpose
in life constitutes the second main path of the model. As reviewed above, Frankl
(1959/1984) suggested that the specific meanings we attribute to our lives result
from our day to day experiences, while a sense of purpose and meaning in life is
105
developed as we strive towards personally meaningful goals (Yalom, 1980). Reker
and Wong (1988) delineated specific statements regarding the structure of purpose
and meaning in life, of which the breadth hypothesis is most germane to the
proposed model. This hypothesis states that the diversity of one’s sources of
meaning provides a basis for “present meaning” which contributes to meaning in life.
Prager (1996) and Reker (1994) have offered empirical support for this position
through the use of the Sources of Meaning Profile, of which activity constitutes the
majority of items. Furthermore, activity participation in older adults has been
positively associated with measures of purpose and meaning in life (Ardelt, 2003;
Weinstein & Xie, 1995). Gerwood, LeBlanc, and Piazza’s (1998) study suggests
that it is not just the activity, but the degree of meaningfulness attributed to the
activity, which contributes to the older adult’s sense of meaning and life purpose.
These converging lines of evidence point to a significant role for meaningful activity
in developing a sense of meaning and purpose in life.
The relatively recent growth of interest in gerontology, positive psychology and
personal meaning has led theorists to posit a causal relationship between meaning
and purpose in life and health and well-being. Reker, Peacock and Wong (1987)
have argued that meaning and purpose in life represents a valid construct which
should be integrated into life-span perspectives of development, while Wong (1989)
has asserted that personal meaning is an important component of successful aging.
Empirical evidence involving older adults samples has supported a positive
106
relationship between purpose and meaning in life and indicators of psychological
health and well-being (e.g., Fry, 2001; Reker et al., 1987; Zika & Chamberlain,
1992). However, these associations fall short of providing evidence for a causal
relationship between purpose in life and psychological health due to the absence of a
descriptive causal theory. Fortunately, two perspectives for a causal relationship are
available to help in interpreting these findings, as well as to support the proposed
model.
The first to be reviewed is the sense of coherence model proposed by Antonovsky
(1987). According to Antonovsky, sense of coherence is composed of three
components termed comprehensibility, manageability, and meaningfulness, and is
defined as a:
…global orientation that expresses the extent to which one has a
pervasive, enduring though dynamic feeling of confidence that (1) the
stimuli deriving one’s internal and external environments in the
course of living are structured, predictable, and explicable; (2) the
resources are available to one to meet the demands posed by these
stimuli; and (3) these demands are challenges, worthy of investment
and engagement. (p. 19)
While the three components are theorized to be intertwined, it is meaningfulness
which serves as the central organizing component of the three. That is, the degree to
which individuals’ find meaning in their lives supports the integration of the other
two components. Within the model, sense of coherence serves as a means of coping
with the challenges of daily life. A sense of coherence also acts to mediate life
107
stressors, thereby having direct physiological consequences (e.g. reduction of stress-
related hormones) within the individual, ultimately impacting an individual’s health
(Antonovsky, 1987).
The second model, offered by Ryff and Singer (1998), takes a salutary approach
towards the influence of purpose and meaning in life upon health. The authors begin
with the premise that purpose and meaning are important aspects of optimal human
functioning and, as defining components of psychological well-being, have
consequences for positive mental and physical health. They posit that there are
biological underpinnings of wellness of mind, and they delineate three interacting
physiological mechanisms which mediate the influence of purpose and meaning in
life upon health (i.e., optimal allostasis, immune competence, and cerebral activation
asymmetry). They argue that having purpose and meaning in life contributes to the
maintenance of a person’s health via these diverse physiological mechanisms. While
each model differs somewhat by relating the construct of purpose and meaning in life
to the phenomenological (Antonovsky, 1987) and psychological (Ryff & Singer,
1998) life of the individual, they are in general agreement that underlying
physiological mechanisms may account for the impact upon human health.
Empirical evidence has been generated in the older adult population to help
substantiate these models. For example, in a small age-matched sample of persons
relocating to new residences (N=28), sense of coherence was found to moderate the
108
influence of positive mood upon natural killer cell activity (i.e., immune function)
within the blood stream, while persons with low sense of coherence had the poorest
natural killer cell activity (Lutgendorf, Vitaliano, Tripp-Reimer, Harvey, & Lubaroff,
1999). Krause and Shaw (2003) provided evidence supporting the contribution of
personal meaning to self-rated health in their larger sample (N=442). Participants
rated their sense of personal control within their three most meaningful social roles
(e.g., spouse, parent, and friend) in addition to completing measures of personal
meaning and self-rated health. Their results indicated that only the most meaningful
social roles predicted personal meaning, while higher personal meaning scores
predicted better self-rated health. In a related study Krause (2004) found that
meaning in life predicted self-rated health, but also that stressors experienced in an
individual’s most salient roles affected health primarily by eroding an older person’s
sense of meaning in life. Finally, in a small sample of individuals recovering from
knee surgery (N=59), Smith and Zautra (2000) reported that purpose in life helped to
predict self-rated health six months later. The results revealed that purpose in life
was directly related to better mental health and indirectly related, through active
coping, to better physical health.
109
CHAPTER THREE
METHODS
Overview of the Study Design
The primary purpose of this paper is to provide evidence of the MAPA’s
psychometric properties. To develop construct validity evidence for this novel scale,
the study tested six main hypotheses: 1) Among community dwelling older adults
there is a positive correlation between the MAPA and the Purpose-in-Life test, 2)
Among community dwelling older adults there are positive associations between the
MAPA scales and other scales of meaningful activity participation, 3) Among
community dwelling older adults there are positive correlations between the MAPA
and two measures of life satisfaction (i.e., LSI-Z and SWLS), 4) Among community
dwelling older adults there is a positive correlation between the MAPA and the four
SF-36v2 Mental Health scales, 5) Among community dwelling older adults there is a
positive correlation between the MAPA and the four SF-36v2 Physical Health scales,
and 6) Among community dwelling older adults there is a negative correlation
between the MAPA and the CES-D. Results from the statistical tests of these
hypotheses were intended to provide convergent validity evidence for the MAPA.
110
Given the unique composition of the MAPA, data analyses were liberal in regards to
exploring the nature of this instrument. Data analyses were designed to explore the
psychometric properties of the MAPA, to: 1) provide evidence of its reliability, 2)
explore the nature of its factor (component) structure, 3) explore relationships among
the scales, 4) explore novel (candidate) variables derived from the scales, 5) explore
the level of associations of these novel variables with criterion variables, and 6)
establish the best single or composite MAPA variable for predicting criterion
variables. A rather large number of new variables from the MAPA scales were
created and evaluated as a consequence of the latter three tasks. Of those, variables
with the greatest substantive contributions to understanding the diverse aspects of the
MAPA will be reported on in detail.
Beyond the main hypotheses of the study, eight specific research questions related to
this general analytical approach were addressed: 1) Is there empirical evidence to
support generating the MAPA-Frequency x Meaning score?, 2) Is MAPA-Frequency
x Meaning or MAPA-Frequency x Health a better predictor of the criterion
variables?, 3) Is there potential utility in the use of principal components involving
MAPA scale variables as predictors of criterion variables?, 4) Will intra-individual
(z-score derived) MAPA scale variables serve to predict criterion variables?, 5) Does
the MAPA-Reasons variable aid in the prediction of the criterion variables?, 6) Do
the identified candidate variables from above (i.e., PCA regression coefficients,
intra-individual and MAPA-Reasons variables) add meaningful, statistically
111
significant variance in the prediction of criterion variables when combined with
MAPA-Frequency x Meaning scores?, 7) Does MAPA-Global, when combined with
MAPA-Frequency x Meaning, contribute unique variance to the prediction of the
criterion measures?, and finally, 8) Does MAPA-Frequency x Meaning add
statistically significant variance to the prediction of criterion variables beyond that of
traditional activity variables (i.e., Activity Frequency and Activity Diversity)?
Finally, two additional data analytic approaches were undertaken with the intention
of testing the construct validity of the MAPA. First, cluster analysis was employed
using the 28 activity items from the MAPA-Frequency scale as cluster variables.
Cluster analysis groups individuals into homogenous clusters based upon specifically
defined variables (i.e., MAPA-Frequency items), which afforded a unique view of
the MAPA that could not be captured via typical approaches (e.g., principal
component analysis). Second, a causal model was tested to identify the extent to
which MAPA-Frequency x Meaning contributed to criterion measures of purpose in
life and health-related quality of life.
Participants
Data were collected on 160 participants during September and October of 2004
following approval of the USC Institutional Review Board (Proposal #047058). The
participants constituted a convenience sample of volunteers who lived in the Los
112
Angeles area and were residents of retirement communities and residential facilities,
or who were community dwelling elders visiting local area senior centers. All
participants were at least 65 years of age and sufficiently fluent in English as
assessed through oral questioning. Participants with significant cognitive deficits
were excluded. Study participants were interviewed by the principal investigator, an
occupational therapist with 12 years of clinical experience working with older adults,
to screen for significant language or cognitive barriers for participation. More
specifically, participants were questioned regarding their understanding of the
informed consent. Clinical judgment was used to exclude persons exhibiting
substantial difficulties with either English language comprehension or understanding
of the informed consent.
Participant Recruitment
Participant recruitment entailed first identifying Los Angeles area retirement
communities, residential facilities and senior centers though a review of telephone
directories and catalogues of senior living facilities. The principal investigator made
initial contact with each entity by telephone. A brief description of the study was
communicated to a representative of an entity, and a more detailed letter was
forwarded to facilities that expressed an interest in participation. A total of 23
entities had been contacted, out of which 13 agreed to participate including: 2 senior
centers, 8 residential communities, and 3 residential facilities.
113
The second aspect of subject recruitment involved establishing an information and
recruitment table at the respective facilities. Each table was staffed by the principal
investigator, in addition to a study trained occupational therapy graduate student for
study sites in which recruitment was likely to identify five or more study
participants. The recruitment process utilized a 36” x 48” information board that
highlighted the importance of the study and details relevant for participation in the
study (e.g., the general nature and importance of the area of study, approximate
length of time to complete the battery of instruments, remuneration for participation,
etc.).
Testing Procedures
Each participant signed an informed consent form before testing was initiated.
Participants were tested in groups of 3 to 15 with the principal investigator present at
all times. For groups with more than 6 participants, study trained graduate students
were also available to assist the principal investigator in the administration of the
battery of study instruments. Testing was conducted in a room identified by each
facility representative. Participants were allowed as much time as was needed to
complete the battery of instruments. Instrument questions and response options were
read to those who had difficulty reading because of visual impairments. After
completing the battery of instruments, participants were given a $10 stipend as
compensation for their time. A randomly chosen group of 25 participants were
114
retested on a reduced battery of instruments including the Meaningful Activity
Participation Assessment, the Daily Occupational Experience Survey, and the
Engagement in Meaningful Activity Survey. These participants were retested by
either the principal investigator or a study trained graduate student between one and
two weeks following initial testing, and participants received $5 as compensation for
the second testing session. Retesting was conducted in a space agreed upon between
the participant and study representative. Details of pilot testing the MAPA can be
found immediately below in the Meaningful Activity Participation Assessment
portion of the Instruments section.
Data Management
The data were entered by hand into a Microsoft Excel (2002) database by staff of the
USC department of Preventive Medicine at the Keck School of Medicine, who
oversaw the data management for the parent Well Elderly II study. Identification of
outlying or missing data was determined by reviewing the SPSS version 12 (2003)
minimum and maximum values for each study variable. A total of 21 subjects were
found to have at least some missing data; no outlying values were found. These
missing data were visually compared to the original instruments and discrepancies in
the database were amended when a missing value had been initially entered in error,
with changes saved to a separate file. A random sample of 40 participants was then
selected, and their entire battery of test instruments was evaluated for data entry
115
errors. Of these 40 participants, 10 were found to have data entry errors with a mean
of 1.6 errors per participant. The majority of errors for these 10 participants
appeared to be related to writing legibility and the errors in this database were
corrected. The data entry error rate was deemed very low and data checking was
ended.
The original sample of 160 participants who had completed the instrument battery
was reduced for data analyses. As one participant was missing MAPA data and
another was less than 65 years of age, a slightly smaller sample (N=158) was used in
the analyses of the MAPA scales. Of these 158 participants, four elders were
missing data from an entire criterion instrument, or missing too many items within
an instrument to allow for imputations of the missing data, resulting in a final sample
size of 154. This sample was used to test the study hypotheses, conduct a causal
path model and perform cluster analysis. Of the 154 participants, income data were
reported by only 150; for subsequent analyses the median income value was imputed
for the 4 subjects missing income data. Missing items from SF36v2 scales were
imputed in the manner suggested by Ware, Kosinski and Dewey (2000). For the
remaining instruments, mean intrapersonal scale values were imputed for missing
items when instruments were missing less than 5% of their total items (Cohen &
Cohen, 1975). There were 16 persons who expressed an interest in participating, but
were excluded from study participation because of difficulties with either language
comprehension or cognition as determined by the principal investigator.
116
Instruments
Meaningful Activity Participation Assessment (MAPA)
The Meaningful Activity Participation Assessment (MAPA) is a checklist-type
survey in which persons indicate how often and the extent to which they experienced
selected qualities of meaningfulness in a number of diverse activities over the past
few months. The structure and content of the MAPA was partially derived from the
Everyday Activity Checklist (Arbuckle, Pushkar Gold, Chaikelson, & Lapidus,
1994; Pushkar et al., 1997). The MAPA includes the measurement of the frequency
of activity participation across a wide array of activities commonly engaged in by
older adults. Additionally, and unique to this instrument, the MAPA was constructed
in an attempt to reflect the degree of meaningfulness individuals ascribe to their
participation in each included daily activity. Together, frequency of activity
participation and the degree of ascribed meaning is intended to reflect the construct
of meaningful activity participation.
Pilot testing was first conducted to identify the ways in which the MAPA might be
improved for use in a local Los Angeles elder population. Modification of a list of
25 activity items (Arbuckle et al., 1994; Pushkar et al., 1997) was pursued via two
methods in order to enhance the face and content validity of the instrument. First,
two two-hour focus groups, consisting respectively of three and five older adult
117
members, were conducted by the principal investigator. A modified Nominal Group
Technique (Moore, 1987) was employed to clarify the list of activity items. This
method of group facilitation encouraged discussion of the definitions of each activity
item. Alternate activity items were suggested by the group members, and input from
all members was solicited. As an example, the activity item of Home Activities was
found to be ambiguous for most participants; Homemaking Activities was suggested
as a less ambiguous alternative. The process ended with an anonymous voting
procedure which provided data for item inclusion and item elimination for the
MAPA. As an example of this process, both groups voted for the removal of the
activity item of Reading Fiction. Second, findings from the two groups were then
discussed with researchers from the Well-Elderly II research team. The researchers
provided professional expert opinions based upon their experiences with older adults
in a previous Lifestyle Redesign ® intervention program.
Arbuckle et al’s (1994) list of activity items was eventually modified and expanded,
based upon the results of the above two procedures, to include the final 28 activity
items. Modifications included changing Home Activities to Homemaking / Home
Maintenance; Writing Letters to Writing Letters / Cards; Organizational Activities to
Community Organization Activities; Volunteering to Volunteering Activities;
Reading Fiction and Professional Reading were combined to Other Reading; and
four new activity categories were added: Talking on the Telephone, Pet Care,
Computer Use for Email, and Other Computer Use. Three “other” blank lines were
118
included to encourage the listing of any important activities not included in the set
provided.
For the purpose of measuring activity frequency, the instructions were: “Please rate
the amount of Time that you spent on the following activities during the last few
months.” For each activity item, the MAPA included the following response options
for rating frequency of participation: 1) Not at all, 2) Less than once a month, 3)
Once a month, 4) 2 to 3 times a month, 5) Once a week, 6) Several times a week, or
7) Every day (see Appendix A). Values were converted from 1-7 to 0-6 due to the
multiplicative weighting of MAPA scales to be employed. The use of a 7-item
frequency rating scale was intended to improve the sensitivity of the 5-item scaling
utilized in earlier studies (e.g., Pushkar et al., 1997). Feedback from subjects
involved in pilot testing the MAPA confirmed that older adults were capable of
discriminating between these added levels of activity participation frequency.
Activity meaning within the MAPA was primarily addressed through participant
ratings of two constructs: meaningfulness and healthfulness. Using likert-like
scaling, respondents indicated the degree of meaningfulness of each of the activities
on the MAPA. At a general level of meaning, participants were directly instructed to
rate the meaningfulness of each of the 28 activities, “Please rate each activity
according to how meaningful it is to you. That is, how much it matters or is
personally fulfilling for you.” The following scale was used: 1) Not at all
119
meaningful, 2) Somewhat meaningful, 3) Moderately meaningful, 4) Very
meaningful, and 5) Extremely meaningful (see Appendix B). Values were converted
from 1-5 to 0-4 due to the multiplicative weighting of MAPA scales to be employed.
At another, more specific level of meaning, participants were instructed to indicate
how their participation in the activity influences their health: “Please rate each
activity according to how healthy it is for you. That is, how much is contributes to
physical or mental health.” For this aspect of meaning, the following Likert-like
scale was used: 1) Extremely unhealthy, 2) Unhealthy, 3) Neither, 4) Healthy, 5)
Extremely healthy (see Appendix C). For data analysis, values were entered as 1-5.
A final aspect of meaning within the MAPA was intended to reflect primary
motivations for activity participation (see Appendix D). For each of the 28 activities,
participants were instructed to indicate their motivation or reasons for participating
in the activity. This scale, referred to as MAPA-Reasons, directed participants as
follows: “Please check ONE box that best indicates why you do each activity.” The
nominal-scaled choice options included: 1) Need or have to do this, 2) For new
experiences, 3) Connect with people, 4) Sense of accomplishment, 5) Other
(Specify), and 6) I don’t do this. The “Other” category provided an opportunity for
participants to indicate a perceived motivation not reflected by the above categories.
From the nominal-level scaling it was possible to generate frequency data for each
behavior motive for each participant across the set of rated activities.
120
MAPA Global
A complement to the MAPA, a truncated version termed the MAPA-Global, was
created to be conceptually analogous to the other MAPA scales: MAPA-Frequency,
MAPA-Meaning, and MAPA-Health. The MAPA-Global was intended as a brief
instrument for tapping the construct of meaningful activity participation. MAPA-
Global included 8-items: six items were reflective of the MAPA constructs and two
items addressed change in both activity participation and meaningfulness. The
following are two examples of items: “Overall, how much do you think your
activities contribute to your mental health?,” and “Overall, are your activities
personally fulfilling for you?” The items included a seven point scale ranging from
1 – Not at all to 7 – A great deal; items 4 and 6 reversed prior to calculating
participant scores. Scores for the MAPA-Global were determined by calculating the
mean score of the first six items with higher scores signifying greater overall
satisfaction and meaningfulness attributed to one’s activities (see Appendix E). For
the purpose of this study the MAPA-Global score excluded two questions related to
change, although it is expected that inclusion of these items may be useful in the
Well Elderly Study II.
121
Criterion Variables
Engagement in Meaningful Activity Survey (EMAS)
The Engagement in Meaningful Activity Survey (EMAS) is a twelve item scale, with
adequate psychometric properties, purported to reflect the construct of meaningful
activity participation (Goldberg et al., 2002). Items in the scale are worded to
address twelve types of meaning attributable to participation in daily activities. In
general, the scale reflects individuals’ beliefs that their daily activities: a) provide
congruence with their value system and needs, b) provide evidence of competence
and mastery, and c) are valued in one’s social / cultural group. The EMAS items are
scaled 1 (never) through 5 (always) scale. For example the respondent is asked to
indicate the extent to which a given statement is true for them (e.g., “The activities I
do give me a sense of satisfaction,” and “The activities I do help other people.”)
(See Appendix F.) The EMAS score is computed as the average of the 12 items.
The EMAS can be found within the public domain (Goldberg et al., 2002).
Administered to a sample of 32 adults with mental illness, the EMAS was found to
have sufficient test-retest reliability (.69) and a Cronbach alpha of (.84). Stepwise
multiple regression analysis was conducted in which the EMAS, depression and
anxiety were entered as predictors of satisfaction with life. The results showed that
depression accounted for 17% of the variance in life satisfaction, while the EMAS
122
and anxiety did not significantly add to this prediction (Goldberg et al., 2002).
However, given the relatively small sample, and significant zero-order correlations
of the EMAS with measures of well-being, the EMAS holds promise as a potential
measure of meaningful activity.
Daily Occupation Experience Survey (DOES)
A modified version of the Daily Occupational Experience Survey (Blanche, 1999,
2002) was also used in this study. The DOES consists of 17 items which measure
play experiences within a person’s most meaningful activity. Thirteen items are
reflective of the characteristics of play experiences identified in the literature by
Blanche (1999), such as feelings of excitement, stress and pleasure. Four additional
items measured process components (e.g., feelings of competence, being
lighthearted, and losing track of time) derived from the process-oriented experiences
of Blanche’s conceptual map (see Appendix G). In completing the DOES,
participants are provided with the following written instructions, “Please list one
activity that is most meaningful to you. That is, think of an activity in your life that
you would least want to give up (and/or) an activity in your life that matters the most
to you.” Participants are then instructed to indicate the degree they experience the
17 attributes of play using a 7-point semantic differential scaling approach along
their respective connotative dimensions (C.H. Christiansen, 1994; Pedhazur &
Schmelkin, 1991). To generate the score for the DOES, items 1, 2, 4, 5, 6, 7, 9, 11,
123
and 12 were reversed, then all items were summed and divided by 17. There
presently is no reliability or validity data on this instrument.
Life Satisfaction Index-Z (LSI-Z)
The Life Satisfaction Index-Z (LSI-Z) (Wood et al., 1969) is a general assessment of
life satisfaction consisting of thirteen items, appropriate for use with older adults
(McDowell & Newell, 1996). The LSI-Z is a reduced version of the LSI-A, a 20-
item measure of life-satisfaction developed specifically for use with older adults
(Neugarten, Havinghurst, & Tobin, 1961). Examples of LSI-Z questions include:
“Most of the things I do are boring or monotonous” and “These are the best years of
my life.” Items are answered as either “Agree”, “Disagree”, or “Unsure,” with each
item having a “right” answer (scored as 2 points), a “wrong” answer (scored as 0
points), and No Response or “Unsure” (scored as 1 point). The item responses are
summed, and the total score may range from 0 to 26 with a higher score indicative of
greater perceived life satisfaction (see Appendix I).
The LSI-Z possesses adequate psychometric properties for use in population-based
research. Internal consistency reliability has been found to range from .70 to .82
(Dobson, Powers, Keith, & Goudy, 1979; Okun & Stock, 1984; Wood et al., 1969)
and test-retest reliability ranged from .80 to .90 (as cited in McDowell & Newell,
1996). The LSI-Z has been found to discriminate between older adults living in the
124
community versus those in psychiatric inpatient units (Himmelfarb & Murrell,
1983), and between persons with and without self-ascribed handicaps (Stock &
Okun, 1982). The convergent validity of the LSI-Z with older adults has been
substantiated through its moderate to high correlations with similar scales. In their
research synthesis, Okun and Stock (1987) found moderate positive correlations
between the LSI-Z and scales purported to measure happiness, life-satisfaction and
morale. Further, the LSI-Z has shown to have significant positive correlations with
subjective health and activity frequency (e.g., Hillerås, Jorm, Herlitz, & Winblad,
2001). The LSI-Z can be found within the public domain (Wood et al., 1969).
The Satisfaction with Life Scale (SWLS)
The Satisfaction with Life Scale (SWLS), according to Diener, Emmons, Larsen, and
Griffen (1985), is an assessment of global life satisfaction suitable for use with
differing age groups. According to Pavot and Diener (1993), the SWLS appears to
measure a somewhat narrow band of well-being, assessing “cognitive” rather than
“affective” aspects of subjective well-being. The SWLS consists of 5 items (e.g., In
most ways my life is close to my ideal; The conditions of my life are excellent) rated
from 1 (strongly disagree) to 7 (strongly agree); the five items are summed resulting
in a possible score ranging from 5 to 35, (see Appendix L).
125
Reliability and validity evidence with older adult samples indicate favorable
psychometric properties. Internal consistency reliability of the SWLS has been
found to range from .61 to .83 (Arrindell, Meeuwesen, & Huyse, 1991; Diener et al.,
1985; Pavot, Diener, Colvin, & Sandvik, 1991), and a test-retest reliability
coefficient of .84 has been found (Pavot et al.). Convergent validity evidence has
been demonstrated with other measures of life satisfaction (Diener et al., 1985).
Further, the SWLS has been found to correlate negatively with measures of
depression (Arrindel et al.) and caregiver burden (Vitaliano, Russo, Young, Becker,
& Maiuro, 1991). Finally, the items within the SWLS appear to represent a
consistent single factor pattern when factor structure studies have been conducted
(Pavot & Diener, 1993). The SWLS can be found within the public domain (Diener
et al.).
Center for Epidemiologic Studies Depression Scale (CES-D)
The Center for Epidemiologic Studies Depression Scale (CES-D) is a twenty-item
self-report scale designed to measure current levels of depressive symptomology.
The scale addresses components of depressive symptomology such as: depressed
mood, feelings of helplessness and hopelessness, psychomotor slowing, loss of
appetite, and sleep disturbance. Participants indicate responses on a 4-point scale
from rarely/none of the time to most/all of the time (see Appendix K). Total score
ranges from 0-60, with a higher score indicating more symptoms of depression.
126
The CES-D is a reliable and valid instrument for ascertaining self-reported
depressive symptomology in the general population (McDowell & Newell, 1996).
For a large community-dwelling sample aged 55 years and older Murrell,
Himmelfarb, and Wright (1983) found internal consistency reliability values of .89.
Radloff (1977) found that internal consistency reliability values ranged from .85 to
.91 and that test-retest reliability tended to range from .45 to .70. The CES-D has
been found to validly assess symptoms of depression in older adults samples
(Callahan & Wolinsky, 1994; Davidson, Feldman, & Crawford, 1994; Hertzog, Van
Alstine, Usala, Hultsch, & Dixon, 1990; Murrell, Himmelfarb, & Wright, 1983).
The CES-D can be found within the public domain (Radloff, 1977).
The Purpose-in-Life Test (PIL)
The Purpose-in-Life Test (PIL) was developed by Crumbaugh and Maholick (1964;
1969) as a measure of Victor Frankl’s concept of ‘existential vacuum,’ intended to
operationalize the existential concept of purpose and meaning in life (Reker & Fry,
2003). The PIL is a twenty item scale with a possible score range of 20 to 140.
Items are rated on a 7-point scale with specific statements anchoring item endpoints
(e.g., I am usually: 1 – completely bored to 7 – exuberant, enthusiastic, with 4 -
neutral) (see Appendix H). The reliability of the PIL has been well established in
terms of split half (Crumbaugh & Maholick, 1964), test-retest (Meier & Edwards,
127
1974) and internal consistency (Chamberlain & Zika, 1988; Leman, 1993; Rizzo,
1990).
The construct validity of the PIL has been demonstrated in elderly samples.
Significant negative relationships were found between the PIL and measures of
depression (Gerwood, 1995; Pintos, 1988; Zika & Chamberlain, 1992), boredom
proneness (Weinstein & Xie, 1995); and loneliness (Bondevik & Skogstad, 2000).
Furthermore, Zika and Chamberlain (1992) found high positive correlations with
measures of life satisfaction and psychological well-being. Across more diverse age
samples, the PIL has been shown to be positively associated with: life satisfaction
and coping beliefs (Ulmer, Range, & Smith, 1991), level of involvement in activity
(Matteson, 1974) and greater organizational involvement (Doerries, 1970; Matteson,
1974). Zika and Chamberlain (1987) have also demonstrated that among various
personality variables and levels of daily hassles, the PIL was the most substantial
predictor of well-being. Further support for the PIL’s construct validity was
evidenced in its factor structure and relationships with similar measures of purpose
and meaning in life (Chamberlain & Zika, 1988; Reker & Fry, 2003). Permission to
use the PIL for this study has been provided by Psychometric Affiliates, Huntsville,
AL.
128
SF-36 Version 2 (SF-36v2)
Version 2 of the SF-36 Health Survey (SF-36v2) is an improved version of the SF-36
Health Survey (Ware et al., 2000) (see Appendix J). The Short-Form Health Survey
(SF-36) was constructed in conjunction with a medical criterions study to assess the
eight health dimensions most frequently included in widely-used health surveys:
physical functioning, role limitations due to physical problems, social functioning,
bodily pain, general mental health, role limitations due to emotional problems,
vitality, and general health perceptions (Ware & Sherbourne, 1992). It is suitable
for use with older adults as a tool for assessing health-related quality of life (Hayes,
Morris, Wolfe, & Morgan, 1995; McHorney, 1996; Walters, Munro, & Brazier,
2001).
Version 2 of the SF-36 Health Survey (SF-36v2) retains the eight multi-item scales
of the original SF-36, consisting of 2 to 10 items within each scale (Ware et al.,
2000). The eight areas of health measured by the SF-36v2 are identical to the above-
noted SF-36 domains. Relative to the SF-36, the SF-36v2 has demonstrated
improvements in internal consistency for some scales (e.g., RF, RE) and a
diminution of floor and ceiling effects. Factor analysis of the SF-36v2 resulted in
two higher-order factors representing the physical and mental health constructs
underlying the instrument; the authors concluded that the SF-36 and the SF-36v2
correlate highly with each other and have the same factor content and interpretation
129
(Ware et al., 2000). The SF-36v2 therefore provides improved psychometric
performance over the SF-36, while maintaining its underlying validity as a measure
of health-related quality of life.
Substantial evidence regarding the reliability the SF-36v2 has been provided by
Ware et al. (2002) and McHorney (1996). When utilized with older adults samples,
the scales of the SF-36 have been shown to have adequate internal consistency
reliability coefficients ranging from .72 to .94 (Lyons et al., 1994; Stadnyk, Calder,
& Rockwood, 1998; Walters et al., 2001). Six-month test-retest values for the SF-36
have been reported to range from .60 to .90 with the exception of bodily pain at .43;
while two-week stability values have ranged from .80 with physical functioning to
.60 for social functioning (McDowell & Newell, 1996).
Evidence in support of the construct validity of the SF-36 has been well established
(McHorney et al., 1993; McHorney, Ware, Rogers, Raczek, & Rachel Lu, 1992).
Stadnyk et al. (1998) have replicated the two factor structure in a sample of frail
older adults. The scale’s convergent validity was also supported in terms of zero-
order correlations of the Physical Functioning, Bodily Pain, and Mental Health scales
with comparable measures. Walter et al. (2001) found greater declines across four
age cohorts in the physical and physical role limitation scales in comparison to the
mental health score, consistent with findings that well-being is generally maintained
with advancing age despite physical losses (Baltes & Baltes, 1990b; Diener, Suh,
130
Lucas, & Smith, 1999). The SF-36 scales have also demonstrated sensitivity to
change within a randomized controlled clinical trial involving an intervention of
preventive occupational therapy (Clark et al., 2001; Clark et al., 1997). Permission
to use the SF-36v2 for this study has been provided by the Medical Outcomes Trust
and QualityMetric Incorporated, license # F1-102304-20345. A summary of the
criterion measures may be found in Table 3.
