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dissertation entitled

RELIABILITY AND VALIDITY OF WELLNESS
INSTRUMENTS: DIFFERENCES IN USERS AND
NON-USERS 0F COUNSELING CENTER SERVICES

presented by
BARBARA JEAN PALOMBI

has been accepted towards fulfillment

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Ph. D. degree in Psychology

 

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RELIABILITY AND VALIDITY OF
WELLNESS INSTRUMENTS:
USERS AND NON-USERS

0F COUNSELING CENTER SERVICES

AND THEIR LEVEL OF WELLNESS

BY

Barbara Jean Palombi

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

School of Health Psychology,
Counseling Psychology, and Human Performance

1987

Copyright by

BARBARA JEAN PALOMBI

1987

“I
{ rJ
I.)

?\
Q

ABSTRACT

RELIABILITY AND VALIDITY

OF WELLNESS INSTRUMENTS:
DIFFERENCES IN USERS AND NON-USERS 0F

COUNSELING CENTER SERVICES

3?

Barbara Jean Palombi

Wellness is a concept of recent origin that has not been
previously examined in the context of users and non-users of
counseling center services and their level of psychological health.
Previous studies have used the premise of the medical model which
infers that users of mental health services have a higher degree of
pathology present. A sample of S3 non-users was obtained by a
stratified random sample. The users of counseling center services
consisted of 57 students who received an intake interview at a large
Southwestern University. Both groups were given three wellness
inventories (Wellness Inventory, Lifestyle Assessment Questionnaire,
and Lifestyle Coping Inventory). The purpose of the study was to
determine the reliability and validity of the wellness instruments
and to identify differences in wellness levels between users and non-
users of counseling center services. The wellness instruments were

found to be both reliable as measured by coefficient alpha and valid

with this college student population. There were no statistically
significant differences as measured by MANOVA between users’ and non-
users’ level of wellness. In addition, supplementary descriptive
analyses were performed with the subscales of the inventories. Nine
of the twenty-nine wellness inventories subscales did show
statistically significant differences. On eight of these subscales,
the users had a higher level of wellness than non-users. These
subscales showed users of counseling center services to have a higher
level of wellness in the areas of finding meaning in life, self
exploration, attitudes towards play/work, cognitions and emotions.
The subscales of the test tend to support the findings that users are
more aware of their internal processes and issues, seek ways to
enhance their psychological well being, and use therapy as one of the
means to do so. The subscale results indicate that certain aspects
of wellness may be related to the utilization of counseling center
services which are counter to the traditional interpretation of

pathology as assumed by the medical model.

ACKNOWLEDGMENTS

This has been a long journey that seemed like it has gone on
forever. At times, I thought it would never end. The journey has
been.one about learning and trusting, not only about myself but that
those who could assist would appear when needed. In summary, this
journey was about trusting and learning to believe in myself and that
the universe will provide for all my needs.

I have many people to thank for their assistance and guidance
along the path. First I would like to thank the members of my
dissertation committee: Dr. William Binds - Chair, Dr. Don Bamachek,
Dr. Gersh Kaufman, and Dr. John Schneider. These four individuals
have been with me throughout this journey. Each of you have
contributed to this process. Many thanks for your assistance.

My stay at Michigan State University was filled with many
individuals who supported me: Ms. Lisa Blank, Betty and Terry Borg,
Dr. Imogene Bowers, Ms. Gwen Callahan, Dr. Joanne De Rosa, Dr. Linda
Forest, Ms. Mary Baas, Ms. Ann Keller, Ms. Kathy McKay, Dr. Jan
Rosenberg, Ms. Mary "Kate" Scala, Mr. Jim Wall, and Ms. Jackie
Williams. Each of these individuals holds a special place with me,
especially in terms of their support and love that they shared with
me. When I left Michigan State, it was very hard to leave all of you

behi nd 0

As an intern at Colorado State University, I had the opportunity
to work with Dr. Nancy Downing, Mary Lou and Ken Frank, Dr. Frank
Harrell, and Dr. Joyce Stein. This was a time that I began to
appreciate my creativity and to trust that the idea for my
dissertation would make a contribution to the field of psychology.

My new home in Arizona has again been filled with many
individuals who have encouraged me during this process. I want to
thank my colleagues at Arizona State University who not only
supported me emotionally, but also assisted in the data collection
process: Dr. Betty Asher, Dr. Teresa Branch, Dr. Leellen Brigman,
Ms. Carol Cameron, Dr. Andy Hogg, Dr. Judy Homer, Dr. Marvalene
Hughes, Dr. Joel Hutchinson, Dr. Stan Iwai, Dr. Elsie Moore, Dr.
Robbie Nayman, Ms. Barbara Riggs, Dr. Ilene Rosenstein, and Mr. Bob
Zubia.

The members of my dissertation support group, Dr. Ilene
Rosenstein, Dr. Julie Savage, and Ms. Libby Howell, shared with me
many valuable comments and helped to clarify the purpose and focus of
this dissertation. Thank you.

I especially want to thank Dr. Rob Witter who had the patience
of "Job" during the data analysis process and helped me to understand
the significance of the findings.

Three of the most important individuals in my life have been my
parents, Frank and Vira Palombi and my grandfather, Walter Cornet.

My parents have had so much faith in me and at times, believed in me
more than I believed in myself. Thank you for being there. And to

my grandfather, I know you would have been so proud.

vi

I also want to thank my brothers and sisters. We have been
through a lot together and your constant encouragement and
questioning of "when will you be done" has meant so much to me.

Thank you Randall, Carol, Robert, Karen, Elaine, Susie and Tom.

My final acknowledgment goes to Jon Vawter, my partner. I don’t
know how to thank you. I have not been the easiest person to live
with during the past few years. Yet, you have always been willing to
move so that I could gain the career experiences that I have needed.
When I felt that this process would never end, you always offered
encouragement. I don’t know what else to say, words can never say

how much I care about you.

vii

LIST 0?

CHAPTER
1.

2.

3.

TABLE OF CONTENTS

TABIJES 0......0.0.0.0....OOOOOOOOOOOOOOOCOO00.0.0.0...

STATEMENT 0? m3 PROBLEM OOOOOOOOOOOOOOOOOO0.0.00.0...

IntrOdUCtion 000000000000000000000000000000000.0000...
Need for the SCUdy 0000000.000000000000000000000000000
Theory 0000000000000000000000000000000000000.000000000
Significance for Counseling 00.00.0000.00.00.00.000...
Purpose Of the SCUdy 0.0000000000...0.000000000000000.
ResearCh Questions 00000000000000.00000000000.00.0000.
Overview of Dissertation .............................

REVIEW OF m3 LITERATURE OOOOOOOOOOOOOOOOOOOO0.0......

Psychological Instruments and Users and Non-Users of

Counseling Center serv1ce8 0000000..000.00.000.0000000
Minnesota Multiphasic Personality Inventory .......
Mooney PrOblen Cheek L18: .C...’...................
"yer8-Br1888 Type Indicator 0.000000000000000000000

Summary 0.000000000000000.0000...0.0000000000000000

Health Risk Appraisals 00000000000000.0000000000000000
StUdies "8108 Health Risk Appraisals 000.000.000.00
Limitations Of Health Risk Appr81881800000000000000

Summary 0000000000.0000000000.000000000000000000000

Wellness-Theoretical Foundation 00000000000000.000000.
WEIlness Instruments 0000.000000000000000...0000000
Wellness SCUdieB 00000000000000000.0000.00000000000
Wellness and the University Community .............

Summary 0000.00000000.0000000000.00.000000000000000

sumry 00....OOCOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO.

DESIGN OF mg STUDY 0.00000000000000000000000000......

Selection and Description of the Sample ..............
Measures Used in the SCUdy 0.00.00.00.0000.000.000.000

viii

Page

xi

15

15
16
22
26
27

29

40
40

41
50
S3
57
62

63

66

66
72

4.

5.

Current Psychometric Data on Instruments .............
Procedures for Data Collection........................
ResearCh HypOtheses 00000000000000.0000000000000000000
Procedures for Quantitative and Supplementary
Descriptive Data Analysis .000000000....000000000000

summEIY0000000000.00.000.00.00000000000000000000000000

RESULTS OF THE STUDY OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

Instrumentation .000O...0..0...OOOOOOOOOOOOOOOOIOOO0.0
Tests Of the ResearCh HypOtheses 0.0000000000000000...
Expectation for Users and Non-Users Concerning

Level Of wellness 0.000.000.00000000000000000000000.
Null Hypothesis for Users and Non-Users of

counseling Center serv1ce8 0.0000000000000000...0000
Supplementary Descriptive Analyses ...................

summary OOOOOOOOOOOOOOOO0.0.0.0000...OOOOOOOOOOOOOOOOO

SUMMARY, DISCUSSION, AND IMPLICATIONS ................

Summary 00000000000000.0000000000000000000000000000000
Discussion 000000000000000.000000000000000000000.0000.
Instrument Development - Reliability of

the Instruments 00.000.000.000000000.000000000000000
Validity Of the Instrument 0.00.0000000000000000000000
Differences Between Users and Non-users ..............
Limitations 0f the Study 000000.000000000000000000000.
Implications Of the ResearCh 000.00.000000000000000...
Instrumentation 00000.00000000000.000.00.0.00000000000
Users and Non-users of Counseling

Center Services 00.000000.0000...000.000.000.0000000
Directions for Future Research .......................
Inventory Rev1810n Studies 00.00.0000000.000....000000
Other TCSC Instrument SCUdies 00.000000000000000.00000
Long Range SCUdies 0000.000.00000000000000000000000000
Studies Based on Student Development

Theories .0.0....OOOOOOICOOOCOOOOOOOOO0..0.0.00.0...

conC1us10n OOOOOOOOOOOOOOOOOOOOO0.0000000000000000000.

ix

Page

75
77
81

82

85

87

87
87

100

101
103

104

110

110
112

112
120
125
133
136
136

137
140
140
140
141

141

142

APPENDICES 0.0...0.0...O.COOOOOOOOOOOOOOOOOOOOO0.00.0.0.000...

A.

B.

C.

D.

NON-USERS REQUEST TO PARTICIPATE LETTER
ANDCONSENT FORM OOOOOOOOOOOOOOOOOOOOOOO0.00.0.0...

RESPONDENT’S QUESTIONNAIRE PACKET IOOOOOOOOOOOOOOOOOOO

USERS REQUEST TO PARTICIPATE LETTER
ANDCONSENT FORM OOOOOOOOOOOOOOOOOOOOOO0.0.0.000...

PARTICIPANTS, FOLLOW-UP LETTER 00.00000000000000000000

LIST OF REFERENCES 0.....OOOOOOOOOOOOOOOOOOOOOOO0.00.00.00.00.

Page

143

144

146

167

169

170

TABLE

3.1

4.1

4.2

4.3

4.4

4.5

4.6

4.7

4.8

4.9

LIST OF TABLES

Description of Users and Non-users Samples
by Demographic Variables ooooooooooooooooooooooooo

Pearson Correlation Coefficients Between
Inventories and Coefficients of
Determination .0...0.0.0...OOOOOOOOOOOOOOOOOOOOOOO

Pearson Product-Moment Correlation Coefficient and
the Probability Value - Lifestyle Assessment
Questionnaire and Wellness Index ooooooooooooooooo

Pearson Product-Moment Correlation Coefficient and
the Probability Value - Lifestyle Coping
Inventory and "3110888 Index ooooooooooooooooooooo

Pearson Product-Moment Correlation Coefficient and
the Probability Value - Lifestyle Assessment
Questionnaire and Lifestyle
Coping Inventory .................................

Subscales that may Possibly Correlate and the
Subsequently Determined Pearson
Corralationa .0.0.00000000000000000000000000......

Total Test Scores of Users and Non-users of
Counseling Center serv1ce8 oooooooooooooooooooooo

Users and Non-users Group t-test Results for the
Lifestyle Assessment Questionnaire

subscales O...O0.0.0....OOOOOOOOOOOOOOOOOOO0.0...

Users and Non-users Group t-test Results for the
Wellness Index SUbscaleE-oooooooooooooooooooooooo

Users and Non-users Group t-test Results for the
Lifestyle Coping Inventary Subscales ............

xi

Page

68

92

95

96

97

98

102

106

107

109

CHAPTER 1

STATEMENT OF THE PROBLEM

Introduction

Since the pioneering work of Schneidler and Berdie in 1942,
counseling psychologists have been interested in the question, Who
are the users of university counseling centers? (Dunn, Lanning,
Patch, & Sturrock, 1980; Nagelberg & Shemberg, 1980; Reifler, 1970;
wechsler, Rohman, & Solomon, 1981) Schneidler and Berdie found that
students who sought counseling did not differ significantly from
their classmates in aptitude for college work, high-school
scholarship, or achievement in English. The student populations
tested resembled each other in measured personality traits such as
morale, social, family, and emotional adjustment, and economic
conservatism. Twenty-five years later, a similar finding was
reported by Berdie and Stein (1966). They compared counseled with
noncounseled college students across socioeconomic, personality, and
ability-achievement variables and discovered no "important"
differences. After forty years of research, the question still
remains, What variables differentiate users of counseling centers’
services from non-users?

One of the reasons for the lack of clarity concerning individual

traits that differentiate counseled from noncounseled students is

that the treatment/medical model, which characterizes the practice of
medicine in the United States today, has been used to examine this
population (Travis, 1981). Traditionally, medical and mental health
professionals have been concerned primarily with detection and
treatment of people who are already ill (Papenfuss & Beier, 1984).
According to Travis, the treatment/medical model is built on the
diagnosis of a disease, the repair of injury, and the elimination of
symptoms. A dimension usually missing is prevention. The
treatment/medical model shifts the responsibility of personal health
away from the consumer and places it on the provider of medical
services (Travis, 1981).

Bloomfield and Kory (1978) labeled the treatment/medical model
the "mechanistic" approach. The mechanistic viewpoint pictures the
body as a machine with parts that can be treated separately. It
stresses the importance of the physician’s role in the treatment of
disease, and de-emphasizes the role of mental and emotional factors
as a part of health. The mechanistic model encourages a disease
orientation and medical specialization at the expense of the client.

The treatment/medical model_has had an effect on the mental
health profession. Throughout the history of psychology,
psychologists have been primarily concerned with the unhealthy
aspects of personality (mental illness) and have ignored conditions
of psychological health (Hosler & Fadely, 1981). Present-day mental
health theories and much of psychological theory display a distinct
interest and focus on sickness rather than actual health (Hosler &

Fadely,l981). Little has been written about defining psychological

health, emphasizing psychological well-being (Jourard, 1971) except
for the work of Maslow (1968 81976).

The research literature on users of counseling center services
has followed the traditional treatment/medical model. The result of
the use of this model has been the assumption that users of
counseling center services have some degree of pathology present.
King (1968), for instance, in his study of students at Harvard found
that students who used counseling centers also used the medical and
surgical clinics more frequently during their college years. King
concluded that "one can interpret these data as indicative of the
general health preoccupation in many neurotic and psychotic
disorders" (p. 156).

Preoccupation with pathology is emphasized in other studies
concerning counseling center users. Boor (1975) found that students
with art majors contacted psychological services more frequently than
did most other students. The data from his study suggest that:

Persons with propensities toward relatively abstract,

subjective ideation are more likely to experience personal

adjustment difficulties or at least be more likely to seek

help for those difficulties than are persons with

propensities toward cognitions related to more concrete,

objective concepts. (p. 108)

According to Boor, psychology majors were another group that
mainfested pathological tendencies. Persons with relatively marked
personal adjustment problems tended to select psychology as a major
and were more likely to seek therapy for their adjustment problems

than other students. Reinhold (1973) found that students who used

counseling centers frequently identified the following symptoms:

depression, anxiety, thoughts of suicide, and fear of a nervous
breakdown.

The instruments used to detect differences between users and non-
users reflect the focus on pathology. Instruments used by
researchers have been the The Minnesota Multiphasic Personality
Inventory (Cooke 8 Kiesler, 1967; Davis 8 Widseth, 1978; Heilbrun,
1960; King, 1968; Kleinmutz, 1960), The Mooney Problem Check List
(Doleys, 1964; Palladino 8 Domino, 1978; Paradise, 1979), the College
Maladjustment Scale (Bosmajian 8 Mattson, 1980), Eysenick Personality
Inventory (McClure et al., 1982), and the Omnibus Personality
Inventory (Kirk, 1973; Rossman 8 Kirk 1970; Synder 8 Kahne, 1969).
The use of these instruments has failed to identify personality
characteristics that differeniate users and non-users. To date,
there is still little information as to why some students choose to
use a university counseling center while others do not (Bosmajian 8

Mattson, 1980).

Need for the Study

The use of the treatment/medical model, based on the diagnosis
of illness, may be one of the reasons why the studies (Bosmajiam 8
Mattson, 1980; Cooke 8 Kiesler, 1967; Davis 8 Widseth, 1978; Doleys,
1964; Heilbrun, 1960; King, 1968; Kirk, 1973; Kleinmutz, 1960;
McClure et al., 1982; Palladino 8 Domino, 1978; Paradise, 1979;
Rossman 8 Kirk 1970; Synder 8 Kahne, 1969) have failed to pinpoint
consistent differences between users and non-users of services. The

treatment/medical model identifies only those personality

characteristics that are deemed pathological. Rimmer et al. (1978),
using psychiatric diagnoses, found that 182 of their college sample
had some degree of psychological disturbance. Yet, only one half of
those defined as ill by the study sought help or considered getting
help. The authors concluded that being "111" was not the reason why
students sought help.

The treatment/medical model does not discriminate between users
and non-users of counseling services. The focus of the
treatment/medical model overlooks nonpathological personality
characteristics. The narrow focus of the treatment/medical model
limits the use of other attributes and behaviors in describing the
differences between users and non-users. Therefore, a need for a new
model is evident in the research that seeks to differentiate users

from non-users.

Theory

Increasingly, there is acknowledgment from both the medical and
mental health professions that mental health care is delivered most
effectively when the total person is addressed. Findings indicate
that a multidimensional model needs to be adopted in the mental
health field (Ferguson, 1980; Flynn, 1980; Lafferty, 1979; Pelletier,
1977, 1979; Ryan 8 Travis, 1981). One model that has the potential
for incorporating mental health care is wellness. The wellness model
offers a holistic view which recognizes that the multiple dimensions

of human functioning are inseparable (Elsenrath, 1984).

Dunn (1961, p. 4) defines wellness "as an integrated method of
functioning oriented towards maximizing the potential of the
individual." This definition implies that there is no optimum level
of wellness, but rather that wellness involves progress towards an
ever-higher level of functioning (Dunn, 1961). In other words,
wellness is an ever-changing state, incorporating many degrees or
levels of wellness (Ryan 8 Travis, 1981). Wellness does not imply
the absence of disease, but rather that disease presents an
opportunity for the growth of the individual (Ardell, 1979). High
level wellness means attending to the physical self, using the mind
constructively, channeling stress energies positively, expressing
emotions effectively, becoming creatively involved with others, and
staying in touch with the environment (Travis, 1981). According to
Travis, a person is constantly striving to improve his/her health,
regardless of where he/she is on the continuum of wellness. This
definition implies that there is no point where wellness is totally
achieved. Wellness is as dynamic as life itself (Lafferty, 1979).

The concept of wellness provides a new way of looking at health,
illness, and the utilization of service. It is a multifaceted
approach that includes physical, mental, intellectual, and spiritual
dimensions. A new paradigm for mental health and medicine, wellness
enlarges the framework of the medical model, incorporating scientific
and technological advances while restoring and validating intuitions
about the mind and interpersonal relationships (Ferguson, 1980).
When this new paradigm of wellness is applied to health care, a

qualitative change is noted (Ferguson, 1980), one that respects the

interaction of mind, body, and environment. The wellness paradigm

seeks to correct the underlying disharmony between mind and body that

is one of the causes of physical and mental health problems

(Ferguson, 1980). Ferguson, in The Aquarian Conspiracy, has compared

 

the assumptions of the old paradigm of medicine with the new paradigm

of health (PP. 246-248):

Assumptions of the old
’Paradigm of’HedICine

 

 

Treatment of symptoms.