Data Analysis
Overview of the General Process of Data Analysis
The primary goal of this dissertation was to provide evidence of the psychometric
properties of the MAPA. In undertaking this objective, an exploratory approach was
adopted within data analyses to substantiate differing avenues for interpreting the
MAPA scales and to identify candidate variables with the potential of improving the
prediction of criterion variables beyond the MAPA scales. Consequently, data
analyses entailed an iterative process of variable identification and exclusion with
ramifications for both the Data Analysis and Results chapters of this paper.
Therefore, in addition to testing the study’s main hypotheses, this section identifies
the general analytic methods utilized as part of the iterative exploratory process.
Details of the analytical decisions and outcomes are described within the Results
131
Table 3
Summary of Study Constructs and Criterion Indicators
Study Construct
Items per
indicator
Method of Measurement
Possible Range of
Scale Units
Meaningfulness of
activities
Perception of activities
as meaningful
12 Engagement in Meaningful
Activity Survey (EMAS)
12 (low) to 60 (high)
Perception of play
experiences in
meaningful activities
17 Daily Occupational Experience
Survey (DOES)
17 (low) to 119 (high)
Psychosocial well-
being
Life satisfaction 13 Life Satisfaction Index-Z (LSIZ) 0 (low) to 26 (high)
Life satisfaction 5 Satisfaction with Life Scale
(SWLS)
7 (low) to 35 (high)
Depressive
symptomology
20 Center for Epidemiologic
Studies Depression Scale
(CESD)
0 (low) to 60 (high)
Purpose and meaning in
life
20 Purpose-in-Life Test (PIL) 20 (low) to 140 (high)
Perceived mental
health
Mental health 5 RAND SF36v2-Mental Health
(SF36v2-MH)
0 (low) to 100 (high)
Roles (Emotional) 3 RAND SF36v2-Role Emotional
(SF36v2-RE)
0 (low) to 100 (high)
Social functioning 2 RAND SF36v2-Social
Functioning (SF36v2-SF)
0 (low) to 100 (high)
Vitality 4 RAND SF36v2-Vitality
(SF36v2-VT)
0 (low) to 100 (high)
Perceived physical
health
Physical functioning 10 RAND SF36v2-Physical
Functioning (SF36v2-PF)
0 (low) to 100 (high)
Roles (Physical) 4 RAND SF36v2-Role Physical
(SF36v2-RP)
0 (low) to 100 (high)
Bodily pain 2 RAND SF36v2-Bodily Pain
(SF36v2-BP)
0 (low) to 100 (high)
General health 5 RAND SF36v2-General Health
(SF36v2-GH)
0 (low) to 100 (high)
132
chapter. The general order of data analysis proceeded as follows: generating
descriptive statistics of the demographic data, generating descriptive and reliability
statistics for the MAPA-derived variables, exploratory factor analysis of the MAPA
scales, generating descriptive and reliability statistics of the criterion variables, tests
of the study’s five main hypotheses, testing of MAPA-derived and potential
candidate variables in predicting the criterion variables, cluster analysis, and finally,
testing the causal path model. All data analyses were performed with the SPSS v. 12
statistical package (2003).
Descriptive Statistics of the MAPA Scales
Descriptive statistics were calculated for each of the MAPA scales (Frequency,
Meaning, Health, Frequency x Meaning, and Frequency x Health). Internal
consistency reliability (Cronbach’s alpha) was determined for each scale. Item
analysis was also conducted, including the calculation of item-total correlations (i.e.,
correlating each MAPA activity item with its respective total scale value) for each
MAPA scale. Test retest reliability (N=25) was calculated using Pearson’s product-
moment correlations (r). Pearson’s r was also used to investigate the level of
association between MAPA variables; an alpha level of 0.05 (two-tailed) was used to
evaluate the correlation coefficients.
133
Seven variables were initially derived from the MAPA Frequency, Meaning and
Health scales. Activity Diversity was defined as the number activities in which a
person reported participating over the past few months; Activity Frequency was the
sum of the MAPA-Frequency values for those activities. MAPA-Meaning was the
sum of the personal meaningfulness ratings, and MAPA-Health was the sum of the
healthfulness ratings for those activities in which persons reported participation.
More specifically, a person may have reported a 3 (moderately meaningful) for
Driving, but if that person reported they did not participate in Driving within the
MAPA-Frequency scale, then that activity was not included in the sum score for
MAPA-Meaning. Average MAPA-Frequency was derived by dividing MAPA-
Frequency by Activity Diversity; this variable therefore represented the average
frequency of participation for those activities in which persons reported participating.
Average MAPA-Meaning was determined by dividing MAPA-Meaning by Activity
Diversity; this value represented the mean level of personal meaningfulness ascribed
to those activities in which persons had reported participation. A similar approach
was utilized to arrive at Average MAPA-Health (see Table 4 for a summary of
MAPA derived variables).
Principal Components Analysis of the MAPA Scales
Exploratory factor analysis (EFA) may be used to uncover the latent structure
(dimensions) of a set of variables, with principal components analysis (PCA) being
134
Table 4
Summary of MAPA Derived Variables
Description of Variable
MAPA-Frequency
(Activity Frequency)
Sum of frequency values for reported
activities
Activity Diversity Number of activity items reported in
MAPA-Frequency
MAPA-Meaning Sum of meaning values for activities
reported in MAPA-Frequency
MAPA-Health Sum of health values for activities
reported in MAPA-Frequency
Average Meaning MAPA-Meaning divided by Activity
Diversity
Average Health MAPA-Health divided by Activity
Diversity
MAPA-F x M Sum of Frequency x Meaning values for
each activity
MAPA-F x H Sum of Frequency x Health values for
each activity
MAPA-Global Sum of items 1 – 6
F x M: Frequency x Meaning
F x H: Frequency x Health
135
the most common form of EFA. PCA was employed in this study to explore the
factor structure of the individual MAPA scales (i.e., Frequency, Meaning, Health,
Frequency x Meaning, and Frequency x Health). PCA of these scales involved
extraction of items with Eigenvalues greater than 1.0, with a Varimax rotation used
for uncorrelated factors to maximize simple structure (Thompson, 2004). Items with
structure coefficients of .45 or greater were maintained to simplify interpretation of
the component – activity relationships. PCA of the MAPA-Meaning and MAPA-
Health scales were conducted after the scales had been adjusted for activity
participation. That is, scores for activities in which persons did not report
participation in the past few months were amended to “0” to reflect an absence of
general meaningfulness or health-related meaning respectively.
Tests of the Study’s Main Hypotheses
The following hypotheses were tested in this study: 1) There is a positive correlation
between the MAPA and the Purpose-in-Life test, 2) There are positive associations
between the MAPA scales and other scales of meaningful activity participation, 3)
There are positive correlation between the MAPA and two measures of life
satisfaction (i.e., LSI-Z and SWLS), 4) There are positive correlations between the
MAPA and the four SF-36v2 Mental Health scales, 5) There are positive correlations
between the MAPA and the four SF-36v2 Physical Health scales, and 6) There is a
negative correlation between the MAPA and the CES-D.
136
Descriptive statistics and coefficient alpha were determined for each criterion
variable. Normalizing transformations were performed for significantly skewed
data. Zero-order correlations among the study variables were calculated using
Pearson’s r; an alpha level of 0.05 (two-tailed) was used to evaluate the correlation
coefficients.
Identification of MAPA Candidate Variables in Predicting Criterion Variables
PCA Regression Coefficients
Principal components analysis was employed in the present study to establish a set of
MAPA variables that best represented the factor structure of the individual scales.
PCA was conducted on the five MAPA scales (Frequency, Meaning, Health,
Frequency x Meaning, and Frequency x Health) to determine the utility of the
components (or factors) as predictors of the study criterion variables. First, the PCA
regression coefficients from the five MAPA scales were compared to the criterion
variables using zero-order correlations. The results of this approach were evaluated
in terms of the greatest number of significant correlations with criterion variables in
each of the five groups of PCA regression coefficients. Backward regression
analyses were then utilized to determine which structure coefficients from the PCA
added to the prediction of the 13 criterion variables beyond MAPA-Frequency x
Meaning.
137
MAPA Reasons
Two alternate avenues were used to best represent the MAPA-Reasons variables.
First, frequency counts of the MAPA-Reasons variables were obtained. Four scores
were generated for each participant by summing each of the four reasons (“Need to
or have to,” “For new experiences,” “To connect with others,” and “For a sense of
accomplishment”) indicated for participating in the list of 28 activities of the MAPA.
Second, four additional scores for each participant were generated by summing the
frequency of activity participation across the 28 activities of the MAPA within each
MAPA-Reason category. This variable reflected the frequency of activity
participation as a function of a given reason. Zero-order correlations between the
MAPA-Reasons variables and the criterion variables were then calculated.
Intra-individual Level Exploration of the MAPA Scales
The final approach to exploring the MAPA scale items was undertaken by
determining z-scores for MAPA – Frequency, Meaning, and Health. As an example,
the MAPA – Meaning scale included five meaning choices for each of the 28
activities: “Not at all meaningful”, “Somewhat Meaningful”, “Moderately
meaningful”, “Very meaningful”, and “Extremely meaningful”. The use of intra-
individual z-scores of the MAPA- Meaning scale items allowed for comparing
activity engagement identified as have lesser versus greater personal meaning on an
138
ipsative level. To generate the z-scores for each scale, the data list for each scale
was transposed thereby having 28 rows representing each activity and 158 columns
for the participants. Z-scores for each person were then calculated using SPSS. The
resulting matrix was then reverse-transposed resulting in intra-individual level data
for each participant. To explore an additional aspect of meaningful activity
participation, analyses also involved the generation of two z-score-based MAPA-
Frequency x Meaning variables. The MAPA-Frequency x MAPA-Meaning values
for each activity were multiplied and summed to create these variables. The first
variable utilized persons’ activities with non-positive (i.e., negative or zero) meaning
z-scores and the second variable utilized activities with positive z-scores.
For the MAPA-Meaning and MAPA-Health scales, only those items in which
persons reported being engaged in the past six months were used in determining the
z-scores. The use of intra-individual level data enables a determination of which
activities were found to be most meaningful and healthful for persons who engaged
in the activities. Similarly, this approach affords a different view on the frequency of
activity participation when compared to the approach above which compared the
mean frequency of participation in all 28 activities in the entire sample. Descriptive
statistics for each activity across the three scales were obtained. These data were
also studied using zero-order correlations and hierarchal regression models with
criterion variables (see Table 5 for a summary of the MAPA derived candidate
variables).
139
Comparison of MAPA-Frequency x Meaning to Activity Frequency and Activity
Diversity
Analyses then proceeded to test whether MAPA-Frequency x Meaning was superior
to traditional methods of measuring activity (i.e., Activity Diversity and Activity
Frequency). As a reminder, the Activity Diversity score was the number of activities
in which persons reported participating over the past few months. Activity
Frequency was generated by summing the reported level of activity participation (i.e.
0 – “Not at all” to 6 – “Every day”) for each of the 28 activity items. Regression
models were employed with the 13 criterion variables serving as respective
dependent variables.
The first approach undertaken was to enter each of the activity variables into separate
regression models with the 13 criterion variables. That is, Activity Diversity,
Activity Frequency and MAPA-Frequency x Meaning each had 13 models for a total
of 39 regression models. Hierarchical regression was employed entering
demographic variables (i.e., gender, ethnicity, marital status, and housing status) into
the first block; SF36v2-BP and SF36v2-GH into the second block for measures of
psychological well-being and the mental health scales of the SF36v2; CESD was
entered into the second block when the physical health scales of the SF36v2 were
used as dependent variables. The MAPA derived activity variables were entered last
into their respective models. The regression models were compared by evaluating
140
Table 5
Summary of MAPA Derived Candidate Variables
Description of Variable
MAPA-Frequency
Regression Coefficients
Regression coefficients from PCA of MAPA-
Frequency
MAPA-Meaning
Regression Coefficients
Regression coefficients from PCA of MAPA-
Meaning
MAPA-Health Regression
Coefficients
Regression coefficients from PCA of MAPA-
Health
MAPA-F x M Regression
Coefficients
Regression coefficients from PCA of MAPA-F x M
MAPA-F x H Regression
Coefficients
Regression coefficients from PCA of MAPA-F x H
MAPA-Reasons (a) Frequency count for each reason:
Need to or have to do this
For new experiences
Connect with people
Sense of Accomplishment
MAPA-Reasons (b) Sum of MAPA-Frequency values for each reason:
Need to or have to do this
For new experiences
Connect with people
Sense of Accomplishment
Intra-individual MAPA-
Frequency
Z-scores for MAPA-Frequency items
Intra-individual MAPA-
Meaning
Z-scores for MAPA-Meaning items
Intra-individual MAPA-
Health
Z-scores for MAPA-Health items
Negative Intra-individual
MAPA-F x M
Sum of MAPA-F x M items with non-positive
MAPA-Meaning z-scores
Positive Intra-individual
MAPA-F x M
Sum of MAPA-F x M items with positive MAPA-
Meaning z-scores
F x M: Frequency x Meaning
F x H: Frequency x Health.
141
the differences in model R-square and R-square change accounted for by the activity
variables.
Cluster Analysis
Cluster analysis is an analytical approach that groups individuals into homogenous
clusters based upon specifically defined variables of interest. Whereas principal
components analysis is concerned with identifying scale items which tend to vary
together, cluster analysis is concerned with identifying persons with similar
characteristics based upon their responses to these same items (Aldenerfer &
Blashfield, 1984). Items from an activity scale have not been studied as a class of
cluster variates in older adults, and therefore warrant attention. From cluster analysis
it might be feasible to identify patterns of activity engagement which could not
otherwise be achieved utilizing principal components analyses.
Hierarchical agglomerative cluster analysis with SPSS v. 12 (2003) was undertaken
using Ward’s method to optimize the minimum variance within clusters (Aldenerfer
& Blashfield, 1984). Cluster variates were the frequency ratings for the 28 MAPA
activities, and the squared Euclidean distance measure was selected for the interval
level data. An a priori range of two to four clusters was chosen to maximize
parsimony in the final cluster solution. One consideration in arriving at this range
was the folk status of a tri-level ascription of activity involvement common to older
142
adults: Go-Go, Slow-Go, and No-Go elderly (Lesnoff-Caravaglia, 2002). Given the
wide age range (65-100 yrs.) of the study participants and the diverse living
situations, this assumption seemed reasonable.
The dendrogram was evaluated in terms of intra-cluster variance to determine an
ideal cluster solution. The cluster centroids from the hierarchical solution were then
entered as starting values for the K-means approach. This approach proceeds in an
iterative manner using the initial start values and allocates each case (participant) to a
cluster with the nearest centroid. This process continues for all cases until there have
been no changes in cluster assignment. The combined use of a hierarchical
agglomerative method with an iterative partitioning method has been suggested to
maximize the likelihood of a final cluster solution which best represents the structure
of the data (Hair & Black, 2000).
One-way analysis of variance (ANOVA) was employed to profile and validate the
final cluster solution (Aldenerfer & Blashfield, 1984). The 28 MAPA-Frequency
items (used as cluster variates) were used as internal variables for the profiling the
final cluster solution. Demographic, MAPA-derived, and criterion variables were
used as external variables to profile and validate the final cluster solution. The
Scheffe statistic was chosen as a conservative post hoc means comparisons test given
the relatively large number of tests being performed (Toothacker, 1995). Differences
in categorical demographic variables were tested by the chi-square statistic.
143
Path Analysis
Path analysis is an extension of the regression model in which the viability of a
proposed causal model can be tested (Klem, 1995; Pedhazur & Schmelkin, 1991).
Figure 2 illustrates the tentative causal model under consideration for the present
study. It was hypothesized that meaningful activity would directly affect purpose in
life, as well as physical and mental components of health-related quality of life.
Further, it was hypothesized that the purpose in life would mediate the relationships
between the meaningful activity and physical and mental components of health-
related quality of life. Finally, it was hypothesized that purpose in life would also
contribute directly to the physical and mental aspects of health-related quality of life.
Figure 2. Tentative Causal Model.
SF- 36v2
Mental
Component
Summary
SF-36v2
Physical
Component
Summary
Purpose in
Life Test
Meaningful
Activity
Participation
Assessment
144
Exogenous variables in a path model are those with no explicit causes; i.e. they are
not deemed to be caused by other variables. Endogenous variables include
intervening causal variables and dependent or criterion variables (Pedhazur &
Schmelkin, 1991). To simplify the structure of the model, age, gender, years of
education and income were controlled for each regression model employed to test
proposed causal model in this study. Though exogenous variables, they have not
been represented in Figure 2 in order to simplify the presentation of model. In this
simplified model, the MAPA serves as the primary exogenous variable measuring
meaningful activity participation. The Purpose in Life Test (PIL) is an endogenous
variable which served as a measure of meaning and purpose in life. The SF-36v2
Physical and Mental health component scores were also endogenous variables
representing the physical and mental sub-constructs of health-related quality of life.
A path coefficient is a standardized regression coefficient (beta) showing the direct
effect of an independent (exogenous) variable on a dependent (endogenous) variable
in the path model. Further, when the model has two or more causal variables, path
coefficients are partial regression coefficients which measure the extent of effect of
one variable on another in the path model controlling for other prior variables. F
tests from respective regression models (controlling for age, gender, education and
income) were used to test the statistical significance of individual path coefficients
(Klem, 1995). The residual error term, also called the disturbance term, reflects
unexplained variance (the effect of unmeasured variables) plus measurement error.
145
Residual error terms were calculated as the variance of the errors (i.e., 1 – R
2
) for
each endogenous variable (Klem, 1995), controlling for the effects of the four
demographic variables.
Multiple regression can also be used for testing whether a given variable mediates
the relationship between an exogenous and endogenous variable. In the present
study, it was of interest to determine if purpose in life mediated the relationship
between meaningful activity and health-related quality of life. Baron and Kenny
(1986) have discussed three steps in establishing mediation: 1) show that the initial
variable affects the mediating variable, 2) show that the initial variable affects the
criterion variable, 3) show that the mediating variable affects the criterion variable
controlling for other relevant variables. If all of these conditions hold in the
predicted directions, then the effect of the independent variable on the criterion
variable must be less in the third equation compared to the second equation.
Establishing a mediating relationship would imply that the effect of meaningful
activity upon health-related quality of life is achieved through the intrapersonal
dynamics of meaning and purpose in life.
Semi-partial correlations (controlling for the four demographic variables) were
calculated between the MAPA, PIL and the two SF-36v2 component scores. F tests
from stepwise regression models (controlling for the four demographic variables)
were used to test the statistical significance of individual path coefficients. Finally,
the Sobel test (Baron & Kenny, 1986) was employed as an approximate significance
146
test of the PIL’s mediation between the MAPA and the SF-36v2 Physical and Mental
health component scores.
147
CHAPTER FOUR
RESULTS
Sample
Table 6 presents the demographic characteristics of the sample. Participants were on
average 80.5 ± 7.1 years old (range 65 to 100). Descriptive statistics reflected a
somewhat non-representative sample as 82% of the participants were Caucasian,
86% reported being married or living with another, and 66% indicated some post-
high school education.
Results of the MAPA Scales
Descriptive statistics for the 28 MAPA-Frequency (Activity Frequency) items were
generated to determine the level of participation across the sample (N=158) (see
Table 7). The mean activity participation rates ranged from 0.8 ± 1.9 for Pet Care
reflecting the sample on average performed these activities less than once a month,
to 5.8 ± 0.7 for Radio / TV, suggesting participation every day. Activity
participation was also calculated to reflect mean participation rates for only those
activities in which persons reported participating (see column two of Table 7).
148
Table 6
Demographic Characteristics
N=154 Frequency Percent
Gender
Female
Male
119
35
77
23
Race/Ethnicity
Caucasian
Other
126
28
82
18
Marital Status
Married/Living Together
Other
132
22
86
14
Housing Status
Independent Living
Assisted Living
123
31
80
20
Education
5-8 Years
Some High School
High School Completed
Business or Trade School
1-3 Years College
4 Years College
Post Graduate Study
1
5
45
19
37
22
25
1
3
30
12
24
14
16
Income
$0 to $1,000 / Month
$1,001 to $3,000 / Month
$3,001 to $5,000 / Month
$5,001 to $7,000 / Month
$7,001 to $10,000 / Month
$10,000 or more / Month
44
61
30
8
4
7
29
40
20
5
2
4
149
Table 7
MAPA – Frequency: Activity Participation by Type of Activity
N=158 Percent of Participation
Activity Type
Mean
(SD)*
Mean (SD)*
Non-
participating
excluded
Not at all
Less than once a
month
Once a month
2-3 Times
a month
Once a week
Several times
a week
Every day
Home
making/home
maintenance
3.1 (2.3) 4.2 (1.7) 26.6 8.2 7.0 6.3 13.9 17.7 20.3
Personal
finances
2.7 (1.8) 3.0 (1.5) 12.7 13.9 23.4 20.9 12.0 8.9 8.2
Driving 2.2 (2.7) 5.1 (1.3) 57.6 2.5 0.0 1.9 2.5 15.8 19.6
Using public
transportation
1.4 (2.1) 3.3 (1.9) 59.5 12.7 2.5 5.7 4.4 8.2 7.0
Medical visits 1.8 (1.1) 1.9 (1.0) 5.1 43.7 26.6 17.7 5.7 .6 .6
Socializing 4.5 (1.6) 4.5 (1.4) 1.3 6.3 6.3 11.4 10.8 34.8 29.1
Writing
letters/cards
2.2 (1.8) 2.7 (1.6) 17.7 26.6 13.9 16.5 9.5 13.3 2.5
Helping others 3.6 (2.0) 4.0 (1.7) 9.5 12.0 10.1 12.0 11.4 24.1 20.9
Gardening 1.3 (2.0) 3.6 (1.6) 64.6 5.7 1.3 8.9 8.9 6.3 4.4
Physical exercise 4.7 (1.6) 4.8 (1.4) 2.5 4.4 3.8 8.2 8.2 36.1 36.7
Crafts/hobbies 2.4 (2.2) 3.8 (1.6) 36.1 8.2 7.0 8.9 14.6 16.5 8.9
Cultural
activities
2.6 (1.9) 3.2 (1.5) 18.4 13.9 14.6 17.1 15.8 15.2 5.1
Musical
activities
2.7 (2.1) 3.5 (1.6) 24.1 12.0 8.9 15.2 15.2 15.2 9.5
Taking courses 1.0 (1.6) 2.9 (1.5) 65.8 8.9 5.7 5.1 9.5 5.1 0.0
Creative
activities
2.2 (2.0) 3.2 (1.7) 31.0 16.5 8.9 13.3 13.3 10.8 6.3
Traveling 1.1 (1.3) 2.0 (1.2) 44.9 25.9 15.2 7.6 2.5 3.2 0.6
Talking on the
telephone
5.0 (1.5) 5.1 (1.2) 2.5 1.9 4.4 5.1 6.3 30.4 49.4
Reading
magazines/
newspapers
5.1 (1.6) 5.3 (1.2) 3.8 1.9 3.2 4.4 5.7 17.7 63.3
Other reading 4.2 (2.1) 4.7 (1.7) 10.8 6.3 7.6 10.8 4.4 17.7 42.4
150
Table 7, continued
N=158 Percent of Participation
Activity Type
Mean
(SD)*
Mean (SD)*
Non-
participating
excluded
Not at all
Less than once a
month
Once a month
2-3 Times
a month
Once a week
Several times
a week
Every day
Playing games 2.5 (2.2) 3.7 (1.7) 32.9 13.9 4.4 8.9 11.4 19.6 8.9
Radio/TV 5.8 (0.7) 5.8 (0.7) 0.0 0.6 1.3 0.6 0.6 12.0 84.8
Religious
activities
2.8 (2.0) 3.6 (1.5) 22.8 9.5 10.8 5.7 34.2 8.9 8.2
Prayer/meditation 3.9 (2.5) 5.0 (1.6) 20.9 5.7 3.2 3.8 8.9 10.8 46.8
Comm.
Organization
activities
2.1 (2.1) 3.4 (1.5) 39.2 9.5 9.5 10.1 12.7 15.8 3.2
Volunteer
activities
2.4 (2.3) 4.0 (1.6) 40.5 8.2 3.8 4.4 17.1 18.4 7.6
Pet care activities 0.8 (1.9) 4.9 (1.8) 83.5 1.9 1.3 0.0 .6 3.2 9.5
Computer use for
email
1.2 (2.2) 4.6 (1.5) 74.1 1.3 1.3 4.4 1.9 7.0 10.1
Other computer
use
1.3 (2.3) 4.8 (1.5) 74.1 1.9 .6 1.9 1.9 8.9 10.8
*MAPA – Frequency scaling:
0-“Not at all”, 1-“Less than once a month”, 2-“Once a month”, 3-“2-3 times a month”,
4-“Once a week”, 5-“Several times a week”, 6-“Every day”
151
Medical visits (1.9 ± 1.0) was the least common activity, whereas Reading
Magazines / Newspapers (5.3 ± 1.3) was most common. Significant upward shifts in
activity frequency were evidenced in Driving, Pet Care, and both aspects of
Computer Use, suggesting that these activities appear to be less common to older
adults on average, yet they may contribute substantially to the routines of a smaller
subset of individuals.
Adequate reliability coefficients were established for all MAPA activity scales.
Two-week test-retest reliability coefficients were significant at p < .01 for each scale:
MAPA-Frequency (Activity Frequency) r(25) = 0.85, Activity Diversity r(25) =
0.89, MAPA-Meaning r(25) = 0.78, MAPA-Health r(25) = 0.85, MAPA –
Frequency x Meaning r(25) = 0.84 and MAPA-Frequency x Health r(25) = 0.85.
Internal consistency reliability coefficients for the MAPA scales were found to be
adequate for population-based research (Streiner & Norman, 2003): MAPA-
Frequency (0.83), MAPA-Meaning (0.86), MAPA-Health (0.85), MAPA-Frequency
x Health (0.83), and MAPA-Frequency x Meaning (0.85).
Only a small number of activity items across the scales were found to perform poorly
in item-analysis. MAPA-Frequency x Meaning was tested to determine the effects
of removing outlying items to improve internal consistency reliability. Three items
with extremely low item-total correlations [Playing Games (-0.01), Medical Visits
(0.02), and Using Public Transportation (0.09)] were removed from the scale
152
resulting in a marginal improvement to coefficient alpha (0.86 from 0.85). A
decision was made to retain the three outlying items, thereby keeping the original
scale intact. Three reasons supporting this choice were based upon pragmatic and
empirical grounds: 1) feedback from focus group members identifying these items as
important in their lives, 2) potential decrement in the content validity of the scale,
and 3) insignificant improvement in scale coefficient alpha with items removed.
This same rationale and decision applied to the remaining four MAPA scales and
they too were left intact.
Zero-order correlations were generated for the main MAPA scale variables (see
Table 8). MAPA-Frequency (Activity Frequency) and Activity Diversity were
strongly positively correlated [r (158) = 0.85, p < .001], as would be expected.
Activity Diversity and Average MAPA-Frequency were not correlated suggesting
that diversity of activities is not related to the average frequency of activity
participation. That is, those with a greater number of activities in their activity
profiles are not engaged in their activities any more or less frequently than those with
a fewer number of activities. Average MAPA-Meaning had significant low positive
correlations with Activity Diversity [r(158) = 0.19, p < .05] and MAPA-Frequency
[r(158) = 0.20, p < .05]. This finding suggests that those persons with a greater
number of activities in their activity profiles or those who are more frequently
engaged in a greater number of activities may ascribe more personal meaning to their
activities, although the effect is slight. Furthermore, Average MAPA-Frequency
153
demonstrated significant low positive correlations with both Average MAPA-Health
[r(158) = 0.25, p < .01] and Average MAPA-Meaning [r(158) = 0.20, p < .05]. This
result supports the idea that more frequent participation in one’s activities is related
to ascribing greater personal meaningfulness and healthful meaning to those
activities. This provides evidence to support the approach taken to define the
MAPA-Frequency x Meaning and MAPA-Frequency x Health scores.
Table 8
Zero-order Correlations between MAPA Derived Variables
1 2 3 4 5 6 7 8 9 10
1. Activity Diversity 1
2. Activity Frequency .85
**
1
3. MAPA-Meaning .80
**
.74
**
1
4. MAPA-Health .95
**
.84
**
.85
**
1
5. Average MAPA-
Frequency
.07 .57
**
.16
*
.13 1
6. Average MAPA-
Meaning
.19
*
.26
**
.72
**
.31
**
.20
*
1
7. Average MAPA-
Health
.09 .18
*
.33
**
.40
**
.25
**
.44
**
1
8. MAPA – Freq. x
Meaning
.71
**
.86
**
.85
**
.80
**
.53
**
.57
**
.46
**
1
9. MAPA – Freq. x
Health
.80
**
.96
**
.77
**
.88
**
.57
**
.35
**
.44
**
.92
**
1
10. MAPA – Global .26
**
.35
**
.30
**
.29
**
.28
**
.19
*
.16
*
.41
**
.37
**
1
**
: Significant at the .01 level
*
: Significant at the .05 level
ns: Non-significant
N=158
154
Principal Components Analyses of the MAPA Scales
Principal components analysis (PCA) of the MAPA-Frequency (Activity Frequency)
scale discerned ten factors comprised of between one and six activities with item
structure coefficients greater than 0.45. Component 1 included six items suggestive
of an independent and community engaged lifestyle. Component 4 was represented
by four activities that appeared to be means for establishing and maintaining social
ties that did not necessarily require physical engagement in the community. Beyond
this, the remaining components were represented by three or fewer activities; see
Table 9. Overall, the results of the PCA indicate that the MAPA items comprise a
rather heterogeneous scale of activities. Despite this finding, the internal consistency
of the MAPA-Frequency scale was established within the present sample (! = 0.83).
Further exploration of the MAPA scales was undertaken with PCA to determine how
these components might compare to MAPA-Frequency. Results of the PCA of the
remaining four MAPA scales (i.e. Meaning, Health, Frequency x Meaning, and
Frequency x Health) are detailed in Tables 10 through Table 13. The MAPA-
Meaning scale held nine components. The number of activities comprising the
MAPA-Meaning scale ranged from one to six; see Table 10. PCA of the MAPA-
Health scale resulted in ten components. The number of activities comprising the
components in this scale ranged from one to seven; see Table 11. PCA of the
155
Table 9
Principal Component Analysis of MAPA-Frequency Ratings
Component Structure Coefficients
Activity Type 1 2 3 4 5 6 7 8 9 10
Home making/home
maintenance
.70
Personal finances .63
Driving .52
Using public transportation .84
Medical visits .77
Socializing .58
Writing letters/cards
Helping others .61
Gardening .47
Physical exercise .87
Crafts/hobbies .72
Cultural activities .57
Musical activities .51
Taking courses .65
Creative activities .82
Traveling
Talking on the telephone .68
Reading
magazines/newspapers
.81
Other reading .64
Playing games .76
Radio/TV .57
Religious activities .83
Prayer/meditation .84
Comm. Organization activities .66
Volunteer activities .63
Pet care activities
Computer use for email .91
Other computer use .89
N=158
156
MAPA-Frequency x Meaning scale resulted in nine components with between one
and five activities reflecting the components; see Table 12. Finally, MAPA-
Frequency x Health was found to have 10 components that held between one and
five activities with item structure coefficients greater than 0.45; see Table 13.
On the whole, the five MAPA scales demonstrated similar characteristics when
subjected to PCA. The communality values for each of the scale items had similar
ranges, never falling below 0.38, while being as high as 0.89. The components
within each of the scales ranged from nine to ten suggesting heterogeneity of activity
items, regardless of the measurement approach (i.e. activity frequency, subjective
meaning, or both). The number of items comprising each of the scales’ components
ranged fairly consistently between one and seven.
One of the main functions of PCA is to identify patterns in one’s data (Thompson,
2004). Therefore any shift in the item-component relationships would be of
significant interest in exploring the effects of meanings attributed to activity
participation. One consistent finding was the shift in activity-component
relationships across the differing MAPA scales. For example, Component 1 from
the MAPA-Frequency PCA included six items suggestive of an independent and
community engaged lifestyle (i.e., Homemaking / Home Maintenance, Personal
Finances, Driving, Gardening, Community Organization activities and Volunteer
157
Table 10
Principal Component Analysis of MAPA-Meaning Ratings
Component Structure Coefficients
Activity Type 1 2 3 4 5 6 7 8 9
Home making/home maintenance .48
Personal finances .48
Driving -.62
Using public transportation .67
Medical visits
Socializing .59
Writing letters/cards .49
Helping others .63
Gardening .66
Physical exercise .71
Crafts/hobbies .61
Cultural activities .68
Musical activities
Taking courses .49
Creative activities .75
Traveling .56
Talking on the telephone .77
Reading magazines/newspapers .46 .58
Other reading .53
Playing games .80
Radio/TV .78
Religious activities .89
Prayer/meditation .86
Comm. Organization activities .54
Volunteer activities .58
Pet care activities .62
Computer use for email .88
Other computer use .89
N=158
158
Table 11
Principal Component Analysis of MAPA-Health Ratings
Component Structure Coefficients
Activity Type 1 2 3 4 5 6 7 8 9 10
Home making/home
maintenance
.57
Personal finances
Driving .58
Using public transportation .81
Medical visits
Socializing .71
Writing letters/cards
Helping others .50
Gardening .51
Physical exercise .67
Crafts/hobbies .48 .51
Cultural activities .69
Musical activities
Taking courses .51
Creative activities .77
Traveling .56
Talking on the telephone .76
Reading
magazines/newspapers
.81
Other reading .71
Playing games .87
Radio/TV .54
Religious activities .86
Prayer/meditation .87
Comm. Organization activities .76
Volunteer activities .69
Pet care activities .70
Computer use for email .89
Other computer use .86
N=158
159
Table 12
Principal Component Analysis of MAPA-Frequency x Meaning Ratings
Component Structure Coefficients
Activity Type 1 2 3 4 5 6 7 8 9
Home making/home maintenance .56
Personal finances .62
Driving .50
Using public transportation .96
Medical visits -.53
Socializing
Writing letters/cards .60
Helping others .65
Gardening .60
Physical exercise .74
Crafts/hobbies .66
Cultural activities .52
Musical activities .65
Taking courses -.57
Creative activities .70
Traveling .54
Talking on the telephone .61
Reading magazines/newspapers .73
Other reading .64
Playing games .54
Radio/TV
Religious activities .74
Prayer/meditation .82
Comm. Organization activities .75
Volunteer activities .81
Pet care activities .66
Computer use for email .91
Other computer use .92
N=158
160
Table 13
Principal Component Analysis of MAPA-Frequency x Health Ratings
Component Structure Coefficients
Activity Type 1 2 3 4 5 6 7 8 9 10
Home making/home
maintenance
.62
Personal finances .75
Driving
Using public transportation .79
Medical visits
Socializing .55
Writing letters/cards
Helping others .64
Gardening
Physical exercise .87
Crafts/hobbies .78
Cultural activities .58
Musical activities .64
Taking courses
Creative activities .76
Traveling
Talking on the telephone .73
Reading
magazines/newspapers
.73
Other reading .77
Playing games -.68
Radio/TV .72
Religious activities .78
Prayer/meditation .83
Comm. Organization activities .70
Volunteer activities .70
Pet care activities .54
Computer use for email .92
Other computer use .90
N=158
161
activities). The MAPA-Frequency x Meaning PCA found only three of those
activities represented in one component (Driving, Community Organization activities
and Volunteer activities) along with Helping Others and Cultural activities.
Homemaking / Home Maintenance and Personal Finances were found in a unique
MAPA-Frequency x Meaning PCA along with Taking Courses, though this last
activity held a negative structure coefficient. Finally, Gardening from the MAPA-
Frequency PCA was grouped with Traveling and Pet Care in the MAPA-Frequency
x Meaning PCA. It appears that the ascription of meaning to the frequency ratings of
the activities results in a significant shift in the composition and interpretation of the
PCA components.
In terms of the MAPA-Frequency x Meaning scale, two components were identified
consisting of greater than three activity items: social community engaged and social
sedentary. The social community engaged lifestyle consisted of the following five
activities in descending structure coefficient order: volunteer activities, community
organization activities, helping others, cultural activities and driving. The social
sedentary lifestyle consisted of: reading magazines/newspapers, other reading,
talking on the telephone and writing letters/cards.
Though the item structure coefficients of 0.45 might have been restrictive, it afforded
some insight into the grouping of variables across the five scales. As an example,
162
there were 4 sets of activities that were consistently paired regardless of the scale
under study: 1) Reading Magazines / Newspapers and Other Reading, 2) Crafts /
Hobbies and Creative Activities, 3) Religious Activities and Prayer / Meditation, and
4) Computer Use for Email and Other Computer Use. Another paired group,
Socializing and Helping Others, was found within four scales. This finding would
suggest a significant association between these paired activities, suggesting either a
reciprocal relationship between these activities regardless of particular ascriptions of
meaning, or that these activities are interpreted by the participants as being rather
synonymous. Nonetheless, components identified by two and fewer activity items
are not typically deemed stable (Thompson, 2004), and must be interpreted with
caution.
Tests of the Study’s Main Hypotheses
Criterion-related and construct validity was tested by using a number of constructs
with which meaningful activity participation has been theoretically associated.
Descriptive statistics were obtained for the criterion variables used in the present
study (see Table 14).
Cronbach’s alphas were acceptable for each instrument with the exception of the
Daily Occupation Experience Survey (! = 0.43). Item-total correlations for this
scale ranged from -0.32 to 0.42 (0.14 ± 0.20), which suggested the scale was not
163
Table 14
Descriptive Statistics for Criterion Variables
N=154 Mean SD Range
Chronbach’s
Alpha
LSIZ 17.8 5.4 4.0 - 26.0 0.77
PIL 108.5 17.3 74.0 - 140.0 0.89
CESD 10.8 8.8 0.0 - 49.0 0.87
EMAS 48.1 6.6 17.0 - 60.0 0.89
SWLS 24.5 6.1 7.0 - 35.0 0.81
SF36v2 - PF 38.9 12.7 14.9 - 59.1 0.93
SF36v2 - RP 42.6 10.3 17.7 - 56.9 0.92
SF36v2 - BP 43.2 10.3 19.9 - 62.1 0.62
SF36v2 - GH 47.9 9.5 25.8 - 63.9 0.75
SF36v2 - VT 51.6 8.9 20.9 - 67.7 0.78
SF36v2 - SF 47.1 11.1 13.2 - 56.9 0.83
SF36v2 - RE 44.0 11.3 9.2 - 55.9 0.88
SF36v2 - MH 50.8 10.0 19.0 - 64.1 0.86
measuring its intended construct; this instrument was therefore excluded from
subsequent data analysis. Evidence regarding the construct validity of the MAPA
scales may be found in their zero-order correlations with criterion variables. In
support of the study’s main hypotheses, the MAPA variables demonstrated
statistically significant zero-order correlations with nearly all of the criterion
variables; see Table 15.
164
Hypothesis 1: There is a positive correlation between the MAPA and the Purpose-in-
Life test.
In partial support of Hypothesis 1, low to moderate positive correlations were found
between the MAPA derived variables and the Purpose-in-Life Test (PIL). Of the
MAPA activity variables, MAPA-Frequency x Meaning had the highest correlation
(r = 0.50), followed by MAPA-Frequency x Health (r = 0.42) and Activity
Frequency (r = 0.37).
Hypothesis 2: There are positive associations between the MAPA scales and other
scales of meaningful activity participation.
In support of Hypothesis 2, positive correlations were found amongst the MAPA
derived variables. Activity Diversity demonstrated the weakest association with the
other MAPA derived variables (e.g., Activity Frequency [r = 0.85] and MAPA-
Frequency x Meaning [.71]). MAPA-Frequency x Health evidenced the largest
correlations (i.e., Activity Diversity [r = 0.96] and Activity Frequency [r = 0.96]).
MAPA-Frequency x Meaning and MAPA-Frequency x Health were also highly
correlated (r = 0.92). The large zero-order correlations between the MAPA derived
variables suggest that these instruments are capturing similar aspects of the activity
participation construct. MAPA-Global evidenced low to moderate positive
correlations with the MAPA derived scales ranging from 0.23 to 0.41. Whereas the
165
Table 15
Zero-Order Correlations between Criterion Variables and Activity Variables
N=154 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1. LSIZ 1
2. PIL .62
**
1
3. CESD -.50
**
-.45
**
1
4. EMAS .34
**
.58
**
-.29
**
1
5. SWLS .64
**
.58
**
-.48
**
.36
**
1
6. SF36v2 - PF .28
**
.26
**
-.21
**
.18
*
.05 1
7. SF36v2 - RP .21
**
.25
**
-.28
**
.23
**
.08 .64
**
1
8. SF36v2 - BP .34
**
.32
**
-.29
**
.11 .23
**
.45
**
.31
**
1
9. SF36v2 - GH .42
**
.42
**
-.34
**
.34
**
.31
**
.44
**
.43
**
.42
**
1
10. SF36v2 - VT .40
**
.45
**
-.46
**
.29
**
.30
**
.41
**
.48
**
.40
**
.59
**
1
11. SF36v2 - SF .41
**
.35
**
-.54
**
.32
**
.31
**
.53
**
.58
**
.34
**
.55
**
.59
**
1
12. SF36v2 - RE .24
**
.29
**
-.47
**
.19
*
.19
*
.43
**
.57
**
.12 .27
**
.46
**
.59
**
1
13. SF36v2 - MH .55
**
.53
**
-.72
**
.35
**
.51
**
.26
**
.30
**
.27
**
.53
**
.57
**
.67
**
.52
**
1
166
Table 15, continued
N=154 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
14. Activity Diversity .26
**
.24
**
-.18
*
.14 -.04 .35
**
.22
**
.04 -.05 .14 .18
*
.31
**
.11 1
15. Activity
Frequency
.29
**
.37
**
-.23
**
.24
**
.08 .36
**
.24
**
.07 .03 .21
**
.23
**
.36
**
.21
**
.85
**
1
16. MAPA – F x M .38
**
.50
**
-.36
**
.42
**
.24
**
.36
**
.34
**
.13 .20
*
.31
**
.36
**
.37
**
.36
**
.71
**
.86
**
1
17. MAPA – F x H .33
**
.42
**
-.26
**
.30
**
.14 .39
**
.30
**
.10 .11 .24
**
.27
**
.37
**
.26
**
.96
**
.96
**
.92
**
1
18. MAPA – Global .53
**
.60
**
-.45
**
.38
**
.40
**
.27
**
.30
**
.12 .27
**
.40
**
.41
**
.34
**
.45
**
.23
**
.35
**
.41
**
.37
**
1
**
: Significant at the .01 level
*
: Significant at the .05 level
ns: Non-significant
F x M: Frequency x Meaning
F x H: Frequency x Health.
167
Engagement in Meaningful Activity Survey (EMAS) was not correlated with
Activity Diversity, it did obtain low to moderate correlations with the other scales
ranging from 0.24 to 0.42. These finding suggests that MAPA-Global and EMAS
are tapping related though somewhat distinct aspects of the meaningful activity
participation construct.
Hypothesis 3: There are positive correlations between the MAPA and two measures
of life satisfaction (i.e., LSI-Z and SWLS).
MAPA-Frequency x Meaning held the largest correlations with both measures of life
satisfaction employed in the present study (see Table 15). In partial support of
Hypothesis 3 low positive correlations were found between the MAPA variables and
the Life Satisfaction Index-Z (LSIZ). MAPA-Frequency x Meaning established the
largest association (r = 0.38) with LSIZ, followed next by MAPA-Frequency x
Health (r = .33). The Satisfaction with Life Scale (SWLS) was also included as a
criterion variable which taps the construct of life satisfaction. The only statistically
significant zero-order correlation with MAPA activity variables and the SWLS
existed with MAPA-Frequency x Meaning (r = 0.24). A correlation of r = 0.64 was
found between the LSIZ and SWLS suggesting that these measures are tapping into
the construct of life satisfaction (see Table 15). Interestingly, the difference in
correlations between the life satisfaction variables (i.e., LSIZ and SWLS) and the
MAPA activity variables suggests that the approach to measuring activity may likely
168
influence the extent to which this relationship is represented; though tests of
significant differences between these correlations were not performed. MAPA-
Frequency x Meaning was the only variable associated with the SWLS, while it and
MAPA-Frequency x Health held the largest associations with LSIZ. As was
expected, the integration of subjective attributions of activity meaning into scales of
activity participation demonstrated greater degrees of congruence with measures of
life satisfaction when compared to the typical approaches to activity measurement
(i.e., activity frequency or activity diversity).
Hypothesis 4: There is a positive correlation between the MAPA and the four SF-
36v2 Mental Health scales.
The SF36v2 Mental Health scales demonstrated positive zero-order correlations with
nearly every MAPA scale, offering support for Hypothesis 4. The Social
Functioning (SF36v2 – SF) and Role-Emotional (SF36v2 - RE) scales were
statistically significantly positively associated with each of the MAPA scales (r =
0.37 to r = 0.18). The Vitality (SF36v2 - VT) and Mental Health (SF36v2 - MH)
scales were positively associated with all but Activity Diversity (see Table 15).
Again, MAPA-Frequency x Meaning and MAPA-Frequency x Health consistently
obtained higher zero-order correlations with these criterion variables compared to
typical activity measurement approaches. MAPA-Frequency x Meaning established
a mean zero-order correlation of 0.35 (median r = 0.36) with the four SF-36v2
169
Table 16
Comparison of MAPA Scale Structure Coefficients in Relation to Criterion Variables
Frequency Structure
Coefficients
Meaning Structure
Coefficients
Health Structure
Coefficients
Frequency x Meaning
Structure Coefficients
Frequency x Health
Structure Coefficients
Criterion Variable
Number of
Correlations
Significant
at p < .05
Adjusted
R-Square
*
Number of
Correlations
Significant
at p < .05
Adjusted
R-Square
*
Number of
Correlations
Significant
at p < .05
Adjusted
R-Square
*
Number of
Correlations
Significant
at p < .05
Adjusted
R-Square
*
Number of
Correlations
Significant
at p < .05
Adjusted
R-Square
*
LSIZ 2 .10 3 .13 2 .08 4 .15 3 .11
PIL 4 .18 3 .16 2 .10 5 .27 5 .20
CESD 2 .06 2 .13 1 ns 3 .13 2 ns
EMAS 2 .15 4 .15 2 .18 3 .25 3 .16
SWLS 4 .10 0 ns 1 ns 3 .17 2 .10
SF36v2 - PF 4 .15 2 .13 1 .14 1 .09 3 .15
SF36v2 - RP 2 .06 2 .11 2 .11 2 .07 2 .09
SF36v2 - BP 0 ns 0 ns 0 ns 0 ns 0 ns
SF36v2 - GH 4 .15 2 .08 3 .08 2 .12 4 .13
F36v2 - VT 2 .08 1 .07 2 ns 3 .10 2 .06
SF36v2 - SF 2 .10 2 .12 3 .09 2 .12 2 .08
SF36v2 - RE 2 .12 1 .12 3 .09 3 .13 1 .12
SF36v2 - MH 3 .11 2 .14 0 ns 2 .14 3 .08
ns: Non-significant
*
: Significant at the .05 level
170
Mental Health scales, whereas MAPA-Frequency established a mean zero-order
correlation of 0.25 (median r = 0.22) with the Mental Health scales.
Hypotheses 5: There is a positive correlation between the MAPA and the four SF-
36v2 Physical Health scales.
In partial support of Hypotheses 5, 9 out of a possible 16 associations were found to
be statistically significant between the MAPA activity variables and the Physical
Health scales of version 2 of the SF-36 Health Survey (SF36v2) (see Table 15). The
Physical Function (SF36v2 - PF) and Role-Physical (SF36v2 - RP) scales held low
positive associations with each of the MAPA activity scales tested, ranging from r =
0.22 to r = 0.39. No significant associations were found between the MAPA
variables and Bodily Pain (SF36v2 - BP), and only MAPA-Frequency x Meaning
was found to have a statistically significant association with General Health (SF36v2
– GH). MAPA-Frequency x Meaning established a mean zero-order correlation of
0.26 (median r = 0.27) with the four SF-36v2 Physical Health scales, whereas
MAPA-Frequency established a mean zero-order correlation of 0.18 (median r =
0.16) with the Mental Health scales.
171
Hypothesis 6) There is a negative correlation between the MAPA and the CES-D.
Hypothesis 6 also received partial support as all of the MAPA activity variables
achieved statistically significant low negative associations with the Center for
Epidemiologic Studies Depression Scale (CESD). MAPA-Frequency x Meaning had
the largest zero-order correlation with this criterion variable (r = -0.36), followed by
MAPA-Frequency x Health (r = -0.26) and Activity Frequency (r = -0.23).
In reviewing the associations between the SF36v2, psychological well-being
variables and the MAPA a clear pattern is evident. The MAPA-Frequency x
Meaning variable appeared to be outperforming the other MAPA activity variables.
MAPA-Frequency x Meaning demonstrated seven statistically significant zero-order
correlations with the SF36v2 variables, followed by Activity Frequency and MAPA-
Frequency x Health, each with six, and Activity Diversity with four. Further,
MAPA-Frequency x Meaning had established correlations which were the same or
greater than the other MAPA variables in seven out of the eight SF36v2 scales;
MAPA-Frequency x Health was the next best performer with three. A similar
pattern was established between MAPA-Frequency x Meaning and the psychological
well-being variables.
The MAPA-Frequency x Meaning variable had utilized ratio level data for MAPA-
Frequency (i.e., 0-6) in determining its scaling. However, it was of interest to
172
determine if this scaling was approximating the wording provided to participants.
Therefore, the MAPA-Frequency x Meaning variable was also calculated utilizing a
0-30 frequency scale that corresponded to the number of days an activity was
performed (i.e., 0 - “Not at all”, 0.5 - “Less than once a month”, 1 - “Once a month”,
2.5 - “2-3 times a month”, 4 - “Once a week”, 15 - “Several times a week”, and 30 -
“Every day”) to assess whether a substantial difference in zero-order correlations
with criterion variables would be evidenced. Results indicated that both approaches
to scaling activity frequency were nearly equivalent as differences in the correlation
coefficients varied by no more than 0.04, ranging from -0.03 to 0.04.
Identification of MAPA Candidate Variables in Predicting Criterion Variables
Data analysis continued to identify the best MAPA derived scale to represent the
construct of meaningful activity participation. The main variables under
consideration were MAPA-Frequency x Meaning and MAPA-Frequency x Health as
they were developed with the intention of reflecting this construct. The 28 activity
items within MAPA-Frequency x Meaning and Frequency x Health were evaluated
in terms of their zero-order correlations. Moderate to high positive associations were
found between these items ranging from r(158) = 0.37 to r = 0.91 with an average
correlation level of r(158) = 0.71 (SD = 0.15). Zero-order correlations between the
two scales were r(158) = 0.92. Together, these two aspects of associations between
173
the scales indicated a very high level of association, and suggested the scales are
sharing a similar construct.
Given the theoretical and empirical support for significant correlations between
meaningful activity participation and measures of psychosocial well-being and
health-related quality of life, zero-order correlations between these constructs were
evaluated (Table 15). MAPA-Frequency x Meaning was found to have higher
correlations with the five measures of psycho-social well being employed in the
study. MAPA-Frequency x Meaning also demonstrated superior correlation
coefficients in five out of the eight SF36v2 scales. MAPA-Frequency x Health
achieved a greater correlation coefficient with only one scale (SF36v2-PF). On the
whole it appeared that of the two activity scales (MAPA-Frequency x Meaning and
MAPA-Frequency x Health) the MAPA-Frequency x Meaning best represented the
construct of meaningful activity participation.
MAPA PCA Regression Coefficients
Data analysis proceeded in order to identify MAPA derived variables with the
potential of enhancing the prediction of criterion variables. Regression coefficients
from the PCA of the MAPA scales were evaluated to determine the degree to which
they were correlated with criterion variables. The MAPA-Frequency x Meaning
regression coefficients evidenced 35 positive associations with the criterion
174
variables, followed by Frequency with 33, and Frequency x Health with 32; see
Table 16 for details. To determine whether MAPA-Frequency x Meaning or MAPA-
Frequency x Health best represented the construct of meaningful activity
participation a Wilcoxon signed-ranks test was performed utilizing the number of
zero-order correlations between these scales’ PCA structure coefficients and the
criterion variables found in Table 15. The results indicated that MAPA-Frequency x
Meaning outperformed MAPA-Frequency x Health (z = -2.11, p < .05, two-tailed).
Next, PCA regression coefficients from each scale were entered into regression
models to compare their contributions towards the prediction of each criterion
variable. The results of these regression models were evaluated in terms of which
group of PCA regression coefficients resulted in the largest R-square values across
the 13 criterion variables. Again, the MAPA-Frequency x Meaning regression
coefficients were superior to the others, as they achieved the largest (or equal to the
largest) adjusted R-square values in 9 out of the 13 criterion variables, followed by
MAPA-Meaning with 4 (see Table 15). From these analyses it was determined that a
likely candidate variable could be found within the components of MAPA-
Frequency x Meaning.
Frequency x Meaning component 1 and Frequency x Meaning component 2 offered
the greatest utility in terms of zero-order correlations with criterion variables (see
Table 17). Backward regression analyses were utilized to determine which of the
175
Frequency x Meaning components best predicted the 13 criterion variables. These
variables were tested in regression models with MAPA-Frequency x Meaning to
determine if significant improvements in the prediction of the criterion variables
could be obtained. Hierarchal regression models were run entering demographic
variables in the first block, health or depression controls in the second block, MAPA-
Frequency x Meaning in the third block and the two MAPA-Frequency x Meaning
component regression coefficients in the final block. Frequency x Meaning
component 1 was found to be statistically significant in three models. Frequency x
Meaning component 1 activities included: driving, helping others, cultural activities,
community organization activities and volunteer activities, suggesting that this
variable was reflective of a lifestyle that is generally active, independent and
community engaged. However, the Betas for Frequency x Meaning component 1
were low negative for LSIZ and SWLS, and low positive with EMAS; and
multicollinearity was clearly evident. Frequency x Meaning component 2 failed to
improve prediction of the criterion variables. Given the equivocal and generally
poor performance of the Frequency x Meaning components in contributing to the
prediction of the criterion variables as a whole, they were excluded from further
consideration.
176
Table 17
Zero-Order Correlations between Criterion Variables
and MAPA – Frequency x Meaning Structure Coefficients
N=154 MAPA – Frequency x Meaning Structure Coefficients
Criterion Variable 1 2 3 4 5 6 7 8 9
1. LSIZ .22
**
.16
*
.17
*
.19
*
2. PIL .22
**
.28
**
.26
**
.24
**
.18
*
3. CESD -.14
*
-.26
**
-.24
**
4. EMAS .30
**
.22
**
.29
**
5. SWLS .21
**
.33
**
.19
*
6. SF36v2 - PF .21
**
7. SF36v2 - RP .21
**
.20
*
8. SF36v2 - BP
9. SF36v2 - GH .24
**
-.20
*
10. SF36v2 - VT .22
**
.19
*
.20
*
11. SF36v2 - SF .24
**
.23
**
12. SF36v2 - RE .28
**
.20
*
.17
**
13. SF36v2 - MH .20
*
.31
**
**
: Significant at the .01 level
*
: Significant at the .05 level
177
MAPA Reasons
Descriptive statistics for the MAPA-Reasons frequency counts were: “Need to or
have to” (6.5 ± 4.0), “For new experiences” (3.7 ± 2.5), “To connect with others”
(6.0 ± 3.1), and “For a sense of accomplishment” (4.8 ± 3.8). Descriptive statistics
for MAPA-Frequency by MAPA-Reasons (i.e., summing the frequency of activity
participation across the 28 activities of the MAPA within each MAPA-Reason
category) were: “Need to or have to” (25.2 ± 18.2), “For new experiences” (11.1 ±
2.5), “To connect with others” (20.1 ± 13.4), and “For a sense of accomplishment”
(14.4 ± 14.6).
Overall, the MAPA-Reasons variables performed poorly in zero-order correlations
with the criterion variables (see Table 18). A likely exception was the summing of
activity frequency for the activities in which persons indicated their reason for
engagement as “Need to or have to”, as it achieved five significant low correlations
with the criterion measures. This variable was then tested in regression models with
MAPA-Frequency x Meaning to determine if significant improvements in the
prediction of the criterion variables could be obtained. The “Need to or have to”
MAPA-Reason variable was entered last into hierarchal regression models following
demographic variables in the first block, health or depression controls in the second
block, and MAPA-Frequency x Meaning in the third block.
178
Table 18
Zero-order Correlations of MAPA-Reasons Variables with Criterion Variables
N=154 Need to or Have to For New Experiences To Connect with Others
For a Sense of
Accomplishment
Criterion Variable
Frequency
Counts (FC)
FC
Multiplied
by Activity
Frequency
Frequency
Counts (FC)
FC
Multiplied
by Activity
Frequency
Frequency
Counts (FC)
FC
Multiplied
by Activity
Frequency
Frequency
Counts (FC)
FC
Multiplied
by Activity
Frequency
LSIZ .16
*
.25
**
ns ns ns ns ns ns
PIL ns .21
**
ns ns ns ns ns ns
CESD ns ns ns ns ns ns ns ns
EMAS ns ns ns ns ns ns .18
*
.18
*
SWLS ns ns ns ns ns ns ns ns
SF36v2 - PF ns ns ns ns ns .20
*
ns ns
SF36v2 - RP ns ns ns ns ns ns ns ns
SF36v2 - BP ns .17
*
ns ns ns ns ns ns
SF36v2 - GH ns ns ns ns ns ns ns ns
SF36v2 - VT .17
*
.19
*
ns ns ns ns ns ns
SF36v2 - SF ns ns ns ns ns ns ns ns
SF36v2 - RE ns ns ns ns ns ns ns ns
SF36v2 - MH ns .20
*
ns ns ns ns ns ns
**
: Significant at the .01 level,
*
: Significant at the .05 level, ns: Non-significant
179
In all 13 regression models, the MAPA-Reason variable failed to contribute
statistically significant variance to the prediction of the criterion variables.
Therefore, the MAPA-Reasons variable was also excluded from further
consideration.
Intra-individual Level Exploration of the MAPA Scales
Another approach to exploring the MAPA scale items was undertaken by
determining z-scores for MAPA-Frequency, Meaning, and Health. The use of intra-
individual z-scores of the MAPA- Meaning scale items allowed for comparing
activity engagement identified as have lesser versus greater personal meaning on an
ipsative level (see Table 19). For those activities in which persons were engaged, the
three most frequent were: Radio / TV (1.05 ± .44), Reading Magazines / Newspapers
(.80 ± .63), and Talking on the Telephone (.66 ± .69). The three activities with the
lowest frequency z-score were: Traveling (-1.24 ± .78), Medical Visits (-1.19 ± .73),
and Writing Letters / Cards (-.69 ± .77). The three most personally meaningful
activities in which persons were engaged were: Driving (.32 ± .87), Reading
Magazines / Newspapers (.25 ± .83), and Radio / TV (.24 ± .87). The three least
personally meaningful were: Playing Games (-.42 ± 1.19), Creative Activities (-.39 ±
.99), and Pet Care (-.31 ± .91). Physical Exercise (.43 ± 1.05) and Prayer /
Meditation (.39 ± .86) were perceived as most healthful whereas Using Public
180
Transportation (-.89 ± 1.28) and Homemaking / Maintenance (-.45 ± 1.02) were
considered the least healthful.
Additional evidence in support of the multiplicative approach to creating the MAPA-
Frequency x Meaning and MAPA-Frequency x Health variables may be found in the
zero-order correlations between the z-scores for the MAPA-Frequency and MAPA-
Meaning, and MAPA-Frequency and MAPA-Health items. In the first column of
Table 19, statistically significant correlations were found between intra-individual
Frequency and intra-individual Meaning in 15 of the 28 activity items. A similar
pattern was established between intra-individual Frequency and intra-individual
Health, with 20 significant correlations evidenced. These results indicate that
persons, on an ipsative level, tend to ascribe a greater level of personal meaning and
healthfulness to those activities in which they were most frequently engaged.
A review of the intra-individual level MAPA-Frequency x Meaning variables (i.e.
positive vs. negative intra-individual meaning) demonstrated that the negative intra-
individual meaning scores on average consisted of 15 activities (SD = 4, range 6-22);
the positive intra-individual meaning scores consisted of a mean of 10 activities (SD
= 5, range 0-22). The negative scores held a mean value of 61.5 (SD = 56.9, range
0-302) and the positive scores held a mean of 140.7 (SD = 79.0, range 0-404). There
were no statistically significant zero-order correlations between the negative intra-
individual meaning scores and the criterion variables. Alternately, the positive intra-
181
Table 19
MAPA Intra-Individual (II) Z-Score Level Correlations and Descriptive Statistics
Activity Type
Correlation
between II
Frequency
and
II Meaning
Correlation
between II
Frequency
and
II Health
II
Frequency
Mean /
SD
II
Meaning
Mean /
SD
II Health
Mean /
SD
Home making/home
maintenance
.06 .20
*
.10 / .89 -.25 / 1.03 -.45 / 1.02
Personal finances -.09 .25
**
-.54 / .79 .13 / 1.05 -.35 / 1.05
Driving .37
**
.13 .64 / .71 .32 / .87 -.16 / 1.04
Using public transportation .15 .21
**
-.32 / 1.07 .22 / 1.12 -.89 / 1.28
Medical visits .07 .17
*
-1.19 / .73 .10 / .95 .21 / .96
Socializing .10 .30
**
.32 / .72 .17 / .83 .33 / .85
Writing letters/cards .27
**
.31
**
-.69 / .77 -.17 / 1.02 -.29 / .94
Helping others .15 .24
**
.02 / .78 .22 / .78 .21 / .95
Gardening .13 .24
**
-.32 / .90 -.29 / .95 -.14 / .90
Physical exercise .29
**
.35
**
.51 / .75 .08 / 1.00 .43 / 1.05
Crafts/hobbies .13 .01 -.10 / .74 -.00 / 1.03 -.15 / .97
Cultural activities -.08 .07 -.42 / .75 -.12 / .94 -.20 / .90
Musical activities .16 .13 -.25 / .87 .08 / 1.00 .12 / .87
Taking courses -.03 .15 -.63 / .87 -.19 / 1.18 -.03 / .75
Creative activities .09 .16
*
-.47 / .79 -.39 / .99 -.13 / .75
Traveling -.42
**
.10 -1.24 / .78 -.06 / .95 .03 / 1.11
Talking on the telephone .16
*
.22
**
.66 / .69 -.21 / .96 -.05 / .95
Reading magazines/newspapers .24
**
.18
*
.80 / .63 .25 / .83 .23 / .77
Other reading .31
**
.39
**
.39 / .85 -.02 / .91 .19 / .92
Playing games .33
**
.48
**
-.15 / .99 -.42 / 1.19 -.18 / .88
Radio/TV .25
**
.14 1.05 / .44 .24 / .87 -.01 / .83
Religious activities .37
**
.39
**
-.19 / .69 .08 / .97 .10 / 1.08
Prayer/meditation -.04 .37
**
.55 / .81 .24 / .90 .39 / .86
Comm. Organization activities .24
**
.27
**
-.35 / .82 -.28 / .99 -.30 / .83
Volunteer activities .24
**
.39
**
-.03 / .78 .21 / .82 .30 / .78
Pet care activities .55
**
.38
**
.53 / .99 -.31 / .91 -.03 / 1.17
Computer use for email .21
**
.00 .35 / .77 -.14 / .88 -.30 / .97
Other computer use .28
**
.20
*
.42 / .80 -.11 / .86 -.13 / 1.07
**
: Significant at the .01 level,
*
: Significant at the .05 level, ns: Non-significant, N=158
182
-individual meaning scores resulted in statistically significant correlations with 10 of
13 criterion variables. This was an especially interesting finding supporting the
addition of a subjective attribution of meaning to an activity frequency scale.