Specialized.

Emphasis on efficiency.

Professional should be
emotionally neutral.

Pain and disease are
wholly negative.

Primary intervention with
drugs, surgery.

Body seen as machine in
good or bad repair.

Disease or disability
seen as thing, entity.

Emphasis on eliminating
symptoms, disease.

Patient is dependent.

Professional is
authority.

Assumptions of the new
Paradigm of Health

 

 

Search for patterns and causes,
plus treatment of symptoms.

Integrated, concerned with
the whole patient.

Emphasis on human values.

Professional’s caring is a
component of healing.

Pain and disease are information
about conflict, disharmony.

Minimal intervention with
"appropriate technology,"
complemented with full
armamentarium of non-invasive
techniques (psychotherapies,
diet, exercise).

Body seen as dynamic system,
context, field of energy within
other fields.

Disease or disability seen as
process.

Emphasis on achieving maximum
wellness, "meta-health."

Patient is (or should be)
autonomous.

Professional is therapeutic
partner.

Body and mind are
separate; psychosomatic
illness is mental,

may be referred to
psychiatrist.

Mind is secondary factor
in organic illness.

Placebo effect shows the
power of suggestion.

Primary reliance on
quantitative information
(charts, tests, dates).

"Prevention" largely
environmental: vitamins,
rest,exercise,

immunization, not smoking.

Note.

 

(Ferguson Paradigms of Illness and Health, continued)

Bodymind perspective; psychosomatic
illness is province of
all health-care professionals.

Mind is primary or coequal
factor in all illness.

Placebo effect shows the mind’s
role in disease and healing.

Primary reliance on qualitative
information, including patient’s
subjective reports and
professional’s intuition;
quantitative data an adjunct.

"Prevention" synonymous with
wholeness: work, relationships,
goals, body-mind-spirit.

From The Aquarian Conspiracy (pp.246-248) by Marilyn

 

Ferguson, 1980, Los Angeles:

by Marilyn Ferguson.

J. P. Tarcher, Inc. Copyright 1980

Advocates of the new paradigm for health strongly believe that

the wellness model will enable the members of society not only to
feel better about themselves, but to also have more of an impact on
determining their own degree of health (Ardell, 1979; Dunn, 1961;
Ferguson, 1980; Flynn, 1981; Gross, 1980; Ryan 8 Travis, 1981;
Travis, 1981). The wellness model emphasizes the need for an
integration of the mind, body, and spirit, and regards illness from a
new perspective-as a possible means of personal growth.

An outcome of the wellness paradigm is that psychologists and

mental health professionals now have an alternative to the

treatment/medical model, which has been used in the field of
psychology since it was developed by Freud (Maslow, 1961). Maslow
believed that this new model would give us more possibilities for
controlling and improving our lives and for making ourselves better
people (1961, p. 5).

The use of the wellness model provides an opportunity for
professionals to seek and develop other means to assess health and
understand the relationship between wellness and illness (Jourard,
1971; Pelletier, 1977; Travis, 1981). Van Ness (1981) found that
professionals using the wellness model looked at the presenting
symptoms of the client in the context of his/her whole life and were
able to recommend medical, life style, psychological and/or spiritual
changes. Travis (1981) developed the following model for

professionals showing the continuum of wellness and illness.

 

Ewes/Wtflna§(bnunmun

        
 

 

   

PREMATURE O O LEVEL
DEAT manmmss rmu‘nrn’yr. (mowm WELLNESS

DIQLBM‘TV 5V}.'P'Oh"\ Stunt;
TFEUUTAENTNMJDEL

A
NEUTRAL POINT
(No W "has or Mm)

    

Note. ILLNESS/WELLNESS CONTINUUM. From The Wellness Workbook

 

(p. 2) by R. S. Ryan and J. W. Travis, 1981, Berkeley, CA: Ten
Speed Press. Copyright 1972, 1981 by John W. Travis. Reprinted
by permission.

Moving from the center to the left shows a progressively

worsening state of health. Moving to the right of center indicates

10

increasing levels of health and well-being. The treatment/medical
model can bring the individual to the neutral point, where the
symptoms of disease are alleviated. The wellness model, which can be
utilized at any point, directs the person beyond neutral, and
encourages her/him to move as far to the right as possible. The
wellness model incorporates the treatment model and adds the
dimensions of awareness, education, and personal growth.

With wellness as a continuum, mental health and service
utilization can be described and evaluated from a broader
perspective, not just from the left half of the continuum that the
medical model addresses. The dimensions of mind, body, intellect,
and spirit can assist mental health professionals in understanding
client concerns and in the development of a wholistic approach to
treatment. Treatment can then serve as a vehicle for personal growth
as well as a means for correcting behavioral problems (Papenfuss 8

Beier, 1984).

Significance for Counseling

The wellness model provides, for the field of psychology, a
preventative and holistic approach to mental health services and it
permits psychologists to break away from the traditional
treatment/medical model, which has not been useful in differentiating
users and non-users. Since wellness theorists regard illness as a
means of personal growth, this may indicate that students who seek
counseling services are healthier than those who do not. This

premise would encourage psychologists to move away from the

ll

assumption that students who use counseling center services have some
degree of pathology present.

The wellness model is congruent with the philosophy of new
approaches to mental health (Elsenrath, 1984; Travis, 1981). The
current trend in counseling centers is to emphasize normal growth and
development, address the issues of person/environment fit,
developmental crises, needs of neglected populations, and issues that
address life span development (Delworth, 1977).

The wellness model examines each of these issues using a
holistic and proactive approach (Travis, 1981). It is believed that
the wellness model has the potential to provide counseling center
professionals with a means to implement this new philosophy of mental

health through its emphasis on prevention and personal growth.

Purpose of the Study
Though the theory of wellness has been part of the psychological
literature since the works of Maslow (1968), Jourard (1971), and
Allport (1955), little research has been conducted to validate this
construct. Several instruments have been developed, however, to
measure an individual’s level of wellness. Three popular inventories

are: Wellness Inventory (Travis, 1981); Lifestyle Assessment

 

 

Questionnaire/Wellness Assessment Questionnaire (The National

 

Wellness Institute, 1983); and Lifestyle Coping Inventory (Hinds,

 

1983). These inventories measure the following characteristics:

wellness
Inventory

Self Responsibility
and Love

Breathing

Sensing

Eating

Moving

Feeling

Thinking

Playing and Working
Communicating

Sex

Finding Meaning

Transcending

12

Dimensions of Wellness

 

Lifestyle
AEsessment

Questionnaire

 

 

Physical Fitness

Self-Care

Drugs and Driving

Nutritional
Social-Environmental
Emotional Awareness
Emotional Control
Intellectual
Occupational

Spiritual

Lifestyle
Coping

IEVEEEBry
Nutritional Actions

Physical Care

Cognitive and
Emotional Actions

Low Risk Actions
Environmental Actions
Coping Style

Social Support

Note. The list of characteristics in column 1 are from Wellness

 

Inventory by J. W. Travis, 1981; the list of characteristics in

column 2 are from Lifestyle Assessment Questionnaire by the National

 

Wellness Institute, 1983; and the characteristics in column 3 are

from Lifestyle Coping Inventory by W. Hinds, 1983.

 

These instruments have also been used to provide a framework for

defining positive mental health in both the university community and

industry (Elsenrath, 1984; Juechter 8 Utne, 1982; Snow, 1982; Van

13

Ness, 1981). Though instruments of this type are readily accepted by
the public and industry, little research has been done to determine
the reliability and validity of the concept of wellness itself. The
literature contains no research to substantiate whether these
instruments actually measure wellness.

The purpose of this dissertation is two-fold. First, this study
is to determine whether wellness inventories measure similar
characteristics, and therefore report similar results in terms of the
level of wellness. The second purpose is to determine whether
wellness inventories identify consistent differences between

counseling center users and non-users.

Research Questions

Two sets of research questions guide this study. The first set
of questions focus on the reliability and initial validity of
wellness inventories: The Wellness Inventory (WI), The Lifestyle
Assessment Questionnaire-Wellness Assessment Questionnaire (LAQ), and
the Lifestyle Coping Inventory (LCI). The second set of questions
center around the differences between users and non-users of
counseling center services. Three main questions will be researched,
and they are stated generally in this section and in statistical form
in Chapter III.

Instrumentation Questions

 

1. Are the WI, LAQ, and LCI reliable measures of wellness

for college student populations?

l4

2. Is there evidence of construct validity with the WI,
LAQ, and LCI?

Differences Between Users and Non-Users of Counseling Center Services

 

3. Do users of counseling center services and non-users of
counseling center services differ in wellness levels as

measured by the WI, LAQ, and LCI?

Overview of Dissertation

In Chapter 1, the problem investigated is presented along with
the need for, importance of, and theory framing the research. In
Chapter 2, a comprehensive review of the literature is presented.
Chapter 3 describes the overall design and methodology for the
study. Chapter 4 will contain the results of the research. In
Chapter 5 a summary will be presented and conclusions drawn from the
results. Implications of the research will be discussed in the final

chapter.

CHAPTER 2

REVIEW OF THE LITERATURE

The purpose of this chapter is to review theory and research
relevant to wellness and users and non-users of counseling center
services. It includes a description of psychological instruments
used to differentiate users and non-users of counseling center
services, the use of Health Risk Appraisals, the theoretical
foundation of wellness, the development of wellness inventories as an
outgrowth of Health Risks Appraisals, and the university community

and wellness.

Psychological Instruments and
Users and Non-users of Counseling Center Services

Since the 1930s professionals have been concerned with the
mental health of college students and the use of counseling center
services (Nikelly, 1966), yet there is little information as to why
some students choose to use a counseling center while others do not
(Bosmajian 8 Mattson, 1980). Researchers have tried to predict which
students would be users of counseling center services through the use
of psychological instruments. A review of the literature shows that
a wide range of instruments have been used to differentiate users

from non-users, from the MMPI to the Survey of Study Habits, yet

15

16

little attention has been paid to the original purposes of the
instrument, methodology and research procedures, and psychometric
limitations associated with the instruments. Therefore, it is
difficult to compare the results of these studies and draw definite
conclusions from the literature.

The following section is a review of studies using psychological
instruments as a means of differentiating users from non-users of
counseling center services.

Minnesota Multiphasic Personality Inventory

 

One instrument that has been used extensively is the Minnesota
Multiphasic Personality Inventory (MMPI). The MMPI consists of 550
affirmative statements, to which the examinee gives the responses

True, False, or Cannot say. The test items of the MMPI range widely

 

 

in content, covering such areas as: health; psychosomatic symptoms;
neurological disorders and motor disturbances; sexual, religious,
political, and social attitudes; educational, occupational, family,
and martial questions; and many neurotic or psychotic behavior
manifestations, such as obsessive and compulsive states, delusions,
hallucinations, phobias, and sadistic and masochistic trends
(Anastasi, 1982, p. 501).

The principal application of the MMPI is to be found in
differential diagnosis. In using the inventory for this purpose, the
procedure is much more complex than the labels originally assigned to
the scales might suggest. The test manual and related publications
caution against literal interpretation of the clinical scales. "We

cannot assume that a high score on the Schizophrenia scale indicates

17

the presence of schizophrenia. Moreover, such a score may occur in a
normal person." (Anastasi, 1982, p. 503) Elevated scores cannot be
solely interpreted as an indicator of pathology and/or mental
illness.

The relevant studies using the MMPI fall into two major
categories: studies comparing the different MMPI scales, and studies
that classify students according to their level of psychological
adjustment. Davis and Wideseth (1978) administered the Minnesota
Multiphasic Personality Inventory to university freshmen males
(N-755) entering in the fall semesters of 1969, 1970, 1971, and
1972. The purpose of the study was to investigate the utility of
elevated MMPI scales 2 (Depression) and 7 (Psychasthenia) as a
predictor of psychological help seeking during college. The results
support the conclusions that among male college students elevated
MMPI 2 and 7 scores were indicators of current anxiety and of a
relatively enduring clinical problem. Students with moderately high
MMPI scales 2 and 7 at college entry were 502 more likely to seek
counseling than were other students. The 2-7 elevation was
characteristic (622) of freshman male counselees (the study did not
include female students). A study by Strupp and Bolxom (1975)
reported similar findings for males and failed to find a comparable
relationship between 2-7 elevation and rate of counseling for
females. Overall, the relationship between the MMPI scale elevation
on college entry and later help seeking appeared stronger for male
than for female students. Therefore, it is difficult to generalize

the results of these studies to all university students.

18

Parker (1961) used the long and short forms of the MMPI to see
which would be a better predictor of counseling center usage. Parker
found that the long form, not the short form, of the MMPI
discriminated between users and non-users if it was given at
orientation. However, if the test was given at the time of
counseling, either form discriminated between the two groups. The
greatest differences were found in the D and AI scales in the long
form. The short form showed greater differences on the Pt and Se
scales. These results question the reliability and validity of these
two instruments. If the two forms of the MMPI were statistically
equivalent, similar test results should be reported. This study
indicated that there are psychometric problems with the two
instruments. One is unable to concluded that either form
differentiates users from non-users.

Cooke and Kiesler (1967) administered the MMPI and the Welsh
Anxiety Index to all incoming freshmen at the University of Iowa from
1958 to 1962. The client subjects for each year (40 males, 40
females) were chosen by a table of random numbers from a group who
applied to the counseling center for personal adjustment problems.
The non-client subjects (40 males, 40 females) were randomly selected
from the routine case files of all incoming freshmen.

For both male and female groups, clients had a significantly
higher total MMPI mean and a significantly higher neurotic triad mean
than non-clients. However, there were no significant differences
between clients and non-clients on the Welsh Anxiety Index. The

results of this study indicate that students who seek counseling

19

generally have more elevated MMPI scales than those who do not. The
elevation was not limited to a few specific scales, but a generally
higher profile across all scales. Cooke and Kiesler concluded that
it might be possible to use the MMPI to predict, at college entrance,
those students who will later require counseling. However, the study
does not answer the question, what are the personality traits that
differentiate users from non-users.

Calhoun and Selby (1974) incorporated the MMPI as part of a test
battery to determine help-seeking attitudes and the severity of
psychological distress with undergraduates (N-45) enrolled in
introductory psychology courses. The scores on the MMPI were
correlated with the overall score on the help seeking inventory. The
results indicated that the more distress, the less favorable the
attitude toward seeking help. In other words, the more disturbed
individuals were less receptive to psychological help. The results
of this study would question whether those who seek counseling are
actually the more disturbed individuals on the college campus.

Bosmajian and Mattson (1980) attributed the lack of differences
between users and non-users in previous studies with the MMPI to
overlooking the wide variability within user and non-user groups in
respect to the individuals' level of personal adjustment. Although
it is well known that counseling users exhibit a wide range of
troubled behavior, research is typically conducted as if the
differing levels of personal adjustment found within users’ and non-

users’ groups is of little consequence in terms of outcome measures.

20

The primary purpose of the Bosmajian and Mattson study (1980)
was to determine the extent to which several predictor variables were
able to discriminate between individuals (matched on levels of
personal adjustment) who sought help at a university counseling
center and those who did not. The College Maladjustment Scale
(Kleinmuntz, 1960) was used as the investigating instrument. The
College Maladjustment Scale is a 43-item scale empirically derived
from the MMPI on the basis of each item’s ability to successfully
discriminate between individuals who were seen at a college mental
health clinic and those who were not.

Bosmajian and Mattson divided the sample into three groups of
females, each containing 40 individuals: 1) Adjusted seekers who
made and kept their first appointment with a counselor for a problem
other than one of a personal-social nature, and scored equal to or
less than 15 on the College Maladjustment Scale; 2) Nonadjusted
seekers who made and kept their first appointment with a counselor
for help with a personal problem (ranging from serious psychological
complaints to other difficulties such as loneliness, loss of
boyfriend/girlfriend) and scored greater than 15 on the College
Maladjustment Scale; 3) Counseling nonseekers, a group comprised of
10 adjusted and 10 nonadjusted subjects. Level of adjustment was
determined by scores on the College Maladjustment Scale, 10 scored 15
or less and 10 scored greater than 15. Bosmajian and Mattson found
that the results of the study would have been quite different had
levels of adjustment been ignored. The tendency for adjusted and

nonadjusted seekers to differ would have gone unnoticed.

21

The results of the study suggest that variables traditionally
associated with help-seeking attitudes and behaviors, such as
willingness to disclose and attitudes toward psychologists and
psychiatrists, did not discriminate between individuals who sought
help and those who did not (when level of adjustment was
controlled). The study also found that seekers and nonseekers were
capable of making and maintaining an intimate friendship. Both
groups did talk to friends about personal problems, however,
nonseekers used more sources of help in efforts to deal with their
problems. The results of the study indicated that the number of
social supports was the discriminating variable between users and non-
users.

The College Maladjustment Inventory has psychometric limitations
due to its construction, i.e. use of items from the MMPI. No
reliability estimates are cited, therefore, it is difficult to
determine whether the study is psychometrically sound. Another
limitation of the study was the sample itself of female students
only. The results can only be generalized to female college
students.

In summary, investigators have used the MMPI in their research
with users and non-users of counseling centers. In some of the
studies, students who seek counseling have generally appeared more
maladjusted on the MMPI than students who do not seek counseling
(Cooke 8 Kiesler, 1967; Danet, 1965; Kleinmuntz, 1960; Parker,

1961). In other studies, the MMPI has not been able to differentiate

between users and non-users and they have indicated that those who

22

need help may not be the ones that seek help (Calhoun 8 Selby,
1974). As a whole, the results of these studies bring into question
the validity of the MMPI as a differentiator of users and non-users.

Mooney Problem Check List

 

Instruments that access students’ current areas of concerns have
been another area of focus for researchers. The Mooney Problem Check
List (1950) has been the primary instrument used in this type of
research. The manual (1950) emphasizes that the counselor must keep
in mind that the Problem Check List is not a test. It does not yield
scores on traits or permit any direct statements about the adjustment
status of the respondent. Rather, the Problem Check List is "a form
of simple communication between the counselee and counselor designed
to accelerate the process of understanding the student" (Mooney 8
Gordon, 1950).

The counselor needs to be continuously aware that the importance
of the number of items checked by a single person cannot be known
except from the total counseling situation (Mooney 8 Gordon, 1950).
A person with many checked problems is likely to have more real
problems for which counseling might be helpful, although this is not
necessarily so. Similarly the importance of the mean number of
checks made by a group and the frequency distribution therefore
resides, not in the magnitude of these statistics, but to a
considerable extent in the purposes for which the survey of student
problems was instituted.

Palladino and Domino (1978) were interested in the dimensions

tapped by using instruments that did not emphasize serious pathology.

23

In 1969, entering freshmen were invited to participate in a testing
program sponsored by the counseling center. Each participant was
given the California Psychological Inventory (CPI), the Survey of
Study Habits and Attitudes (SSHA), and the Mooney Problem Check List
(MPCL). In 1974-75 an analysis of counseling center files was made
to locate students from the entering class of 1969 whose folders
contained complete and valid test protocols, clear record of their
contacts, and the registrar’s certification that they had graduated
as expected. For this study, 279 files were selected.

The MPCL was the only instrument of the test battery that
yielded significant results. Eight problem areas of the MPCL showed
significant differences between users and non-users: social and
recreational activities; social-psychological relations; personal-
psychological relations; courtship, sex, and marriage; home and
family; morals and religion; and adjustment to college work. The
author conducted further statistical analyses to determine if
significant differences existed between long-term clients and short-
term clients. For males, the short-term clients checked the fewest
items, non-clients were in the middle, and long-term clients checked
the most. For females, non-clients checked fewer problems in the
health area, followed by short-term and long-term clients, while the
order of short-term and long-term clients was reversed for the
section on finances.

The authors of the study concluded that those seeking counseling
were not substantially different from their peers in basic

personality dimensions but were significantly different in the

24

reporting of actual and potential difficulties. This conclusion
seems premature. The authors did not address inconsistencies such as
sex differences and inconsistent ranking within groups, which
heightens the caution mentioned in the test manual. The MPCL is an
instrument designed to assist the therapist in identifying clients’
concerns, but not necessarily identifying the severity of their
distress (Mooney 8 Gordon, 1950).

Doleys (1964) administered the Mooney Problem Check List to six
sections (N-158) of introductory psychology classes. However,
instead of asking the students to complete the essay questions at the
end of the check list, another page was inserted. This sheet
contained statements and instructions designed to determine how
interested the student was in using counseling center services.

Those students who expressed either very interested or interested,

 

were contacted either by phone or by letter. If the client continued
to express an interest in counseling, an appointment was made. Of
the 158 students tested, 63 (402) met the above criteria for
potential clients. After all of these were contacted, 33 (212)
actually became clients, while 30 (192) had either changed their
minds about wanting counseling, or made appointments and failed to
keep them on two consecutive occasions.

Doleys found that students who became clients of the university
counseling center expressed significantly more total problems on the
Mooney Problem Check List in the areas of: Health and Physical
Development; Finances, Living Conditions, and Employment; Social-

Psychological Relations; Personal-Psychological Relations; and

25

Adjustment to College Work. The author concluded that the MPCL was
able to differentiate among students who did not want counseling,
students who wanted counseling but did not become clients, and
students who became clients by counting the number of problems
checked on the instrument.

The results of study are misleading. The sample of counseling
center users were students who were directly contacted by the staff
of the counseling center. It is difficult to determine which
variable identified counseling center users, the number of problems
checked on the MPCL or the personal contact by the counseling center
staff member. The sampling procedures may have biased the results of
the research.

Tryon’s study (1978) attempted to identify incoming freshmen who
would request counseling by determining the relationship between
difficulties endorsed during summer orientation and later counseling
problems. In this study 343 freshmen took the Mooney Problem Check
List (MPCL), the Strong Vocational Interest Blank, and the Survey of
Study Habits and Attitudes.

The results of the study indicated that students who came for
personal counseling, vocational counseling, and test feedback all
endorsed similar numbers of problems. These students did not differ
from students who made appointments but did not show or from students
who did not seek counseling. Even when students were classified as
either users or non-users of counseling, they were found to differ

only on one MPCL scale. The users of counseling underlined

26

significantly more problems in the moral and religion category than
non-users.

The outcome of Tryon’s study were in agreement with previous
studies that found little or no differences between users and non-
users of counseling (Berdie 8 Stein, 1966; Rossman 8 Kirk, 1970;
Schneidler 8 Berdie, 1942). In summary, the results of Tyron’s study
indicated that the MPCL was not a good predictor of help-seeking
behaviors. Issues that bothered students before they entered college
were not necessarily what caused them to seek counseling after entry.

Myers-Briggs Type Indicator

 

The Myers-Briggs Type Indicator (MBTI) is a personality
inventory based largely on Jungian theory and yields scores on four
dimensions: Judgment-Perception, Thinking-Feeling, Sensation-
Intuition, and Extraversion-Introversion. The client must choose
between two descriptive terms or phrases that appear equally
acceptable but differ in validity. The MBTI is concerned with the
way people prefer to use their minds, interact with their
environment, and process information (Anastasi, 1982).

Mendelsohn and Kirk (1962) used the Myers-Briggs Type Indicator
to complete a study concerning personality differences between users
and non-users of counseling services. One sixth of the 1959 freshman
class at the University of California-Berkeley was given the MBTI
during registration week as part of an assessment battery. By
inspecting the files of the counseling center, sub-samples of those
who had been given the MBTI and had utilized the counseling service

within the following year were formed. The results of the study

27

indicated that the user sample and the non-user samples were similar
on a number of important variables, for example, intelligence, age,
education, socio-economic status. The two dimensions that
discriminated best between the client and the non-client samples were
Judgment-Perception and Sensation-Intuition. The data indicated that
those whose preference was toward perception rather than judgment and
who relied less on overt, concrete stimuli (Intuition types) were
more likely to seek counseling assistance. The conclusions of the
study may lead one to assume that students who are more perceptive
and intuitive are less healthy than the judging-sensing types. The
test manual cautions users from drawing such conclusion when using
the MBTI.

King (1968) used the Myers-Briggs Type Indicator as one of the
variables in a study with undergraduate students (N-666) who received
psychiatric services before graduation and those who did not seek
services. King found that students who used psychiatric services
were more intuitive and introspective. King also compared these two
groups on a number of other variables including psychological
mindedness, social desirability, need deference, and emotionality.

He found that users of counseling centers possess psychological
characteristics that are highly valued within the university
including, being more individualistic, able to think for oneself,
less emphasis on the work-success ethic, and more present focus.
Summary
The assumption that the average counseling center user is more

disturbed than the average non-user is not clearly supported by the

28

literature. A close inspection of research that purports to
discriminate counseling users from non-users on the basis of level of
adjustment reveal users and non-users to be more alike than different
on most measures (Bruch, 1977; Cooke 8 Kiesler, 1967). In 1940,
Williamson and Bordin reported that counseled students were better
adjusted and achieved higher grade-point averages than noncounseled
students. These findings were confirmed by Campbell (1963). Snyder
and Kahne (1969) noted that freshman users as compared to non-users
showed more of the qualities that the college values: "an
appreciation of a broad range of intellectual interests, tolerance
for ambiguity, autonomy, and a relative lack of stereo-typical
responses" (p. 28). There seems to be in the user a pattern of
positive and valued qualities that may make adjustment more difficult
and complex in the student’s college years, and lead to more personal
problems and adjustment difficulties, that also may well put this
student ahead in the long run (Snyder 8 Kahne, 1969).

Carskadon (1975) in his review of the literature concerning help
seeking behaviors noted:

Helpseekers are more psychologically minded than

nonhelpseekers,more questioning, and more introspective.

They are less authoritarian and less accepting of

traditional values in and out of college. They are more

cosmopolitan and more aesthetic. They are more complex

in their thinking, and tend to be more autonomous. (p. 132)
Whether or not helpseeking is a sign of weakness remains debatable
(Carskadon, 1975). It is a value judgment whether the

characteristics that distinguish users from non-users represent

strength or weakness (Carskadon, 1975). Given the goals of higher

29

education, however, it is difficult not to see some of these

attributes as strengths.

Health Risk Appraisals

Health Risk Appraisals (HRA), also known as Health Hazard
Appraisals (HHA), are tools that describe an individual’s chances of
being ill or dying from selected diseases (Chenoweth, 1981). (The
literature does not clearly differentiate between HHA and HRA. To
elimination confusion, the term HRA will be used in this literature
review.) The questions used on Health Risk Appraisal forms cover
age, race, sex, height, weight, blood pressure, cholesterol level,
history of chronic bronchitis or emphysema, family health history,
and such life-style issues as smoking, drinking, seat-belt usage, and
exercise habits (Imperato 8 Mitchell, 1985). The objective of HRA is
to modify an individual’s behavior by motivating lifestyle changes
(Chenoweth, 1981). According to Pelletier, HRA systems are one of
the most important tools now being developed for preventive medicine
(1977).

The Health Risk Appraisal, based on the work of Lewis Robbin and
Jack Hall (Fenger 8 Byrd, 1979), was developed at the Methodist
Hospital in Indianapolis (Milsum, 1981). During 1975, Robbin and
Hall sent more than 40,000 appraisals to physicians, medical schools,
residency programs, health educators, health clubs, and departments
of public health (Pelletier, 1979). Robbin and Hall established the
validity of the HRA by comparing the responses on the returned

appraisals to the twelve leading causes of death. The data bases for

30

HRA were based on several studies and a compilation of death
certificates over the past two decades. From the results of the
comparison an estimate of a participant’s probability of dying in the
next ten years was determined (Imperato 8 Mitchell, 1981; Milsum,
1981).

Upon completion of the HRA, the individual’s computerized score
is compared to their peer group based on the most recent Geller Table
to precisely determine potential health risks to that person. The
Geller Tables are risk tables based on a search of about 20 years of
medical literature. From this data, a determination of probability
is made concerning the 15 leading causes of death for each of the
four categories: black males/females and white males/females.

According to Pelletier (1977) the assessment program is intended
to determine whether the person is above or at an average in terms of
health risks as compared to his/her peers. After the HRA is scored,
the individual is given a health-hazard age, which might be the same
as or in excess of his/her chronological age.

For example, an individual of age forty-five may in fact

have a health-hazard age of fifty, in the sense that he

is engaged in sufficient negative life-style activity at

the present time to place him at the risk of a decreased

longevity of five years. At this point the individual

simply has the information he is in fact living in a

high-risk manner. (Pelletier, 1977, p. 313)

The HRA proceeds one essential step further. The computer
printout informs the individual of the years that are recoverable and
notes to the person the specific area in which s/he should alter

his/her life style to decrease the health risk. Included in this

risk reduction procedure are recommendations such as: start an

31

exercise program, quit smoking, lose ten pounds, have a yearly
physical checkup, or, simply, wear seat belts all the time while
driving. Each of these factors is given a numerical value of how
many years can be regained though implementing these
recommendations. Often it is possible to regain or to reverse the
risk by as much as 902 (Pelletier, 1977). Simply stated:

The HRA process identifies preventable and unpreventable
health risks for each individual participant. These

risks, which are presented in a graphic format demonstrate
the beneficial effects in terms of longevity and of
reducing preventable health risks. (Fenger 8 Byrd, 1979, p.
121).

One of the doctors most active in the development and continued
application of HRA and preventive health care is John W. Travis
(Pelletier, 1977, 1979). As part of his work, he developed an
appraisal system concerning the etiology of disorders. Inherent in
this appraisal system is the assumption that the etiology of a
disorder is a long developmental process that can be altered by
either a health or a disease orientation (Ryan 8 Travis, 1981;
Travis, 1981). According to the HRA literature written by Travis and
Reichard (1978), the natural history of a disease progresses in a
series of seven stages:

Stage 1: ’No-risk’ category-constitutes the early part of
life, when an individual is least likely to have a severe
disease.

Stage 2: ’At risk’ category-when conditions such as age
and environmental pollution exist and the individual may
become increasingly vulnerable to a disease.

Stage 3: ’Excessive Stress’-a particular physical agent
or psychosocial situation is present which is determined
places excessive stress upon the person. During this
third stage the patient might smoke or engage in another
activity which is a precursor of disease and places that
individual into a higher stage of risk.

32

Stage 4: ’Disease Initiated’-there are definite clinical
signs that a disease is initiated, but the individual is
as yet unaware of it.

Stage 5: ’Help Seeking’-there are clear symptoms, such
as pain, blood in the urine, or other unequivocal signs
to the individual that lead him to his physician to seek
help for his discomfort.

Stage 6: ’Disability’-there is disability, and at this
point the individual has usually already sought medical
care, since he is now in a stage of acute pain, disease,
or disorder. If this stage is not adequately noted or
treated, then the final stage;

Stage 7: ’Death’

Note: From Holistic Medicine from Stress to Optimum Health

 

 

(p. 84-85) by K. R. Pelletier, 1979, New York: Dell Publishing.

Health practitioners do not usually concern themselves with the
disease process until it reaches the signs characteristic of stage
four when there are definite clinical signs of a disease (Pelletier,
1979). HRA makes it possible to look at stages two and three prior
to the symptoms of a disorder; at this time preventive techniques can
be initiated. During stage four, psychological, sociological, and
situational variables can be used in conjunction with the traditional
medical exam. Obviously, at stages five and six there is a pressing
need for traditional medical care. Most important, detecting disease
at early stages allows health practitioners to practice truly
preventive medicine by giving ample warning both to the person and
the practitioner before a disease becomes manifest (Pelletier, 1977,
p. 315).

In primary prevention, the first step is to make high-risk
individuals aware of their potential health problems. Only after
this recognition is the person likely to engage in activities

designed to lower that risk. Often a patient is aware of what

33

activities s/he needs to do to restore or maintain health, but, all
too frequently, the patient does not implement activities to restore
health. A reliable health status appraisal can often provide strong
motivation to change self-destructive habits (Pelletier, 1979).

Milsum (1981) outlined the following issues as needing to be
clarified with the client when using HRA:

1. The concept of reduced risk does not necessarily
guarantee avoidance of death, or even sickness.

2. Mortality figures represent only a small part of the
total disease entity, the tip of an iceberg of
morbidity.

3. The program is intended to be educational and the
important issue is to become aware of how various
lifestyle habits are capable of influencing one’s
health.

4. Although the recommendations may appear rather
commonplace, and are not new, these issues keep
coming up because they are the important ones.

5. Finally, the HRA is not primarily a screening tool
for disease. Rather, the underlying intention of
HRA is to motivate individuals for lifestyle change
in those stages when the person’s risk of contracting
such diseases through imprudent health habits is
increasing (p. 112).

Studies Using Health Risk Appraisals (HRA)

 

The HRA has been incorporated as part of a proactive approach to
health care and prevention in police departments, business and
industry, social service agencies, and in educational systems
(Badenhop et al., 1985; Bensley, 1981; Chenoweth, 1981; Cottrell 8
St. Pierre, 1983; Fenger 8 Byrd, 1979; Juechther 8 Utne, 1982; LaDou,
Sherwood, 8 Hughes, 1975; McClaran 8 Sarris, 1985; Shea, 1981; Van
Ness, 1981; Wilson et al., 1980; Wood 8 et al., 1982). Many
professionals regard the HRA as a solution to problems facing

agencies and institutions (Wilson et al., 1980). The following is a

34

review of the literature concerning the use of HRA with high school
and college student populations. Included in the review is a summary
of the findings and possible limitations of the research.

Bensley (1981) incorporated the HRA entitled Database
Acquisition For Student Health (DASH), a commercially available HRA
instrument designed specifically for college students, in his health
education course. As a result of the attitude survey (N-31)
regarding the use of HRA the following observations were made:

1) Students seemed excited about the use of health risk appraisals as
a means of building a curriculum for health education courses; 2)
Students welcomed the opportunity to change their health behaviors
using a group setting; and 3) Students committed themselves to
positive health behavior changes. From the follow-up survey, Bensely
concluded that students were healthier in December than they were in
August; every student achieved some of their health goals.

Nagelberg (1981) also used DASH in his evaluation of Bowling
Green State University’s health risk education program. Freshmen
students (N-337) who had completed a DASH health questionnaire prior
to entering the university, were assigned to one of three treatment
groups: 1) DASH information was discussed with a peer health
educator and then distributed to the student; 2) DASH results were
sent through the mail; and 3) DASH results were temporarily withheld
(no-feedback control group). After the treatment phase of the study,
a post-test questionnaire was mailed to all students who completed
the pretest. A number of items dealing directly with DASH and the

peer health education programs were included in the post-test for the

35

peer health education and mail feedback groups. It was hypothesized
that the most effective means of feedback would be by the peer health
education program.

The results obtained from these measures failed to support the
original hypothesis. Though the student evaluations of the DASH and
peer health education programs were favorable, the three groups did
not significantly differ from one another. Nagelberg provided three
possible reasons for the results: 1) Peer health education was not a
powerful intervention in affecting students’ health attitudes and did
not motivate students to improve their health; 2) The testing
measures utilized were not psychometrically adequate; and 3) It may
be argued that the students were already "healthy" (as a group) at
the time of pretesting, and thus changes were not forthcoming nor to
be expected. A measure of "risk" was determined for each student
based on their health risk index. Only 12.32 of the sample was
classified as "high risk." Nagelberg concluded that further research
is needed regarding the use of this instrument with "healthy"
students, its role in prevention, and promoting positive health
across all age groups. The results of the study, however, did
support the assumption that students regard the use of HRA as a valid
part of health education.

In contrast, Chenoweth (1981) in his study of college students
(N-113) enrolled in health education classes found that students who
completed the HRA pretest and post-test, experienced changes in
health behaviors significantly more than students in the control

groups. Chenoweth concluded that the HRA.when combined with a

36

feedback session with peer student assistants, caused a positive
change in the students’ health age as compared to the pretest
results.

The University of Minnesota (Duluth) Health Education Program in
cooperation with the student health service and the St. Louis County
Health Department, developed, taught, and evaluated a course
surrounding the concept of Health Risk Appraisal (Fenger 8 Byrd,
1979). The course revolved around the centralized theme "How to Take
Care of Yourself" and the use of the HRA as a teaching instrument in
health education. The results of this evaluation indicated that this
group of university students (N-32) perceived the HRA experience as
highly favorable. A high percentage (942) of the population
evaluating the HRA experience felt it was a worthwhile learning
experience. Over one-half of the students thought HRAs should be a
requirement for all university students. Students interpreted the
HRA as a tool that helped to identify health concerns on which they
could concentrate to improve their own health status. Fenger and
Byrd concluded that the HRA promoted individual responsibility for
health, lifestyle examination, and the identification of conditions
that may precede disease states.

Cottrell and St. Pierre (1983) studied the effectiveness of HRA
in motivating self-reported behavior change. The HRA was
incorporated into a college health education course (N-234) centered
around a lifestyle theme. This study differed from previous research
(Bensley, 1981; Chenoweth, 1981; Fenger 8 Byrd, 1979; LaDou,

Sherwood, 8 Hughes, 1975) in that the HRA was used only as an

37

independent variable, not as a dependent or combination dependent-
independent variable. A second purpose of this study was to
investigate the motivational impact of the health education course.

The study concluded that the HRA, when incorporated into a
college health education course, did not produce a significant
difference in the overall rate of behavioral change. Enrollment in a
health education class produced a slightly greater (but not
significant) rate of behavior change for those specific topic areas
that were assessed by the HRA. The behaviors easily modified were
less traditional concerns such as salt and cholesterol intake,
testicular self-examination, sun exposure, and the inclusion of high
fiber foods in the diet. Smoking, exercise, diet, and weight control
were not significantly affected by either the HRA or the course.

In an earlier study, Dunton and Rasmussen (1977) had concluded
that the amount of positive behavior change was directly related to
the initial health risk of the client. The health risk index for the
Cottrell and St. Pierre study was very low; 90.42 of the sample had a
greater than average life expectancy. Cottrell and St. Pierre (1983)
concluded that the HRA should be used with student populations that
are at a higher health risk. The use of the HRA in college level
health education classes served as an attention-gaining device and as
a possible motivator of behaviors.

McClaran and Sarris (1985) surveyed 85 college students who were
enrolled in a one-credit mini-course "Health and Lifestyle." The
seminar explored the concepts of health promotion and personal

responsibility for health. The primary evaluation instrument was a

38

50-item questionnaire designed by the authors to access attitudes,
behavior, and knowledge before and immediately after the course.

Statistical analysis of the questionnaire yielded the following
results. Students’ health behaviors showed significant positive
changes after the course in reported personal intake of salt, fats
and oils, sugar, alcohol, number of times per week in exercising for
at least 20 minutes, and drinking and driving or riding with someone
who had been drinking. There was no statistically significant change
for perception of weight, inclusion of the four basic food groups in
the diet, regular examination of breasts or testes, use of
contraceptives, wearing seatbelts, and cigarette smoking. In regard
to mental health related attitudes, students stated that they felt
better about themselves, felt more comfortable expressing anger
toward others, and felt more strongly that they could prevent
themselves from becoming 111.

In conclusion, McClaran and Sarris saw health maintenance and
lifestyle courses for academic credit offering a workable and
effective mechanism for providing health information as well as
changing health behaviors. The positive response, seen through
students’ comments and general interest in the course, indicated that
not only were college students interested in learning health
information, they were also enthusiastic about the subject. The
significant changes in reported health-related behaviors, attitudes,
and underlying knowledge suggested that this format was successful in
promoting at least short-term behavior change in this self-selected

population.