Activities imbued with less than average personal meaning were not related to any of
the criterion measures, whereas those activities with greater than average personal
meaning obtained correlation coefficients nearly approximating the MAPA-
Frequency x Meaning scale (see Table 20).
To test if the z-score derived variable would aid in the prediction of criterion
measures, the positive intra-individual meaning scores were entered last into
hierarchal regression models following demographic variables in the first block,
health or depression controls in the second, and MAPA-Frequency x Meaning in the
third. In all 13 regression models, the positive intra-individual meaning variables
failed to contribute statistically significant variance to the prediction of the criterion
variables, and they too were excluded from further analyses.
Regression Models with MAPA-Frequency x Meaning Predicting Criterion
Variables
From these analyses it was evident that the best single variable derived from the
MAPA scales to represent the construct of meaningful activity participation was
183
Table 20
Zero-order Correlations of MAPA-Intra-Individual Variables
with Criterion Variables
N=154
Intra-Individual MAPA
Frequency x Meaning
Criterion Variable
Negative
Intra-
Individual
Meaning
Positive
Intra-
Individual
Meaning
MAPA Frequency
x Meaning
LSIZ ns .26
**
.37
**
PIL ns .33
**
.51
**
CESD ns -.20
*
-.36
**
EMAS ns .28
**
.42
**
SWLS ns ns .24
**
SF36v2 - PF ns .34
**
.36
**
SF36v2 - RP ns .29
**
.35
**
SF36v2 - BP ns ns ns
SF36v2 - GH ns ns .21
**
SF36v2 - VT ns .24
**
.32
**
SF36v2 - SF ns .27
**
.36
**
SF36v2 - RE ns .33
**
.38
**
SF36v2 - MH ns .18
*
.35
**
**
: Significant at the .01 level
*
: Significant at the .05 level
ns: Non-significant
MAPA-Frequency x Meaning. Beyond zero-order correlations with criterion
measures, regression analysis was utilized as a further test of MAPA-Frequency x
Meaning’s validity. Regression analysis with the criterion variables serving as
dependent variables was employed utilizing the following statistical controls:
demographic variables (i.e., gender, ethnicity, marital status, and housing status),
184
SF36v2-BP and SF36v2-GH for measures of psychological well-being and the
mental health scales of the SF36v2 or the CESD was entered when the physical
health scales of the SF36v2 were used as dependent variables.
Results of these analyses evidenced that MAPA-Frequency x Meaning contributed to
the prediction of nearly all criterion variables. In each of the five psychological
well-being criterion measures, MAPA-Frequency x Meaning contributed the greatest
amount of variance compared to the other model variables; General Health from the
SF36v2 added meaningfully to four of these five models. When SF36v2 mental
health variables were modeled, MAPA-Frequency x Meaning added to the prediction
of each criterion measure. Finally, MAPA-Frequency x Meaning predicted all but
bodily pain from the SF36v2 physical health measures (see Tables 21 to 23).
MAPA-Frequency x Meaning was more consistently associated, and to a larger
extent with measures of psychological well-being and mental health compared to
physical health aspects of health- related quality. These results are consistent with
the conceptualization of the MAPA and offer additional evidence for its construct
validity.
185
Table 21
MAPA-F x M: Psychosocial Well-Being Regression Models
LSIZ PIL CESD EMAS SWLS
Variable SE B ! SE B ! SE B ! SE B ! SE B !
Constant 5.80 16.64 1.63 664.70 328.29
Gender .95 .12 2.72 .14* .27 -.09 108.86 .12 53.76 .20*
Race 1.01 .16* 2.90 .15* .29 -.12 115.78 -.02 57.18 .15
Age .06 .08 .18 .12 .02 -.06 7.12 .10 3.52 .31**
Education .26 .01 .75 .07 .07 .00 29.89 -.08 14.76 -.13
Marital Status 1.13 .08 3.23 .06 .32 -.08 129.23 .08 63.83 .01
Housing Status 1.00 -.04 2.87 .15* .28 -.09 114.51 .03 56.56 .01
Income .76 .05 2.17 -.13* .21 .03 86.71 -.12 42.82 -.05
SF36v2-BP .04 .16* .11 .14* .01 -.16 4.29 -.08 2.12 .12
SF36v2-GH .05 .27** .13 .24** .01 -.19* 5.15 .26** 2.54 .16
MAPA-F x M .01 .32** .02 .50** .00 -.35** .59 .43** .29 .33**
R
2
.34 .46 .26 .29 .26
F 7.33** 12.28** 4.92** 5.86** 5.08**
*p < .05, **p < .01
186
Table 22
MAPA-F x M: SF36v2 Mental Health Regression Models
VT SF RE MH
Variable SE B ! SE B ! SE B ! SE B !
Constant 843.50 945.08 1030.88 977.64
Gender 138.14 .00 154.77 -.08 168.83 -.06 160.11 .00
Race 146.92 .09 164.62 .01 179.56 .02 170.29 .07
Age 9.03 .06 10.13 -.04 11.05 -.04 10.48 .14
Education 37.92 .10 42.49 -.06 46.35 .12 43.95 -.07
Marital Status 163.10 -.02 183.75 -.01 200.43 -.04 190.08 .06
Housing Status 145.32 -.02 162.82 -.09 177.60 -.17* 168.43 -.04
Income 110.03 .00 123.28 .05 134.47 .14 127.53 .02
SF36v2-BP 5.45 .17* 6.10 .13 6.60 -.03 6.31 .06
SF36v2-GH 6.54 .47** 7.33
.47**
8.00
.23**
7.58
.42**
MAPA-F x M .75 .20** .84
.22**
.92
.26**
.87
.32**
R
2
.43 .40 .24 .37
F 10.84**
9.52** 4.58** 8.39**
*p < .05, **p < .01
187
Table 23
MAPA-F x M: SF36v2 Physical Health Regression Models
PF RP BP GH
Variable SE B ! SE B ! SE B ! SE B !
Constant 14.82 1001.38 14.13 11.71
Gender 2.33 .13 157.32 .08 2.22 .11 1.84 .06
Race 2.48 -.08 167.51 -.17* 2.36 -.13 1.96 -.04
Age .15 -.03 10.07 -.15 .14 .02 .12 .24
Education .64 .13 42.98 .00 .61 .12 .50 .07
Marital Status 2.78 -.04 187.41 -.09 2.64 .07 2.19 .03
Housing Status 2.45 -.30** 165.71 -.09 2.34 -.11 1.94 -.03
Income 1.85 .06 125.24 .10 1.77 -.08 1.46 .01
CESD .70 -.10 46.96 -.21* .66 -.26** .55 -.27**
MAPA-F x M .01
.24**
.89 .20* .01 .01 .01 .19*
R
2
.28 .21 .15 .18
F
6.11** 4.35** 2.81** 3.42**
*p < .05, **p < .01
188
Testing the Contributions of MAPA-Global in the Prediction of Criterion Variables
MAPA-Global was intended as a brief instrument for tapping the construct of
meaningful activity participation and it was created to be conceptually analogous to
the other MAPA scales (i.e., MAPA-Frequency, MAPA-Meaning, and MAPA-
Health). MAPA-Global scores obtained a mean of 33.7 ± 5.9 with a range of 8.0 to
42.0, and evidenced sound internal consistency (r = 0.75) and test-retest (r(25) =
0.86) reliability. Additionally, the zero-order correlation between MAPA-Global
and MAPA-Frequency x Meaning (r = 0.41) suggested that the two instruments were
likely measuring shared aspects of the meaningful activity participation construct.
Furthermore, MAPA-Global demonstrated slightly higher zero-order correlations
with 9 of 13 criterion variables compared to MAPA-Frequency x Meaning (see
Table 15). Therefore, it seemed feasible that MAPA-Global would contribute
additional variance in predicting the criterion variables beyond MAPA-Frequency x
Meaning. To test this supposition, MAPA-Global was entered with MAPA-
Frequency x Meaning in regression models with criterion variables serving as
dependent variables. Regression analysis was again employed, utilizing the
statistical controls from the preceding analyses.
Results evidenced that the combination of both variables played a substantial role in
predicting the majority of criterion variables. MAPA-Frequency x Meaning and
MAPA-Global contributed to the prediction of 11 of 13 criterion variables; the
189
exceptions were SF36v2-BP and SF36v2-GH (see Tables 24 to 26). In 7 of 13
models MAPA-Frequency x Meaning and MAPA-Global each contributed
statistically significant variance to the prediction of the criterion variables (i.e., LSIZ,
PIL, CESD, EMAS, SWLS, SF36v2-RE and MH). Of the remaining four models,
MAPA-Global contributed to the prediction of three criterion variables (SF36v2-RP,
SF36v2-VT, and SF36v2-SF) at the exclusion of MAPA-Frequency x Meaning,
whereas only MAPA-Frequency x Meaning contributed unique variance in
predicting SF36v2-PF.
Of the many MAPA variables assessed, the combination of MAPA-Frequency x
Meaning and MAPA-Global may best reflect the construct of meaningful activity
participation. This effect was most notable for measures of psychological well-
being, as would be expected given the nature of the meaningful activity variables.
Considered alone, MAPA-Frequency x Meaning was capable of predicting all but
one criterion measure, a finding which suggests the instrument adequately reflects
the construct of meaningful activity participation. However, MAPA-Global tended
to improve models predicting psychological well-being with R-square values as
much as 0.12 larger (see Table 27), though F change statistics were not calculated. It
is likely that both instruments are tapping unique aspects of the meaningful activity
participation construct given the different measurement approach taken by each.
190
Table 24
MAPA-F x M and MAPA-Global: Psychosocial Well-Being Regression Models
LSIZ PIL CESD EMAS SWLS
Variable SE B ! SE B ! SE B ! SE B ! SE B !
Constant 5.28 14.90 1.56 654.02 313.74
Gender .86 .10 2.44 .13* .26 -.08 107.16 .11 51.41 .18*
Race .92 .12 2.60 .11* .27 -.09 114.37 -.04 54.86 .12
Age .06 .05 .16 .09 .02 -.04 7.02 .09 3.37 .28**
Education .24 -.04 .67 .02 .07 .04 29.60 -.10 14.20 -.16*
Marital Status 1.03 .10 2.90 .07 .30 -.09 127.27 .09 61.06 .02
Housing Status .91 -.05 2.57 .14* .27 -.08 112.69 .02 54.06 .01
Income .70 .11 1.97 -.07 .21 -.01 86.37 -.09 41.43 -.01
SF36v2-BP .03 .17* .10 .15* .01 -.16* 4.22 -.09 2.03 .13
SF36v2-GH .04 .19** .12 .16* .01 -.13 5.16 .23** 2.48 .10
MAPA-F x M .01 .17* .01 .35** .00 -.23** .62 .35** .30 .21*
MAPA-Global .00 .40** .00 .38** .00 -.31** .13 .19* .06 .30**
R
2
.46 .57 .33 .32 .33
F 10.88** 17.24** 6.25** 6.03** 6.39**
*p < .05, **p < .01
191
Table 25
MAPA-F x M and MAPA-Global: SF36v2 Mental Health Regression Models
VT SF RE MH
Variable SE B ! SE B ! SE B ! SE B !
Constant 823.82 911.11 1010.16 934.22
Gender 134.98 -.01 149.28 -.09 165.51 -.07 153.07 -.01
Race 144.06 .08 159.32 -.01 176.65 .00 163.37 .05
Age 8.84 .04 9.78 -.05 10.84 -.06 10.03 .12
Education 37.29 .08 41.24 -.09 45.72 .10 42.28 -.10
Marital Status 160.32 -.01 177.30 .00 196.58 -.03 181.80 .07
Housing Status 141.95 -.03 156.99 -.09 174.05 -.17* 160.97 -.04
Income 108.79 .03 120.32 .08 133.40 .18* 123.37 .06
SF36v2-BP 5.32 .18* 5.88 .14 6.52 -.02 6.03 .07
SF36v2-GH 6.50 .43** 7.19 .42** 7.97 .19* 7.37
.37**
MAPA-F x M .78 .12 .87 .12 .96 .18* .89
.21**
MAPA-Global .16 .20** .18 .25** .20
.22**
.19
.28**
R
2
.46 .45 .28 .43
F 11.06** 10.40**
4.98** 9.69**
*p < .05, **p < .01
192
Table 26
MAPA-F x M and MAPA-Global: SF36v2 Physical Health Regression Models
PF RP BP GH
Variable SE B ! SE B ! SE B ! SE B !
Constant 14.88 997.68 14.32 11.79
Gender 2.31 .12 155.11 .08 2.23 .11 1.83 .06
Race 2.47 -.08 165.43 -.18* 2.38 -.13 1.95 -.05
Age .15 -.04 9.96 -.16 .14 .02 .12 .23*
Education .64 .11 42.71 -.02 .61 .12 .50 .05
Marital Status 2.76 -.03 185.30 -.08 2.66 .06 2.19 .04
Housing Status 2.44 -.30** 163.37 -.09 2.35 -.11 1.93 -.03
Income 1.86 .08 124.83 .12 1.79 -.08 1.47 .02
CESD .73 -.05 49.17 -.15 .71 -.26** .58 -.23**
MAPA-F x M .01 .20* .92 .14 .01 .02 .01 .15
MAPA-Global .00 .14 .20 .20* .00 -.02 .00 .13
R
2
.29 .21 .15 .19
F
5.84** 4.54** 2.52** 3.31**
*p < .05, **p < .01
193
Table 27
Comparison of MAPA-F x M Models to MAPA-F x M and MAPA-Global Models
Standardized
!
Model R-
Square†
Standardized !
Model R-
Square†
MAPA-
F x M
MAPA-
F x M
MAPA-
Global
LSIZ .32** .34 .17** .40** .46
PIL .50** .46 .35** .38** .57
CESD -.35** .26 -.23** -.31** .33
EMAS .43** .29 .35** .19* .32
SWLS .33** .26 .21* .30* .33
SF36v2-PF .24** .28 .20* .14 .29
SF36v2-RP .20* .21 .14 .20* .21
SF36v2-BP .01 .15 .02 -.02 .15
SF36v2-GH .19* .18 .15 .13 .19
SF36v2-VT .20* .43 .12 .20* .46
SF36v2-SF .22** .40 .12 .25** .45
SF36v2-RE .26** .24 .18* .22** .28
SF36v2-MH .32** .37 .21** .28** .43
† all models significant at p < .01, * p < .05, ** p < .01.
194
Comparison of MAPA-Frequency x Meaning to
Activity Frequency and Activity Diversity
Regression analysis was also employed to determine if MAPA-Frequency x Meaning
was capable of outperforming more traditional approaches to activity measurement
in the prediction of criterion variables. In sum, the performance of MAPA-
Frequency x Meaning was found to be superior to the other approaches, adding
additional support to the scales construct validity. Results of the analyses which
evaluated the degree with which either MAPA-Frequency x Meaning, Activity
Frequency or Activity Diversity contributed to the prediction of the criterion
variables are detailed in Table 28.
When the psychological well-being variables were evaluated as a group, model
improvements were evidenced for each activity variable with the exception of
Activity Diversity in the SWLS model. Statistically significant model R-square
change values ranged from 0.026 to 0.182 which indicated that the activity variables
were capable of accounting for between 2.6% and 18.2% of the variance in these
variables beyond statistical controls. Models with MAPA-Frequency x Meaning
consistently demonstrated the largest model R-square and were superior in terms of
model R-square change. Differences between the MAPA-Frequency x Meaning
scale and the other activity variables in model R-square change were greatest for the
PIL, a measure of life purpose and meaning, and EMAS, a measure of activity
195
Table 28
Comparison of Activity Measurement Approaches in Prediction of Criterion
Variables
Criterion
Variable
Activity
Measure
Model
R-Square
Model
Adjusted
R-Square
Std.
Error
of the
Estimate
R-Square
Change
Model F
Change
‡
Significance
of Model
Change
LSIZ
* Activity
Diversity
.32 .27 4.63 .053 11.16 .001
Activity
Frequency
.32 .27 4.62 .058 12.16 .001
MAPA –
F x M
.34 .29 4.55 .076 16.41 .000
PIL
* Activity
Diversity
.34 .30 14.42 .063 13.72 .000
Activity
Frequency
.41 .37 13.65 .132 32.02 .000
MAPA –
F x M
.46 .42 13.06 .182 48.28 .000
CESD
* Activity
Diversity
.20 .14 1.33 .029 5.24 .024
Activity
Frequency
.21 .15 1.32 .040 7.26 .008
MAPA –
F x M
.26 .20 1.28 .087 16.63 .000
EMAS
* Activity
Diversity
.19 .13 558.95 .026 4.63 .033
Activity
Frequency
.22 .16 548.41 .057 10.36 .002
MAPA –
F x M
.29 .24 521.64 .131 26.51 .000
SWLS
* Activity
Diversity
.19 .13 270.37 .004 .69 .407
Activity
Frequency
.21 .16 266.03 .030 5.43 .021
MAPA –
F x M
.26 .21 257.63 .079 15.25 .000
196
Table 28, continued
Criterion
Variable
Activity
Measure
Model
R-Square
Model
Adjusted
R-Square
Std.
Error
of the
Estimate
R-Square
Change
Model F
Change
‡
Significance
of Model
Change
SF36v2 -
PF
†
Activity
Diversity
.27 .23 11.19 .037 7.31 .008
Activity
Frequency
.28 .23 11.18 .038 7.65 .006
MAPA –
F x M
.28 .23 11.16 .039 7.73 .006
SF36v2 -
RP
†
Activity
Diversity
.19 .14 766.49 .004 .80 .373
Activity
Frequency
.19 .14 765.02 .008 1.36 .246
MAPA –
F x M
.21 .17 755.61 .027 5.00 .027
SF36v2 -
BP
†
Activity
Diversity
.15 .10 10.65 .002 .28 .596
Activity
Frequency
.15 .10 10.66 .001 .12 .732
MAPA –
F x M
.15 .10 10.66 .000 .01 .927
SF36v2 -
GH
†
Activity
Diversity
.16 .11 8.93 .006 1.00 .319
Activity
Frequency
.15 .10 8.96 .000 .005 .943
MAPA –
F x M
.18 .13 8.83 .023 4.01 .047
F36v2 -
VT
*
Activity
Diversity
.41 .37 673.81 .008 1.94 .166
Activity
Frequency
.42 .38 666.15 .021 5.29 .023
MAPA –
F x M
.43 .39 661.96 .029 7.17 .008
SF36v2 -
SF
*
Activity
Diversity
.38 .34 750.95 .019 4.35 .039
Activity
Frequency
.39 .34 750.70 .019 4.45 .037
MAPA –
F x M
.40 .36 741.67 .034 8.06 .005
197
Table 28, continued
Criterion
Variable
Activity
Measure
Model
R-Square
Model
Adjusted
R-Square
Std.
Error
of the
Estimate
R-Square
Change
Model F
Change
‡
Significance
of Model
Change
SF36v2 -
RE
*
Activity
Diversity
.23 .18 815.74 .038 7.10 .009
Activity
Frequency
.25 .19 806.90 .055 10.41 .002
MAPA –
F x M
.24 .19 809.01 .051 9.60 .002
SF36v2 -
MH
*
Activity
Diversity
.31 .27 800.98 .016 3.40 .067
Activity
Frequency
.34 .29 787.71 .039 8.38 .004
MAPA –
F x M
.37 .33 767.23 .073 16.57 .000
*
: Initial model included Gender, Ethnicity, Marital Status, Housing Status, Education, Income, Age,
SF36v2 Bodily Pain and General Health
†
: Initial model included Gender, Ethnicity, Marital Status, Housing Status, Education, Income, Age,
and CESD
‡
: df 1 = 1, df 2 = 143
N=154, F x M: Frequency x Meaning
meaningfulness. MAPA-Frequency x Meaning model R-square change values were
0.18 and 0.13 respectively for these scales, and notable finding given the existential
quality shared by these three measures.
Prediction of the SF36v2 physical health scales was somewhat equivocal, though
MAPA-Frequency x Meaning contributed the greatest amount of variance in 8 of the
12 models. None of the activity variables improved the R-square of SF36v2-BP
models beyond that of the control variables. Statistically significant R-square
198
change was modest ranging from 0.03 to 0.04, as MAPA-Frequency x Meaning
accounted for the largest gains among the activity variables. Prediction of the
SF36v2 mental health scales showed a rather clear preference for MAPA-Frequency
x Meaning with better gains in 11 of 12 models. Statistically significant R-square
change was again modest, ranging from 0.02 to 0.07 (see Table 29 for a summary of
these analyses).
Table 29
Improvements in Model R-Square and R-Square Change
MAPA – F x M
Model R-Square
MAPA – F x M
Model R-Square Change
Criterion Variable
Activity
Diversity
Activity
Frequency
Activity
Diversity
Activity
Frequency
1. LSIZ + + + +
2. PIL + + + +
3. CESD + + + +
4. EMAS + + + +
5. SWLS + + + +
6. SF36v2 - PF + + +
7. SF36v2 - RP + + + +
8. SF36v2 - BP
9. SF36v2 - GH + + + +
10. SF36v2 - VT + + + +
11. SF36v2 - SF + + + +
12. SF36v2 - RE + +
13. SF36v2 - MH + + + +
F x M: Frequency x Meaning
+: Frequency x Meaning coefficients were larger than other measurement type
199
MAPA-Frequency x Meaning was more consistently outperforming the other
measurement approaches in predicting the psychological well-being variables as
apposed to the HRQL variables. To explore this finding more closely a paired t-test
was conducted evaluating the difference in mean model R-square change values
between MAPA-Frequency x Meaning and MAPA-Frequency across three classes of
variables (i.e., psychological well-being, SF-36v2 mental health and SF-36v2
physical health). A significant difference was found between these two variables in
terms of psychological well-being (t = 5.35; p < .01), whereas no differences were
found with the SF-36v2 mental health (t = 1.67; p = .19) or SF-36v2 physical health
(t = 1.71; p = .19) variables.
Stepwise entry hierarchical regression analysis was undertaken next as a more
stringent approach for establishing the differential effects of the activity variables in
the prediction of criterion variables. Stepwise entry allowed for a statistical test of
model improvement by comparing the activity variables amongst themselves.
Demographic variables, SF36v2-BP and SF36v2-GH or CESD were utilized as
statistical controls in the same manner as above. In the last block the activity
variables were paired as follows: MAPA-Frequency x Meaning with Activity
Diversity, and MAPA-Frequency x Meaning with Activity Frequency, for a total of
26 regression models.
200
A clear pattern was established indicating that MAPA-Frequency x Meaning was
statistically preferred over the other activity variables (see Table 30).
Table 30
Regression Models Utilizing Stepwise Entry of Activity Variables
Criterion Variable
MAPA –
F x M
Activity
Diversity
MAPA –
F x M
Activity
Frequency
1. LSIZ + na + na
2. PIL + na + na
3. CESD + na + na
4. EMAS + na + na
5. SWLS +* + + na
6. SF36v2 - PF + na + na
7. SF36v2 - RP + na + na
8. SF36v2 - BP na na na na
9. SF36v2 - GH +* + +* +
10. SF36v2 - VT + na + na
11. SF36v2 - SF + na + na
12. SF36v2 - RE + na na +
13. SF36v2 - MH + na + na
F x M: Frequency x Meaning
+: entered into model;
na: not entered into model
*: entered first into model
MAPA-Frequency x Meaning entered into 10 of 13 models at the exclusion of
Activity Diversity and a similar result occurred when MAPA-Frequency x Meaning
was tested against Activity Frequency. Of the remaining models, MAPA-Frequency
201
x Meaning was first to enter into models predicting SWLS and SF36v2-GH,
followed by Activity Diversity; the SF36v2-BP model did include either activity
variable. Activity Frequency was alone in the SF36v2-RE model, and entered
second after MAPA-Frequency x Meaning in predicting SF36v2-GH. Neither
MAPA-Frequency x Meaning or Activity Frequency gained entry into the model
predicting SF36v2-BP. Table 31 provides details for the regression models which
differed from those first obtained in Table 28. Of note, multicollinearity was a
concern for models involving any two activity variables as the tolerance statistics
ranged between 0.39 and 0.41.
Table 31
Detailed Models Utilizing Stepwise Entry of Activity Variables
Criterion
Variable
Activity
Measure
Model
R-Square
Model
Adjusted
R-Square
Std.
Error
of the
Estimate
R-Square
Change
Model
F
Change
Significance
of Model
Change
SWLS
*
MAPA –
F x M
.26 .21 257.63 .079 15.25
‡
.000
Activity
Diversity
.29 .24 253.50 .029 5.71£ .018
SF36v2 -
GH
†
MAPA –
F x M
.18 .13 8.83 .023 4.01
‡
.047
Activity
Diversity
.23 .17 8.60 .049 9.05£ .003
SF36v2 -
GH
†
MAPA –
F x M
.18 .13 8.83 .023 4.01
‡
.047
Activity
Frequency
.23 .18 8.57 .053 9.92£ .002
*
: Initial model included Gender, Ethnicity, Marital Status, Housing Status, Education, Income, Age,
SF36v2 Bodily Pain and General Health
†
: Initial model included Gender, Ethnicity, Marital Status, Housing Status, Education, Income, Age,
and CESD
‡
: df 1 = 1, df 2 = 143; £: df 1 = 1, df 2 = 142; F x M: Frequency x Meaning
202
The last approach taken to evaluate the differences between activity variables
focused on testing the ability of MAPA-Frequency x Meaning to add statistically
significant variance to regression models containing either Activity Diversity or
Activity Frequency; there were 26 hierarchical regression models tested. Statistical
controls used in earlier regression models were entered into the first two blocks of
these models. The third block held either Activity Diversity or Activity Frequency
and MAPA-Frequency x Meaning was entered last. Regression model details may
be found in Tables 32 and 33; Table 34 contains a summary of these results.
Statistically significant R-square change values were found in 17 of 26 models when
MAPA-Frequency x Meaning was entered last. R-square change values ranged from
0.018 to 0.121, indicating that MAPA-Frequency x Meaning was able to explain
1.8% to 12.1% of the variance in these criterion variables beyond that of the other
activity variables. Notably, the largest statistically significant variance added by
MAPA-Frequency x Meaning again involved the prediction of PIL and EMAS,
measures of purpose and meaning in life and activity meaningfulness. MAPA-
Frequency x Meaning was not able to add to the prediction of SF36v2-PF, SF36v2-
SF, nor SF36v2-RE beyond the contributions of Activity Diversity and Activity
Frequency. Lastly, MAPA-Frequency x Meaning was unable to improve the
prediction of SF36v2-PF beyond Activity Frequency.
203
Table 32
Activity Diversity: Regression Models with
MAPA – Frequency x Meaning Entered Last
Criterion
Variable
Unstandardized
coefficient
Model
R-Square
Model
Adjusted
R-Square
Std.
Error
of the
Estimate
R-Square
Change
Model
F
Change
‡
Significance
of Model
Change
LSIZ
Activity
Diversity
.32 .27 4.63 .053 11.16 .001
MAPA –
F x M
*
.34 .29 4.56 .026 5.71 .018
PIL
Activity
Diversity
.34 .30 14.42 .063 13.72 .000
MAPA –
F x M
*
.46 .42 13.08 .121 32.02 .000
CESD
Activity
Diversity
.20 .14 1.33 .029 5.24 .024
MAPA –
F x M
*
.26 .20 1.29 .058 11.16 .001
EMAS
Activity
Diversity
.19 .13 558.95 .026 4.63 .033
MAPA –
F x M
*
.29 .24 519.12 .117 23.80 .000
SWLS
Activity
Diversity
.19 .13 270.37 .004 .69 .407
MAPA –
F x M
*
.26 .24 253.50 .103 20.67 .000
SF36v2
- PF
Activity
Diversity
.27 .23 11.19 .037 7.31 .008
MAPA –
F x M
†
.28 .23 11.16 .010 1.92 .168
SF36v2
- RP
Activity
Diversity
.19 .14 766.49 .004 .80 .373
MAPA –
F x M
†
.21 .16 757.61 .025 4.58 .034
SF36v2
- BP
Activity
Diversity
.15 .10 10.65 .002 .28 .596
MAPA –
F x M
†
.15 .09 10.68 .002 .30 .585
204
Table 32, continued
Criterion
Variable
Unstandardized
coefficient
Model
R-Square
Model
Adjusted
R-Square
Std.
Error
of the
Estimate
R-Square
Change
Model
F
Change
‡
Significance
of Model
Change
SF36v2
- GH
Activity
Diversity
.16 .11 8.93 .006 1.00 .319
MAPA –
F x M
†
.23 .17 8.60 .066 12.21 .001
F36v2 -
VT
Activity
Diversity
.41 .37 673.81 .008 1.94 .166
MAPA –
F x M
*
.43 .39 663.68 .022 5.40 .022
SF36v2
- SF
Activity
Diversity
.38 .34 750.95 .019 4.35 .039
MAPA –
F x M
*
.40 .35 744.07 .015 3.70 .058
SF36v2
- RE
Activity
Diversity
.23 .18 815.74 .038 7.10 .009
MAPA –
F x M
*
.25 .19 809.94 .016 3.06 .083
SF36v2
- MH
Activity
Diversity
.31 .27 800.98 .016 3.40 .067
MAPA –
F x M
*
.38 .33 766.78 .062 14.04 .000
*
: Initial model included Gender, Ethnicity, Marital Status, Housing Status, Education, Income, Age,
SF36v2 Bodily Pain and General Health, and Activity Diversity
†
: Initial model included Gender, Ethnicity, Marital Status, Housing Status, Education, Income, Age,
CESD, and Activity Diversity
‡
: Activity Diversity: df 1 = 1, df 2 = 143
MAPA – F x M: df 1 = 1, df 2 = 142
N=154
F x M: Frequency x Meaning.