39

Wilson et a1. (1980) used the Risk of Death Section, part of the
Lifestyle Assessment Questionnaire, to determine the health status of
undergraduate students (N-89). This section asks about age, sex,
race, biochemical and physical measurements, medical history, and key
aspects of lifestyle. Many health professionals have viewed the HRA
as the solution to changing lifestyles problems (Wilson et al.,
1980). The results of this study suggest this is not the case with
young college students. The findings of Wilson et al.’s study
indicated that the HRA was not an effective free-standing personal
health behavior change tool with a young college population. It was
not possible to identify any motivational differences between the
study and the control groups.

Wilson et al.’s study has not demonstrated that the HRA was of
no value; rather it has clarified the role an.HRA can play in health
education efforts with college populations. The HRA created a
briefly heightened interest in health. According to Wilson et al.,
even though the HRA may not change personal health behavior, its use
encourages students to enter specific health programs where more
effective behavior change modalities can be implemented.

The HRA’s primary long-term importance may reside in the fact
that it creates a "teachable moment," when a health professional and
a client/patient can come together and discuss comprehensively the
person’s health condition, and the risks to which s/he is being
exposed (Milsum, 1981). At that time, according to Milsum, possible
changes in lifestyle can then be discussed. These changes take into

account the client’s present beliefs, reservations, prejudices, and

40

more, in such a way that the decision to contract for change is
fundamentally reserved for the client.

Limitations of Health Risk Appraisals

 

Studies have incorporated the concept of differential age or
changes in risk age as the key dependent variable under investigation
(Bensley, 1981; Fenger 8 Byrd, 1979). The use of risk age creates a
problem in that once an individual has filled out an HRA and obtained
the results, s/he recognizes that changing certain behaviors may
increase his/her longevity as predicted by the HRA. The second time
the questionnaire is completed, a testing effect could be present.
There may be a conscious or subconscious motivation to improve the
results by altering the responses even though behaviors have not been
modified (Cottrell 8 St. Pierre, 1983).

Researchers measure behavioral changes through self-reports,
differences in risk age through pre-test/post tests, and comparing
control groups with experimental groups. The studies also vary
according to the HRA used. Some studies used commercially prepared
instruments while others use instruments designed by the authors.
Because of the lack of consistency in both the research methods and
the instruments used, it is impossible to compare the results of
these studies and generalize the findings to the population at large.

Summary

The Health Risk Appraisal in and of itself involves a rather
negative process (Opatz, 1983). Many of the risks identified in a
standard HRA that contribute to a lowered life expectancy are risks

over which the individual has little or no control, such as family

41

history, a history of certain diseases (e.g. cancer), and the number
of miles driven annually in an automobile. The HRA tells people what
not to do and overlooks what one can do in a positive way to remain
or to become healthy (Ng et al., 1981). For this reason, a number of
the available Health Risk Appraisals include sections providing
information on aspects of an individual’s health other than morbidity
and mortality estimates. These sections have been labeled and
developed into wellness inventories.

Wellness inventories encompass all aspects of one’s life,
including the dimensions of work, play, emotional awareness, social
interactions, spiritual development, coping styles, eating habits,
and more. Wellness inventories provide positive and encouraging
information to the individual about his/her lifestyle over which s/he
has the greatest control. In order to understand the benefits of
using a wellness inventory rather than the medical emphasis of the

HRA, the theoretical foundations of wellness will be discussed.

Wellness-Theoretical Foundation
Practitioners have developed wellness models incorporating the
idea of creating an optimally functioning self by integrating the
body, mind, and spirit (Warner, 1984). The following will be a
review of wellness literature covering the works of Maslow (1968),
Dunn (1961), Jourard (1963 8 1971), Ardell (1977 8 1981), Travis and
Ryan (1981), Travis (1981), Hettler, Elsenrath, and Leafgren (1980),

Elsenrath (1984), and Hinds (1983).

42

The major wellness theorists Ardell (1977), Ryan and Travis
(1981), Travis (1981), and Elsenrath (1984) attribute the theoretical
foundation of wellness to transpersonal psychology and the works of
Abraham Maslow and his teacher Alfred Adler (Carlson, 1979). Maslow
and Adler believed that health was more than the absence of disease
and pain. An underlying assumption of their theories was that
physical, emotional, intellectual, and spiritual growth were
interrelated (Carlson, 1978). The work of Maslow and Adler addressed
itself to the idea of the full development of human potential,
emphasizing self-responsibility as a key factor in the process
(Travis, 1981).

Maslow (1963) believed that within the human being there is a
tendency toward or need for growth in a direction that he labeled as
"self-actualization," or psychological health. Maslow regarded
growth as a continuous and forward moving process. The more one
moves toward growth, the more one desires growth. Growth becomes an
endless process that can never be attained or fully satisfied. Self-
actualized individuals have a zest for life, happiness, serenity,
calmness, responsibility, and confidence in their ability to handle
stress, anxieties, and problems. When these feelings are used to
guide one’s life, Maslow saw the individual as being able to grow
"healthy, fruitful, and happy" (1963). If the essential core of a
person is denied or suppressed, the individual could become ill. At
the same time, Maslow viewed illness as an Opportunity for growth.
Illness is a communication to the organism of the need for change and

growth. Maslow believes that self-actualizers are superior as

43

"choosers" and, therefore, are predisposed towards health-promoting
behaviors.

The history of wellness dates back to 1961 with the work of Dr.
Halbert Dunn (Warner, 1984). Dunn was a retired public health
service physician, who in the 19503 began lecturing in the
Washington, D.C. area and writing articles about an idea he called
"high level wellness" (Ardell, 1984). Dunn (1961) coined the term
"wellness" and defined it as "an integrated method of functioning
which is oriented toward maximizing the potential of which the
individual is capable" (p. 4). Dunn did not believe that there was
an optimum level of wellness, but rather that wellness was a
direction toward an ever higher potential of functioning. Each
individual is responsible for deciding his/her level of functioning.

In order to achieve a high level of wellness, Dunn assumed that
individuals needed to develop an understanding about the self and to
be able to accept themselves as others perceived them. Dunn labeled
this "an integrity of the self" (p. 132). Dunn also saw a
relationship between the way we use our mind and the way we use the
energy of the body. If individuals maintain integration between mind
and body, it would enable them to operate as a whole. An inability
to maintain the integration between mind and body would result in
illness or what Dunn labeled as psychosomatic illness.

Within the psychological literature, the major psychologist who

has written about wellness is Jourard. In The Transparent Self

 

(1963), Jourard attributed higher-level wellness to such events as

having one’s individuality respected and acknowledged, of being

44

listened to with understanding, and of being touched. He found that
pe0ple who have much to live for, who love deeply and broadly, who
draw on their inner resources to solve the mysteries of the universe,
and to satisfy the needs and wants of mankind, lived longer than less
dedicated people.

Jourard believes that normal personalties are not necessarily
healthy personalities and, therefore, most individuals within society
do not function at a high-level of wellness. Individuals who do not
function at a high-level of wellness seldom have great jobs, great
enthusiasm, or passionate dedication. If this pattern continues, the
person may develop such psychological problems as depression,
boredom, or anxiety. In time, these psychological problems permit
illness to take root and may eventually lead to the individual’s
death.

Ardell was one of the first wellness theorists who publicized

the theory of wellness. His book High Level Wellness: An

 

Alternative to Doctors, Drugs, and Disease (1977) is a classic within

 

wellness literature. Ardell divided high level wellness into five
dimensions: self-responsibility, nutritional awareness, physical
fitness, stress management, and environmental sensitivity. In order
to achieve wellness, an individual needs to obtain a level of
proficiency in each of these areas and not to emphasize one area over
another. Ardell believed that each dimension of wellness affected
another and motivated the individual to pursue other dimensions of
high level wellness. He believed, as did Maslow, that it is possible

to be "well" in the midst of illness and dying. One can interpret

45

illness as a message from within-a signal that some aspect of life
deserves attention and reform. According to Ardell, a wellness
lifestyle will not only drastically reduce risk of illness or
disease, it will also provide a life of greater satisfactions,
increased serenity, and an expanded interest in the future.

Ardell (1982) defined high level wellness as a lifestyle-focused
approach that an individual designs for the purpose of pursuing the
highest level of health within his/her capability. A wellness
lifestyle is dynamic, ever-changing, and a lifetime process. Such a
lifestyle will minimize the chances of becoming ill and vastly
increase one’s prospects for well-being by reducing stress,
increasing fitness, providing better feelings of physical health
through changed food patterns, more awareness of environmental
subtleties, and a greater sense of self through acceptance and
constant practice of personal responsibility.

To Travis (1981) high level wellness means giving care to the
physical self, using the mind constructively, channeling stress
energies positively, expressing emotions effectively, becoming
creatively involved with others, and staying in touch with the
environment. Travis believes that wellness begins when an individual
sees himself or herself as a growing, changing person.

Travis and Ryan (1981) summarize wellness as the following:

Wellness is a choice-a decision you make to move toward

optimal health.

Wellness is a way of life-a lifestyle you design to

achieve your highest potential for well-being.

Wellness is a process-a developing awareness that there

is no end point, but that health and happiness are
possible in each moment, here and now.

46

Wellness is an efficient channelling of energy-energy
received from the environment, transformed within you,

and sent on to affect the world outside.

Wellness is the integration of body, mind and spirit-the
appreciation that everything you do, and think, and feel, and
believe has an impact on your state of health.

Wellness is the loving acceptance of yourself (Ryan and Travis,
1981, p.1).

Wellness allows the individual to integrate extremes. It also
allows the individual to appreciate the dynamic of illness and health
as complementary parts of the life process. Wellness means moving
freely between seeming opposites, learning from each, and growing
from both. Illness is created when one becomes stuck at an extreme
through fear or fatigue.

We resign ourselves to being helpless victims of disease, we

give up on ourselves, we latch on to one system and refuse

to let go even though it fails to meet our needs, or we

become compulsively attached to what we know and refuse to

accept that there might be a better way. (Ryan 8 Travis, 1981,

p. 6)

Moving toward high level wellness involves four phases: awareness,

education, growth, and revaluating.

AWARENESS EDUCATION GROWTH
Seeing how’ Exploring options Trying out
you are presently looking within. some of the
conducting your life. Receiving from options.

others.
RE-EVALUATING

Note: From The Wellness Workbook (p. 3) by Regina Ryan and John

 

Travis, 1981, Berkeley, CA: Ten Speed Press. Copyright 1981 by

John W. Travis.

These four phases allow the individual to determine what is
working, or not working currently in their life. Ryan’s and Travis’s

wellness model provides options for personal growth, suggestions for

47

alternatives, invitations to stretch personal limits, permission to
risk, and encouragement to change.

Hinds (1983) has incorporated wellness into a new model entitled
"Personal Paradigm Shift-A Lifestyle Intervention Approach to Health
Care Management." Hinds sees this model as valuable for anyone
wanting to make changes along the wellness - sickness continuum. The
paradigm shift of personal health care behaviors is based on the
belief that life is directed toward the goals of growth and
development. Healthy behaviors contribute to personal growth, while
unhealthy behaviors contribute to decay or death. The process one
can use to promote growth and development is that of dynamic
equilibrium.

Dynamic equilibrium is a process that maintains the balance
between adaptive resources and adaptive demands.

When we are well, we have the resources for coping with ever

changing adaptive demands; when we are ill, the balance is

upset, because we may have too few resources to meet the demands

of the illness. (Hinds, 1983, p. 7)

When life’s demands exceed, deplete, or threaten our adaptive
resources, a state of stress, both physical andmental, is
experienced. However, with preventive health care behaviors and
stress reduction strategies, a reasonable balance between resources
and demands can be maintained. Hinds perceives this process as a
dynamic system, since both sides of the equation are constantly
undergoing change. "When we become unbalanced (disequilibrium) our
life falters and breaksdown; when we maintain a healthy balance, a

sense of physical and mental harmony can be achieved" (p. 7).

48

Hinds does not believe that we "catch" an illness or a disease.
Rather, we create the opportunity for them to happen. The biological
defenses given to us at birth to prevent, reject, and neutralize
"harmful invaders" become weakened to a point where they can no
longer resist and defend. Hinds attributes the weakening of the
defense system to a seemingly "comfortable lifestyle" (p.4)!

The continuation of this comfortable lifestyle has three
negative consequences that affect one’s health:

1. The maintenance and aggravation of stressful internal and
external environments which weaken the body’s immune
system and its ability to defend against an illness.

2. The maintenance and aggravation of a current disease.

3. The acceleration of the natural wear and tear that life
experiences have on our physical and psychological
health. (Hinds, 1983, p. 4-5)

The harmful effects of the comfortable lifestyle can either be
reversed or the effects slowed down if one believes s/he has some
control over "habits of life."

Hinds identified three components/steps in reversing the harmful
effects of the comfortable lifestyle. These steps enable the
individual to make changes along the wellness-sickness continuum,
provide a firm foundation for enhancing one’s quality of life, and
promote sound health care habits:

1. An awareness that self-generated change involves self-
generated fear and discomfort. Personal expectations
about experiences of fear, loss, pain and shame must be
confronted for self-generated change to be successful.
Otherwise, the process of change will continue to be
delayed, avoided, escaped, and finally denied.

2. Successful change involves initially some dependency on
others. Individuals and groups who are supportive can
facilitate lifestyle change. While independent behavior
is an ideal goal, there’s truth in the philosophical

attitude of a "balance in all things." We are neither
independent or dependent, we are both.

49

3. One needs a change process, an organized approach to
personal lifestyle change, and such an organized
approach should include:

a. health care behaviors which impact the environ-
mental system, psychosocial system, psychological
system, biophysical system, and the genotype system.

b. a general change model which encompasses the
dynamics of health promotion and stress reduction.

c. a specific change model which allows one to work on
specific equilibrium health care stressors and
helps promote specific health care behaviors, i.e.,
the Personal Paradigm Shift. (Hinds, 1983, p. 4-5)

 

Note: From Personal Paradigm Shift: A Lifestyle Intervention

 

Approach to Health Care Management (p. 4-5) by W. C. Hinds,

 

1983, E. Lansing, MI: Michigan State University. Copyright

1983 by W. C. Hinds

The dynamic equilibrium model (wellness model) provides a
structure that facilitates examination of the critical relationship
between health and lifestyle, and health and stress. Understanding
these relationships allows the individual to choose between health or
illness. As one expert once said, "If there’s such a thing as
psychosomatic illness, then there’s such a thing as psychosomatic
health" (Hinds, 1983, p. 5).

Adler, Ardell, Dunn, Jourard, Hinds, Maslow, Ryan and Travis,
provided the theoretical framework for wellness. They agree that
wellness is a lifestyle in which the individual assumes an active
role in determdning his/her level of wellness. Wellness is a
lifetime process and does not have a definite end or beginning. As

Jourard stated in his book Personal Adjustment (1963), an individual

 

can "grow" in the direction of fuller functioning, and a healthier

personality, or s/he can "regress" in the direction of mental illness

50

(p. 24). The purpose of wellness is to help increase the likelihood
of healthier personality growth and to decrease the probability of
mental and/or physical illness.

Wellness Instruments

 

A major issue facing wellness theorists has been the development
of a means to assist individuals in determining their personal level
of wellness. One of the most active researchers in the development
of a paper and pencil instrument to measure wellness is John Travis
(Pelletier, 1979). Travis’s Wellness Inventory grew out of his early
work with Lewis Robbin’s original Health Risk Appraisal for the U.S.
Public Health Service in 1973. Travis shared Robbin’s
dissatisfaction with the Health Risk Appraisals, which were based on
mortality statistics. Travis decided "to provide an instrument that
focused on wellbeing and developed the Wellness Inventory" (J. W.
Travis, personal communication, January 13, 1986).

Travis described the Wellness Inventory in the following manner:

The Wellness Inventory is growth oriented, not "illness"

oriented. It is designed to stir up new ways of approaching

personal issues or problems. It gets at the root causes of

the high risk behavior quantified by HRAs and is much more

effective for behavior change than the scare tactics Health

Risk Appraisals often invoke. (J. W. Travis, personal

communication, January 13, 1986)

With the use of the Wellness Inventory, the concept of wellness was
placed in a format that provided direct feedback to the client
concerning his/her level of wellness.

Travis (1981) realized that assessing an individual’s wellness

level was only the beginning step in achieving personal growth and

wellbeing. He incorporated the Wellness Inventory into an

51

educational framework. The primary purpose of wellness education was
to increase conditions of wellness and to encourage pe0ple to take
charge of their own health.

Travis outlined the following objectives of wellness education:

1) To enhance personal wellness and create a supportive

professional environment; 2) To foster personal

responsibility among clientele by personal example;

3) To impact the existing illness/crisis-care system by

adding alternatives which are attractive to those who wish

to become more well. (Travis, 1981, p. 24)

According to Travis, most clients who participate in wellness
education programs are motivated to do so by chronic physical
symptoms or by some psychological discomfort they are experiencing.
Travis’s educational model not only provides a means for clients to
assess their level of wellness but also educational information to
deal with the symptoms and discomforts that initially motivated the
client to seek assistance.

Another group of individuals interested in measuring wellness
were Bill Hettler, Dennis Elsenrath, and Fred Leafgren at the
University of Wisconsin-Stevens Point (1980). Hettler, Elsenrath,
and Leafgren saw that the standard health physical required by the
university provided limited information for most students and staff
while reinforcing a passive posture among students with regard to
their well-being.

The initial departure from the standard physical examination
requirement at the University of Wisconsin-Stevens Point (UWSP)

occurred in 1974. Students were given the choice of completing a

commercially available computer-scored medical history or submitting

52

to a traditional physical examination. After using the computer-
scored medical history, Hettler, Elsenrath, and Leafgren believed
that they could create an assessment instrument tailored to students’
needs and at less cost than the standard physical or commercial
computer-scored medical history and developed the Lifestyle
Assessment Questionnaire (LAQ).

The Lifestyle Assessment Questionnaire was first introduced on a
pilot basis during the fall of 1976 and has been revised. The LAQ
was designed to help students assess their current level of wellness
and the potential risks or hazards that they choose to face at that
point in their lives. More importantly, the LAQ helps identify the
areas of self-improvement that lead to higher levels of joy and
wellness (Hettler, Elsenrath, 8 Leafgren, 1980). The LAQ could help
pe0ple to realize that the individual was the most important provider
of health or "illth" care (Hettler, Elsenrath, 8 Leafgren, 1980).

The purpose and function of the LAQ are:

To help one examine lifestyle behaviors so that the

individual can assess his/her current level of wellness in

addition to identifying the risks or hazards that one faces

at the present point in their life. (Hettler, 1976, p. 1)

The LAQ is divided into four sections: Wellness Inventory,
Topics for Personal Growth, Risk of Death, and Medical Alert.
Presently the LAQ is being utilized by 84 colleges and universities
as an alternative to a physical required by school health centers and
as an evaluation tool for health education (Warner,1984).

One of the newest wellness inventories that emphasizes wellness

behaviors is the Lifestyle Coping Inventory (Hinds, 1983). From his

53

extensive work with university students and adults, Hinds (1983)
developed the Lifestyle Coping Inventory to help the individual
understand health promotion - stress reduction actions. The
inventory covers various lifestyle, nutritional, drug, exercise,
environmental, problem solving, and psychosocial habits that affect
health and stress levels.

The Lifestyle Caping Inventory (LCI) is a component of Hinds’s
lifestyle management program (1983). The program is structured so
the individual can educate him/herself about the significant
relationships that influence personal health and stress experiences.
The purpose of the LCI, is not to prescribe or diagnose, but to
structure information for personal decision-making goals. The LCI
can be used in cooperation with a doctor to institute a stress
reduction - health promotion program. As with Travis’s and the
UWSP’s models, the Lifestyle Coping Inventory is part of a wholistic
program that both educates and provides guidelines for the individual
to expand his/her level of wellness.

Wellness Studies

 

Within the literature, researchers have incorporated wellness
inventories as an assessment instrument in their studies (Jeney,
1985; Melby, 1985/86; National Wellness Institute, 1985; Papenfuss
and Bier, 1984; Richter, 1985). These studies either report on the
reliability and possible validity of wellness inventories or have
used wellness inventories as an evaluation instrument for psycho-
educational programs and/or instruction. The following is a review

of these studies.

54

Studies Examining Psychometric Properties

 

Jeney (1985) administered the LCI at pretreatment and at a 3-
month follow-up in a study with chronic pain patients (N-12). Using
the total scores obtained from the pretreatment administration of the
LCI, the split-half reliability coefficient was reported to be .74.

A study was conducted by the National Wellness Institute (1985)
to measure the reliability of the LAQ and the wellness subsections.
Thirty-nine parents of incoming students volunteered to take the LAQ,
then repeat the instrument two weeks later. Test-retest reliability
coefficients among the eleven wellness subsection dimensions of the
test ranged from .57 to .87 with an overall coefficient of .76.

Richter (1985) used the LAQ in a study with junior year female
college students (N-88) who were enrolled in an introductory course
in nursing. Test-retest reliability of the subscales ranged from .81
to .97. Cronbach’s coefficient alpha was computed on the wellness
scale data to estimate internal consistency reliability. Reliability
of the wellness subscales ranged from .67 to .94. Factor analysis
was used to gain an estimate of construct validation. Content
validity of the tool was established with the evaluation by two
experts in measurement and health promotion.

Program Evaluation

 

Papenfuss and Bier (1984) studied forty-eight tenth graders to
determine the effectiveness of a wellness behavior inventory (WBI)
and a wellness education program in changing student’s attitudes and
behaviors concerning wellness. The WBI was administer as a pre-test

and as a post-test to both experimental and control groups.

55

Papenfuss and Bier found that wellness education significantly
enhanced both attitudes toward wellness and wellness behaviors among
tenth grade health education students. Additional conclusions were
drawn upon completion of the longitudinal study one and one half
years later. They found a continuation of both attitude enhancement
and behavior change by both the experimental and the control group.
Papenfuss and Bier concluded that completing a wellness inventory can
produce changes in attitudes and behaviors that are sustained over a
period of time by both the experimental and control groups.

The National Wellness Institute (1985) administered the LAQ to
students who were then provided with no results. These students were
surveyed nine and twenty-one months later in an attempt to ascertain
the degree of learning and behavior change that occurred. Eighty-
seven percent of the students reported learning to some degree from
simply completing the LAQ. Sixty-five percent reported learning to a
high or moderate degree. In this same study, twenty-seven percent of
the students involved responded that they had made moderate changes
in their lifestyles while twenty-six per cent reported making a small
degree of change as a result of completing the LAQ. The LAQ gave
these individuals an indication of their lifestyle status and served
as a stimulus for change towards a more positive lifestyle.

Melby (1985/86) in his health education classes used Travis’
Wellness Inventory (WI) to identify health behaviors that detracted
from students’ health, or increased their risk for illness or
disorder. From the results of the inventories, students then

specified the desired behavior they would like to change. Students

56

were encouraged to understand the educational, social, psychological,
spiritual, physical, and emotional factors surrounding the particular
desired changed and then to plan and carry out appropriate change
strategies.

Each student was required to complete a project concerning
changing undesirable health behaviors. At the end of the semester,
oral presentations were made by each student to explain the nature of
his/her project and the successes, failures, and new insights
gained. While the project emphasized successful health behavior
change, the evaluation of student performance was not based on the
degree to which the desired change was realized. Rather, the overall
attempt, the use of creative methods and change strategies, and the
acquisition of new insights, was the basis for performance
evaluation.

In summary, the studies that have used wellness inventories as
an evaluation tool for behavioral changes indicated a positive
response both in terms of student acceptance of the use of the
inventories and as an indicator of health behavioral changes.
Statistically the studies have shown that the reliability
coefficients among the wellness inventories were within acceptable
range. For research purposes an alpha coefficient of .65 is
acceptable (Mehrens 8 Lehmann, 1978). These statistical findings
indicate that wellness inventories are possible alternatives to the

current assessment instruments being used in the counseling field.

57

Wellness and the University Community

 

The wellness model within higher education has been labeled as
"a systems approach to education that is based on the idea that
growth in one area of living affects functioning in other areas as
well" (Snow, 1982, p. 554). The wellness approach is highly
compatible with the educational mission of universities. The mission
of both the university and wellness is "helping people to understand
themselves, think clearly and rationally, recognize the inter-
connections of their total functioning, and assume increasing degrees
of self-directedness" (Elsenrath, 1984, p. 30).

Van Ness (1981) in his work at the University of Colorado-
Boulder identified the following reasons for a wholistic or wellness
approach on the college campus:

1. Students are living through one of the major stress
periods of life.

2. Most campuses have a group of students easily identified
as "disturbed" and who fail to respond to present modes
of treatment. The wellness approach offers a different
mode of treatment which may well provide the needed help.

3. Wellness programs instill within the students both a
sense of responsibility and certain basic health
information to enable them to live a more healthy life
style.

4. A.wellness approach can assist students with the impact
of undesirable life events and therefore help improve
their academic performance.

5. Educational programs, which are essential in any well-
ness approach, are easily developed in a campus
environment.

6. Because they are in a learning frame of mind, students
are more likely to accept the new points of view
inherent in the wellness approach than the general
public. (p. 26-27)

Dr. Philip Marshall (1984), Chancellor at the University of

Wisconsin-Stevens Point, found the wellness model to be "a positive

58

and uplifting experience" for the campus. According to Chancellor

Marshall:
A campus with an emphasis on health promotion programming
gains a competitive edge for attracting, retaining,
graduating, and placing its students. There is growing
evidence from the business world that employees who pursue
a wellness lifestyle are more productive, use less sick

time and cost less in terms of disease care benefits.
(p. 3)

Learning about preventive lifestyle choices during college is
particularly important because the causes of death at age forty are
often the result of behaviors that were established during adolescent
and young adult years (Hettler, 1980). Introducing wellness in the
university community may be one means of preventing unnecessary
illness and death at the workplace in later years.

Professionals within higher education believe that the wellness
model benefits students (Elsenrath, 1984; Hettler, 1980; Petosa,
1984; Shea, 1981; Van Ness, 1981; Warner, 1984) and prevents illness
and disease at a later time during the student’s life (Hettler,
1980). They also believe that college is a time when students are
more receptive to wellness programs (Van Ness, 1981).

Barth and Johnson (1983) surveyed 107 colleges and universities
offering at least a master’s programs in school or community health
education to determine which colleges and universities were
developing wellness/healthy lifestyle centers. Barth and Johnson
found that wellness/healthy lifestyle centers were operating on the
campuses of 12.82 of the respondents. A recent study by TIAA-CREF
shows that wellness programs are becoming more widespread in the

campus community. More than half of the colleges and universities

59

who participated in the survey offered at least one wellness
program. The most frequent offering reported was exercise/physical
fitness (NACUBO, 1986).

The wellness movement found its way into higher education
largely due to the efforts of the Student Life Program at the
University of Wisconsin-Stevens Point (Warner, 1984). UWSP has one
of the most comprehensive and influential wellness promotion programs
in higher education. Their program began in 1972 and was devoted to
lifestyle improvement (Hettler, 1980). The UWSP wellness model uses
the basic premise that wellness involves the development of a whole
person through the integration of six dimensions of one’s life:
intellectual, emotional, physical, social, occupational, and
spiritual (Warner, 1984). The goal of both the UWSP and the wellness
approach is to help students understand themselves, think clearly and
rationally, recognize the interconnections of their total
functioning, and assume increasing degrees of self-directedness
(Elsenrath, 1984).

Elsenrath (1984), the director of the counseling center at UWSP,
incorporated the wellness perspective as part of the mission of the
center. The philosophy of many centers and the staff members
includes promoting health and effective functioning with a desire to
place less emphasis on clinical treatment. University counseling
centers are in an excellent position to promote lifestyle behaviors
that will be of benefit not only to a particular individual but also
to society in general as these individuals assume leadership

positions. Through group sessions, individual counseling sessions,

60

seminars, workshops, and instructional programs, counseling staff
have the opportunity to apply their resources in a concrete and
highly usable way. They also have an opportunity to supervise
practicum students and interns as these students develop their
counseling skills and prepare programs for presentation within the
counseling center or on an outreach basis on the campus or in the
community.

Eckerd College (Snow, 1982) used a campus survey to determine
the special areas of interest in wellness. From the survey results,
students requested further programs in the area of body tune-up,
massage technique, relationships, relaxation techniques, and exercise
programs. Campus resources were mobilized and resulted in the
develOpment of the Wellness Support and Strategy Committees. These
two committees developed and implemented a wellness program for the
Eckerd campus to address the areas of interest identified by the
students. During the last week of classes, a second survey was taken
to assess the impact of the wellness program during the academic
year. The results of the survey indicated that the wellness program
had made an impact. The majority of students became aware of the
term wellness and were interested in learning more about the life-
style choices associated with healthful living.

At the Rochester Institute of Technology (RIT) the wellness
model has been incorporated into a comprehensive program designed to
positively influence the development of the whole person (Chandler,
1985). To encourage a coordinated and consistent approach to

wellness campus wide, a Wellness Resource Committee was established

61

which included representatives from various departments under the
Division of Student Affairs. The committee provided wellness-
oriented programs throughout the year and served as a resource for
students, faculty, and staff. The wellness programs were designed to
a) create an environment supporting a wellness-oriented culture and
promote positive lifestyles and attitudes, b) bring about positive
changes in student behaviors and attitudes with emphasis on the
development of the whole person, and c) coordinate campus-wide
programming focused on an integrated wellness approach.

The evidence suggests that the wellness program did produce
additional positive changes on the RIT campus. For example,
nutritious snack machines, increased nonsmoking areas, wellness
floors in residence halls, and a wellness club were changes made at
RIT. Chandler found that motivating students’ interest in wellness
was not difficult, providing students had specific opportunities to
become involved in wellness activities and take responsibility for
their own behavior.

James Madison University (Van Ness, 1981) has developed an
extensive wellness promotion program. The major emphasis has been on
a program entitled "Superperson" sponsored by the Divisions of
Student Affairs. "Superperson" consisted of a week of activities
directed towards familiarizing students and faculty with the basic
dimensions of wellness: mind, body, and spirit. In 1978, over 2,300
students and faculty participated in the first "Superperson"

programs. The success of the initial "Superperson" promoted

62

"Superperson II," "Pressures," and "Lifestyling: Living and Loving
It," in subsequent years.

As an outgrowth of the university’s wellness philosophy and the
commitment to an integrative approach to health and well being, James
Madison developed the Optimal Health Inventory (OHI) as an
alternative to the junior year physical. During 1981, the first year
of its use, 590 students chose this alternative; in 1982 there was an
increase to over 700 participants. The inventories were interpreted
by a Health and Wellness Educator, and the students were given
resource lists to help them broaden their knowledge in particular
areas. Students would also enroll in a mini course entitled
"Wholistic Health Seminar." The content of the course dealt with the
six dimensions of wellness and incorporated an active element into
the course. The response from students was favorable.

Summary

In summary, wellness programs that have been incorporated into
the university structure have had a positive influence on the health
behaviors of students. The students have changed their behaviors,
have become actively involved in the organization and implementation
of these programs, and have seen a need for the continuation of these
programs. The one question that is missing from these reports is,
Have these programs influenced the mental health of the students

involved?

63

Summary

Extensive research has been conducted to identify the traits
that differentiate counseling centers users from non-users. The
research methodology has primarily focused on the use of
psychological instruments as the means to assess these traits. The
conclusions from this research have not answered the question of what
traits differentiate users and non-users of counseling centers
services. Researchers have found either no differences between users
and non-users (Berdie 8 Stein, 1966; Bruch, 1977; Rossman 8 Kirk,
1970; Schneidler 8 Berdie, 1942; Tryon, 1978), definite pathological
tendencies in counseling center users (Bosmajian 8 Mattson, 1980;
Cooke 8 Kiesler, 1967; Davis 8 Wideseth, 1978; Palladino 8 Domino,
1978; Parker, 1961; Strupp 8 Bolxom, 1975), or regard counseling
center users as possessing personality traits that are important to
academic achievement and future success (Calhoun 8 Selby, 1974;
Carskadon, 1975; King, 1968; Synder 8 Kahne, 1969; Williamson 8
Bordin, 1940). A possible reason for the lack of consistent
conclusions is that the research instruments seek to identify
psychological pathology rather than addressing the whole person.
Gross, in his review of the wholistic health movement, defines the
whole person as:

An integration of body, mind, feelings, spirit, and life-

style as well as the physical and social environment

of the individual and the interdependence of these

factors in growth and change. (Gross, 1980, p. 99)

In 1938 and again in 1949, the student personnel profession

called for consideration of the whole person, advocating service to

64

the physical, social, spiritual, emotional, and intellectual needs of
students (The American Council on Education, 1939, 1949). More
recently numerous human service professionals have advanced the whole
person philosophy advocating wholistic, interactional, synergistic
viewpoints (Ardell, 1977; Ferguson, 1980; Flynn, 1980; Hinds, 1983;
Pelletier, 1977; Travis, 1981). The wellness paradigm emphasizes
consideration of the whole person, the interaction of the person with
environmental variables, preservation of positive mental and physical
health, and prevention of potential problems or disorders (Meinecke,
1981). The implementation of this new paradigm within the mental
health field calls for a new model to assess and then incorporate the
needs of the whole person.

Professionals in higher education have used Health Risk
Appraisals (HRA) as a means to assess the needs of its students. The
HRA identifies preventable and unpreventable health risks for the
individual (Fenger 8 Byrd, 1979). The HRA in and of itself, however,
is a rather negative process (Opatz, 1983).

A model better suited to the philosophy and goals of higher
education and that addresses the needs of the whole person is
wellness. The wellness model does not view health as the absence of
illness, but as a continual process of learning, growth, and
development throughout the life cycle (Ng et al., 1981). Like the
development of an illness, the deve10pment of wellness may be
conceived as a cumulative process that can be influenced by
environmental, physical, behavioral, psychological, and social

factors.

6S

Counseling psychology has a heritage of psycho-educational
strategies that describe the interactions between people and their
personal, social environments, and regard the individual as the agent
of change. This heritage has prepared counseling psychologists to
promote health, the prevention and treatment of illness, and the
analysis and improvement of the health care system (Matarazzo,

1982). Counseling psychology has the opportunity to move away from
conventional medical approaches and to move toward broad-based

quality of life approaches such as wellness. Within the field, no
research has been conducted that assesses the traits of users and non-
users using a wholistic model such as wellness.

Clearly, there is a need for descriptive research that would
provide an understanding of wellness and the use of wellness
inventories as a means for counseling psychologists to obtain a
wholistic view of client concerns. The purpose of this research is
to determine whether wellness inventories can identify the traits
that differentiate users from non-users of counseling center services
and allow counseling psychologists to explore the use of a wholistic

model that addresses the needs of the total individual.

CHAPTER 3

DESIGN OF THE STUDY

The purpose of this chapter is to present the plan of operation
for the study. The following sections are included: Selection and
Description of the Sample, Measures Used in the Study, Current
Psychometric Data on the Instruments, Procedures for Data Collection,
Research Hypotheses, and Procedures for Quantitative and

Supplementary Descriptive Data Analysis.

Selection and Description of the Sample
The subjects in this study consisted of counseling center
service users and non-users. Information regarding wellness levels
were obtained from client-subjects through three wellness

inventories: The Lifestyle Assessment Questionnaire-Wellness

 

Assessment Questionnaire (National Wellness Institute, 1983), The

 

Wellness Inventory (Travis, 1981), and The Lifestyle Coping Inventory

 

 

(Hinds, 1983). The data obtained from the wellness inventories were
used to determine if differences exist between users and non-users of
counseling center services.

Users of counseling center services were recruited from a large
Southwestern university counseling center (UCC). The group consisted

of 15 males and 42 females (a total of 57 client subjects), from

66

67

18-50 years of age, who were enrolled as a student for the fall
and/or spring semester, had an appointment for an intake interview at
UCC, were United States citizens, and had a current local address.
The 57 counseling center users received an intake interview after
November 30, 1986, agreed to participate in the study, and returned
the wellness inventories.

The non-users of counseling center services were a random sample
of 500 students recruited from the same large Southwestern university
population, excluding UCC users. This sample consisted of 250 males
and 250 females. After using the following criteria, at least 18
years of age and not over 50 years of age, enrolled as a student for
the fall semester, have not used the services of the university
counseling center, and were United States citizens with a current
local address, 309 students remained in the sample pool. The final
subject pool of non-users consisted of 19 males and 34 females (a
total of 53).

The total sample was 34 males and 76 females, a total of 110
subjects. The ages of the total group ranged from 18-50 years. The
largest proportion of the subjects were between the ages of 18-24:
262 were 18-20 years, 462 were 21-24 years, and 25-50 years were the
remaining 302 of the sample. According to class standing, 142 of the
sample were freshman, 142 sophomores, 292 juniors, 372 seniors, and
72 were classified as other. 0f the sample, 302 were liberal arts
majors, 222 were business majors, 182 majored in nursing, and 122
were from the college of education. (Refer to Table 3.1 for complete

demographic data.) There were no statistically significant (p_<.05)

68

differences between the users and non-users groups on all the

demographic variables as measured by Chi Square.

Table 3.1

Description of Users and Non-users Samples
by Demographic Variables*

 

 

 

 

wUsers ‘Non-Users Total
Demographic Variables (N-57) (N-53) (N-llO)
Gender
Males 26.3 2 35.8 2 30.9 2
Females 73.7 64.2 69.1
£85.
1) 18-20 years 28.1 2 23.1 2 25.7 2
2) 21-24 years 36.8 55.8 45.9
3) 25-30 years 19.3 7.7 13.8
4) 31-40 years 8.8 7.7 8.3
5) 41-50 years 7.0 5.8 6.4
Class
Freshman 17.5 2 9.6 2 13.8 2
Sophomore 17.5 9.6 13.8
Junior 26.3 32.7 29.4
Senior 29.8 44.2 36.7
Other 8.8 3.8 6.8
College
Architecture 1.8 2 3.8 2 2.8 2
Business 14.0 30.8 22.0
Education 12.3 11.5 11.9
Engineering 3.5 7.7 5.5
Fine Arts 8.8 1.9 5.5
Liberal Arts 36.8 23.1 30.3
Nursing 3.8 1.8
Public Programs 21.1 15.4 18.3
Other 1.8 1.9 1.8

 

* All differences between groups were 2 >.05 using Chi Square

Description of Users and Non-users Samples

69

Table 3.1 (cont.)

by Demographic Variables*

 

 

 

 

 

 

 

‘Users ‘an-Users Total
Demographic Variables (N-57) (N-53) (N-llO)
Martial Status
Single, Never Married 78.9 2 78.8 2 78.9
Married 12.3 17.3 14.7
Divorced, Widowed, Sep. 8.8 3.8 6.4
Children Live With You
No 91.2 2 84.6 2 88.1
Yes 8.8 15.4 11.9
Type of Housing
Residence Hall 21.1 2 9.8 2 15.9
Frat/Soro 2.0 .9
Rent W/Others 54.4 51.0 53.3
Rent - Alone 7.0 7.8 7.5
Own W/Others 12.5 29.4 20.6
Own - Alone 1.8 1.9
Distance To Campus
Live on Campus 17.5 2 11.8 2 14.8
< 1 Mile 15.8 11.8 13.9
1 - 3 M1138 29.8 29.4 2906
4 - 5 Miles 14.0 15.7 14.8
6 " 10 M1138 7.0 1108 903
ll - 15 M1168 1005 309 7.4
More Than 15 Miles 5.3 15.7 10.2
Current I Enrolled Hours
Less Than 9 Hours 12.3 2 15.4 2 13.8
9 " 11 Hours 305 7.7 505
12 or More Hours 84.2 76.9 80.7

 

* All differences between groups were p_>.05 using Chi Square

70

Table 3.1 (cont.)