205
Table 33
Activity Frequency: Regression Models with
MAPA – Frequency x Meaning Entered Last
Criterion
Variable
Activity
Measure
Model
R-Square
Model
Adjusted
R-Square
Std.
Error of
the
Estimate
R-Square
Change
Model
F
Change
‡
Significance
of Model
Change
LSIZ
Activity
Frequency
.32 .27 4.62 .058 12.16 .001
MAPA –
F x M
*
.34 .29 4.57 .018 3.93 .049
PIL
Activity
Frequency
.41 .37 13.65 .132 32.02 .000
MAPA –
F x M
*
.46 .42 13.10 .050 13.21 .000
CESD
Activity
Frequency
.21 .15 1.32 .040 7.26 .008
MAPA –
F x M
*
.26 .21 1.28 .054 10.51 .001
EMAS
Activity
Frequency
.22 .16 548.41 .057 10.36 .002
MAPA –
F x M
*
.31 .25 517.52 .091 18.58 .000
SWLS
Activity
Frequency
.21 .16 266.03 .030 5.43 .021
MAPA –
F x M
*
.28 .22 265.02 .063 12.40 .001
SF36v2 –
PF
Activity
Frequency
.28 .23 11.18 .038 7.65 .006
MAPA –
F x M
†
.28 .23 11.19 .004 .78 .380
SF36v2 –
RP
Activity
Frequency
.19 .14 765.02 .008 1.36 .246
MAPA –
F x M
†
.22 .17 754.57 .027 5.02 .027
SF36v2 –
BP
Activity
Frequency
.15 .10 10.66 .001 .12 .732
MAPA –
F x M
†
.15 .09 10.68 .003 .44 .509
206
Table 33, continued
Criterion
Variable
Activity
Measure
Model
R-Square
Model
Adjusted
R-Square
Std.
Error of
the
Estimate
R-Square
Change
Model
F
Change
‡
Significance
of Model
Change
SF36v2 –
GH
Activity
Frequency
.15 .10 8.96 .000 .005 .943
MAPA –
F x M
†
.23 .18 8.57 .076 14.17 .000
F36v2 –
VT
Activity
Frequency
.42 .38 666.15 .021 5.29 .023
MAPA –
F x M
*
.43 .39 664.26 .007 1.81 .180
SF36v2 –
SF
Activity
Frequency
.39 .34 750.70 .019 4.45 .037
MAPA –
F x M
*
.40 .35 743.66 .016 3.72 .056
SF36v2 –
RE
Activity
Frequency
.25 .19 806.90 .055 10.41 .002
MAPA –
F x M
*
.25 .19 808.28 .003 .51 .476
SF36v2 -
MH
Activity
Frequency
.34 .30 787.71 .039 8.38 .004
MAPA –
F x M
*
.37 .33 767.89 .037 8.48 .004
*
: Initial model included Gender, Ethnicity, Marital Status, Housing Status, Education, Income, Age,
SF36v2 Bodily Pain and General Health, and Activity Frequency
†
: Initial model included Gender, Ethnicity, Marital Status, Housing Status, Education, Income, Age,
CESD, and Activity Frequency
‡
: Activity Frequency: df 1 = 1, df 2 = 143
MAPA – F x M: df 1 = 1, df 2 = 142
N=154
F x M: Frequency x Meaning.
207
Table 34
Comparison of R-Square Change with
MAPA-Frequency x Meaning Entered Last
R-Square Change
Criterion Variable
Activity
Diversity
MAPA-F x M
Activity
Frequency
MAPA-F x M
1. LSIZ .03* .02*
2. PIL .12** .05**
3. CESD .06** .05**
4. EMAS .12** .09**
5. SWLS .10*† .06**
6. SF36v2 -PF .01 .00
7. SF36v2-RP .03*† .03*†
8. SF36v2-BP .00† .00†
9. SF36v2-GH .07**† .08**†
10. SF36v2-VT .02*† .01
11. SF36v2-SF .02 .02
12. SF36v2-RE .02 .00
13. SF36v2-MH .06**† .04**†
*: p < .05
**: p < .01
†: Activity Diversity or Activity Frequency with non-significant model contribution
F x M: Frequency x Meaning
208
The most consistent trend from these analyses was that MAPA-Frequency x
Meaning outperformed the two traditional approaches to activity measurement in
predicting criterion measures. This tendency was evidenced across nearly all 13
indicators, though was most noticeable with regards to the psychological well-being
variables. Furthermore, models with the largest R-square and model R-square
change for MAPA-Frequency x Meaning involved the prediction of measures of
activity meaningfulness and purpose and meaning in life. These results appear to
offer additional validity evidence in support of the MAPA-Frequency x Meaning
scale as a measure of meaningful activity participation.
Cluster Analysis
A review of the dendrogram from the hierachical agglomerative cluster analysis
indicated that only minimal increases in intra-cluster variance occurred up to a three
cluster solution. A significant jump in intra-cluster variance was found when three
clusters were combined into two, indicating that a three cluster solution was likely
optimal. Further, prior to the two cluster solution there appeared to be a meaningful
cluster, despite having only 25 cases, which had remained relatively distinct from the
other clusters. The inclusion of this cluster affected a substantial increase in intra-
cluster variance as three clusters were combined into two, offering additional support
for the three cluster solution. The three cluster centroids obtained through
agglomerative cluster analysis were then entered as starting values for the K-means
209
approach of clustering. After the iteration procedure was unable to modify case
assignment, the final three cluster solution consisted of 55, 32 and 67 participants in
Clusters 1 through 3 respectively.
In sum, Cluster 2 (N=32) and Cluster 1 (N=55) members were more frequently
engaged across the majority of items than were Cluster 3 (N=67) members when the
28 MAPA-Frequency items were used to profile the three cluster solution. One-way
ANOVA were performed to evaluate the differences among the three clusters in
these activity items. Non-significant differences were found between the three
clusters for five activities: Using Public Transportation (F(2,151) = 2.33, p = .10),
Medical Visits (F(2,151) = 2.42, p = .09), Physical Exercise (F(2,151) = 1.02, p =
.37), Playing Games (F(2,151) = .18, p = .83), and Radio/TV (F(2,151) = 1.40, p =
.25); which indicated that these activities may not be useful in distinguishing
between persons based upon their cluster membership. A review of the Scheffe
multiple comparison results indicated that beyond the five activities noted above, no
statistically significant differences were found between Clusters 1 and 2 in an
additional 13 activity items. Five activities did distinguish between Clusters 1 and 2.
Cluster 2 participants engaged more frequently in Driving, Gardening, and both
Computer use activities, whereas Cluster 1 participants engaged more often in
Cultural activities (see Table 35).
210
Table 35
Scheffe Multiple Comparison of Clusters by MAPA Activity Frequency Ratings
Cluster 1 >
Cluster 3
Cluster 2 >
Cluster 3
Cluster 1 >
Cluster 2
Cluster 2 >
Cluster 1
Activity Type Mean Difference
Home making/home
maintenance
2.24** 2.13**
Personal finances 1.14** 1.64**
Driving 1.62** 3.82** 2.22**
Using public transportation
Medical visits
Socializing 1.40** 1.24**
Writing letters/cards 1.44** 2.02**
Helping others 2.41** 1.74**
Gardening 1.25** 2.27** 1.02*
Physical exercise
Crafts/hobbies 3.00** 2.40**
Cultural activities 2.12** 1.22** 0.92*
Musical activities 1.05**
Taking courses 1.37**
Creative activities 1.95** 2.19**
Traveling 0.93** 0.92**
Talking on the telephone 0.79** 1.00**
Reading
magazines/newspapers
0.92*
Other reading 1.48** 1.50**
Playing games
Radio/TV
Religious activities 1.76**
Prayer/meditation 1.74** 1.30*
Comm. Organization activities 2.23** 2.94**
Volunteer activities 2.60** 2.82**
Pet care activities
Computer use for email 4.67** 4.82**
Other computer use 5.16** 4.99**
**Indicates statistically significant mean differences, p < .001; * p < .01.
Non-significant findings are left blank
211
Demographic variables, MAPA derived variables and criterion variables were used
next to profile and validate the three cluster solution. Significant group differences
were found between clusters for age (F(2,151) = 12.88, p < .001) and income
(F(2,151) = 3.48, p = .03) but not for education. Scheffe follow-up procedures
indicated that both Cluster 1 and Cluster 3 participants were older than Cluster 2
participants, and Cluster 2 participants reported greater annual income than those of
Cluster 1. No significant differences were found between clusters for gender,
ethnicity or marital status. However cluster differences in housing status were
statistically significant ["
2
(2, N = 154) = 16.03, p < .001], with 74% of persons in
assisted living assigned to Cluster 3, whereas only 3% of persons in assisted living
belonged to Cluster 2.
Each of the three clusters was distinguishable from the others for the summated
MAPA derived scores (see Table 36). Statistically significant differences in group
means were found in Activity Diversity (F(2,151) = 104.06, p < .001); Activity
Frequency (F(2,151) = 215.64, p < .001), and MAPA – Frequency x Meaning
(F(2,151) = 104.38, p < .001). Cluster 2 participants engaged in a mean of 24.3
activities (SD = 2.7), followed by Cluster 1 with a mean 20.9 (SD = 2.6), and Cluster
3 with a mean 15.5 (SD = 3.5); and Scheffe follow-up procedures confirmed that
significant differences existed between these Clusters in terms of activity diversity,
activity frequency and meaningful activity participation, though these differences
were less pronounced between members of Cluster 1 and Cluster 2.
212
Table 36
Scheffe Multiple Comparisons of Clusters by MAPA and Criterion Variables
**Indicates statistically significant mean differences, p < .001; * p < .01; † p < .05.
CESD: Cluster 3 > Cluster 2 - mean difference 3.56, p < .05.
Non-significant findings are left blank
Cluster 1 >
Cluster 3
Cluster 2 >
Cluster 3
Cluster 2 >
Cluster 1
Activity Type Mean Difference
Activity Diversity 5.37** 8.82** 3.45**
Activity Frequency 33.63** 45.63** 12.00**
MAPA – Frequency x Meaning 111.00** 148.18** 37.19*
MAPA – Global 2.34† 4.45**
LSIZ 2.34† 4.43**
PIL 12.0** 11.5*
EMAS 3.11†
SWLS
SF-36v2 - PF 9.09** 11.03**
SF-36v2 - RP 5.96* 7.55*
SF-36v2 - BP
SF36v2 - GH
SF36v2 - VT 4.66†
SF36v2 - SF 6.40* 6.96†
SF36v2 - RE 7.43** 9.80**
Sf36v2 - MH
213
One-way ANOVA was also employed to test if group differences existed in terms of
the z-score-based positive intra-individual MAPA-Frequency x Meaning variable
and the average level of personal meaningfulness members assigned to their activity
participation. These analyses were employed to ascertain the extent to which the
level of meaningfulness persons’ ascribe to their activity participation and
engagement in participants’ most meaningful activities vary as a function of cluster
membership. Significant group differences were found for each variable: F(2,151) =
6.58, p < .01, and F(2,151) = 4.94, p < .01, respectively. Post hoc analysis discerned
that Cluster 2 participants had greater average scores for these variables compared to
Cluster 3 participants. These findings suggest that members of Cluster 2 are more
engaged in meaningful activities and ascribing greater personal meaningfulness to
their activities compared to Cluster 3 members.
Differences in psychosocial well-being and health related quality of life variables
were tested across clusters again using one-way ANOVA (see Table 36). A general
pattern in the results suggested greater psychosocial well-being for members of
Clusters 1 and 2 compared to Cluster 3. Group differences were found for the
MAPA – Global (F(2,151) = 12.37, p < .001), LSIZ (F(2,151) = 8.50, p < .001), PIL
(F(2,151) = 9.83, p < .001), CESD (F(2,151) = 4.76, p = .01), and EMAS (F(2,151)
= 3.90, p = .02); no group differences were found for the SWLS (F(2,151) = 0.94, p
= .39). Post hoc comparisons discerned Cluster 1 and Cluster 2 participants having
greater LSIZ and PIL scores compared to Cluster 3. Cluster 3 participants reported
214
greater depressive symptoms compared to Cluster 2; and Cluster 1 participants had
EMAS scores greater than Cluster 3.
Significant between groups differences were found for six out of the eight SF36v2
scales: SF36v2-PF (F(2,151) = 13.25, p < .001, SF36v2-RP (F (2,151) = 8.94, p <
.001), SF36v2-VT (F (2,151) = 5.37, p < .01), SF36v2-SF (F (2,151) = 7.25, p <
.001), SF36v2-RE (F (2,151) = 11.96, p < .001), and SF36v2-MH (F(2,151) = 3.19,
p = .04). No differences were found between groups for SF36v2-BP (F (2,151) =
1.33, p = .27) and SF36v2-GH (F (2,151) = 1.39, p = .25). Scheffe follow-up
procedures indicated that Cluster 1 and Cluster 2 participants had greater scores than
Cluster 3 participants for SF36v2-PF, SF36v2-RP, SF36v2-SF, and SF36v2-RE; and
Cluster 1 participants had higher SF36v2-VT scores than those in Cluster 3 (see
Table 36). Multiple comparisons between clusters in terms of the SF36v2 – MH
were not statistically significant, though Clusters 1 and 2 were larger than Cluster 3.
The cluster analysis methodology established three distinct groups with differing
levels of meaningful activity participation. In sum, Cluster 2 members were the most
active and engaged in personally meaningful activity, followed respectively by
Cluster 1 and 3 members based upon measures of activity diversity, activity
frequency and meaningful activity participation. In terms of demographic variables,
Cluster 2 members were typically younger, whereas a majority of Cluster 3 members
resided in assisted living facilities. Members of both Cluster 2 and Cluster 1 tended
215
to be equivalent in reporting greater levels of psychosocial well-being and health-
related quality of life compared to Cluster 3 members despite significant differences
in meaningful activity participation across the three groups, though some exceptions
did arise. From these results it appears that some minimal level of meaningful
activity participation may be required to maintain psychosocial well-being and
health-related quality of life.
Path Analysis
Semi-partial correlations between each of the four model variables were obtained
demonstrating theoretically anticipated relationships (see Table 37).
Table 37
Partial Correlations
†
between Tentative Causal
Model Variables
Model Variables
1 2 3 4
1. MAPA 1
2. PIL .53
**
1
3. SF-36v2 Physical Health
Component Score
.23
**
.24
**
1
4. SF-36v2 Mental Health
Component Score
.39
**
.44
**
.01‡ 1
†: controlling for age, gender, education and income
**: significant at p < .01
‡: non-significant
216
Stepwise regression models employed to establish the effects the exogenous and
intervening variables upon the endogenous variables resulted in three significant
paths, one marginally significant path, and one non-significant path. The tentative
causal model was partially supported in this present sample (see Figure 3). MAPA-
Frequency x Meaning demonstrated a substantial direct effect upon the PIL (! = .56,
p < 0.001), and accounted for 26% of the PIL’s variance (e = 0.74). MAPA-
Frequency x Meaning did not have a statistically significant direct affect upon the
SF-36v2 Physical health component (! = .14, p = 0.15) but did achieve a
meaningfully significant direct affect upon the SF-36v2 Mental health component (!
= .23, p = 0.02). In turn, the PIL had a marginal direct effect upon the SF-36v2
Physical health component (! = .17, p = 0.07), and a sizeable direct affect upon the
SF-36v2 Mental health component (! = .35, p < 0.001). Together, MAPA-
Frequency x Meaning and PIL contributed 7% (e = 0.93) of the unique variance to
the SF-36v2 Physical health component and 23% (e = 0.77) to the SF-36v2 Mental
health component. The error variance (e) values in Figure 3 do not reflect
contributions from the four demographic variables, as these variables were controlled
in the regression models.
Results for identifying the PIL as a mediating variable were mixed, though the three
criteria proposed by Baron and Kenny (1986) were by in large upheld (see Table 38).
MAPA-Frequency x Meaning demonstrated statistically significant effects upon the
PIL (! = .56, p < 0.001), SF-36v2 Physical health (! = .24, p < 0.01) and SF-36v2
217
**: p < 0.01; *: p < 0.05
Figure 3. Path Analysis of Causal Model.
Mental health (! = .42, p < 0.001) components, satisfying the first two criteria. In
support of the third criterion, the PIL contributed substantial variance to the
prediction of the SF-36v2 Mental health component (! = .35, p < 0.001) and was
marginally significant in predicting the SF-36v2 Physical health component (! = .17,
p = 0.07) controlling for the MAPA. In further support of the third criterion, the
unstandardized betas of MAPA-Frequency x Meaning were diminished from Models
2a and 2b when controlling for the PIL (compare to Models 3a and 3b in Table 38).
A marginally significant Sobel test suggested that the PIL may mediate the
.23*
.56**
.35**
SF-36v2
Mental
Component
Summary
SF-36v2
Physical
Component
Summary
Purpose in
Life Test
Meaningful
Activity
Participation
Assessment
e = .74
e = .77
e = .93
218
relationship between MAPA-Frequency x Meaning and the SF-36v2 Physical health
component score [z(154) = 1.79, p = 0.07]. However, the PIL did not appear to
mediate the relationship between MAPA-Frequency x Meaning and the SF-36v2
Mental health component [z(154) = 0.25, p = 0.80], despite satisfying Baron and
Kenny’s (1986) three criteria.
Table 38
Test of PIL Mediation between MAPA and SF-36v2 Components
Mediator
Criterion
Predictor
Variable(s)
Outcome
Variable
Unstandardized Standardized Significance
Beta
Standard
Error
Beta
1 MAPA PIL 0.115 .015 0.558 p < 0.001
2a MAPA SF36v2 PCS 0.029 0.011 0.238 p < 0.01
2b MAPA SF36v2 MCS 0.053 0.010 0.423 p < 0.001
3a MAPA 0.018 0.012 0.142 p = 0.15
PIL
SF36v2 PCS
0.103 0.056 0.172 p = 0.07
3b MAPA 0.029 0.012 0.229 p = 0.02
PIL
SF36v2 MCS
0.210 0.054 0.346 p < 0.001
PCS: Physical Component score
MCS: Mental Component score
each model controls for age, gender, education and income.
219
CHAPTER FIVE
Discussion
The findings of this study offer initial empirical support for the validity of the
MAPA as a measure of meaningful activity participation. Tests of the six main study
hypotheses provided nearly unequivocal confirmation of the study’s propositions, as
the MAPA, and more specifically MAPA-Frequency x Meaning, established
theoretically predicted relationships with a broad array of psychological well-being
and health-related quality of life indicators. This study explored a large number of
MAPA-derived variables to determine their utility in predicting key health and well-
being criterion measures. Of these MAPA-derived variables, MAPA-Frequency x
Meaning emerged as the best single indicator of the construct of meaningful activity
participation. Additionally, the MAPA-Frequency x Meaning scale was found to
have very good test-retest and internal consistency reliability, further supporting its
psychometric qualities.
The following discussion addresses some of the more significant aspects of this
study. In terms of the six main study hypotheses, discussion will focus primarily on
the MAPA-Frequency x Meaning scale as it was found to best represent the construct
of meaningful activity. Discussion will then turn to the eight research questions
employed as part of the general analytic approach taken to explore the many facets
220
of the MAPA scales. Next, the implications of the cluster analysis and the test of the
tentative causal model will be briefly reviewed. Finally, the study limitations and
some suggestions for future research will be addressed.
Tests of the Study’s Main Hypotheses
In support of the first hypothesis, a moderate positive correlation was found between
MAPA-Frequency x Meaning and the PIL. This is a notable finding given the
centrality of meaningful activity and meaning and purpose in life in occupational
science. For example, Clark et al (1991) had asserted that engagement in
meaningful activity contributes to an individual’s sense of meaning and life purpose.
Further, it had been posited that personal meanings are attached to the activities that
occupy our time (Jackson, 1996; Yerxa et al, 1989). Given these propositions, one
challenge for occupational science has been, and will continue to be, how to best
operationalize the idea of participation in meaningful activity. The support of this
hypothesis offers some initial empirical evidence relating these two vital constructs,
and introduces an instrument capable of tapping into the construct of meaningful
activity participation.
This finding also has important implications for social gerontology research, as
previous studies have typically only explored the relationships between purpose and
meaning in life and discrete activities such as work and volunteering (Gerwood,
221
1995; Weinstein, Xie, and Cleanthouse, 1995), and spiritual activities (Ardelt, 2003),
typically with equivocal findings. This is the first study that has demonstrated the
important connection between a more comprehensive measure of activity and
meaning and purpose in life. Given that our day to day activities serve as critical
sources of personal meaning (Prager, 1996; Reker & Wong, 1988), the MAPA-
Frequency x Meaning scale may offer a fundamental tool to investigate the
contributions that meaningful activity offers to the development of life purpose and
meaning.
Support for the second hypothesis was established as moderate positive associations
were evidenced between the MAPA-Frequency x Meaning scale and other scales of
meaningful activity participation. The two more notable correlations were found
with the EMAS, a previously validated measure of meaningful activity participation,
and MAPA-Global, a tool developed to reflect the aspects of meaningful activity
represented in the multiple forms of the MAPA tested in this study. Both the EMAS
and MAPA-Global consist of items requiring a judgment of overall activity
meaningfulness across multiple categories of meaning, whereas MAPA-Frequency x
Meaning takes a more ground-level approach in its focus on specific activities and
their related personal meaningfulness. Therefore, the resultant moderate correlations
lend support to the position that these scales are addressing related aspects of the
meaningful activity participation construct despite their unique item content.
222
As hypothesized, a positive correlation was found between MAPA-Frequency x
Meaning and the two measures of life satisfaction employed in this study (i.e., LSI-Z
and SWLS), though the magnitude of these relationships was moderate (r’s < 0.40.
Nonetheless, this finding offers additional evidence of the construct validity of the
MAPA-Frequency x Meaning scale given the longstanding understanding that
measures of activity are associated with life satisfaction (e.g., Brown & Frankel,
1993; Harlow & Cantor, 1996; Menec & Chipperfield).
Meaningful positive associations were also found between seven of the eight
indicators of health-related quality of life and MAPA-Frequency x Meaning, offering
nearly unequivocal support to two additional study hypotheses. The larger and most
consistent relationships were evidenced with the SF36v2 mental health subscales,
including Vitality, Social Functioning, Role Emotional and Mental Health. In terms
of the physical health subscales, Physical Functioning, Role Physical and General
Health established consequential correlation coefficients; only Bodily Pain failed to
yield a significant association with MAPA-Frequency x Meaning. MAPA-
Frequency x Meaning also evidenced greater mean zero-order correlations with these
indices compared to MAPA-Frequency.
These findings are consistent with previous research that has demonstrated positive
relationships between measures of activity and self-rated health (Luoh & Herzog,
2002; Pinquart, 2001; Ritchey, Ritchey & Dietx, 2001; Van Willigen, 2000), and
223
specifically, the SF-36 (Jenkins, Pienta, & Horgas, 2002). Further, Spiro III and
Bossé (2000) have suggested that measures of health-related quality of life should be
included in research studies to improve our understanding of health and well-being
among older persons. The present findings may serve to inform future studies in
social gerontology, as they imply that mental health may be related to meaningful
activity participation to a greater degree than is physical health. Furthermore, the
MAPA-Frequency x Meaning scale resulted in a larger mean correlation with the
SF36-v2 subscales compared to the MAPA-Frequency scale. This finding suggests
that combining subjective attributions of meaning with activity frequency ratings
holds potential for explicating the relationships between activity participation and
both mental and physical health. Additionally, these results are relevant to the
discipline of occupational science as they are consistent with the proposition that
engagement in meaningful occupation (activity) facilitates health (Clark et al., 1991;
Yerxa, et al., 1989).
Finally, in support of the final main study hypothesis, a low negative correlation was
discerned between MAPA-Frequency x Meaning and the CES-D. This result offers
additional evidence supporting the construct validity of the MAPA-Frequency x
Meaning scale given that previous research has revealed low negative relationships
between measures of activity and measures of depressive symptomology (e.g.,
Adams, Sanders, & Auth, 2004), and the CES-D (Utz, Carr, Ness, and Wortman,
2002; Herzog, Franks, Markus, & Holmberg, 1998).
224
Discussion of the Study’s Eight Research Questions
Beyond the main hypotheses of the study, eight specific research questions were
addressed. These research questions had been employed as part of a general analytic
approach to explore the many facets of the MAPA scale, including the potential of
identifying variables derived from the MAPA that could meaningfully aid in the
prediction of the criterion variables. These analyses ultimately involved a wide array
of statistical methods including zero-order correlations, principal component
analysis, and multiple regression analysis. The following sections discuss each of
the research questions in the general order with which they had unfolded throughout
the course of data analyses.
Is there empirical evidence to support generating the MAPA-Frequency x Meaning
score?
There were a number of results which together offered evidence to support the
multiplicative approach taken to generate the MAPA-Frequency x Meaning variable.
Zero-order correlations evidenced positive associations between MAPA-Meaning,
Activity Diversity and Activity Frequency, which suggested persons who were
participating in a greater number of activities or were engaged more frequently in a
greater number of activities ascribed more meaning to their activities. Further,
Average MAPA-Frequency demonstrated significant low positive correlations with
225
Average MAPA-Meaning, also supporting the idea that more frequent participation
in one’s activities is related to ascribing greater personal meaningfulness to those
activities. Finally, low positive associations were also evidenced between intra-
individual frequency and intra-individual meaning for a majority of the MAPA
activity items which indicated that persons, on an ipsative level, tended to ascribe a
greater level of personal meaning to those activities in which they were more
frequently engaged.
The methods used to identify relationships between activity frequency (or breadth)
and activity meaning were more discriminating compared to other studies. For
example, Ray and Heppe (1986) had found a positive association between activity
frequency and activity commitment in their study. However, they had not controlled
for the variance of activity breath inherent in both variables, which likely contributed
to their large correlation coefficient. The present study utilized both nomothetic and
ipsative level variables reflecting activity meaning and frequency. The resultant
positive associations between meaning and frequency from both of these approaches
are therefore noteworthy.
Though positive associations between activity meaningfulness and frequency found
in the present study were low, the finding that activities which were performed more
often tended to be ascribed greater levels of personal meaning may be of theoretical
interest. For example, within their model of selective optimization with
226
compensation, Baltes and Baltes (1990a) suggest that the aging individual selects
and concentrates on those activities which are of high priority. The selection process
engages subjective evaluations of activity options, in which activity meanings would
be salient. Declines in the frequency of performing certain activities due to age-
related changes could feasibly be associated with concomitant downward shifts in
the personal meaningfulness associated with those activities. This position is in
agreement with Shultz and Heckhausen’s (1995) model of developmental regulation,
wherein the process of secondary control involves shifting perceptions, or the
devaluing of goal pursuits, when personal competencies are challenged.
Consequently, the MAPA could be employed as a reliable and valid tool capable of
measuring these changes in activity participation and meaningfulness.
Is MAPA-Frequency x Meaning or MAPA-Frequency x Health a better predictor of
the criterion variables?
A number of lines of evidence converged to indicate that MAPA-Frequency x
Meaning, compared to MAPA-Frequency x Health, was more useful in predicting
criterion measures. Extremely high zero-order correlations between these two
variables were found indicating a high degree of similarity. However, zero-order
correlations with the criterion measures indicated that MAPA-Frequency x Meaning
had consistently higher associations and larger model R-square values, and was also
a significant predictor within multiple regression models.
227
From a conceptual standpoint, it was not clear why MAPA-Frequency x Meaning
was superior to MAPA-Frequency x Health, though one result may offer some light
to this finding. An extremely high zero-order correlation was demonstrated between
Activity Frequency and MAPA-Frequency x Health (r = 0.96), suggesting these two
variables were nearly identical and could easily be considered proxies. The
operationalization of the subjective attribution of health therefore offered little
significant variance beyond the MAPA Frequency scale when compared to the
MAPA-Frequency x Meaning scale. Though both of these MAPA variables were
intended to capture aspects of activity meaningfulness, the general meaningfulness
inherent in MAPA-Frequency x Meaning was likely capable of tapping broader or
more varied ascriptions of its intended concept.
Is there potential utility in the use of principal components involving MAPA scale
variables as predictors of criterion variables beyond MAPA-Frequency x Meaning?
Overall, it was found that the regression coefficients derived from principal
component analyses of the varied MAPA scales did not contribute to the prediction
of the criterion measures beyond MAPA-Frequency x Meaning. This was not an
unforeseeable finding given that factor analytic methods applied to activity scales
typically achieve marginal success. For example, Warr, Butcher and Robertson
(2004) found six factors using PCA, of those only one representing socially engaged
activities was able to predict psychological well-being. Nonetheless, a finding
228
unique to this study involved shifting activity-component relationships across the
different scales. The novel design of the MAPA allowed exploration of the factor
structure of activity scales combining frequency ratings with subjective attributions
of meaning. Changes in factor structure were clearly evident, suggesting that
subjective attributions of meaning induce shifts in activity–component relationships.
This was clearly the case when activity–component relationships between MAPA-
Frequency and MAPA-Frequency x Meaning were evaluated. The MAPA-
Frequency component with the greatest variance was found to include six activity
items suggestive of an active and community engaged lifestyle. However, these
same six activities were shared by three of the MAPA-Frequency x Meaning scale
components. These findings suggest that the ascription of meaning to activities
results in unique activity–component relationships that could not be discerned when
only analyzing frequency ratings.
Will intra-individual (z-score derived) MAPA scale variables serve to predict
criterion variables beyond MAPA-Frequency x Meaning?
The intra-individual MAPA variables did not as a group help in the prediction of the
criterion measures, though they did provide important information about the nature
of the MAPA. Analysis of specific activity–criterion measure relationships were not
reported in this study, though some intra-individual level activity data were
especially interesting. For example, Driving, Reading Magazines/Newspapers, and
229
Radio/Television were the three most personally meaningful activities for persons
who were engaged in them. This finding has important corollaries with other
research indicating relationships between these activities and well-being (e.g.,
Harlow & Cantor, 1996). Also, persons reported Physical Exercise and
Prayer/Meditation as the two most healthful activities, suggesting participants
perceived both physical and spiritual activities as contributing to their health.
Alternatively, Using Public Transportation was perceived as least healthy, though it
was one of the more personally meaningful activities. Therefore, intra-individual
level data afforded a refined look into activity meaning that could not have been
gained through a normative lens.
Analyses also involved the generation of two z-score-based MAPA-Frequency x
Meaning variables. Negative MAPA-Frequency x Meaning utilized persons’
activities with below average personal meaning; the positive MAPA-Frequency x
Meaning variable included activities that were above average in personal
meaningfulness. This approach thereby established contrasting activity groups for
each person based upon the degree of each activity’s personal meaningfulness. A
stark contrast between these variables was found in zero-order correlations with
criterion measures. The negative MAPA-Frequency x Meaning variable failed to
achieve even one statistically significant association with measures of psychological
well-being and health-related quality of life, whereas positive MAPA-Frequency x
Meaning held low to moderate correlations with 10 of the 13 criterion measures.