Description of Users and Non-users Samples
by Demographic Variables*

 

 

 

 

 

 

Users -:an-Users fTEtal
Demographic Variables (N-57) (N-53) (N-110)
Participated in Student Club(s)
Yes 24.6 2 21.2 2 22.9
No 75.4 78.8 77.1
Participated in Student Government
Yes 3.5 2 1.9 2 1.8
No 96.5 98.1 98.2
Participate in a Regular Fitness Program
Yes 57.9 2 55.8 2 56.9
Patronage of Bars or Nightclubs
Yes 36.8 2 41.2 2 38.9
No 63.2 58.8 61.1

Religious Affiliation or Spiritual Discipline

 

 

 

Yes 29.8 2 38.5 2
No 70.2 61.5
"Partying"

Yes 45.6 2 44.2 2
No 54.4 55.8
Membership in a Greek Organization

Yes 10.5 2 7.7 2
No 89.5 92.3

 

* All differences between groups were p_>.05 using Chi Square

71

Table 3.1 (cont.)

Description of Users and Non-users Samples
by Demographic Variables*

 

Users :an-Users -Tbtal
Demographic Variables (N-57) (N-53) (N-llO)

 

Outdoor Recreation or Intramurals

 

Yes 43.9 2 44.2 2 44.0 2
No 56.1 55.8 56.0

Played Intercollegiate Athletics

 

 

Yes 5.3 2 5.8 2 5.5 2
No 94.7 94.2 94.5
Performing Arts

Yes 19.3 2 15.4 2 17.4 2
No 80.7 84.6 82.6

 

* All differences between groups were p_>.05 using Chi Square

72

Measures Used in the Study
Three measures were used in the present study. The three

measures, The Wellness Inventory (Travis, 1981), The Lifestyle

 

 

Assessment Questionnaire-Wellness Inventory Section (National

 

Wellness Institute, 1983), and The Lifestyle Coping Inventory (Hinds,

 

1983), were developed to directly assess an individual’s level of
wellness. The results of the wellness inventories were used to
differentiate users from non-users of counseling center services.

The Wellness Inventory

 

The Wellness Inventory (WI) is a self-scoring questionnaire. It
contains 120 questions and is designed to educate as well as test the
respondent concerning twelve dimensions of wellness. Items for the
WI are on a five point continuum from yes always, or usually to 22,

never, or hardly ever, and items are scored on a one to five point

 

 

scale. The lower the score on the item and total scale, the lower
the level of personal wellness.

The WI is comprised of twelve dimensions developed around the

theme of wellness as outlined by John Travis (1981). The twelve
dimensions are: 1) Wellness and Self Responsibility and Love;
2) Wellness and Breathing; 3) Wellness and Sensing; 4) Wellness and
Eating; 5) Wellness and Moving; 6) Wellness and Feeling; 7) Wellness
and Thinking; 8) Wellness, Playing, and Working; 9) Wellness and
Communicating; 10) Wellness and Sex; 11) Wellness and Finding
Meaning; and 12) Wellness and Transcending.

After completing the inventory, the respondent totals his/her

points on the twelve dimensions and divides this sum by the number of

73

statements answered. The average score, which ranges from one to
five, is then transferred to the "Wellness Inventory Wheel" on the
back page of the inventory. The Wellness Inventory Wheel is a visual
representation of the individual’s wellness level and serves as a
guide to further one’s wellness.

The Life Assessment Questionnaire-Wellness Assessment Questionnaire

 

The Life Assessment Questionnaire-Wellness Assessment
Questionnaire (LAQ) is a self-scoring questionnaire. The LAQ
contains 100 questions, and is designed to educate as well as test
the respondent concerning his/her level of wellness. Items for the
Wellness Assessment Questionnaire are on a five point continuum from

almost always (1) to almost never (5), and items are scored on a one

 

 

to five point scale. The scale was reflected to show that the lower
the score on the item and the total scale, the lower the level of
personal wellness.

The LAQ is comprised of ten dimensions developed around the
theory of wellness as outlined by the National Wellness Institute at
the University of Wisconsin - Stevens Point (1983). The ten
dimensions are: 1) Physical Fitness; 2) Physical - Nutritional;

3) Physical - Self-Care; 4) Drugs and Driving; 5) Social -
Environment; 6) Emotional Awareness; 7) Emotional Control;
8) Intellectual; 9) Occupational; and 10) Spiritual.

After completing the LAQ, the respondent is asked to total the

points on each of the wellness dimensions. The totals are computed

as a percentage for each dimension and then compared to a table

74

printed on the last page of the inventory. The ranges of the
percentiles are:
90-1002 Excellent - Super Job!
80-892 Good - Better than most
70-792 Average - Mediocrity is ok, but?
60-692 Fair - Reassess your present lifestyle
Less than 602 Poor - are you really trying?
(National Wellness Institute, 1983)

The LAQ was developed in 1980. It was subsequently revised with
a thorough review over a two year period. The items identified for
the ten wellness categories were prepared by a professional working
in each of the wellness dimensions. The items were selected to
define as accurately as possible each dimension of wellness in
behavioral terms. Each statement is a specific behavior to which the
individual is asked to respond in terms of the personal degree of
participation. These items were tested and modified over the two
year development period to provide as much clarity and conciseness as
possible.

The LAQ’s items were written in a manner designed to be
educational. An individual’s scores on the wellness section of the
LAQ can be compared to two norm groups. The one norm group is the
group in which the individual is a member. For example, all of the
employees of an organization using the LAQ would be members of the
same group. The other norm group is all the people who have taken
the instrument. This norm group consists of students, adults in
government, business and industry, and health care clients. The

total number of people who have taken the instrument through the

University of Wisconsin-Stevens Point is approximately 250,000.

75

The Lifestyle Coping Inventory

 

The Lifestyle Coping Inventory (LCI) is a self-scoring
questionnaire. The LCI contains 142 questions and is also designed
to educate as well as test the respondent concerning his/her level of

wellness. Items for the LCI are on a five point continuum from never

 

to very often, and items are scored on a one to five point scale.
The lower the score on the item and total scale, the lower the level
of personal wellness. In the present study, total point score
obtained by adding the seven behavioral categories will be used.

The LCI is comprised of seven dimensions developed around the
theory of a personal paradigm shift as outlined by Hinds (1983). The
eight dimensions are: 1) Copying Style Actions; 2) Nutritional
Actions; 3) Physical Care Actions; 4) Cognitive and Emotional
Actions; 5) Low-Risk Actions; 6) Environmental Actions; and 7) Social

Support Actions.

Current Psychometric Data on the Instruments

Current psychometric data is limited concerning the three
instruments. Three studies have been completed that do report
reliability and validity estimates for the LAQ and the LCI (Jeney,
1985; The National Wellness Institute, 1983; Richter, 1985).

The LCI was administered at pretreatment and at a three month
follow-up in a study with twelve chronic pain patients (Jeney,
1985). Using the total scores obtained from the pretreatment
administration of the LCI, the split-half reliability coefficient was

reported to be .74.

76

A study was conducted to measure the reliability of the LAQ and
the wellness subsections (The National Wellness Institute, 1983).
Thirty-nine parents of incoming students volunteered to take the LAQ,
then repeat the instrument two weeks later. Test-retest reliability
coefficients among the eleven wellness subsection dimensions of the
test ranged from .57 to .87 with an overall coefficient of .76.

The LAQ was used in a study with junior year female college
students (N-88) who were enrolled in an introductory course in
nursing (Richter, 1985). Test-retest reliability of the subscales
ranged from .81 to .97. Cronbach’s coefficient alpha was computed on
the wellness scale data to estimate internal consistency
reliability. Reliability of the wellness subscales ranged from .67
to .94. Factor analysis was used to gain an estimate of construct
validity. Content validity of the tool was established with the
evaluation by two experts in measurement and health promotion
(Richter, in press).

The relationship between the three inventories, WI, LAQ/WAQ, and
LCI, has not been studied before. As discussed previously, there are
several studies using these instruments that do state reliability
coefficients (Jeney, 1985; The National Wellness Institute, 1983;
Richter, 1985). The reliability coefficients reported are from
experimental designs with pre- and post-tests. No studies have been
completed that address alternate form reliability. Therefore the
construct validity of the instruments has not been addressed. A
purpose of this study is to begin to address the issue of construct

validity o

77

Procedures for Data Collection

Selection of Non-users Group

 

The non-users group contained 53 students, 19 males and 34
females. The list of non-users of counseling center services were
obtained by a stratified random sample of 500 students (250 females
and 250 males). The random sample was selected from students who
were 18-50 years of age, enrolled as a student for the fall semester,
who had not used the services of the university counseling center,
and who were United States citizens with a current local address.

The list of names selected by the computer was compared to the
records of those who had previously used UCC’s services. Any student
who had received UCC services was eliminated from the sample pool: A
52 elimdnation rate was found. There was a control for a 2:1
respondent ratio of female and male students.

To assure a maximum return of inventories from the non-users
group, each individual on the list was sent a letter asking them to
participate in the study. The letter explained the purpose of the
study, indicated the time commitment needed, and extended an
invitation to be part of a $100.00 lottery upon completion of the
inventories. The letter included directions on how the student could
secure a packet of test materials if s/he wished to participate in
the study, a consent form, and a self-addressed, stamped return
envelope. A sample of the Non-Users Request to Participate Letter is
found in Appendix A.

The test packets were distributed to the students by the

receptionist at the Student Life Office or mailed directly to

78

her/him. Included in the packet were the three wellness
inventories: WI, LAQ, and LCI. Approximately 1 1/2 hours were
required to complete the three inventories. To compensate for the
fatigue factor that may have occurred, the sequence of the
inventories were rotated prior to their placement within the packet.
A cover letter was included that provided the participant with
general information concerning the purpose of study, how the
student’s name was selected, and assurance of the confidentiality of
the results. In the cover letter, there was a place for the student
to indicate if s/he wished to receive feedback concerning the tests
results. A sample of the Respondent’s Questionnaire Packet is found
in Appendix B.

Procedures were used to maximize response rate. After a two
week return period, a follow-up letter was sent to encourage the non-
users to complete and return the testing packet. If they had
misplaced the packet, instructions were included on how to receive a
new packet. A sample of this letter is found in Appendix D.

Prior to the mailing, 175 names were eliminated from the
original sample pool. The current local address of these 175
individuals was listed as out of state. Of the 309 students who were
mailed a letter inviting them to participate in the study, 67
responded. 0f the 67 who sent back the consent form, 53 returned a
completed packet. The response rate of those who were mailed a
letter was 222, slightly lower than the 252 response rate most often
observed in social science survey research (Sellitz, Wrightsman, 8

Cook, 1976). Of the students who received the packets, there was an

79

802 return rate. All non-user respondents were offered a copy of
summary results, if so desired.

Selection of Users Group

 

Users of counseling center services were recruited from a large
Southwestern university counséiing center. This group reflected the
usage of counseling center services: There was a 3:1 respondent
ratio of female and male students. Users were at least 18 years of
age and not over 50 years of age, enrolled as a full-time student for
the fall or spring semester, had made an appointment for an intake
interview at UCC, were U.S. citizens, and had a current local
address. All UCC clients who met the above criteria beginning
November 15, 1986 were included in the users subject pool until the
sample size (N-50) was achieved.

When a student arrived at the counseling center for his/her
appointment, s/he was asked either by the receptionist or the intaker
to participate in a study to identify the physical and mental health
issues of college students. It was important that the receiving of
clinical services was not dependent upon the completion of the
wellness inventories. Therefore, the receptionist/intaker informed
the student that participation in the study was not a requirement for
receiving service. If the student agreed to participate in the
study, s/he was given a packet of testing materials. Included in the
packet were the three wellness inventories; WI, LAQ, and LCI.
Approximately one and one-half hours was required to complete the
three inventories. To compensate for the fatigue factor that may

have occurred, the sequence of the inventories were rotated prior to

80

their placement within the packet. A cover letter was included that
provided the participant with general information concerning the
purpose of the study, and the assurance of the results being
confidential. In the cover letter, there was a place for the student
to indicate if s/he wished to receive feedback concerning the tests
results. See Appendix B for a sample of Questionnaire Packet for
Respondents.

After a two week return period, a follow-up letter was sent to
encourage the users to complete and return the testing packet. If
they misplaced the packet, instructions were included on how to
receive a new packet. See Appendix D for a sample of the Follow-Up
Letter.

Every student who came in for an intake was asked to participate
in the study. 238 000 clients were asked to participate. 86 users
received a packet; 57 packets were completed and returned to the
counseling center. This was a 662 return rate for packets. All
users respondents were offered a capy of summary results, if so
desired.

To assure a high return rate for both user and non-user groups a
lottery of $100.00 was used as an incentive. A ticket to participate
in the drawing for $100.00 was included in the packet. Returning the
packet placed the student’s name in the lottery pool. Use of this
incentive was approved by the University Committee for Research with
Human Subjects at Muchigan State University and the University Human

Subjects Research Review Committee at Arizona State University.

81

After the completion of study, the $100.00 prize was awarded to the

winning student.

Research Hypotheses
The purpose of this study was two fold: to determine whether
the wellness inventories measure similar characteristics and report
similar results and to investigate whether wellness inventories
identify consistent differences between counseling centers’ users and
non-users.

Instrumentation Hypothesis

 

Hypothesis I (a): The internal consistency of the total items
of the Wellness Index will be sufficiently high to infer homogeneity
of the construct of wellness.

 

Hypothesis I (b): The internal consistency of the total items
of the Lifestyle Assessment Questionnaire will be sufficiently high
to infer homogeneity of the construct of wellness.

 

Hypothesis I (c): The internal consistency of the total items
of the Lifestyle Coping Inventory will be sufficiently high to infer
homogeneity of the construct of wellness.

 

Hypothesis II (a): The correlations between the total scales of
the WEllness Index and the Lifestyle Assessment Questionnaire will be
sufficiently high to infer that these instruments will be measuring
the dimensions of wellness.

 

Hypothesis II (b): The correlations between the total scales of
the WElIfiess Index and the Lifestyle Coping Inventory; and the
Lifestyle Assessment Questionnaire and the Lifestyle Coping Inventory
will be sufficiently high to infer that these instruments will be
measuring the dimensions of wellness.

 

Null Hypothesis for Users and Non-users of Counseling Center Services

 

Hypothesis III (a): There will be no difference among the total
scales of the Wellness Index, the Lifestyle Assessment Questionnaire,
and the Lifestyle Coping Inventory for users and non-users of
counseling center services (p (.05).

 

82

Hypothesis III (b): There will be no difference between the
total scale scores on the Wellness Index for users and non-users of
counseling center services (p (.05).

 

Hypothesis III (c): There will be no difference between the
total scale scores Offithe Lifestyle Assessment Questionnaire for
users and non-users of counseling center services (2 (.05).

 

Hypothesis III (d): There will be no difference between the
total scale scores of‘the Lifestyle Coping Inventory for users and
non-users of counseling center services (p (.05).

 

Procedures for Quantitative and Supplementary
Descriptive Data Analysis

The statistical procedures used to test the three research
hypotheses included: MANOVA, ANOVA, t-tests, Pearson Product-Moment
Correlations, and reliability (Cronbach’s alpha) and descriptive
analyses (means, standard deviations, and frequency). Additionally,
t-tests were completed on each subscale to determine if there were
differences between the user and non-user groups. The analytic
procedures used are discussed below for each hypothesis.

Instrumentation Hypotheses

 

Hypothesis I (a, b, and c) refers to the reliability of the

 

wellness inventories. Test reliability in its broadest sense
provides an estimate on the extent to which individual differences in
test scores are attributable to "true" differences in the
characteristics under consideration and the extent to which they are
attributable to chance errors (Anastasi, 1982). In other words,
reliability is an index of the degree to which a test can
discriminate and is thereby a measure of the test’s potential
effectiveness (Guilford, 1954). A number of means to estimate

reliability are available. Some of the estimates require data from

83

two testing situations with the same individual. In the present
study, two testing sessions were not feasible, due to a testing
effect, so a reliability estimate was made from one administration of
the instruments.

A measure of internal consistency was used to estimate the
reliability of the wellness inventories and their sub-scales. The
internal consistency of a test is a statement about the homogeneity
of test items. It is the degree to which each item correlates with
the total test score and the degree to which each item is tapping a
similar construct. Cronbach’s coefficient alpha was used as a
measure of internal consistency for the wellness inventories’ total
scale scores. The coefficient is determined by computing all the
possible means of the split-half coefficients resulting from all
possible random pairings (Cronbach, 1971). A value of at least .75
is considered necessary to judge a scale internally consistent and to
infer homogeneity of test items. For research purposes an alpha
coefficient of .65 is acceptable (Mehrens 8 Lehmann, 1984).

Hypothesis II (a) tests the relationship between the two most

 

well known wellness inventories: the Lifestyle Assessment
Questionnaire and the Wellness Index, total scores. In order to test
this hypothesis, a Pearson Product-Moment Correlation was computed.
A product-moment correlation is used when both variables to be
correlated are expressed as continuous scores. The product-moment
correlation is the most stable correlation, with the smallest
standard error of the correlation techniques, which provides a

measure of the magnitude and significance of the relationship between

84

two variables. In order to infer that the wellness inventories are
measuring a a similar construct, a significant level (p_(.05) of
correlation between the total scale and sub-scales needs to be
observed.

Hypothesis II (b) relates to the construct validity of the

 

wellness inventories. The construct validity of a test is the extent
to which the test measures a theoretical construct or trait and as
such requires the gradual accumulation of information from a number
of sources (Anastasi, 1982). A method for obtaining construct
validity is to show that the test correlates with other variables
with which it is supposed to theoretically (Mehrens 8 Lehmann,
1984). In the present study, it is hypothesized that a linear
correlation will be observed between a subject’s score on the WI and
LAQ with LCI. Following an analysis of subjects’ wellness scores on
the inventories, a Pearson Product-Moment Correlation was computed
for LCI with the other two wellness inventories scores to determine
if there was a statistically significant (p_(.05) relationship.

Hypothesis for Users and Non-users of Counseling Center Services

 

Hypothesis III (a, b, and c) was concerned with identifying the

 

differences between counseling center users and non-users. Prior to
the testing of the hypothesis, the mean, standard deviation, and
frequencies were observed for both the users scores and the non-users
scores on the three wellness inventories. A Multiple Analysis of
Variance (MANOVA) was performed on the three scales, WI, LAQ, and
LCI, to simultaneously compare users and non-users of counseling

center services. MANOVA enables the user to analyze a large class of

85

repeated measures designs (Hull 8 Nie, 1981). Univariate Analysis of
Variance (ANOVA) were performed for each scale subsequent to the
MANOVA. An univariate analysis of variance is an inferential
technique used to determine if two or more sample means differ
significantly from one another. It is the appropriate test statistic
to use when comparing two or more groups, because of its power and
flexibility. Analysis of variance determines if the variability
between groups is large enough to justify the inference that the
means of the populations from which the different groups are sampled
are not the same. If the variability between groups is large enough,
it is inferred that individuals in these groups came from different
populations and that there is a statistically significant difference
between the two populations (Isaac 8 Michael, 1971). In this testing
situation there were two sets of means that were compared with each
other, users and non-users of counseling center services and their
wellness scores. For research purposes a Hotelling’s T statistic

with significance level of .05 was used.

Summary
The purpose of the present study was twofold. The first
purpose was to determine if the Wellness Inventory (WI), Lifestyle
Assessment Questionnaire (LAQ), and Lifestyle Coping Inventory (LCI)
were reliable measures of wellness for college student populations.
The second purpose was to see if users of counseling center services
and non-users of counseling center services differ in wellness levels

as measured by the WI, LAQ, and LCI.

86

Using a survey approach for data collection, a sample of 53 non-
users and 57 users from a large Southwestern university completed the
Wellness Inventory, Lifestyle Assessment Questionnaire, and Lifestyle
Coping Inventory. The results of these scales were used to test the
construct validity of wellness. Three hypotheses related to whether
wellness inventories measure similar characteristics and report
similar results and the differences between users and non-users of
counseling center services were develOped and tested. The
statistical procedures used to test the three research hypotheses
included: MANOVA, ANOVA, t-tests, Pearson Product-Moment
Correlations, reliability (Cronbach’s alpha) and descriptive analysis
(means, standard deviations, and frequency). Additionally, t-tests
were completed on each subscale to determine if there were

differences between the user and non-user groups.

CHAPTER 4

RESULTS OF THE STUDY

Chapter 4 contains the results related to instrumentation and
the results specifically related to the differences between users and

non-users of counseling center services and their level of wellness.

Instrumentation

As demonstrated by the comprehensive review of literature,
current psychometric data are limited concerning the three wellness
instruments. Three studies have been completed that do report
reliability and validity estimates for the LAQ and the LCI (Jeney,
1985; The National Wellness Institute, 1983; Richter, 1985). The
relationship between the three inventories, WI, LAQ, and LCI, has not
been studied before. No studies have been completed that address
alternate form reliability. Therefore the construct validity of
wellness through the use of these instruments has not been
addressed. For the purpose of this study, two major hypotheses were
developed and tested to address the question of construct validity.

Tests of the Research Hypotheses

 

Instrumentation Hypotheses

 

Hypothesis I (a): The internal consistency of the total items
of the Wellness Index will be sufficiently high to infer homogeneity
of the construct of wellness.

 

87

88

The internal consistency of the Wellness Index (WI) was
determined by computing Cronbach’s coefficient alpha. The total
scale alpha coefficient was .93. A coefficient alpha of .93 is a
high coefficient, especially for a self-report instrument (Anastasi,
1982).

Any reliability coefficient may be interpreted directly in terms
of the percent of score variance attributed to different sources.
Thus a reliability coefficient of .93 signifies that 932 of the
variance in the tests scores depend on true variance in the trait
being measured, and 72 depends on error variance (Anastasi, 1982).
This can be interpreted as the percentage of the true variance. The
square root of the correlation coefficient, known as the index of
reliability, represents the portion of the common total variance
(Anastasi, 1982).

The correlations between the WI and twelve subscales were
determined by computing a Pearson Product Moment Correlation Matrix.
The inter-scale correlations ranged from .50 to .69. All interscale
correlations were significant at a .001 alpha level, suggesting that
the WI is measuring a unidimensional construct. In light of the fact
the the total scale has good reliability and measuring a
unidimensional construct, all further analyses were performed on the
total scale.

Hypothesis I (b): The internal consistency of the total items

of the Lifestyle Assessment Questionnaire will be sufficiently high
to infer homogeneity of the construct of wellness.

 

The internal consistency of the Lifestyle Assessment

Questionnaire (LAQ) was determined by computing Cronbach’s

89

coefficient alpha. The total scale alpha coefficient was .93. A
coefficient alpha of .93 is a high coefficient, especially for a self-
report instrument (Anastasi, 1982). An inference can be made that
the LAQ is measuring a homogeneous construct, that of wellness.

The correlations between the LAQ and ten subscales were
determined by computing a Pearson Product Moment Correlation Matrix.
The inter-scale correlations ranged from .42 to .68. All interscale
correlations were significant at a .001 alpha level, suggesting that
the LAQ is measuring a unidimensional construct. In light of the
fact the the total scale has good reliability and measuring a
unidimensional construct, all further analyses were performed on the
total scale.

Hypothesis I (c): The internal consistency of the total items

of the Lifestyle Coping Inventory will be sufficiently high to infer
homogeneity of the construct of wellness.

 

The internal consistency of-the Lifestyle Coping Inventory (LCI)
was determined by computing Cronbach’s coefficient alpha. The total
scale alpha coefficient was .93. A coefficient alpha of .93 is a
high coefficient, especially for a self-report instrument (Anastasi,
1982). An inference can be made that the LCI is measuring a
homogeneous construct, that of wellness.

The correlations between the LCI and seven subscales were
determined by computing a Pearson Product Moment Correlation Matrix.
The inter-scale correlations ranged from .38 to .83. All interscale
correlations were significant at a .001 alpha level, suggesting that
the LCI is measuring a unidimensional construct. In light of the

fact the the total scale has good reliability and measuring a

90

unidimensional construct, all further analyses were performed on the

total scale.

Hypothesis II (a): The correlation between the total scale of
the WEIlness Index and the Lifestyle Assessment Questionnaire will be
sufficiently high to infer that these instruments will be measuring
the dimension of wellness (p (.05).

 

The correlation between the Lifestyle Assessment Questionnaire
and the Wellness Index was determined by computing a Pearson Product-
Moment Correlation Matrix. The between-test correlation was .79 (p
(.001). Any correlation coefficient may be interpreted directly in
terms of the percent of score variance attributed to different
sources. The square of the correlation coefficient represents the
portion of the total variance on one of the distributions that can be
predicted from the other (Magnussen, 1967). The square of the
correlation coefficient is known as the coefficient of
determination. The coefficient of determination gives the amount of
variance which is determined by the relationship with some other
variable. In other words, 622 of the variance in the LAQ is
explained by the variance in the WI.

Hypothesis II (b): The correlations between the total scale of
the Lifestyle Assessment Questionnaire and the Lifestyle Coping
Inventory; and the Wellness Index and the Lifestyle Coping Inventory

will be sufficiently high to infer that these instruments will be
measuring the dimension of wellness (p_<.05).

 

The correlation between the Lifestyle Assessment Questionnaire,
and the Lifestyle Coping Inventory was determined by computing the
Pearson Product-Moment Correlation. A correlation expresses the
degree of correspondence or relationship between two sets of scores

(Anastasi, 1982). The correlation coefficient between the LAQ and

91

the LCI was .70 (p_<.01). The correlation coefficient between the WI
and the LCI was .82 (p_(.001). Students who scored high or low on
the LCI, scored in a similar direction on the LAQ and the WI.

As previously discussed, any correlation coefficient may be
interpreted directly in terms of the percent of score variance
attributed to different sources. The square of the correlation
coefficient represents the portion of the total variance on one of
the distributions which can be predicted from the other (Magnussen,
1967). The square of the correlation coefficient is known as the
coefficient of determination. The coefficient of determination gives
the amount of variance which is determined by the relationship with
some other variable. In other words, 672 of the variance in the LCI
is explained by the variance in the WI while 492 of the variance of
the LCI is accounted for by the LAQ. Due to the high reliability
coefficient for all three instruments, WI, LAQ, and LCI, the
reliability of all three scales is established. The Pearson
Correlation Coefficients and coefficients of determination for

Hypothesis II (a and b) are presented in Table 4.1.

92

Table 4.1
Pearson Correlation Coefficients* Between Inventories

and Coefficients of Determination (r?)

 

 

LCI Total LAQ Total WI Total
LCI Total 1.00 .70 .82
52-.49 £?=.67
LAQ Total .70 1.00 .79
33-.62
WI Total 1.00

 

*p_(.001

Subscale Analysis - Content Validity

 

One purpose of a test is to make an inference about a property
or behavioral domain of a person (Mehrens 8 Lehmann, 1984). A test
serves as a sample of the domain if the items are drawn from a
clearly defined universe. Content validity is related to how
adequately the content of, and responses to the test samples the
domain about which inferences are to be made. In content validity we
are interested in how adequately we can infer from a particular score
to a larger domain (Mehrens and Lehmann, 1984). Thus, building three
tests (wellness inventories) over the same content (wellness), giving
them to the same set of students (users and non-users), and
correlating the results tells us something about both equivalent form

reliability and content validity.

93

Since the alpha coefficient of each instrument was .93 and the
correlations between tests ranged from .70 - .82, it was important to
determine if the subscales of the instruments also supported the
initial finding indicating content validity. The interscale
correlations of the LAQ and W1 subscales ranged from -.12 (not
signifcant) between Drugs and Driving (LAQ) and Play/Work (WI) to .65
between Emotional Awareness (LAQ) and Feelings (WI). Out of 120
correlations between the WI and LAQ subscales (refer to Table 4.2),
101 of the subscales indicated statistical significance; 21 were
significant at (p (.05), 21 were significant at (p (.01), and 59 were
significant (p (.001).

The interscale correlations of the subscales of the WI and LCI
ranged from -.01 (not significant) between Feelings (WI) and
Nutrition (LCI) to .66 between Feelings (WI) and Coping Style (LCI).
Out of 84 correlations between WI and LCI subscales (refer to Table
4.3), 72 of the subscales indicated statistical significance; 9 were
significant at (p (.05), 11 were significant at (p (.01), and 52 were
significant (p (.001).

The interscale correlations of the LAQ and LCI subscales ranged
from -.03 (not significant) between Emotional Awareness (LAQ) and
Nutrition (LCI) to .63 between Physical Fitness (LAQ) and Physical
Care (LCI). Though the correlation coefficient between the LAQ and
LCI was not as strong as the other pairing (refer to Table 4.4), out
of 70 correlations, 42 of the subscales indicated statisical
significance; 9 were significant at (p (.05), 11 were significant at

(p (.01), and 22 were significant (p_(.001).

94

In addition, the distribution of the responses to each question
of the subscales was examined. The distribution for most of the
subscales was reasonably normal rather than bimodal or skewed. The

exception to this was the LCI’s Low Risk subscale.

95

Table 4.2
Pearson Product-Moment Correlation Coefficient
and the Probability Value
Lifestyle Assessment Questionnaire and Wellness Index

 

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'1

Phfli NMIi- Ekdf Dug] Sadal me: lmnt Inufll (knqr-thit

 

 

3' Fflzmss tux: (hue lkive .Heme Cbgn uumfl.amflon
Welhmmsihfiex
w .1) 0% 035 033 057 01) 037 0% .10 045
‘JMD .003 JIM. .001 .001 JIM .001 .001 JIM .001
mal- 031 023 025 013 037 051 0% .3 01) 048
1ng .JDI JIB .in .093 ‘JDI JIM .001 JIQ. .001 .001
amm- .4) .22 41) .08 4!? .23 .JB .32 .22 .26
tag .001 .011 .001 .193 .001 .009 .027 .001 .012 .003
Eating .42 .60 .37 .40 .45 .20 .20 .13 .24 .19
.001 .001 .001 .001 .001 .020 .016 .094 .005 .023
W 0% 034 035 003 016 010 -007 017 021 021
JIM JIM JIM .385 .050 .161 .258 .037 .013 .014
M. 017 0m .26 0% 0% 065 055 024 0% 041
ing .JBS .183 .JD3 .ZX) .001 JIM .001 JIM» .001 .001
Think? .25 .18 .23 .07 .32 .55 .43 .32 .44 .38
ing .004 J32 JIM .2“) .001 .001 JIM .001 .001 .001
my, 025 015 019 -012 031 051 035 0% 023 022
Wbtk. .004 .060 .025 .104 .001 .001 .001 .003 .008 .010
m- 024 016 023 -0“ 021 032 031 019 019 022
cation .006 .050 .008 .281 .013 .001 .001 .022 .024 .012
h 007 022 0% -001 027 0“ 047 042 03) 021
.246 .012 .004 .447 .002 .001 .001 .001 .001 .013
Find .12 .29 .27 .14 .47 .55 .59 .43 .32 .52
Dian .HI) JIM. .002 .067 JIM .001 JIM. .001 JIM .001
Tmms- .35 .23 4E5 .03 .34 (£5 .26 .44 .Z) .53
oend .001 .007 .001 .383 .001 .001 .004 .001 .019 .001

96

Table 4.3
Pearson Product-Moment Correlation Coefficient
and the Probability Value
Lifestyle Coping Inventory and Wellness Index

 

Iifaquethdngihmemuny

 

 

r Nuni- Phyflbal qufltiwa low? Emdr- axial Gmflng
3' tux: (hue ‘meiamd Rum; ommmt Smxnrt Ekyha
WeLhmmsIBdex
Self .17 .34 .47 .40 .31 .31 .45
CW Om]. .m1 .m1 Om]. .m1 .m1
Bummh- .22 .43 .47 .24 .33 .35 .36
ing .010 .001 .001 .(D7 .031 .031 .001
Samr- .30 .50 .30 .25 .40 .27 .34
ing .001 .001 .001 .005 .001 .003 .001
Eating' .62 .44 .17 .35 .39 .10 .23
.001 .001 .0“) .001 .001 .154 .009
Maving .31 .57 .11 .13 .25 .27 .19
.001 .001 .125 .£88 .004 .003 .023
Fell-IE -001 024 .70 019 028 0” .66
JWB {£06 .001 .023 .001 .001 .001
Think- .08 .35 .51 .19 .28 .38 .47
ing .211 .001 .001 .022 .002 .001 .001
Play! .01 .38 .57 .08 .27 .51 .60
Wed: .453 .001 .001 .199 .002 .001 .001
Qlllllmi' 0” 032 054 0% 0% 039 057
cation .019 .001 .001 .204 .001 .001 .001
Sex .13 .28 .41 .06 .18 .30 .47
.087 .002 .001 .274 .032 .001 .001
m .23 .31 O“ .13 01) .42 .55
andng .007 .001 .001 .095 .001 .001 .001
fhmns- .20 .34 .43 .09 .37 .36 .46
semi .021 .001 .001 .183 .001 .001 .001

 

97

Table 4.4
Pearson Product-Moment Correlation Coefficient
and the Probability Value
Lifestyle Assessment Questionnaire and Lifestyle Coping Inventory

 

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'3. Hmm Numi- as: Dngy Sadal Elm me: lmnflfl.(kmmr-SMJit
p Fuzmss than (kue [hive Awame Cay: \nual anion

 

LflkstyHBCqugikwemUKy

 

Md- 037 071 025 .Z) 022 -003 0% .09 005 017
tion .001 .001 .004 .021 .010 .367 .268 .172 .298 .043

“Wiml .63 .w .w .14 On Om 0% 028 .25 .26
line JIM .001 JIM .ONZ .002 JIM .001 .IDZ JIB .003

W/ .19 .24 I” .01 .45 .70 .w 0% .32 .52
mm .024 .m7 .m1 0% .m1 .m1 .m1 0m2 Owl .ml

1m .17 .34 .35 .62 .1) .14 .13 .10 .10 .18
RiSk . .036 .001 .001 .001 .001 .070 .082 .159 .160 .034

wr- .31 O” .31 .17 .49 .18 .13 .23 .17 CE
(Iment .001 .001 .001 .042 .001 .03) JIfii .008 .041 .001

W .31 .17 .17 Gm 027 0% On .12 .21 .37
Sapport .(IM .042 .038 . 175 .(D2 .(IM JI)2 . 104 .015 .001

m 0% .25 .m .01 0% .59 .51 0% O” O”
Sqfle JIB .in .OGZ .48) .001 .001 .001 J02 .JDI JIM

 

98

Subscale Analysis - Intercorrelations

 

The data analysis has shown that the intercorrelations with the
overall scales were high. Based on the face validity of the
individual scales, subscales were selected based on similar domains
(i.e. subscales that refer to similar domains such as nutrition and
eating). Prior to the data analysis the following subscales were
matched to determine if the inventories reflected a representative
sample of the domain (refer to Table 4.5). Some subscales were
matched with more than one subscale. Likewise, some tests had
subscales that did not correspond with any other subscales on another
test (e.g. Sex-WI, Breathing-WI, and Environment-LCI). All subscale
intercorrelations were significant at (p (.01) except for four scales
in which the probability of statistical significance ranged from
p -.013 to p -.02. The scales are being displayed in tables 4.5 in

terms of rank order, based upon the correlation coefficient.

Table 4.5
Subscales That May Possibly Correlate
and The Subsequently Determined Pearson Correlations

Lifestyle Assessment Questionnaire and Wellness Index

 

 

LAQ r WI
Emotional Awareness .65* Feeling
Nutrition .60* Eating
Physical Fitness .56* Moving
Spiritual .53* Transcending
Spiritual .52* Finding Meaning
Emotional Cognition .43* Thinking
Self Care .35* Self
Intellectual .32* Thinking
Occupation .23 Work/Play
Social .21 Communication

 

* p ( .001

99

Wellness Index and Lifestyle Coping Inventory

 

 

 

WI r LCI
Feeling .70* Cognitive/Emotional
Eating .62* Nutrition
Moving .57* Physical Care
Thinking .51* Cognitive/Emotional
Thinking .47* Coping
Communication .39* Social Support
Self .34* Physical Care
Self .31* Social Support
* p < .001

Lifestyle Assessment Questionnaire and Lifestyle Coping Inventory

 

 

 

LAQ r LCI
Nutrition .71* Nutrition
Emotional Awareness .70* Cognitive/Emotional
Physical Fitness .63* Physical Care
Drugs and Driving .62* Low Risk Actions
Self Care .50* Physical Care
Intellectual .28 Coping
Social .27 Social Support
* p < .001

Out of the twenty-five matched pairs of subscales, 8 pairs had
an intercorrelation of .60 and above; seven pairs had an
intercorrelation of .40-.59; and nine pairs had an intercorrelation
below .40. Ten pairs were formed from the combined subscales of the
LAQ and the WI: two pairs had a high intercorrelation of .60 and
above (Emotional Awareness and Feeling, Nutrition and Eating) four
pairs had an intercorrelation of .40-.59 (Physical Fitness and
Moving, Spiritual and Finding Meaning, Spiritual and Transcending,

Emotional Cognition and Thinking); and four pairs had a low

100

intercorrelation below .40 (Self Care and Self, Intellectual and
Thinking, Occupation and Work/Play, and Social and Communication).
Comparing the WI and the LCI, eight pairs were formed from the
combined subscales: 2 pairs had a high intercorrelation of .60 and
above (Feeling and Cognitive/Emotional, Eating and Nutrition); three
pairs had an intercorrelation of .40-.59 (Thinking and
Cognitive/Emotional, Thinking and Coping); and three pairs had a low
intercorrelation below .40 (Communication and Social Support, Self
and Physical Care, and Self and Social Support). Comparing the LAQ
and the LCI, seven pairs were formed from the combined subscales:
four pairs had a high intercorrelation of .60 and above (Nutrition
and Nutrition, Emotional Awareness and Cognitive/Emotional, Physical
Fitness and Physical Care, Drugs and Driving and Low Risk Actions);
one pair had an intercorrelation of .40-.59 (Self Care and Physical
Care); and two pairs had a low intercorrelation below .40
(Intellectual and Coping, Social and Social Support).

The higher correlations may indicate a higher level of content
validity, while a low correlation coefficient such as between
Intellectual (LAQ) and Thinking (WI) may indicate a lack of content
validity or a difference in conceptualizing of the concept among the
test authors.

Expectation for Users and Non-Users
Concerning Level of Wellness

Health is frequently seen as a consequence--the result of

avoiding illness-producing circumstances or behaviors (Bruhn et al.,

1977). In actuality, good health is a continual process that can

101

evolve into wellness. Good health thus becomes one point along the
health continuum; it is one point in the process of being or becoming
well. There are several differences between wellness and good
health. First, wellness is a process that continues through time,
whereas good health is a state of being or a stage along the health
continuum. We can lose good health, we can be ill, but the potential
for wellness is always present in some degree. According to numerous
authors in the field of wellness (Ardell,1977; Jourard, 1971; Maslow,
1968; Travis, 1981) one can be ill and still achieve wellness. One
indication of striving for wellness is learning when to seek
assistance (Travis, 1981). In this section the hypothesis will ask
if there is any difference between users and non-users of counseling
center services and also will note the direction of the wellness
scores within the inventories. As previously discussed in Chapter 3
(refer to Table 3.1), there are no statistically significant
differences (p_(.05) between the users and non-users of counseling

center services on the 18 demographic characteristics reported.