230
Further, the negative MAPA-Frequency x Meaning variable was comprised, on
average, of 50% more activities than its counterpart. This finding was suggestive of
the critical role personal meaning may play in persons’ overall activity routines.
From this analysis, it appeared that relationships with key health and well-being
indicators may be more a function of the personal meaningfulness ascribed to
activity participation as opposed to the sheer breadth of one’s activities.
Does the MAPA-Reasons variable aid in the prediction of the criterion variables
beyond Frequency x Meaning?
Unfortunately, the results of these analyses were rather unequivocal, as the reasons
for activity engagement did not contribute to the prediction of criterion measures. In
zero-order correlations with criterion variables, the best performing MAPA-Reasons
variable involved the frequency of activity participation for activities persons
indicated the reason of “Need to of have to,” as it held five low positive correlations.
However, these relationships did not persist when this MAPA-Reasons variable was
entered with MAPA-Frequency x Meaning in regression models. This finding was
somewhat unexpected given positive results reported by other researchers (Bevil,
O’Connor, & Mattoon, 1993; Everard, 1999; Steinkamp & Kelly, 1987).
One explanation for the negative finding may be related to how the MAPA-Reasons
variables were operationalized in this study. For each activity, participants were
231
asked to choose only one of the reasons options available to them. This forced-
choice approach limited each activity to only one reason. Bevil, O’Connor, and
Mattoon (1993) allowed participants to choose from a broad range of benefits
(reasons) perceived as relevant for a given activity and found that the number of
different reasons was associated with well-being. A similar approach was taken by
Everard (1999), though participants were offered a more limited set of reasons. The
approach taken in the present study resulted in only one reason option per activity,
likely limiting participants’ ability to report multiple reasons for their engagement.
Does MAPA-Frequency x Meaning add statistically significant variance to the
prediction of criterion variables beyond that of traditional activity variables (i.e.,
Activity Frequency and Activity Diversity)?
The findings from a range of statistical procedures converged in demonstrating the
superior performance of MAPA-Frequency x Meaning in predicting criterion
variables. The findings from these analyses suggested that merging objective
frequency data with subjective attributes of personal meaningfulness results in a
scale that is not only comparable, but outperforms traditional activity measurement
approaches. The first line of evidence to support this position came from zero-order
correlations between the differing activity measurement approaches and measures
psychological well-being and health-related quality of life. MAPA-Frequency x
Meaning evidenced low to moderate correlations with 12 of the 13 criterion
232
variables. Further, MAPA-Frequency x Meaning demonstrated correlation
coefficients that were equal to or larger than Activity Diversity and Activity
Frequency in these 12 health and well-being indicators.
Multiple regression analyses were utilized to garner evidence of the predictive
capability of MAPA-Frequency x Meaning index. Larger model R-square and R-
square change values were found for nearly every criterion variable when MAPA-
Frequency x Meaning was compared to models including either Activity Diversity or
Activity Frequency. MAPA-Frequency x Meaning consistently outperformed
Activity Diversity, though these differences were most apparent in measures of
psychological well-being when Activity Frequency was evaluated. A similar pattern
was discerned when step-wise entry hierarchical regression analysis was employed.
MAPA-Frequency x Meaning was selected for entry into 11 of 13 models predicting
criterion measures at the exclusion of Activity Diversity, and MAPA-Frequency x
Meaning was preferred at the exclusion of Activity Frequency in 10 models. In the
last multiple regression analysis approach, MAPA-Frequency x Meaning was forced
into models already containing either Activity Diversity or Activity Frequency.
MAPA-Frequency x Meaning resulted in nine model improvements when included
with Activity Diversity, and eight models were improved when combined with
Activity Frequency. Again, MAPA-Frequency x Meaning consistently enhanced the
prediction of psychological well-being indicators, whereas contributions to the
233
health-related quality of life indicators were less striking. SF36v2-BP was the only
criterion indicator the group of activity variables was unable to predict.
The general trend of results supports the MAPA-Frequency x Meaning scale as a
valid indicator of meaningful activity participation. Given that the instrument was
operationalized, in part, with an activity check-list approach, high correlations found
between it, Activity Diversity and Activity Frequency were expected. The
multiplicative approach taken to generate MAPA-Frequency x Meaning resulted in a
scale that was capable of establishing consistently larger correlations with the
criterion variables employed in this study. The most substantial differences were
evidenced in regression models predicting the Engagement in Meaningful Activity
Survey (Goldberg, et al, 2002) and the Purpose-in-Life test (Crumbaugh &
Maholick, 1969). These findings contribute additional evidence to support the
construct validity of the MAPA-Frequency x Meaning scale as a valid measure of
meaningful activity participation.
Though MAPA-Frequency x Meaning was unfailing in outperforming the other
activity measurement approaches in the prediction of the psychological well-being
variables, this was not the case in terms of the HRQL indices. It would therefore
appear that the combination of subjective attributes of meaning with frequency
ratings of activity participation relate most consistently to the cognitive and affective
aspects of life satisfaction, depression, and purpose and meaning in life. In turn,
234
subjective attributes of meaning may be somewhat less critical in explaining HRQL
beyond that of activity frequency or breadth.
Does MAPA-Global contribute unique variance to the prediction of the criterion
measures when combined with MAPA-Frequency x Meaning?
Results from multiple regression models evidenced MAPA-Global contributing
unique variance to 10 of the 13 indicators of psychological well-being and health-
related quality of life. This finding was not wholly unexpected as MAPA-Global
was intended as a brief instrument for tapping the construct of meaningful activity
participation. However, what was not anticipated was the extent to which MAPA-
Global would aid MAPA-Frequency x Meaning in predicting criterion measures.
MAPA-Global obtained larger standardized betas in six out of the seven models in
which both variables were contributing statistically significant variance, adding an
additional .03 to .12 to the models’ R-square. The largest and most consistent of
these contributions were in predicting psychological well-being measures.
The combination of MAPA-Frequency x Meaning and MAPA-Global may therefore
best represent the construct of meaningful activity participation for the majority of
criterion indicators. This understanding was substantiated for the psychological
well-being measures including: life satisfaction, depressive symptomology, activity
meaningfulness and purpose and meaning in life. The combination of the two
235
meaningful activity participation measures also aided in the prediction of the Role
Emotional and Mental Health subscales from the SF36v2. However, this
combination of MAPA scales, in general, offered little to the prediction of the
physical health subscales of the SF36v2 beyond MAPA-Frequency x Meaning.
These findings may offer interesting possibilities for future studies exploring activity
meaning and its relationship to measures of psychological well-being and health-
related quality of life. As mentioned above, the MAPA-Global scale was developed
to reflect aspects of meaningful activity represented in the multiple forms of the
MAPA, utilizing six items in which judgments of overall activity meaningfulness
were required. The MAPA-Frequency x Meaning took a more ground-level
approach in its focus on specific activities and their related personal meaning.
Cluster Analysis
Cluster analysis was employed in this study as an exploratory approach, given its
novel use of activity items as cluster variables. Hierarchical agglomerative and
iterative clustering procedures were used to best represent the structure of the data
(Hair & Black, 2000), resulting in a three cluster solution. The clusters were
distinguished most clearly by MAPA-Frequency x Meaning, Activity Diversity and
Activity Frequency, as Cluster 2 members were most frequently engaged in a greater
number of personally meaningful activities, followed by members of Clusters 1 and
236
2 respectively. The use of the MAPA-Frequency activity items as cluster variables
thereby afforded a contrasted groups approach for studying differences in criterion
measures. One-way ANOVA and post-hoc analyses demonstrated that, in general,
members of Clusters 2 and 1 reported greater levels of psychological well-being and
health-related quality of life compared to members of Cluster 3. This finding was
consistent with the zero-order correlations found between MAPA-Frequency x
Meaning and criterion variables.
Results from the contrasted groups analyses led to the supposition that a critical level
of meaningful activity involvement may be required for the maintenance of health
and well-being in older adults. However, it remained uncertain as to what factors
might explain this finding. The following tentative explanation is proffered to
elucidate this issue, with the understanding that the implied causal relationships
cannot be confirmed given the study’s design. Three related considerations that
arose from the results form the basis of the explanation. First, despite differences in
meaningful activity participation (MAPA) between Clusters 2 (high MAPA) and 1
(medium MAPA), these persons were equivalent in terms of psychological well-
being and health-related quality of life. Next, differences in meaningful activity
participation between members of Clusters 1 (medium MAPA) and 3 (low MAPA)
were associated with comparable differences in the majority of health and
psychological well-being indicators. Finally, a group of meaning-related variables
(i.e., PIL, EMAS, MAPA-Global) did not differ between members of Clusters 2
237
(high MAPA) and 1 (medium MAPA), though these indices were, in general, higher
for members of Cluster 1 (medium MAPA) compared to Cluster 3 (low MAPA)
members.
These findings led to the idea that the meaning-related variables may serve a critical
role in the maintenance of health and well-being as older adults are faced with age-
related declines. For instance, as meaningful activity declines, health and well-being
may be sustained through a sense of meaning and purpose in life, in addition to
perceiving one’s activities as meaningful; members of Cluster 1 (medium MAPA)
compared to Cluster 2 (high MAPA) reflect this proposition. However,
concomitantly low levels of both meaningful activity participation and the meaning-
related variables appear to be associated with lower levels of health and well-being,
as was evidenced for members of Cluster 3 (low MAPA). Theoretical and empirical
support for this interpretation arises mainly from studies which have related purpose
and meaning in life to key aging outcomes (e.g., Smith & Zautra, 2000; Ryff &
Singer, 1998; Zika & Chamberlain, 1992). Therefore, it is feasible to suggest that as
participation in meaningful activity declines, health and well-being may be sustained
through personal meaning. A sense of meaning may also serve to support coping
processes in the face of age-related physical declines (Antonovsky, 1987; Park &
Folkman, 1997). However, at some point, if declines in meaningful activity
participation levels are associated with decrements in critical meaning related-
238
variables, there may be significant negative implications for personal health and
well-being.
Tentative Causal Path Model
The primary purpose of the causal model employed in this study was to empirically
test the validity of the MAPA-Frequency x Meaning scale by situating it in
relationship to measures of theoretically related constructs (e.g., purpose and
meaning in life and health-related quality of life). The secondary purpose was to
substantiate the theoretical relationships among these four constructs. However,
because of the correlational design of this study, results supporting the contributory
links suggested within this model should not be construed as evidence of causality.
Though it was proposed that meaningful activity participation influences purpose
and meaning in life, a reciprocal relationship between these two constructs may also
be likely; this would be the case for other directional relationships suggested by the
model.
Overall, the results of the path analysis provide mixed support for the hypotheses
inherent in the model proposed for this study. Partial support for the hypothesis that
meaningful activity would directly affect purpose in life, as well as physical and
mental components of health-related quality of life was found. MAPA-Frequency x
Meaning had a direct effect on both the PIL and the SF-36v2 Mental health
239
component, but not the SF-36v2 Physical health component. Mixed support was
also found for the hypothesis that purpose and meaning in life would mediate the
relationships between meaningful activity and health-related quality of life. The PIL
was found to mediate the relationship between MAPA-Frequency x Meaning and the
SF-36v2 Physical health component, though the significance of the Sobel statistic
was marginal. Based on the Sobel test, the PIL did not mediate the relationship
between MAPA-Frequency x Meaning and the SF-36v2 Mental health component;
however, all three of Baron and Kenny’s (1986) mediational criteria were satisfied.
Finally, the hypothesis that purpose in life would contribute directly to the physical
and mental aspects of health-related quality of life was also partially supported. The
PIL had a marginal direct affect upon the SF-36v2 Physical health component and
the direct affect of the PIL upon the SF-36v2 Mental health component was
substantial.
Ultimately, the results of the path model reflect the findings from earlier multiple
regression analyses in which MAPA-Frequency x Meaning predicted the criterion
variables employed in this study. Notably, these findings serve to validate the
relationships between meaningful activity participation, meaning and purpose in life
and mental health, a finding that was not afforded from previous analyses in this
study. This research is unique in demonstrating that meaningful activity
participation contributes to purpose and meaning in life. Furthermore, the findings
from tests of this model suggest that meaningful activity not only supports meaning
240
and purpose in life, but that both constructs may serve unique roles in maximizing
mental health.
The failure of both MAPA-Frequency x Meaning and the PIL to contribute to the
Physical health component of the SF-36v2 was an unexpected finding from the test
of this model. Both the PIL and MAPA-Frequency x Meaning established low
partial-correlation coefficients with the SF-36v2 Physical health component,
suggesting their contributions to physical health would be slight. And though
MAPA-Frequency x Meaning initially evidenced a direct effect upon the SF-36v2
Physical health component, the addition of the PIL substantially reduced this
contribution, resulting in non-significant coefficients for both paths. Though, as
discussed above, MAPA-Frequency x Meaning did not contribute to the prediction
of the HRQL variables beyond MAPA-Frequency, it is interesting that MAPA-
Frequency x Meaning was found to predict the SF-36v2 Mental health component.
One interpretation of these findings is that the constructs of purpose and meaning in
life and meaningful activity participation play a smaller role in the promotion of
physical as apposed to mental health. Both MAPA-Frequency x Meaning and the
PIL were intended as measures reflecting unique aspects of personal meaning,
relying on cognitive and affective evaluations which are more likely related to
psychological well-being and mental health. Therefore, the findings of the present
241
study serve to extend the growing literature that has reported similar relationships
between personal meaning and health (e.g., Zika and Chamberlain, 1992).
However, some prior research on these relationships may be criticized for utilizing
limited indicators of their constructs. For example, Krause and Shaw (2003) had
reported a significant contribution of meaning in life to self-rated health, though both
indicators used in their study had not been validated, and only three questions
composed their measure of self-rated health. The present study utilized a well
validated measure of health-related quality of life, with distinct mental health and
physical health components, thereby allowing more refined insight into the
contributions of personal meaning and meaningful activity to health. Nonetheless,
meaningful activity, and the possible mediating effects of life purpose and meaning
upon physical health are of significant interest, given that the models proposed by
Antonovsky (1987) and Ryff and Singer (1998) highlight diverse physiological
systems linking purpose and meaning in life to health. It is likely that relatively long
intervals of exposure may be required to ascertain the health outcomes of these
physiological mechanisms, and the design of this study was clearly not capable of
this.
242
Limitations of the Study
The main study limitation involved the use of a convenience sample of older adults
from the Los Angeles area. U.S Census Bureau statistics on persons 65 years and
older living in the Los Angeles area in 2005 indicated that 61% were Caucasian
(82% in study sample), 59% were female (77% in the study), 52% were living with
another person (86% in the study), and 46% (66% in the study) were educated
beyond the high school level (U. S. Census Bureau. 2005 American Community
Survey, 2005). The present sample differed from the Los Angeles area population in
that most were Caucasian females, living with their spouse or another person,
therefore, care must be taken when extrapolating the study findings. Sub-group
analyses were not conducted to determine the impact of these demographic variables
in terms of MAPA/criterion relationships, though these variables were controlled in
multiple regression models.
Another concern relates to the ‘third variable’ problem, wherein the relationship
between two variables might be explained by some other variable. For example, the
positive relationship found between meaningful activity and well-being (i.e., life
satisfaction) may be due to the influence of social support. This is a reasonable
supposition given the associations that have been reported between social support
and well-being (e.g., Finch, Okun, Berrera, Zautra, & Reich, 1989; Fry, 2001), and
social support and activity participation (Eyler et al., 1999; Stähl et al., 2001).
243
Though social support was not measured in this study, the use of statistical controls
in multiple regression combined with the consistency by which MAPA-Frequency x
Meaning predicted a broad array of criterion indicators affords some initial evidence
in support of the measures validity.
Also, the design of the present study does not allow for any conclusions to be drawn
about causal relationships amongst the study constructs. For example, though theory
would support the role meaningful activity participation plays in the development of
meaning and purpose in life, the results from this study do not offer evidence to rule
out the possibility that meaning and purpose in life causes greater activity
participation. Nevertheless, theory has played a substantial role in supporting the
operationalization of the MAPA, in addition to proposing the main study hypotheses
for testing its validity, and the evidence garnered from this study does support the
construct validity of the MAPA-Frequency x Meaning scale.
Another possible limitation involved the use of measures that rely solely on
participant self-report, thereby subjecting the study to the criticism of response bias.
Nonetheless, this study utilized well-validated indicators of the criterion constructs
which established relatively high internal consistency coefficients in this sample,
thereby suggesting that participants were generally consistent in their responding to
these measures. A related issue is the concern for recall bias, specifically in terms of
the MAPA-Frequency scale, as respondents were directed to recall their activity
244
participation over the past ‘few months’. However, the two-week test-retest
reliability coefficients for the MAPA-Frequency x Meaning scale was quite good,
suggesting that participant recall was reasonably consistent.
A final concern deals with the possibility that some of the statistically significant
findings may have been obtained by chance due to the rather large number of
statistical tests employed to examine the study’s main hypotheses, in addition to
exploring the multiple facets of the MAPA scales. This critique relates to an
increased likelihood of committing a Type I error. A common approach for dealing
with multiple tests involves reducing the alpha level for every test by a factor of the
total number of tests employed in the study; the Bonferroni adjustment is commonly
employed (Pedhazur & Schmelkin, 1991; Thomas et al., 1985). Given this
perspective the, correlations between just the MAPA-Frequency x Meaning scale and
the 13 criterion variables would require a family-wise alpha level of .004, as study
alpha levels were set at .05. Interestingly, upon reexamining the results of the study,
11 of the associations obtained p-values just below .004, with SF-36v2 General
Health (p = .014) and Bodily Pain (p = .11) being the exceptions.
However, given the exploratory nature of this study, many more tests of association
were involved, and applying such an adjustment would have likely led to an
unjustified dismissal of meaningful results (Pernegar, 1998; Savitz & Olshan, 1995;
Thomas et al., 1985). For example, it was also of interest to determine which of the
245
MAPA-derived scales performed best in zero-order correlations with the criterion
variables. Given at least five derivations of the of the MAPA scales (i.e., Frequency,
Meaning, Health, Frequency x Health, Frequency x Meaning), a test-wise alpha level
of .0008 would have been required. There was also interest in exploring associations
between the criterion variables and other MAPA-derived variables such as MAPA-
Reasons, PCA regression coefficients, and intra-individual (z-score) variables. In
sum, the calculation of all zero-order correlations employed in this study resulted in
at least 650 correlation coefficients, thereby necessitating a test-wise alpha level of
nearly .00008. Such an alpha level adjustment would have made it extremely
difficult, if not impossible to identify any meaningful patterns of associations in the
data.
Nonetheless, care was taken within the process of data analyses and reporting to
minimize the likelihood of suggesting spurious and non-meaningful results. In
general, the results from the many tests were evaluated and reported with a focus on
the consistency of meaningful, theoretically relevant associations. Furthermore, data
were summarized to present the general trends or patterns obtained between the
MAPA-derived and criterion variables. Tables were also provided as a more
understandable format for the presentation of the results, and served to organize the
findings so patterns could be more readily observable.
246
Suggestions for Future Research
The construct of meaningful activity participation will require continued theoretical
development and empirical study to substantiate its place in both occupational
science and social gerontology. The findings of the present study offer initial
evidence in support of the MAPA-Frequency x Meaning scale as one instrument
capable of tapping this domain. However, there is a need for additional research to
confirm the findings of this study and pursue additional evidence supporting the
validity of the MAPA as a measure of meaningful activity participation. Future
research should involve a greater number of participants, obtained though random
sampling, which are more representative of the population in terms of key
demographic variables such as gender and ethnicity.
Future validation studies should also consider methods and measures that address
both convergent and discriminant validity. For example, the multitrait-multimethod
approach described by Cambell and Fiske (1959) may be utilized to assess the
construct validity of a set of meaningful activity participation measures. This
approach would entail measures of several constructs, with each construct requiring
several distinct measurement procedures. In terms of meaningful activity, the
MAPA scale could be used, perhaps along with dichotomously coded narrative or
interview data (Sommer & Baumeister, 1998) that address meaningful activity
engagement, in addition to experience sampling method data (Csikszentmihalyi,
247
1975) to highlight in-the-moment meaningful activity participation. Structural
equation modeling would be an ideal statistical methodology as it is capable of
testing relationships amongst both latent variables (constructs) and their indicators
(Bollen, 1989; Hays, Revicki, & Coyne, 2005). Exploring meaningful activity
participation with a multitrait-multimethod approach would likely encourage
methodological innovation as researchers seek to merge positivistic and naturalistic
methodologies (M. E. Carlson & Clark, 1991).
Studies could also utilize the MAPA-Frequency x Meaning scale to explore change
processes common to older adults. Longitudinally designed studies would therefore
be warranted, as understanding aging requires the analysis of change within
individuals over time (Hofer, Sliwinski, & Flaherty, 2002). Experimental designs
could also be used to evaluate the effectiveness of interventions intended to influence
meaningful activity participation (Clark et al., 2001; Clark et al., 1997). Studies
employing the MAPA scale could evaluate the extent of change in activity patterns,
and concurrently measure the role activity meaningfulness plays in these shifting
patterns. The data generated by the MAPA are capable of addressing research
questions related to inter- and intra-individual level change. These data could
ultimately inform theoretical models that seek to understand the manner by which
persons adapt to age-related change (e.g., Baltes & Baltes, 1990a).
248
Given the finding that both MAPA-Global and MAPA-Frequency x Meaning
contributed to the prediction of psychological well-being and health-related quality
of life indicators, future research studies should consider utilizing both measures of
meaningful activity participation. One important effect would be the provision of
additional research that tests the validity of both scales. Questions supporting this
research could focus on the manner by which each measure of meaningful activity
relates to constructs such as purpose and meaning in life and coping. These studies
might seek to enhance our understanding of the role meaningful activity plays in the
development of purpose and meaning in life, or to discern the mediating role
differing coping styles play in linking meaningful activity and meaning and purpose
in life to health and well-being.
249
REFERENCES
Adams, K. B., Sanders, S., & Auth, E. A. (2004). Loneliness and depression in
independent living retirement communities: risk and resilience factors. Aging
& Mental Health, 8(6), 475-485.
Ahern, K. D. (1996). The Older Woman: The Able Self. New York: Garland
Publishing.
Aldenerfer, M. S., & Blashfield, R. K. (1984). Cluster Analysis. Newbury Park:
Sage.
Anderson, E. M., & Meyers, A. R. (2000). Health-related quality of life outcome
measures. Archives of Physical Medicine and Rehabilitation, 81(Suppl 2),
S30-S45.
Antonovsky, A. (1987). Unraveling the Mystery of Health. San Francisco, CA:
Jossey-Bass.
AOTA. (1995). Position paper - occupation. American Journal of Occupational
Therapy, 49, 1015-1018.
Arbuckle, T. Y., Pushkar Gold, D., Chaikelson, J. S., & Lapidus, S. (1994).
Measurement of activity in the elderly: the activities checklist. Canadian
Journal on Aging, 13, 550-565.
Ardelt, M. (2003). Effects of religion and purpose in life on elders' subjective well-
being and attitudes toward death. Journal of Religious Gerontology, 14(4),
55-77.
Arrindell, W. A., Meeuwesen, L., & Huyse, F. J. (1991). The satisfaction with life
scale (SWLS): Psychometric properties in a non-psychiatric medical
outpatients sample. Personality and Individual Difference, 12(2), 117-123.
Atchley, R. C. (1989). A continuity theory of normal aging. The Gerontologist, 29,
183-190.
Atchley, R. C. (1998). Activity adaptations to the development of functional
limitations and results for subjective well-being in later adulthood: A
qualitative analysis of longitudinal panel data over a 16-year period. Journal
of Aging Studies, 12, 19-38.
250
Atchley, R. C. (1999a). Continuity and Adaptation in Aging: Creating Positive
Experiences. Baltimore, MD: Johns Hopkins University Press.
Atchley, R. C. (1999b). Continuity theory, self, and social structure. In C. D. Ryff &
V. W. Marshall (Eds.), The Self and Society in Aging Processes (pp. 94-121).
New York: Springer.
Baker, N. A., Jacobs, K., & Tickle-Degnen, L. (2003). A methodology for
developing evidence about meaning in occupation: exploring the meaning of
working. Occupational Therapy Journal of Research: Occupation,
Participation and Health, 23(2), 57-66.
Baltes, B. B., & Baltes, M. M. (1990a). Psychological perspectives on successful
aging: The model of selective optimizations with compensation. In B. B.
Baltes & M. M. Baltes (Eds.), Successful Aging: Perspectives from the
Behavioral Sciences. Cambridge: University of Cambridge.
Baltes, B. B., & Baltes, M. M. (1990b). Successful Aging. Cambridge: Cambridge
University Press.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction
in social psychological research: Conceptual, strategic, and statistical
considerations. Journal of Personality and Social Psychology, 51(6), 1173-
1182.
Baumeister, R. F. (1991). Meanings of Life. New York: The Guilford Press.
Baumeister, R. F. (1992). Neglected aspects of self theory: motivation, interpersonal
aspects, culture, escape, and existential value. Psychological Inquiry, 3(1),
21-25.
Bengston, V. L., Rice, C. J., & Johnson, M. L. (1999). Are theories of aging
important? Models and explanations in gerontology at the turn of the century.
In V. L. Bengston & K. W. Schaie (Eds.), Handbook of Theories of Aging.
New York: Springer.
Benson, J. (1998). Developing a strong program of construct validation: A test
anxiety example. Educational measurement: issues and practice, 17(1), 10-
22.
Bevil, C. A., O'Connor, P. C., & Mattoon, P. M. (1993). Leisure activity, life
satisfaction, and perceived health status in older adults. Gerontology &
Geriatrics Education, 14(2), 3-19.
251
Blanche, E. I. (1999). Play and Process: The experience of Play in the Life of the
Adult. Unpublished Dissertation, University of Southern California, Los
Angeles.
Blanche, E. I. (2002). Play and process: Adult play embedded in the daily routine. In
J. L. Roopnarine (Ed.), Conceptual, Social-Cognitive, and Contextual Issues
in the Fields of Play (Vol. 4, pp. 249-278). Westport, CT: Ablex.
Blazer, D. G. (2004). The epidemiology of depressive disorders in late life. In S. P.
Roose & H. A. Sackeim (Eds.), Late-Life Depression. New York: Oxford
University Press.
Bollen, K. A. (1989). Structural Equations with Latent Variables. New York: John
Wiley & Sons.
Bonder, B. R., & Martin, L. (2000). Personal meanings of occupation for women in
later life: Two women compared. Journal of Women & Aging, 12(3/4), 177-
193.
Bondevik, M., & Skogstad, A. (2000). Loneliness, religiousness, and purpose in life
in the oldest old. Journal of Religious Gerontology, 11(1), 5-21.
Borell, L., Lilja, M., Svidén, G. A., & Sadlo, G. (2001). Occupations and signs of
reduced hope: an explorative study of older adults with functional
impairments. American Journal of Occupational Therapy, 55, 311-316.
Bowling, A., Gabriel, Z., Dykes, J., Dowding, L. M., Evans, O., Fleissig, A., et al.
(2003). Let's ask them: a national survey of definitions of quality of life and
its enhancement among people aged 65 and over. International Journal of
Aging and Human Development, 56(4), 269-306.
Brandtstädter, J., & Rothermund, K. (1994). Self-percepts of control in middle and
later adulthood: Buffering losses by rescaling goals. Psychology and Aging,
9, 265-273.
Brandtstädter, J., Wentura, D., & Greve, W. (1993). Adaptive resources of the aging
self: Outlines of an emergent perspective. International Journal of
Behavioral Development, 16, 323-349.
Brown, B. A., & Frankel, B. G. (1993). Activity through the years: Leisure, leisure
satisfaction, and life satisfaction. Sociology of Sport Journal, 10, 1-17.
Bruner, J. (1990). Acts of Meaning. Cambridge: Harvard University Press.
252
Bundgaard, K. M. (2005). The meaning of everyday meals in living units for older
people. Journal of Occupational Science, 12(2), 91-101.
Callahan, C. M., & Wolinsky, F. D. (1994). The effect of gender and race on the
measurement properties of the CES-D in older adults. Medical Care, 32, 341-
356.
Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by
the multitrait-multimethod matrix. Psychological Bulletin, 56(2), 81-105.
Caplan, M. (1961). Toward a theory of leisure for social gerontology. In R. W.
Kleemeier (Ed.), Aging and Leisure. New York: Oxford University Press.
Carlson, M., Clark, F., & Young, B. (1998). Practical contributions of occupational
science to the art of successful ageing: How to sculpt a meaningful life in
older adulthood. Journal of Occupational Science, 5(3), 107-198.
Carlson, M. E., & Clark, F. (1991). The search for useful methodologies in
occupational science. American Journal of Occupational Therapy, 45(3),
235-241.
Carstenson, L. L. (1992). Social and emotional patterns in adulthood: Support for
socioemotional selectivity theory. Psychology and Aging, 7(3), 331-338.
Chamberlain, K., & Zika, S. (1988). Measuring meaning in life: An examination of
three scales. Personality and Individual Difference, 9(3), 589-596.
Christiansen, C. H. (1994). Classification and study in occupation a review and
discussion of taxonomies. Journal of Occupational Science: Australia, 1(3),
3-21.
Christiansen, C. H. (1999). Defining lives: occupation as identity: an essay on
competence, coherence, and the creation of meaning. American Journal of
Occupational Therapy, 53, 547-558.
Christiansen, C. H., Backman, C., Little, B. R., & Nguyen, A. (1999). Occupations
and well-being: a study of personal projects. American Journal of
Occupational Therapy, 53, 91-100.
Clark, F. (1993). Occupation Embedded in a real life: interweaving occupational
science and occupational therapy. American Journal of Occupational
Therapy, 47(12), 1067-1078.
253
Clark, F. (2001). Health Mediating Effects of the Well Elderly Program.
Unpublished manuscript.
Clark, F., Azen, S. P., Carlson, M., Mandel, D., LaBree, L., Hay, J., et al. (2001).
Embedding health-promoting changes into the daily lives of independent-
living older adults: Long-term follow-up of occupational therapy
intervention. Journal of Gerontology: Psychological Sciences, 56, 60-63.
Clark, F., Azen, S. P., Zemke, R., Jackson, J., Carlson, M. E., Mandel, D., et al.
(1997). Occupational therapy for independent-living older adults. Journal of
the American Medical Association, 278(16), 1321-1326.
Clark, F., Carlson, M., Zemke, R., Frank, G., Patterson, K., Ennevor, B. L., et al.
(1996). Life domains and adaptive strategies of a group of low-income, well-
older adults. American Journal of Occupational Therapy, 50, 99-108.
Clark, F., & Jackson, J. (1989). The application of the occupational science negative
heuristic in the treatment of persons with human immunodeficiency infection.
Occupational Therapy in Health Care, 6(4), 69-91.
Clark, F., Parham, D., Carlson, M. E., Frank, G., Jackson, J., Pierce, D., et al. (1991).
Occupational science: academic innovation in the service of occupational
therapy's future. American Journal of Occupational Therapy, 45(4), 300-310.
Cohen, J., & Cohen, P. (1975). Applied multiple regression/correlation analysis for
the behavioral sciences. Hillsdale, New Jersey: Lawrence Erlbaum
Associates.
Crabtree, J. L. (1998). The end of occupational therapy. American Journal of
Occupational Therapy, 52(3), 205-214.
Cronbach, L., & Meehl, P. (1955). Construct validity in psychological tests.
Psychological Bulletin, 52, 281-302.
Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in
existentialism: The psychometric approach to Frankl's concept of noogenic
neurosis. Journal of Clinical Psychology, 20(2), 200-207.
Crumbaugh, J. C., & Maholick, L. T. (1969). Manual of Instruction for the Purpose
in Life Test. Huntsville, AL: Psychometric Affiliates.
Csikszentmihalyi, M. (1975). Beyond Boredom and Anxiety. San Francisco: Jossey-
Bass.
254
Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. New
York: Harper & Rowe.
Davidson, H., Feldman, P. H., & Crawford, S. (1994). Measuring depressive
symptoms in the frail elderly. Journal of Gerontology: Psychological
Sciences, 49, P159-P164.
Deci, E. L., & Ryan, R. M. (Eds.). (2002). Handbook of self-determination theory.
Rochester, NY: University of Rochester Press.
DePoy, E., & Gitlin, L. N. (2005). Introduction to Research (3rd ed.). St. Louis:
Mosby.
Diener, E. (1984). Subjective well-being. Psychological Bulletin, 95(3), 542-575.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with
life scale. Journal of Personality Assessment, 49(1), 71-75.
Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. L. (1999). Subjective well-being:
Three decades of progress. Psychological Bulletin, 125(2), 276-302.
Dijkers, M. (1999). Measuring quality of life. American Journal of Physical
Medicine and Rehabilitation, 78(3), 286-300.
Dobson, C., Powers, E. A., Keith, P. M., & Goudy, W. J. (1979). Anomia, self-
esteem, and life satisfaction: Interrelationships among three scales of well-
being. Journal of Gerontology, 34, 569-572.
Doerries, L. E. (1970). Purpose in life and social participation. Journal of Individual
Psychology, 26(1), 50-53.
Dublouloz, C.-J., Laporte, D., Hall, M., Ashe, B., & Smith, D. (2004).
Transformation of meaning perspectives in clients with rheumatoid arthritis.
American Journal of Occupational Therapy, 58, 398-407.
Dunn, T., & Hocking, C. (2001). Occupational Terminology Interactive Dialogue.
Journal of Occupational Science, 8(2), 38-41.
Ebrahim, S. (1995). Clinical and public health perspectives and applications of
health-related quality of life measurement. Social Science Medicine, 41(10),
1383-1394.
255
Edwards, J. N., & Kemmack, D. L. (1973). Correlates of life satisfaction: A re-
examination. Journal of Gerontology, 28(4), 497-502.
Emmons, R. A. (1986). Personal strivings: An approach to personality and subjective
well-being. Journal of Personality and Social Psychology, 51(5), 1058-1068.
Everard, K. (1995). The relationship between subjective aspects of activity and older
adult well-being. Unpublished Dissertation, University of Kentucky,
Lexington, Kentucky.
Everard, K. M. (1999). The relationship between reasons for activity and older adult
well-being. Journal of Applied Gerontology, 18, 325-340.
Eyler, A. A., Brownson, R. C., Donatelle, R. J., King, A. C., Brown, D., & Sallis, J.
F. (1999). Physical activity social support and middle- and older-aged
minority women: results from a US survey. Social Science & Medicine, 49,
781-189.
Ferguson, J. M., & Trombly, C. A. (1997). The effect of added-purpose and
meaningful occupation on motor learning. American Journal of Occupational
Therapy, 51(7), 508-515.
Fernandez-Ballesteros, R., Zammarron, M. D., & Ruiz, M. A. (2001). The
contribution of socio-demographic and psychosocial factors to life
satisfaction. Aging and Society, 21, 25-43.
Finch, J. F., Okun, M. A., Berrera, M. J., Zautra, A. J., & Reich, J. W. (1989).
Positive and negative social ties among older adults: Measurement models
and the prediction of psychological distress and well-being. American journal
of community psychology, 17(5), 585-605.
Fisher, A. B. (1998). Uniting practice and theory in an occupational framework.
American Journal of Occupational Therapy, 52(7), 509-521.
Frankl, V. E. (1959/1984). Man's Search for Meaning. New York: Simon &
Schuster.
Fry, P. S. (1992). Major social theories of aging and their implications for counseling
concepts and practice. The Counseling Psychologist, 20, 246-329.
Fry, P. S. (2001). The unique contribution of key existential factors to the prediction
of psychological well-being of older adults following spousal loss. The
Gerontologist, 41(1), 69-81.
256
Gahnström-Strandqvist, K., Liukko, A., & Tham, K. (2003). The meaning of the
working cooperative for persons with long-term mental illness: a
phenomenological study. American Journal of Occupational Therapy, 57,
262-272.
Gerwood, J. B. (1995). The purpose-in-life test: a comparison in elderly people by
relational status, work, and mood. Unpublished Dissertation, University of
Toledo, Toledo, OH.
Glass, T. A., Mendes de Leon, C., Marottoli, R. A., & Berkman, L. F. (1999).
Population based study of social and productive activities as predictors of
survival among elderly Americans. British Medical Journal, 319, 478-483.
Glass, T. A., Seeman, T. E., Herzog, A. R., Kahn, R., & Berkman, L. F. (1995).
Change in productive activity in late adulthood: MacArthur studies of
successful aging. Journal of Gerontology: Social Sciences, 50B, S65-S75.
Goldberg, B., Brintnell, E. S., & Goldberg, J. (2002). The relationship between
engagement in meaningful activities and quality of life in persons disabled by
mental illness. Occupational Therapy in Mental Health, 18(2), 17-44.
Gregory, M. D. (1983). Occupational behavior and life satisfaction among retirees.
American Journal of Occupational Therapy, 37(8), 548-553.
Hair, J. F. J., & Black, W. C. (2000). Cluster Analysis. In L. G. Grimm & P. R.
Yarnold (Eds.), Reading and Understanding More Multivariate Statistics (pp.
147-205). Washington, D. C.: American Psychological Association.
Hammell, K. W. (2004). Dimensions of meaning in the occupations of daily life.
Canadian Journal of Occupational Therapy, 71, 296-305.
Hannam, D. (1997). More than a cup of tea: meaning construction in an everyday
occupation. Journal of Occupational Science: Australia, 4(2), 69-74.
Harlow, R. E., & Cantor, N. (1996). Still participating after all these years: A study
of life task participation in later life. Journal of Personality and Social
Psychology, 71(6), 1235-1249.
Hasselkus, B. R. (2002). The meaning of everyday occupation. Thorofare, NJ: Slack.
Havinghurst, R. J. (1957). The leisure activities of the middle-aged. The American
Journal of Sociology, 63(2), 152-162.
257
Havinghurst, R. J. (1961). The nature and values of meaningful free-time use. In R.
W. Kleemeier (Ed.), Aging and leisure. New York: Oxford University Press.
Havinghurst, R. J., & Albrecht, R. (1953). Older People. New York: Longmans,
Green.
Hayes, V., Morris, J., Wolfe, C., & Morgan, M. (1995). The SF-36 Health Survey
Questionnaire: is it suitable for use with older adults. Age and Ageing, 24,
120-125.
Hays, R. D., Revicki, D., & Coyne, K. S. (2005). Applications of structural equation
modeling to health outcomes research. Evaluation & the Health Professions,
28(3), 295-309.
Heckhausen, J., & Schultz, R. (1995). A life-span theory of control. Psychological
Review, 102, 284-304.
Hendricks, J., & Achenbaum, A. (1999). Historical development of theories of aging.
In V. L. Bengston & K. W. Schaie (Eds.), Handbook of Theories of Aging.
New York: Springer.
Hertzog, C., Van Alstine, J., Usala, P. D., Hultsch, D. F., & Dixon, R. (1990).
Measurement properties of the Center for Epidemiological Studies
Depression Scale (CES-D) in older populations. Psychological Assessment, 2,
64-72.
Herzog, A. R., Franks, M. M., Markus, H. R., & Holmberg, D. (1998). Activities and
well-being in older age: Effects of self concept and educational attainment.
Psychology and Aging, 13, 179-185.
Herzog, A. R., Kahn, R., Morgan, J. M., Jackson, J. S., & Antonucci, T., C. (1989).
Age differences in productive activities. Journal of Gerontology: Social
Sciences, 44(4), S129-S138.
Herzog, A. R., & Markus, H. R. (1999). The self concept in life span and aging
research. In V. L. Bengston & K. W. Schaie (Eds.), Handbook of Theories of
Aging. New York: Springer Publishing Co.
Hillerås, P. K., Jorm, A. F., Herlitz, A., & Winblad, B. (2001). Life satisfaction
among the very old: A survey on a cognitively intact sample aged 90 years or
above. International Journal of Aging and Human Development, 52(1), 71-
90.
258
Himmelfarb, S., & Murrell, S. A. (1983). Reliability and validity of five mental
health scales in older persons. Journal of Gerontology, 38, 333-339.
Hinojosa, J., & Kramer, P. (1997). Fundamental concepts of occupational therapy:
occupation, purposeful activity, and function. American Journal of
Occupational Therapy, 51(10), 864-866.
Hocking, C., Wright-St. Clair, V., & Bunrayong, W. (2002). The meaning of
cooking and recipe work for older Thai and New Zealand women. Journal of
Occupational Science, 9(3), 117-127.
Hofer, S. M., Sliwinski, M., & Flaherty, B. P. (2002). Understanding ageing: Further
commentary on the limitations of cross-sectional designs for ageing research.
Gerontology, 48, 22-29.
Ikiugu, M. N. (2005). Meaningfulness of occupations as an occupational-life-
trajectory attractor. Journal of Occupational Science, 12(2), 102-109.
Jackson, J. (1996). Living a meaningful existence in old age. In R. Zemke & F. Clark
(Eds.), Occupational Science The Evolving Discipline (pp. 339-361).
Philadelphia: F.A. Davis.
Jackson, J., Carlson, M., Mandel, D., Zemke, R., & Clark, F. (1998). Occupation in
lifestyle redesign: the well elderly study occupational therapy program.
American Journal of Occupational Therapy, 52, 326-336.
Jenkins, K. R., Pienta, A. M., & Horgas, A. L. (2002). Activity and health-related
quality of life in continuing care retirement communities. Research on Aging,
24(1), 124-149.
Johansson, U., & Tham, K. (2006). The meaning of work after acquired brain injury.
American Journal of Occupational Therapy, 60, 60-69.
Jonsson, H., Borell, L., & Sadlo, G. (2000). Retirement: an occupational transition
with consequences for temporality, balance and meaning of occupations.
Journal of Occupational Science, 7(1), 29-37.
Kane, M. T., Kingsbury, C., Colton, D., & Estes, C. (1989). Combining data on
criticality and frequency in developing test plans for licensure and
certification examinations. Journal of Educational Measurement, 26(1), 17-
27.
259
Kaufman, E. R. (1986). The Ageless Self: Sources of Meaning in Late Life. Madison,
WI: University of Wisconsin Press.
Kaufman, S. R. (1993). Values as sources of the ageless self. In J. R. Kelly (Ed.),
Activity and Aging. Newbury Park, CA: Sage.
Kelly, J. R. (1978). Situational and social factors in leisure decisions. The Pacific
Sociological Review, 21(3), 313-330.
Kelly, J. R. (Ed.). (1993). Activity and Aging: Staying Involved in Later Life.
Newbury Park, CA: Sage.
Kelly, J. R., Steinkamp, M. W., & Kelly, J. R. (1986). Later life leisure: How they
play in Peoria. The Gerontologist, 26(5), 531-537.
Kerlinger, R. N. (1986). Foundations of Behavioral Research. New York: Holt,
Rinehart and Winston.
King, G. A. (2004). The meaning of life experiences: Application of a meta-model to
rehabilitation sciences and services. American Journal of Orthopsychiatry,
74(1), 72-88.
Kleemeier, R. W. (1961a). Time, activity, and leisure. In R. W. Kleemeier (Ed.),
Aging and Leisure. New York: Oxford University Press.
Kleemeier, R. W. (Ed.). (1961b). Aging and Leisure. New York: Oxford University
Press.
Klem, L. (1995). Path analysis. In L. G. Grimm & P. R. Yarnold (Eds.), Reading and
Understanding Multivariate Statistics (pp. 65-97). Washington, D.C.:
American Psychological Association.
Koenig, H. G., Kvale, J. N., & Ferral, C. (2001). Religion and well-being in later life.
The Gerontologist, 28(1), 18-28.
Kozma, A., & Stones, M. J. (1978). Some research issues in the assessment of well-
being in the elderly. Canadian Psychological Review, 19(241-249).
Krause, N. (2004). Stressors arising in highly valued social roles, meaning in life,
and the physical health status of older adults. Journals of Gerontology,
59B(5), S287-S297.
260
Krause, N., & Shaw, B. A. (2003). Role-specific control, personal meaning, and
health in late life. Research on Aging, 25(6), 559-586.
Lawton, M. P. (1985). Activities and leisure. Annual Review of Gerontology and
Geriatrics, 5, 127-164.
Lawton, M. P. (1993). Meanings of activity. In J. R. Kelly (Ed.), Activity and Aging:
Staying Involved in Later Life (pp. 25-39). Newbury Park, CA: Sage.
Lawton, M. P., Winter, L., Kleban, M., & Ruckdeschel, K. (1999). Affect and
quality of life. Journal of Aging and Health, 11, 169-198.
Leman, C. J. (1993). Spirituality and meaning in later life. Unpublished Dissertation,
University of Nebraska, Lincoln, NE.
Lemon, B. W., Bengston, V. L., & Peterson, J. A. (1972). An exploration of the
activity theory of aging: Activity types and life satisfaction among in-movers
to a retirement community. Journal of Gerontology, 27, 511-523.
Lennartsson, C., & Silverstein, M. (2001). Does engagement with life enhance
survival of elderly people in Sweden? The role of social and leisure activities.
Journal of Gerontology: Social Sciences, 56B, S335-S342.
Lesnoff-Caravaglia, G. (2002). Response to "agism in gerontological language" or
growing old absurd. Gerontology, 42(3), 431.
Litwin, H. (2000). Activity, social network and well-being: An empirical
examination. Canadian Journal on Aging, 19, 343-362.
Lomranz, J., Bergman, S., Eyal, N., & Shmotkin, D. (1988). Indoor and outdoor
activities of aged women and men as related to depression and well-being.
International Journal of Aging and Human Development, 26(4), 303-314.
Longino, C. F., & Kart, C. S. (1982). Explicating activity theory: A formal
replication. Journal of Gerontology, 37, 713-722.
Luoh, M.-C., & Herzog, A. R. (2002). Individual consequences of volunteer and paid
work in old age: health and mortality. Journal of Health and Social Behavior,
42, 490-509.
261
Lutgendorf, S. K., Vitaliano, P. P., Tripp-Reimer, T., Harvey, J. H., & Lubaroff, D.
M. (1999). Sense of coherence moderates the relationship between life stress
and natural killer cell activity in healthy older adults. Psychology and Aging,
14(4), 552-563.
Lyons, R. A., Perry, H. M., & Littlepage, B. N. C. (1994). Evidence for the validity
of the short-form 36 questionnaire (SF-36) in and elderly population. Age and
Ageing, 23, 182-184.
Maddi, S. R. (1998). Creating meaning through making decisions. In P. T. P. Wong
& P. S. Fry (Eds.), The Human Quest for Meaning: A Handbook of
Psychological Research and Clinical Applications (pp. 3-26). Mahwah, NJ:
Lawrence Erlbaum Associates.
Mancini, J. A., & Orthner, D. K. (1980). Situational influences on leisure satisfaction
and morale in old age. Journal of the American Geriatrics Society, 28, 466-
471.
Markus, H. R., & Herzog, A. R. (1991). The role of the self concept in aging. Annual
Review of Gerontology and Geriatrics, 11, 110-143.
Markus, H. R., & Herzog, A. R. (1999). The self-concept in life span and aging
research. In V. L. Bengston & K. W. Schaie (Eds.), Handbook of Theories of
Aging. New York: Springer.
Maslow, A. H. (1970). Motivation and personality (2nd ed.). New York: Harper &
Row.
Matteson, R. E. (1974). Purpose in life as related to involvement in organized groups
and certain sociocultural variables. Unpublished Dissertation, Northern
Illinois University, Dekalb, IL.
McDowell, I., & Newell, C. (1996). Measuring Health: A Guide to Rating Scales
and Questionnaires. New York: Oxford University Press.
McHorney, C. A. (1996). Measuring and monitoring general health status in elderly
persons: Practical and methodological issues using the SF-36 survey. The
Gerontologist, 36(5).
McHorney, C. A., Ware, J. E., & Raczek, A. E. (1993). The MOS 36-item short-
form health survey (SF-36): II. psychometric and clinical tests of validity in
measuring physical and mental health constructs. Medical Care, 31, 247-263.
262
McHorney, C. A., Ware, J. E., Rogers, W., Raczek, A. E., & Rachel Lu, J. F. (1992).
The validity and relative precision of MOS short- and long-form health status
scales and Dartmouth COOP charts. Medical Care, 30, MS253-MS265.
McLaughlin Grey, J., Kennedy, B. L., & Zemke, R. (1996). Application of dynamic
systems theory to occupation. In F. Clark (Ed.), Occupational science: the
evolving discipline (pp. 309-324). Philadelphia: F. A. Davis Comp.
McNeil, J. K., Stones, M. J., & Kozma, A. (1986). Subjective well-being in later life:
Issues concerning measurement and prediction. Social Indicators Research,
18, 35-70.
Meier, A., & Edwards, H. (1974). Purpose-in-life test: Age and sex differences.
Journal of Clinical Psychology, 30(3), 384-386.
Menec, V. H. (2003). The relation between everyday activities and successful aging:
A 6-year longitudinal study. Journal of Gerontology: Social Sciences,
58B(2), S74-S82.
Menec, V. H., & Chipperfield, J. G. (1997). Remaining active in later life: The role
of locus of control in senior's leisure activity participation, health and life
satisfaction. Journal of Aging and Health, 9, 105-125.
Miller, K. S., Bunch-Harrison, S., Braumbaugh, B., Kutty, R. S., & FitzGerald, K.
(2005). The meaning of computers to a group of men who are homeless.
American Journal of Occupational Therapy, 59, 191-197.
Moore, C. M. (1987). Group Techniques for Idea Building. Thousand Oaks, CA:
Sage.
Morgan, K., Dallosso, H., Bassey, E. J., Ebrahim, S., Fentem, P. H., & Arie, T. H. D.
(1991). Customary physical activity, psychological well-being and successful
ageing. Aging and Society, 11, 399-415.
Morrow-Howell, N., Hinterlong, J., Rozario, P. A., & Tang, F. (2003). Effects of
volunteering on the well-being of older adults. Journal of Gerontology:
Social Sciences, 58B(3), S137-S145.
Murphy, S., Trombly, C. A., Tickle-Degnen, L., & Jacobs, K. (1999). The effect of
keeping an end-product on intrinsic motivation. American Journal of
Occupational Therapy, 53(2), 153-158.
263
Murrell, S. A., Himmelfarb, S., & Wright, K. (1983). Prevalence of depression and
its correlates in older adults. American Journal of Epidemiology, 117, 172-
185.
Nelson, D. L. (1988). Occupation: form and performance. American Journal of
Occupational Therapy, 42, 633-641.
Nelson, D. L. (1996). Therapeutic occupation: a definition. American Journal of
Occupational Therapy, 50(10), 775-782.
Neugarten, B. I., Havinghurst, R. J., & Tobin, S. S. (1961). The measurement of life
satisfaction. Journal of Gerontology, 16, 134-143.
Okun, M. A., & Stock, W. A. (1984). Quality of research on correlates of subjective
well-being in adulthood. Experimental Aging Research, 10, 161-163.
Okun, M. A., Stock, W. A., Haring, M. J., & Witter, R. A. (1984). The social activity
/ subjective well-being relation. Research on Aging, 6, 45-65.
Ormel, J., Rijsdijk, F. V., Sullivan, M., van Sonderen, E., & Kempen, G. I. J. M.
(2002). Temporal and reciprocal relationship between IADL/ADL disability
and depressive symptoms in late life. Journal of Gerontology: Psychological
Sciences, 57B(4), P388-P347.
Overton, W. F. (1994). Contexts of meaning: The computational and the embodied
mind. In W. F. Overton (Ed.), The Nature and Ontogenesis of Meaning.
Hillsdale, NJ: Lawrence Erlbaum Associates.
Palys, T. S., & Little, B. R. (1983). Perceived life satisfaction and the organization of
personal project systems. Journal of Personality and Social Psychology, 44,
1221-1230.
Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping.
Review of General Psychology, 1(2), 115-144.
Pavot, W., & Diener, E. (1993). Review of the satisfaction with life scale.
Psychological Assessment, 5(2), 164-172.
Pavot, W., Diener, E., Colvin, C. R., & Sandvik, E. (1991). Further validation of the
satisfaction with life scale: Evidence for the cross-method convergence of
well-being measures. Journal of Personality Assessment, 57(1), 149-161.
264
Pedhazur, E. J., & Schmelkin, L. P. (1991). Measurement, Design, and Analysis: An
Integrated Approach. Hillsdale, NJ: Lawrence Erlbaum.
Pernegar, T. V. (1998). What's wrong with Bonferroni adjustments. British Medical
Journal, 316, 1236-1238.
Persson, D., Erlandsson, L.-K., Eklund, M., & Iwarsson, S. (2001). Value
dimensions, meaning, and complexity in human occupation - a tentative
strucure for analysis. Scandinavian Journal of Occupational Therapy, 8, 7-
18.
Pinquart, M. (2001). Correlates of subjective health in older adults: a meta-analysis.
Psychology and Aging, 16, 414-426.
Pinquart, M. (2002). Creating and maintaining purpose in life in old age: a meta-
analysis. Ageing International, 27, 90-114.
Pintos, C. C. G. (1988). Depression and the will to meaning: A comparison of the
GDS and PIL in an Argentine population. Clinical Gerontologist, 7(3/4), 3-9.
Prager, E. (1996). Exploring personal meaning in an age-differentiated Australian
sample: Another look at the Sources of Meaning Profile (SOMP). Journal of
Aging Studies, 10(2), 117-136.
Prager, E., Bar-Tur, L., & Abramowici, I. (1997). The sources of meaning profile
(SOMP) with aged subjects exhibiting depressive symptomology. Clinical
Gerontologist, 17(3), 25-39.
Pushkar, D., Arbuckle, T., Conway, M., Chaikelson, J., & Maag, U. (1997).
Everyday activity parameters and competence in older adults. Psychology
and Aging, 14, 600-609.
Radloff, L. S. (1977). The CES-D scales: a self-report depression scale for research
in the general population. Applied Psychological Measurement, 1, 385-401.
Ray, R. O., & Heppe, G. (1986). Older adult happiness: The contributions of activity
breadth and intensity. Physical & Occupational Therapy in Geriatrics, 4(4),
31-43.
Raymond, M. R. (2001). Job analysis and the specification of content for licensure
and certification exams. Applied Measurement in Education, 14(4), 369-415.
265
Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th century
medicine. American Journal of Occupational Therapy, 16(1), 1-9.
Reilly, M. (1969). The education process. American Journal of Occupational
Therapy, 23, 299-307.
Rejeski, W. J., & Mihalko, S. L. (2001). Physical activity and quality of life in older
adults. Journal of Gerontology: SERIES A, 56A(Special Issue II), 23-35.
Reker, G. T. (1994). Logotheory and logotherapy: Challenges, opportunities, and
some empirical findings. International Forum for Logotherapy, 17, 47-55.
Reker, G. T. (1997). Personal meaning, optimism, and choice: Existential predictors
of depression in community and institutional elderly. The Gerontologist,
37(6), 709-716.
Reker, G. T. (2000). Theoretical perspective, dimensions, and measurement of
existential meaning. In G. T. Reker & K. Chamberlain (Eds.), Exploring
existential meaning: Optimizing human development across the life span (pp.
39-55). Thousand Oaks, CA: Sage.
Reker, G. T., & Chamberlain, K. (2000). Existential meaning: Reflections and
directions. In G. T. Reker & K. Chamberlain (Eds.), Exploring Existential
Meaning: Optimizing Human Development Across the Life Span (pp. 199-
209). Thousand Oaks, CA: Sage Publications.
Reker, G. T., & Fry, P. S. (2003). Factor structure and invariance of personal
meaning measures in cohorts of younger and older adults. Personality and
Individual Difference, 35, 977-993.
Reker, G. T., Peacock, E. J., & Wong, P. T. P. (1987). Meaning and purpose in life
and well-being: A life-span perspective. Journal of Gerontology, 42(1), 44-
49.
Reker, G. T., & Wong, P. T. P. (1988). Aging as an individual process: Toward a
theory of personal meaning. In D. E. Deutchman (Ed.), Emergent Theories of
Aging (pp. 214-246). New York: Springer Publishing Company.
Riediger, M., Freund, A. M., & Baltes, P. B. (2005). Managing life through personal
goals: Intergoal facilitation and intensity of goal pursuit in younger and older
adulthood. Journal of Gerontology: Psychological Sciences, 60B(2), P84-
P91.
266
Ritchey, L. H., Ritchey, P. N., & Dietz, B. E. (2001). Clarifying the measurement of
activity. Activities, Adaptation and Aging, 26(1), 1-21.
Rizzo, J. A. (1990). An investigation of the relationship of life satisfaction, purpose
in life, and power in individuals sixty-five and older. Unpublished
Dissertation, New York University, New York.
Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of
psychological well-being. Journal of Personality and Social Psychology, 57,
1069-1081.
Ryff, C. D., & Keyes, L. M. (1995). The structure of psychological well-being
revisited. Journal of Personality and Social Psychology, 69(4), 719-727.
Ryff, C. D., & Singer, B. (1998). The role of purpose in life and personal growth in
positive human health. In P. T. P. Wong & P. S. Fry (Eds.), The Human
Quest for Meaning: A Handbook of Psychological Research and Clinical
Applications (pp. 213-235). Mahway, NJ: Lawrence Erlbaum Associates.
Sagy, S., Antonovsky, A., & Adler, I. (1990). Explaining life satisfaction in later life:
The sense of coherence model and activity theory. Behavior, Health, and
Aging, 1(1), 11-25.
Savitz, D. A., & Olshan, A. F. (1995). Multiple comparisons and related issues in the
interpretation of epidemiologic data. American Journal of Epidemiology,
142(6), 904-908.
Scheerer, C. R., Cahill, L. G., Kirby, K., & Lane, J. (2004). Cake decorating as
occupation: meaning and motivation. Journal of Occupational Science, 11(2),
68-74.
Schultz, R., & Heckhausen, J. (1996). A lifespan model of successful aging.
American Psychologist, 51, 702-714.
Searle, J. S. (1992). The Rediscovery of the Mind. Cambridge: MIT Press.
Smith, B. W., & Zautra, A. J. (2000). Purpose in life and coping with knee-
replacement surgery. The Occupational Therapy Journal of Research, 20,
96S-99S.
Smith, N. R., Kielhofner, G., & Watts, J. H. (1986). The relationships between
volition, activity pattern, and life satisfaction in the elderly. American
Journal of Occupational Therapy, 40(4), 278-283.
267
Sommer, K. L., & Baumeister, R. F. (1998). The construction of meaning from life
events: empirical studies of personal narratives. In I. B. Weiner (Ed.), The
Human Quest for Meaning (pp. 143-161). Mahwah, New Jersey: Lawrence,
Erlbaum Associates.
Specht, J., King, G., Brown, B., & Foris, C. (2002). The importance of leisure in the
lives of persons with congenital physical disabilities. American Journal of
Occupational Therapy, 56, 436-445.
Spiro, A., & Bossé, R. (2000). Relations between health-related quality of life and
well-being: the gerontologist's new clothes. International Journal of Aging
and Human Development, 50(4), 297-318.
SPSS. (2003). SPSS 12.0. Chicago: SPSS Inc.
Stadnyk, K., Calder, J., & Rockwood, K. (1998). Testing the measurement properties
of the short form-36 health survey in a frail elderly population. Journal of
Clinical Epidemiology, 51, 827-835.
Stähl, T., Rütten, A., Nutbeam, D., Bauman, A., Kannas, L., Abel, T., et al. (2001).
The importance of the social environment for physically active lifestyle -
results from an international study. Social Science Medicine, 52, 1-10.
Steinkamp, M. W., & Kelly, J. R. (1987). Social integration, leisure activity, and life
satisfaction in older adults: Activity theory revisited. International Journal of
Aging and Human Development, 25, 293-307.
Stock, W. A., & Okun, M. A. (1982). The construct validity of life satisfaction
among the elderly. Journal of Gerontology, 37, 625-627.
Stock, W. A., Okun, M. A., & Benin, M. (1986). Structure of subjective well-being
among the elderly. Psychology and Aging, 1(2), 91-102.
Stones, M. J., & Kozma, A. (1986). Happiness and activities as propensities. Journal
of Gerontology, 41(85-90).
Streiner, D. L., & Norman, G. R. (2003). Health Measurement Scales (3rd ed.).
Oxford: Oxford University Press.
Strong, S. (1998). Meaningful work in supportive environments: experiences with
the recovery process. American Journal of Occupational Therapy, 52(1), 31-
38.
268
Thomas, D. C., Siemiatycki, J., Dewar, R., Robins, J., Goldberg, M., & Armstrong,
B. G. (1985). The problem of multiple inference in studies designed to
generate hypotheses. American Journal of Epidemiology, 122(6), 1080-1095.
Thompson, B. (2004). Exploratory and Confirmatory Factor Analysis. Washington,
DC: American Psychological Association.
Toothacker, L. E. (1995). Multiple Comparisons Procedures. Thousand Oaks, CA:
Sage.
Tornstam, L. (1999). Transcendence in later life. Generations, 23(4), 10-14.
Trombly, C. A. (1995). Occupation: purposefulness and meaningfulness as
therapeutic mechanisms. American Journal of Occupational Therapy, 49(10),
960-972.
U. S. Census Bureau. 2005 American Community Survey. (2005). Retrieved 4/15/07,
from http://factfinder.census.gov/servlet/STTable?_bm=y&-
geo_id=16000US0644000&-qr_name=ACS_2005_EST_G00_S0103&-
ds_name=ACS_2005_EST_G00_&-redoLog=false
Ulmer, A., Range, L. M., & Smith, P. C. (1991). Purpose in life: A moderator of
recovery from bereavement. Omega, 23(4), 279-289.
Unger, J. B., McAvay, G., Bruce, M. L., Berkman, L., & Seeman, T. (1999).
Variation in the impact of social network characteristics on physical
functioning in elderly persons: MacArthur studies of successful aging.
Journal of Gerontology: Social Sciences, 54B, S245-S251.
Utz, R. L., Carr, D., Nesse, R., & Wortman, C. B. (2002). The effect of widowhood
on older adults' social participation: An evaluation of activity theory,
disengagement, and continuity theories. The Gerontologist, 42(4), 522-533.
Van Willigen, M. (2000). Differential benefits of volunteering across the life course.
Journal of Gerontology: Social Sciences, 55B(5), S308-S318.
Vitaliano, P. P., Russo, J., Young, H. M., Becker, J., & Maiuro, R. D. (1991). The
screen for caregiver burden. The Gerontologist, 31(1), 76-83.
Walters, S. J., Munro, J. F., & Brazier, J. E. (2001). Using the SF-36 with older
adults: a cross-sectional community based survey. Age and Ageing, 30, 337-
343.
269
Ware, J. E., Kosinski, M., & Dewey, J. E. (2000). How to score version 2 of the SF-
36® Health Survey. Lincoln, RI: QualityMetric Incorporated.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey
(SF-36). Medical Care, 30, 473-481.
Warr, P., Butcher, V., & Robertson, I. (2004). Activity and psychological well-being
in older people. Aging & Mental Health, 8(2), 172-183.
Weinstein, L., & Xie, X. (1995). Purpose in life, boredom, and volunteerism in a
group of retirees. Psychological Reports, 76, 482.
Wilcock, A. A. (1998). Occupations for health. British Journal of Occupational
Therapy, 61, 340-345.
Williamson, G. M., & Schulz, R. (1992). Pain, activity restriction, and symptoms of
depression among community-residing elderly adults. Journal of
Gerontology: Psychological Sciences, 47(6), P367-P372.
Wilson, R. S., Barnes, L. L., & Bennett, D. A. (2003). Assessment of lifetime
participation in cognitively stimulating activities. Journal of Clinical and
Experimental Neuropsychology, 25(5), 634-642.
Wong, P. T. P. (1989). Personal meaning and successful aging. Canadian
Psychology, 30(3), 516-525.
Wong, P. T. P., & Fry, P. S. (Eds.). (1998). The Human Quest for Meaning.
Mahwah, NJ: Lawrence Erlbaum Associates.
Wood, V., Wylie, M. L., & Sheafor, B. (1969). An analysis of a short self-report
measure of life satisfaction: correlation with rater judgments. Journal of
Gerontology, 24, 465-469.
Yalom, I. D. (1980). Existential Psychotherapy. USA: BasicBooks.
Yerxa, E. J. (1993). Occupational science: A new source of power for participants in
occupational therapy. Journal of Occupational Science: Australia, 1(1), 3-10.
Yerxa, E. J., Clark, F., Frank, G., Jackson, J., Parham, D., Pierce, D., et al. (1989).
An introduction to occupational science: a foundation for occupational
therapy in the 21st century. Occupational Therapy in Health Care, 6(1), 1-17.
270
Zemke, R., & Clark, F. (Eds.). (1996). Occupational science: the evolving discipline.
Philadelphia: F. A. Davis Comp.
Zika, S., & Chamberlain, K. (1987). Relation of hassles and personality to subjective
well-being. Journal of Personality and Social Psychology, 53(1), 155-162.
Zika, S., & Chamberlain, K. (1992). On the relation between meaning in life and
psychological well-being. British Journal of Psychology, 83, 133-145.
271
APPENDIX A
MEANINGFUL ACTIVITY PARTICIPATION ASSESSMENT (MAPA) –
FREQUENCY
Please rate the amount of Time that you spent on the following
activities during the last few months. Circle one number.
Not
at
all
Less
than
once a
month
Once a
month
2-3
times a
month
Once
a
week
Several
times a
week
Every
day
1 Home
Making/
Home
Maintenance
1 2 3 4 5 6 7
2 Personal
Finances
1 2 3 4 5 6 7
3 Driving
1 2 3 4 5 6 7
4 Using Public
Transportation
1 2 3 4 5 6 7
5 Medical Visits
1 2 3 4 5 6 7
6 Socializing
1 2 3 4 5 6 7
7 Writing
Letters/Cards
1 2 3 4 5 6 7
8 Helping
Others
1 2 3 4 5 6 7
9 Gardening
1 2 3 4 5 6 7
10 Physical
Exercise
1 2 3 4 5 6 7
11 Crafts/Hobbies
1 2 3 4 5 6 7
272
Not
at
all
Less
than
once a
month
Once a
month
2-3
times a
month
Once
a
week
Several
times a
week
Every
day
12 Cultural
Activities
1 2 3 4 5 6 7
13 Musical
Activities
1 2 3 4 5 6 7
14 Taking
Courses
1 2 3 4 5 6 7
15 Creative
Activities
1 2 3 4 5 6 7
16 Traveling
1 2 3 4 5 6 7
17 Talking on the
Telephone
1 2 3 4 5 6 7
18 Reading
Magazines/
Newspapers
1 2 3 4 5 6 7
19 Other Reading
1 2 3 4 5 6 7
20 Playing
Games
1 2 3 4 5 6 7
21 Radio/TV
1 2 3 4 5 6 7
22 Religious
Activities
1 2 3 4 5 6 7
23 Prayer/
Meditation
1 2 3 4 5 6 7
24 Community
Organization
Activities
1 2 3 4 5 6 7
273
Not
at
all
Less
than
once a
month
Once a
month
2-3
times a
month
Once
a
week
Several
times a
week
Every
day
25 Volunteer
Activities
1 2 3 4 5 6 7
26 Pet Care/
Activities
1 2 3 4 5 6 7
27 Computer Use
for Email
1 2 3 4 5 6 7
28 Other
Computer Use
(List below)
1 2 3 4 5 6 7
274
APPENDIX B
MAPA – MEANING
Please rate each activity according to how meaningful it is to
you. That is, how much it matters or is personally fulfilling
for you
1 Home Making/
Home
Maintenance
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
2 Personal
Finances
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
3 Driving
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
4
Using Public
Transportation
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
275
5 Medical
Visits
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
6 Socializing
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
7 Writing
Letters/
Cards
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
8 Helping
Others
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
9 Gardening
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
10 Physical
Exercise
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
276
11 Crafts/
Hobbies
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
12 Cultural
Activities
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
13 Musical
Activities
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
14 Taking
Courses
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
15 Creative
Activities
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
16 Traveling
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
277
17 Talking on
the
Telephone
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
18 Reading
Magazines/
Newspapers
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
19 Other
Reading
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
20 Playing
Games
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
21 Radio/TV
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
22 Religious
Activities
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
278
23 Prayer/
Meditation
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
24 Community
Organization
Activities
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
25 Volunteer
Activities
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
26 Pet Care/
Activities
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
279
27 Computer
Use for
Email
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
28 Other
Computer
Use
(List Below)
1-Not at all
meaningful
2-Somewhat
meaningful
3-Moderately
meaningful
4-Very
meaningful
5-Extremely
meaningful
280
APPENDIX C
MAPA – HEALTH
Please rate each activity according to how healthy it is for you.
That is, how much it contributes to physical or mental health.
1
Home
Making/
Home
Maintenance
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
2 Personal
Finances
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
3 Driving
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
4
Using Public
Transportation
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
5 Medical
Visits
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
6 Socializing
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
281
7 Writing
Letters/
Cards
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
8 Helping
Others
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
9 Gardening
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
10 Physical
Exercise
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
11 Crafts/
Hobbies
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
12 Cultural
Activities
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
13 Musical
Activities
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
14 Taking
Courses
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
282
15 Creative
Activities
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
16 Traveling
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
17 Talking on
the
Telephone
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
18 Reading
Magazines/
Newspapers
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
19 Other
Reading
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
20 Playing
Games
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
21 Radio/TV
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
22 Religious
Activities
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
283
23 Prayer/
Meditation
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
24 Community
Organization
Activities
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
25 Volunteer
Activities
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
26 Pet Care/
Activities
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
27 Computer
Use for
Email
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
28 Other
Computer
Use
(List Below)
1-Extremely
unhealthy
2-Unhealthy
3-Neither
4-Healthy
5-Extremely
healthy
284
APPENDIX D
MAPA – REASONS
Please check ONE box that best indicates why you do each
activity.
1 Home
Making/
Home
Maintenance
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
2 Personal
Finances
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
3 Driving
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
4
Using Public
Transport-
ation
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
285
5 Medical
Visits
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
6 Socializing
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
7 Writing
Letters/
Cards
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
8 Helping
Others
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
286
9 Gardening
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
10 Physical
Exercise
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
11 Crafts/
Hobbies
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
12 Cultural
Activities
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
287
13 Musical
Activities
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
14 Taking
Courses
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
15 Creative
Activities
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
16 Traveling
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
288
17 Talking on
the
Telephone
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
18 Reading
Magazines/
Newspapers
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
19 Other
Reading
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
20 Playing
Games
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5-Other
6-I don’t do
this
289
21 Radio/TV
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5- Other
6-I don’t do
this
22 Religious
Activities
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5- Other
6-I don’t do
this
23 Prayer/
Meditation
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5- Other
6-I don’t do
this
24 Community
Organization
Activities
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5- Other
6-I don’t do
this
290
25 Volunteer
Activities
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5- Other
6-I don’t do
this
26 Pet Care/
Activities
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5- Other
6-I don’t do
this
27 Computer
Use for
Email
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5- Other
6-I don’t do
this
28 Other
Computer
Use
(List Below)
1-Need or
have to do this
2-For new
experiences
3-Connect
with people
4-Sense of
accomplishment
5- Other
6-I don’t do
this
291
APPENDIX E
MAPA – GLOBAL
Please circle the number that best describes your beliefs.
1. Overall, how much do you think your activities contribute
to your mental health?
Not at all
Only a
little
Somewhat
A great
deal
1 2 3 4 5 6 7
2. Overall, how much do you think your activities contribute
to your physical health?
Not at all
Only a
little
Somewhat
A great
deal
1 2 3 4 5 6 7
3. Overall, how satisfied are you with your activities?
Not at all
Only a
little
Somewhat
A great
deal
1 2 3 4 5 6 7
4. Overall, how much would you like a change in your activities?
Not at all
Only a
little
Somewhat
A great
deal
1 2 3 4 5 6 7
292
5. Overall, are your activities personally fulfilling for you?
Not at all
Only a
little
Somewhat
A great
deal
1 2 3 4 5 6 7
6. Overall, do you feel that you are often bored, with too
little to do?
Not at all
Only a
little
Somewhat
A great
deal
1 2 3 4 5 6 7
7. Over the past six months, have your daily round of
activities changed in terms of how meaningful or
personally fulfilling they are for you?
Not at all
Only a
little
Somewhat
A great
deal
1 2 3 4 5 6 7
8. What change has there been in your overall activity level
from six months ago to today? Compared to six months
ago I now participate:
A great
deal less
Somewhat
less
A little
less
The
same
amount
A little
more
Somewhat
more
A great
deal
more
1 2 3 4 5 6 7
293
APPENDIX F
ENGAGEMENT IN MEANINGFUL ACTIVITY SURVEY
Below is a list of statements about your activities. Please read each one
carefully and circle the number that best describes to what extent each
statement is true for you. Take your time and try to be as accurate as
possible.
1. The activities I do help me take care of myself (e.g., keep
clean, budget my money).
Never Rarely Sometimes Usually Always
1 2 3 4 5
2. The activities I do reflect the kind of person I am.
Never Rarely Sometimes Usually Always
1 2 3 4 5
3. The activities I do express my creativity.
Never Rarely Sometimes Usually Always
1 2 3 4 5
4. The activities I do help me achieve something which gives
me a sense of accomplishment.
Never Rarely Sometimes Usually Always
1 2 3 4 5
5. The activities I do contribute to feeling competent.
Never Rarely Sometimes Usually Always
1 2 3 4 5
6. The activities I do are valued by other people.
Never Rarely Sometimes Usually Always
1 2 3 4 5
294
7. The activities I do help other people.
Never Rarely Sometimes Usually Always
1 2 3 4 5
8. The activities I do give me pleasure.
Never Rarely Sometimes Usually Always
1 2 3 4 5
9. The activities I do give me a feeling of control.
Never Rarely Sometimes Usually Always
1 2 3 4 5
10. The activities I do help me express my personal values.
Never Rarely Sometimes Usually Always
1 2 3 4 5
11. The activities I do give me a sense of satisfaction.
Never Rarely Sometimes Usually Always
1 2 3 4 5
12. The activities I do have just the right amount of challenge.
Never Rarely Sometimes Usually Always
1 2 3 4 5
295
APPENDIX G
DAILY OCCUPATIONAL EXPERIENCE SURVEY
Please list one activity that is most meaningful to you. That is, think of
an activity in your life that you would least want to give up (and/or) an
activity in your life that matters the most to you.
LIST YOUR ACTIVITY HERE
_________________________________________________
Please note that the numbers below range from one extreme to another.
“Neutral” implies no judgment either way. Try to use the “neutral”
rating as little as possible. Please circle the number that best represents
how YOU experience this activity.
1. The activity usually occurs
Spontaneously (Neutral) Is planned
1 2 3 4 5 6 7
2. The activity usually makes me feel
Excited (Neutral) Bored
1 2 3 4 5 6 7
3. The activity usually makes me feel
Stressed (Neutral) Relaxed
1 2 3 4 5 6 7
4. The activity usually leaves me feeling
Full of energy (Neutral) Worn out
1 2 3 4 5 6 7
5. The activity is usually
Pleasurable (Neutral) Miserable
1 2 3 4 5 6 7
296
6. The activity is usually
A frill (Neutral) Necessary
1 2 3 4 5 6 7
7. The activity usually involves me
Being creative (Neutral) Following rules
1 2 3 4 5 6 7
8. The activity usually has
No clear purpose
(Neutral)
A clear purpose
1 2 3 4 5 6 7
9. The activity usually requires me to
Be physically
active
(Neutral) Not be
physically
active
1 2 3 4 5 6 7
10. The activity usually involves
No mental
activity
(Neutral) A lot of
mental
activity
1 2 3 4 5 6 7
11. The activity usually allows me to have
A lot of
freedom
(Neutral) No
freedom
1 2 3 4 5 6 7
12. I usually do this activity
For myself (Neutral) For someone else
1 2 3 4 5 6 7
297
13. The activity usually involves
No imagination (Neutral) A lot of imagination
1 2 3 4 5 6 7
14. I usually feel I have
A lot of competence
in the activity
(Neutral) No competence
in the activity
1 2 3 4 5 6 7
15. The activity usually offers me
Routine experiences (Neutral) New experiences
1 2 3 4 5 6 7
16. The activity usually involves me
Being serious (Neutral) Being lighthearted
1 2 3 4 5 6 7
17. During the activity I
Often lose track of
the time
(Neutral) Never lose track of
the time
1 2 3 4 5 6 7
298
APPENDIX H
PURPOSE-IN-LIFE TEST
For each of the following statements, circle the number that would be
most nearly true for you. Note that the numbers always extend from one
extreme feeling to its opposite kind of feeling. “Neutral” implies no
judgment either way. Try to use the “neutral” rating as little as possible.
1. I am usually
completely bored (neutral) exuberant,
enthusiastic
1 2 3 4 5 6 7
2. Life to me seems
always exciting (neutral) completely routine
1 2 3 4 5 6 7
3. In life I have
no goals or aims at
all
(neutral) very clear goals and
aims
1 2 3 4 5 6 7
4. My personal existence is
utterly meaningless,
without purpose
(neutral) very purposeful and
meaningful
1 2 3 4 5 6 7
5. Every day is
constantly new and
different
(neutral) exactly the same
1 2 3 4 5 6 7
299
6. If I could choose, I would
prefer never to have
been born
(neutral) like nine more lives
just like this one
1 2 3 4 5 6 7
7. After retiring I would
do some of the
exciting things I
have always wanted
to do
(neutral) loaf completely the
rest of my life
1 2 3 4 5 6 7
8. In achieving life goals I have
made no
progress
whatever
(neutral) progressed to
complete
fulfillment
1 2 3 4 5 6 7
9. My life is
empty, filled
only with
despair
(neutral) running over
with exciting
good things
1 2 3 4 5 6 7
10. If I should die today, I would feel that my life has been
very
worthwhile
(neutral) completely
worthless
1 2 3 4 5 6 7
300
11. In thinking of my life, I
often wonder
why I exist
(neutral) always see a
reason for
my being
here
1 2 3 4 5 6 7
12. As I view the world in relation to my life, the world
completely confuses
me
(neutral) fits meaningfully
with my life
1 2 3 4 5 6 7
13. I am a:
very irresponsible
person
(neutral) very responsible
person
1 2 3 4 5 6 7
14. Concerning man’s freedom to make his own choices, I
believe man is
absolutely free to
make all life choices
(neutral) completely bound by
limitations of
heredity and
environment
1 2 3 4 5 6 7
15. With regard to death, I am
prepared and
unafraid
(neutral) Unprepared and
afraid
1 2 3 4 5 6 7
301
16. With regard to suicide, I have
thought of it
seriously as a way
out
(neutral) never given it a
second thought
1 2 3 4 5 6 7
17. I regard my ability to find a meaning, purpose, or mission
in life as
very great (neutral) practically none
1 2 3 4 5 6 7
18. My life is
in my hands and I
am in control of it
(neutral) out of my hands and
controlled by
external factors
1 2 3 4 5 6 7
19. Facing my daily tasks is
a source of pleasure
and satisfaction
(neutral) a painful and boring
experience
1 2 3 4 5 6 7
20. I have discovered
no mission or
purpose in life
(neutral) clear-cut goals and a
satisfying life
purpose
1 2 3 4 5 6 7
302
APPENDIX I
LIFE SATISFACTION INDEX – Z
Here are some statements about life in general that people feel
differently about.
Would you read each statement on the list, and:
If you agree with it, put a check mark in the box next to “Agree.”
If you do not agree with a statement, put a check mark in the box
next to “Disagree.”
If you are not sure one way or the other, put a check mark in the
box next to “Unsure.”
Please be sure to answer every question on the list.
1. As I grow older, things seem better than I
thought they would be.
1 = Agree
2 = Disagree
3 = Unsure
2. I have gotten more of the breaks in life than
most of the people I know.
1 = Agree
2 = Disagree
3 = Unsure
3. This is the dreariest time of my life. 1 = Agree
2 = Disagree
3 = Unsure
4. I am just as happy as when I was younger. 1 = Agree
2 = Disagree
3 = Unsure
5. These are the best years of my life. 1 = Agree
2 = Disagree
3 = Unsure
303
6. Most of the things I do are boring or
monotonous.
1 = Agree
2 = Disagree
3 = Unsure
7. The things I do are as interesting to me as
they ever were.
1 = Agree
2 = Disagree
3 = Unsure
8. As I look back on my life, I am fairly well
satisfied.
1 = Agree
2 = Disagree
3 = Unsure
9. I have made plans for things I'll be doing a
month or a year from now.
1 = Agree
2 = Disagree
3 = Unsure
10. When I think back over my life, I didn't get
most of the important things I wanted.
1 = Agree
2 = Disagree
3 = Unsure
11. Compared to other people, I get down in the
dumps too often.
1 = Agree
2 = Disagree
3 = Unsure
12. I've gotten pretty much what I expected out
of life.
1 = Agree
2 = Disagree
3 = Unsure
13. In spite of what people say, the lot of the
average man is getting worse, not better.
1 = Agree
2 = Disagree
3 = Unsure
304
APPENDIX J
RAND 36-ITEM SHORT-FORM HEALTH SURVEY
This survey asks for your views about your health. This information
will help you keep track of how you feel and how well you are able
to do your usual activities.
Answer every question by selecting the answer as indicated. If you
are unsure about how to answer a question, please give the best
answer you can.
1. In general, would you say your health is:
Excellent Very
Good
Good Fair Poor
1 2 3 4 5
2. Compared to one year ago, how would you rate your
health in general now?
Excellent Very
Good
Good Fair Poor
1 2 3 4 5
3. The following questions are about activities you might do
during a typical day. Does your health now limit you in
these activities? If so, how much?
a. Does your health now limit you in
Vigorous activities, such as running,
lifting heavy objects, or participating
in strenuous sports?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
305
b. Does your health now limit you in
Moderate activities, such as moving a
table, pushing a vacuum cleaner,
bowling, or playing golf?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
c. Does your health now limit you in
Lifting or carrying groceries?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
d. Does your health now limit you in
Climbing several flights of stairs?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
e. Does your health now limit you in
Climbing one flights of stairs?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
f. Does your health now limit you in
Bending, kneeling, or stooping?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
306
g. Does your health now limit you in
Walking more than a mile?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
h. Does your health now limit you in
Walking several hundred yards?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
i. Does your health now limit you in
Walking one hundred yards?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
j. Does your health now limit you in
Bathing or dressing yourself
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
307
4. During the past 4 weeks have you had any of the following
problems with your work or other regular daily activities as
a result of your physical health?
All of
the time
Most of
the time
Some of
the time
A little
of the
time
None
of the
time
a.
Cut down on
the amount of
time you spent
on work or
other activities?
1 2 3 4 5
b.
Accomplished
less than you
would like?
1 2 3 4 5
c.
Were limited in
the kind of
work or other
activities?
1 2 3 4 5
d.
Had difficulty
performing the
work or other
activities (for
example, it took
extra effort)?
1 2 3 4 5
308
5. During the past 4 weeks, how much of the time have you had
any of the following problems with your work or other
regular daily activities as a result of any emotional problems
(such as feeling depressed or anxious)?
All of
the
time
Most of
the
time
Some
of the
time
A little
of the
time
None
of the
time
a.
Cut down the
amount of time
you spent on
work or other
activities?
1 2 3 4 5
b.
Accomplished
less than you
would like?
1 2 3 4 5
c.
Did work or
activities less
carefully than
usual?
1 2 3 4 5
6. During the past 4 weeks, to what extent has your physical
health or emotional problems interfered with your
normal social activities with family, friends, neighbors,
or groups?
Not at all Slightly Moderately Quite a bit Extremely
1 2 3 4 5
309
7. How much bodily pain have you had during the
past 4 weeks??
None Very
mild
Mild Moderate Severe Very
severe
1 2 3 4 5 6
8. During the past 4 weeks, how much did pain interfere with
your normal work (including both work outside the home
and housework)?
Not at all A little bit Moderately Quite a bit Extremely
1 2 3 4 5
9. These questions are about how you feel and how things have
been with you during the past 4 weeks. For each question,
please give the one answer that comes closest to the way you
have been feeling.
All of
the
time
Most
of the
time
Some
of the
time
A little
of the
time
None
of the
time
a.
How much of
the time
during the past
4 weeks, Did
you feel full of
life?
1 2 3 4 5
b.
How much of
the time
during the past
4 weeks, Have
you been very
nervous?
1 2 3 4 5
310
c.
How much of
the time
during the past
4 weeks, Have
you felt so
down in the
dumps that
nothing could
cheer you up?
1 2 3 4 5
d.
How much of
the time
during the past
4 weeks, Have
you felt calm
and peaceful?
1 2 3 4 5
e.
How much of
the time
during the past
4 weeks, Did
you have a lot
of energy
1 2 3 4 5
f.
How much of
the time
during the past
4 weeks, Have
you felt
downhearted
and depressed?
1 2 3 4 5
311
g.
How much of
the time
during the past
4 weeks, Did
you feel worn
out?
1 2 3 4 5
h.
How much of
the time
during the past
4 weeks, Have
you been
happy?
1 2 3 4 5
i.
How much of
the time
during the past
4 weeks, Did
you feel tired?
1 2 3 4 5
10. During the past 4 weeks, how much of the time has your
physical health or emotional problems interfered with
your social activities (like visiting friends, relatives, etc.)?
All of the
time
Most of the
time
Some of the
time
A little of
the time
None of
the time
1 2 3 4 5
312
11. How TRUE or FALSE is each of the
following statements for you?
Definitely
true
Mostly
true
Don’t
know
Mostly
false
Definitely
false
a.
I seem to get
sick a little
easier than
other people.
1 2 3 4 5
b.
I am as healthy
as anybody I
know.
1 2 3 4 5
c.
I expect my
health to get
worse.
1 2 3 4 5
d.
My health is
excellent.
1 2 3 4 5
12. The following questions are about activities you might do
during a typical day. Does your health now limit you in
these activities? If so, how much?
a.
Does your health now limit you in
Walking one block?
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
b.
Does your health now limit you in
Walking several blocks
1 = Yes, limited
a lot
2 = Yes, limited
a little
3 = No, not
limited at all
313
APPENDIX K
CENTER FOR EPIDEMIOLOGICAL STUDIES DEPRESSION INVENTORY
Below is a list of some of the ways you may have felt or behaved. Please
circle the number that best indicates how often you have felt this way
during the past week (7 days).
1. During the past
week
I was bothered by
things that usually
don’t bother me.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
2. During the past
week
I did not feel like
eating; my appetite
was poor.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
3. During the past
week
I felt that I could
not shake off the
blues even with
help from my
family or friends.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
314
4. During the past
week
I felt that I was just
as good as other
people.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
5. During the past
week
I had trouble
keeping my mind
on what I was
doing.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
6. During the past
week
I felt depressed.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
7. During the past
week
I felt that
everything I did
was an effort.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
315
8. During the past
week
I felt hopeful about
the future.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
9. During the past
week
I thought my life
had been a failure.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
10. During the past
week
I felt fearful.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
11. During the past
week
My sleep was
restless.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
316
12. During the past
week
I was happy.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
13. During the past
week
I talked less than
usual.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
14. During the past
week
I felt lonely.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
15. During the past
week
People were
unfriendly.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
317
16. During the past
week
I enjoyed life.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
17. During the past
week
I had crying spells.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
18. During the past
week
I felt sad.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
19. During the past
week
I felt that people
disliked me.
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
318
20. During the past
week
I could not “get
going.”
1-Rarely/None of the time (less than 1
day)
2-Some/A little the time (1-2 days)
3-Occasionally/Moderate amount of
the time (3-4 days)
4-Most/All of the time (5-7 days)
319
APPENDIX L
SATISFACTION WITH LIFE SCALE
Below are five statements that you may agree or disagree with. Using the
1 - 7 scale below, indicate your agreement with each item by placing the
appropriate number on the line preceding that item. Please be open and
honest in your responding.
• 7 - Strongly agree
• 6 - Agree
• 5 - Slightly agree
• 4 - Neither agree nor disagree
• 3 - Slightly disagree
• 2 - Disagree
• 1 - Strongly disagree
__________ 1. In most ways my life is close to my
ideal.
__________ 2. The conditions of my life are
excellent.
__________ 3. I am satisfied with my life.
__________ 4. So far I have gotten the important things
I want in life.
__________ 5. If I could live my life over,
I would change almost nothing.
320
APPENDIX M
BACKGROUND VARIABLES
Please provide the following:
1. What is your sex? [Please select ONE response] 1 - Male
2 - Female
2. What is your race? [Please select one or more responses]
1 - White
2 - Black or African-American
3 - Hispanic
4 - Asian
5 - Native Hawaiian or Other Pacific Islander
6 - American Indian or Alaska Native
7 - Some other race (please list) ___________________
3. What is your birth date?
Month Day Year
4. How far did you go in school? [Please select ONE response]
1 - 0-4 years of school completed
2 - 5-8 years of school completed
3 - Some high school
4 - High school completed
5 - Post high school, business or trade school
6 - 1-3 years of college completed
7 - 4 years college completed
8 - Post graduate study
321
5. Are you currently. . .? [Please select ONE response]
1 - Single
2 - Married or Living with a life partner
6a. Have you lost a spouse or life partner to death?
1 -Yes
2 -No
6b. What year did he/she die? 1
2 -Does not apply to me
7a. Have you ever been divorced or separated? 1 -Yes 2 -No
7b. What year was the divorce or separation? 1
2 -Does not
apply to me
322
8. Are you presently: [Please check ALL that apply]
1 -
Employed full-time
2 - Employed part-time
3 - Retired
4 - Retired on disability
5 - Not employed and seeking work
6 - Not employed and not seeking work
7 - Full-time student
8 - Part-time student
9 - Volunteer full-time
10 - Volunteer part-time
11 - Caregiver full-time
12 - Caregiver part-time
13 - Other [Please describe in detail]
9. What kind of work have you done most of your life?
[Please select ONE response]
1 - Never employed
2 - Homemaker
3 - Other [State the specific occupation in detail]
______________________________________________
10a. If you have/ had a spouse/ life partner does he/she now work
or did he/she ever work? [Please select ONE response - This applies
only to the spouse or life partner with whom you were together the
longest.]
1 -Yes
2 -No
3 -Not applicable- never had a spouse or life partner
323
10b. What kind of work did or does he/she do?
1 - Never employed
2 - Homemaker
3 - Other [State the specific occupation in detail]
____________________________________________
4 - Not applicable- never had a spouse or life partner
11a. How much total income do you (and your spouse/life partner)
have each MONTH?
1 - $0 -$1,000 per month 4 -
$5,001- $7,000 per
month
2 -$1,001-$3,000 per month 5 -
$7,001- $10,000 per
month
3 -$3,001-$5,000 per month 6 -
$10,001- Or more per
month
11b. How many people live on this income?
12a. What type of housing do you presently live in?
1 - Subsidized housing (Independent living)
2 - Subsidized housing (Assisted living)
3 - Private retirement community (Independent living)
4 - Private retirement community (Assisted living)
5 - Community dwelling: a house, condo or apartment
6 - Other [Please describe]
12b. Do you rent or own? 1 -Rent
2 -Own
3 -Other [specify] ______________
Abstract (if available)
Linked assets
University of Southern California Dissertations and Theses
Conceptually similar
PDF
Examination of the long-term psychosocial and functioning effects of a healthy living, life management behavior intervention for older adults
PDF
A mixed methods study of older adults in a Lifestyle Redesign® program
PDF
The relationship of expectation and satisfaction of filial piety with stroke-related outcomes of Chinese older adults in stroke rehabilitation
PDF
Optimizing participation of military service members with chronic symptoms after mild traumatic brain injury
PDF
Transformative occupations: life experiences of performers with disabilities in film and television
PDF
Situated experiences: a qualitative study of day-to-day life and participation of adolescents and young adults with a spinal cord injury and their caregivers
Asset Metadata
Creator
Eakman, Aaron M.
(author)
Core Title
A reliability and validity study of the meaningful activity participation assessment
School
School of Dentistry
Degree
Doctor of Philosophy
Degree Program
Occupational Science
Publication Date
06/19/2007
Defense Date
05/21/2007
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
activity,Depression,Gerontology,health related quality of life,life satisfaction,meaningful activity,measurement,OAI-PMH Harvest,occupation,Occupational Science,older adult,purpose in life
Language
English
Advisor
Clark, Florence A. (
committee chair
), Knight, Bob G. (
committee member
), Jackson, Jeanne Marie (
committee member
), Carlson, Michael (
committee member
), Azen, Stanley Paul (
committee member
)
Creator Email
ameakman@earthlink.net
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-m538
Unique identifier
UC167703
Identifier
etd-Eakman-20070619 (filename),usctheses-m40 (legacy collection record id),usctheses-m538 (legacy record id),usctheses-c127-514873 (legacy record id)
Legacy Identifier
etd-Eakman-20070619.pdf
Dmrecord
514873
Document Type
Dissertation
Rights
Eakman, Aaron M.
Type
texts
Source
University of Southern California
(contributing entity),
University of Southern California Dissertations and Theses
(collection)
Repository Name
Libraries, University of Southern California
Repository Location
Los Angeles, California
Repository Email
cisadmin@lib.usc.edu
Tags
activity
health related quality of life
life satisfaction
meaningful activity
measurement
older adult
purpose in life