Null Hypothesis for Users and Non-users of Counseling Center Services

 

Hypothesis III (a): There will be no differences among the
totaI’scaIes of the Wellness Index, the Lifestyle Assessment
Questionnaire, and the Lifestyle Coping Inventory for users and non-
users of counseling center services (p (.05).

 

A Hotelling’s Multivariate T with (3, 105) degrees of freedom
was computed for all three instruments. The resulting coefficient
was 0.064 (p_>.05). Therefore, looking at all three tests

simultaneously, there is no difference between the users and non-

102

users of counseling center services. The null hypothesis is retained
(refer to Table 4.6. for means and standard deviations of the user

and non-user groups).

Table 4.6
Total Test Scores of
Users and Non-users of Counseling Center Services

 

 

Test infof Cases Mean Standard
Deviation
LAQ
Non-users 53 219.1 39.5
Users 57 234.0 39.4
WI
Non-users 53 274.4 43.2
Users 57 290.4 39.6
LCI
Non-users 53 460.6 54.3
Users 57 454.2 34.5

 

Hypothesis III (b): There will be no difference between the
total scale scores on the Wellness Index for users and non-users of
counseling center services (p_(.05).

 

A univariate F test was conducted on the Wellness Index with (1,
107) degrees of freedom. The resulting F-value was 3.87 (p >.05)
which indicated that there were no differences between users and non-
users of counseling services using the Wellness Index. The null
hypothesis is retained. .

Hypothesis III (c): There will be no difference between the

total scale scores ofithe Lifestyle Assessment Questionnaire for
users and non-users of counseling center services (2 (.05).

 

A univariate F test was conducted on the Lifestyle Assessment

Questionnaire with (1, 107) degrees of freedom. The resulting

103

coefficient was 3.91 (p_>.05), which indicated that there were no
differences between users and non-users of counseling services using
the Lifestyle Assessment Questionnaire. The null hypothesis is
retained.

Hypothesis III (d): There will be no difference between the

total scale scores Bf'the Lifestyle Coping Inventory for users and
non-users of counseling center services (p (.05).

 

A univariate F test was conducted on the Lifestyle Coping
Inventory with (1, 107) degrees of freedom. The resulting F
coefficient was .654 (p_>.05), which indicated that there were no
differences between users and non-users of counseling services using
the Lifestyle Coping Inventory. The null hypothesis is retained.

Supplementary Descriptive Analyses

 

Although no statistically significant differences among the

three tests were found and post hoc tests are not indicated,

 

nonetheless, they were performed with the caveat that these tests

should not be viewed as true post hoc tests. The reason for these

 

additional statistics is to determine whether the subscales identify
differences between users and non-users of counseling center
services.

Although no global differences for the tests as a whole were
found, the subscale analysis seems to indicate a trend toward
differences on some subscales between users and non-users. In
particular, one of the subscales, Cognitive Emotional (LCI), shows a
higher level of wellness (p_<.05) for the non-user group than for the
user group. In contrast, the following eight subscales show a higher

level of wellness (p_<.05) for the user group: Emotional Awareness

104

(LAQ), Social (LAQ), Emotional Cognition (LAQ), Self (WI), Feeling
(WI), Thinking (WI), Play/Work (WI), and Finding Meaning (WI). See
Table 4.7 for complete means, standard deviations, and £_values for
significant subscales of the LAQ; see Table 4.8 for complete means,
standard deviations, and E values for significant subscales of the
WI; and see Table 4.9 for complete means, standard deviations, and t_
values for significant subscales of the LCI.

The supplemental descriptive analyses indicate that the
subscales which differentiate between users and non-users have
reasonably high correlations among themselves (2 (.05). Refer to
Tables 4.2, 4.3, and 4.4 for these correlations. The nine subscales
that differentiate seem to measure a construct of the self rather
than a more behavioral construct such as nutrition or physical
fitness. In eight of the subscales that emphasize personal
perceptions, users have a higher level of wellness than non-users,
but in the subscale that emphasizes Cognitive Emotional Action (LCI),

the non-users have a higher level of wellness than users.

Summary
All three scales, WI, LAQ, and LCI have high alphas (.93), which
infer high reliability. Therefore, construct validity can be
inferred. The high intercorrelation of the subscales infers content
validity. The analysis of the tests concerning users and non-users
of counseling center services show no differences between the two
groups. All null hypotheses concerning users and non-users are

retained.

105

The supplemental descriptive analyses indicate that the
subscales which differentiate between users and non-users have
reasonably high correlations among themselves (p_(.05). These nine
subscales measure a construct that may be more difficult to
operationalize, those that emphasize personal perceptions of self,
affect, the meaning of life (e.g. Finding Meaning-WI and Emotional
Awareness-LAQ), rather than subscales that specify behaviors that are
more easily identified and measured (e. g. Nutrition). In eight of
the nine subscales that emphasize personal perceptions, users have a
higher level of wellness than non-users, but in the subscale that
emphasizes Cognitive Emotional Action (LCI), the non-users have a

higher level of wellness than users.

106

Table 4. 7
Users and Non-users Group t-test Results for the
Lifestyle Assessment Que§tionnaire Subscales

 

Subscale 1? Mean Standard’ Probability
Deviation of t value
betweefi'groups

 

Nutrition
Non-Users 53 26.8 7.9 .147
Users 57 24.6 8.1

Physical Fitness
Non-Users 53 29.9 7.2 .050
Users 57 27.3 6.3

Self Care
Non-Users 53 25.9 6.2 .455
Users 57 26.9 6.7

Drug/Driving
Non-Users 53 16.9 5.9 .752
Users 57 17.3 6.1

Social
Non-Users 53 18.6 5.0 .007*
Users 57 21.3 5.4

Emotional Awareness
Users 57 25.1 7.1

Emotional Cognitive
Non-Users 53 20.2 5.6 .001*
Users 57 24.3 6.3

Intellectual
Non-Users 53 19.4 5.8 .205
Users 57 20.8 6.1

Occupational
Non-Users 53 21.3 8.0 .205
Users 57 24.1 7.6

Spiritual
Non-Users 53 21.4 5.9 .406
Users 57 22.4 6.3

 

* p (.05

107

Table 4.8
Users and Nonusers Group t-test Results for the
Wellness Indefoubscales

 

Subscale N Mean Stafiderdi Probability
Deviation of t Value

between groups

 

Self
Users 57 24.3 5.3

Breathing
Non-Users 53 28.7 4.8 .079
Users 57 30.3 4.7

Sensing
Non-Users 53 20.8 4.7 .978
Users 57 20.8 3.8

Eating
Non-Users 53 24.0 5.2 .442
Users 57 25.0 7.1

Moving
Non-Users 53 30.9 8.7 .113
Users 57 28.4 7.4

Feeling
Non-Users 53 21.4 5.1 .030*
Users 57 23.8 6.3

Thinking
Non-Users 53 21.9 4.7 .011*
Users 57 24.1 4.2

Play/Work
Non-Users 53 21.2 5.4 .020*
Users 57 23.9 6.6

Communication
Non-Users 53 21.3 4.9 .323
Users 57 22.2 5.1

Sex
Non-Users 53 19.1 4.9 .127
Users 57 20.6 5.2

 

* p_(.05

108

Table 4.8 continue

Users and Nonusers Group t-test Results for the

Wellness IndexISubscales

 

 

Subscale N ‘Mean Standard Probability
Deviation of t Value
betweEh groups
Finding Meaning
Non-Users 53 20.0 6.1 .003*
Users 57 23.6 6.2
Transcending
Non-Users 53 23.4 6.4 .948
Users 57 23.4 5.8

 

* E.<'05

109

Table 4.9
Users and Nonusers Group t-test Results for the
Lifestyle Coping Inventory Subscales

 

Subscales 'TT Mean Standardi’ Probability
Deviation of t Value
between groups

 

Nutrition
Non-Users 53 46.2 12.1 .05
Users 57 50.7 11.9

Physical Care
Non-Users 53 40.4 10.8 .81
Users 57 40.8 8.1

Cognitive/Emotional
Non-Users 53 90.9 16.1 .008*
Users 57 83.3 13.2

Low Risk
Non-Users 53 13.7 3.3 .861
Users 57 13.6 2.7

Environment
Non-Users 53 25.2 5.3 .713
Users 57 24.8 4.5

Social Support
Non-Users 53 29.1 9.7 .917
Users 57 28.9 8.5

Coping
Non-Users 53 79.0 12.2 .147
Users 57 75.8 10.7

 

* p <.05

CHAPTER 5

SUMMARY, DISCUSSION, AND IMPLICATIONS

This chapter summarizes the research study. The findings of the
study are presented along with a discussion of the results related to
wellness instruments and users and non-users of counseling center
services and their level of wellness. Implications of the findings

are discussed, along with directions for future research.

Summary

The purpose of the present study was twofold. The first
purpose was to determine if the Wellness Inventory (WI), Lifestyle
Assessment Questionnaire (LAQ), and Lifestyle Coping Inventory (LCI)
were reliable measures of wellness for college student populations.
The second purpose was to see if users of counseling center services
and non-users of counseling center services differ in wellness levels
as measured by the WI, LAQ, and LCI.

Using a survey approach for data collection, a sample of 53 non-
users and 57 users from a large Southwestern university completed the
WI, LAQ and LCI. The data collected from the survey were used to
address the construct validity of wellness and if differences between
users and non-users of counseling center services could be detected

through the use of a wholistic approach such as wellness.

110

111

Two hypotheses regarding the reliability and initial validation
of the three wellness inventories were developed and tested. The
results regarding the two hypotheses are as follows:

1. The Wellness Index (WI), Lifestyle Assessment Questionnaire
(LAQ), and Lifestyle Coping Inventory (LCI) were
demonstrated to be internally consistent and reliable
instruments. A coefficient alpha of .93 was obtained for
all three of the instruments total scales.

2. The construct of wellness is assumed to be a unidimensional
construct. Statistically significant correlations were
observed between the WI and the LAQ, .79; between the LAQ
and the LCI .70; and between the WI and the LCI .82.

3. Construct validation of wellness has been established by
the high intercorrelations between the WI, LAQ, and LCI.

A hypothesis related to users and non-users of counseling center
services and their level of wellness was developed and tested. The
results regarding this hypothesis is as follows:

4. There were no differences between the users and non-users of
counseling center services in terms of total wellness
scores. Both groups exhibited a similar level of wellness.

Supplementary descriptive analyses were performed to determine
whether the subscales identified differences between users and non-
users of counseling center services. The results related to the
supplementary descriptive analyses are as follows:

5. Users of counseling center services have a higher level of
wellness in the areas of finding meaning in life, issues
pertaining to self-exploration, emotional awareness,
emotional cognitions, attitudes toward work/play, and
spirituality.

6. Non-users of counseling center services have higher level of
wellness in areas that pertain to emotional and cognitive
c0ping skills.

7. Users and non-users of counseling center services have

similar behavioral patterns in terms of nutrition, physical
fitness, and high risk activities.

112

Discussion

Though the major hypothesis of this research study did not show
differences between the two groups, it was found that users of
counseling centers have a higher level of wellness on eight of nine
significant subscales. Therapists, who ascribe to the medical model,
have made the assumption that seeking counseling services is a sign
of pathology. The subscale finding indicate that students who seek
therapy may have a higher level of personal wellness in some areas.
The finding of the subscale differences would encourage psychologists
to move away from the assumption that students who a use counseling
center services have some degree of pathology present. The
dimensions of mind, body, intellect, and spirit can assist mental
health professionals in understanding college student concerns and in
the development of a wholistic approach to treatment. Treatment can
then serve as a vehicle for personal growth as well as a means for
correcting behavioral problems (Papenfuss 8 Beier, 1984).

The following is an in depth discussion of the findings of this
study. Included in the discussion are issues concerned with the
reliability and validity of the instruments and wellness variables
that identify differences between users and non-users.

Instrument Development - Reliability of the Instruments

 

One type of reliability, that of internal consistency, was
tested for the three inventories (WI, LAQ, and LCI) and their
subscales. A reliability coefficient of .93 was obtained for all
three inventories. This reliability coefficient suggests a

relatively high level of internal consistency, especially for a

113

self-report measure. An understanding of the factors that contribute
to the reliability of a scale provides some explanation for the high
level of internal consistency observed. Factors contributing to an
instrument’s reliability that are particularly relevant to the
reliability of the WI, LAQ, and LCI are: the length of the test, the
heterogeneity of the sample, and whether the items are scored
dichotomously or on a Likert-type scale (Mehrens 8 Lehmann, 1984).

The reliability for the total scales were based on 120 items for
the WI, 100 items for the LAQ, and 142 items for the LCI. The number
of items is relatively high and is assumed to have significantly
contributed to the overall reliability of the inventories.
Additionally, the sample of subjects was heterogeneous with respect
to gender, age, class standing, college major, marital status, and 15
other demographic variables. Refer to Table 3.1 for complete
demographic information. The heterogeneity of the sample positively
influenced the overall reliability. Similarly, the use of a Likert-
type rather than a dichotomous scoring system appeared to aid
reliability by providing for more heterogeneity in responses.

In addition to test construction theory another possible
explanation for the adequate reliability obtained on the three tests
is that each item was based on a set of objectives that were
supported by theories relevant to wellness. It is likely that the
development of items around stated objectives, reflective of a clear
and consistent definition of that which constitutes wellness, aided
in the measurement of a homogenous construct and high internal

consistency of the measure.

114

Wellness Inventory (WI)

 

It is likely that the W1 is measuring a single construct with a
number of different dimensions. The same core theme is reflected in
all items, but in a number of different ways. The high inter-scale
correlations between the WI and the twelve subscales, (all
correlations were significant at .001 alpha level) provide evidence
that the WI is measuring a unidimensional construct.

The internal consistency of the twelve subscales was acceptably
high for research purposes. Coefficient alphas of above .74 were
obtained for eight of the twelve subscales (Eating, Moving, Feeling,
Thinking, Play/Work, Communicating, Finding Meaning, and
Transcending). The exceptions to this are the subscales concerning
Self Responsibility (.59), Breathing (.52), Sensing (.57) and Sex
(.63) which, although having statistically significant correlations
with the other scales, demonstrated observably lower interscale
reliability.

The Self Responsibility subscale contains a variety of questions
such as an interest in community events, financial security, wasting
of energy, oral hygiene, smoking, and wearing seatbelts. A
respondent may have marked that s/he never smoked and always used
seatbelts. Both responses indicate a high level of wellness, but the
scores are reported in the opposite direction. The inconsistency in
the direction of the scoring may have affected the reliability of the
scale. Another explanation for the lower reliability coefficient of

the scale is due to the lack of homogeneity within the scale. The

115

lack of homogeneity is evident by the number of unrelated topics
incorporated into the scale.

The Breathing subscale combines physiological factors associated
with breathing and relaxation such as temperature of fingertips,
meditation, touching one’s hands to toes, plus questions concerning
personal stressors such as work, personal relationships, feeling
tried and rundown, and biting fingernails. An explanation for the
low reliability may be due to the incorporation of questions dealing
with behaviors that signify high levels of stress with questions
dealing with personal perceptions. The respondent may be aware of
many of the personal stressors in his/her life, yet be unaware of how
the physiological factors of stress contribute to one’s ability or
inability to relax.

The Sensing subscale also combines numerous concepts including
taking walks, giving presents to self, receiving backrubs, touching
and being touched, spending time alone, type of lighting in one’s
place of work, and avoiding noisy areas. The nature of the scale
makes it difficult to have high internal consistency since the
principle of homogeneity has been violated (Anastasi, 1981).

The Sex subscale appears to be homogenous in content yet has low
internal reliability. The Sex subscale includes questions on sex
education, body image, and type and degree of intimacy. The
appearance of homogeneity fails at this point and may make it
difficult for the scale to have high internal consistency. Although
the operational explanation may explain the lower intercorrelation, a

more cogent explanation may be that it is difficult for college

116

students to answer in a consistent manner due to developmental
differences. The scale may reflect responses to the individual
stages of development concerning intimacy and sexuality (Erikson,
1963). Some students are working on the issues associated with
developing close relationships with members of their own sex, while
other students may have completed that developmental stage and are
now addressing issues dealing with members of the opposite sex. The
scale may need to be modified for use with college students to
reflect the developmental differences of students.

Out of twelve WI subscales, eight indicated high internal
consistency above .74. According to Mehrens 8 Lehmann (1984) a high
intercorrelation of subscales is an indicator of high content
reliability. These results also indicate that the author is
measuring a unidimensional concept since the distribution is
reasonably normal rather than a bimodal or skewed distribution.

Lifestyle Assessment Questionnaire (LAQ)

 

It is likely that the LAQ is measuring a single construct with a
number of different dimensions. The same core theme is reflected in
all items, but in a number of different ways. The high inter-scale
correlations between the LAQ and the ten subscales, (all correlations
were significant at .001 alpha level) provide evidence that the LAQ
is measuring a unidimensional construct.

The internal consistency of the ten subscales was acceptably
high for research purposes. Coefficient alphas of above .74 were
obtained for eight of the ten subscales (Nutrition, Drugs and

Driving, Emotional Awareness, Emotional Control, Intellectual,

117

Occupational, Social, and Spiritual) provide evidence that the LAQ is
measuring a unidimensional construct. The authors of the LAQ were
consistent in the content for the eight subscales. The exceptions to
this are the scales concerning Physical Fitness (.64) and Self Care
(.68) which, although having statistically significant correlations
with the other scales, demonstrated observably lower interscale
reliability.

The Physical Fitness subscale asks about behaviors dealing with
exercise except for two questions that request specific physiological
information concerning the respondent’s resting pulse and the amount
of sleep. In reviewing the data concerning the reliability of the
scale, if these two items were removed, the scale’s reliability would
be increased. This is an indication that these two questions do not
meet the criteria of homogeneity.

The subscale concerning Self Care addresses many issues that may
lead to the prevention of major illnesses including heart disease,
lung disease, cancer, and oral health disease. These diseases may
have some common contributing factors, yet the etiologies of these
diseases may be different. The etiologies of disease may have been
too large of an area to cover within one subscale of ten questions.
It is difficult to have a scale that is internally consistent when
dealing with four major societal health problems of the 19803.

Out of ten subscales of the LAQ, eight of them indicated high
internal consistency above .74. According to Mehrens 8 Lehmann
(1984) a high intercorrelation of subscales is an indicator of high

content reliability. These results also indicate that the authors

118

are measuring a unidimensional concept since the distribution was
reasonably normal rather than a negatively or positively skewed
distribution.

Lifestyle Coping Inventory (LCI)

 

It is likely that the LCI is measuring a single construct with a
number of different dimensions. The same core theme is reflected in
all items, but in a number of different ways. The high inter-scale
correlations between the LCI and the seven subscales, (all
correlations were significant at .001 alpha level) provide evidence
that the LCI is measuring a unidimensional construct.

The internal consistency of the ten subscales was acceptably
high for research purposes. Coefficient alphas of above .74 were
obtained for five out of the seven subscales (Nutrition, Physical
Care, Cognitive and Emotional Actions, Environmental Actions, Coping
Style and Social Support) provide evidence that the LCI is measuring
a unidimensional construct. The exceptions to this are the scales
concerning Physical Fitness (.64) and Low Risk Actions (.13) which,
although having statistically significant correlations with the other
scales, demonstrated observably low interscale reliability.

The Physical Fitness subscale combines several topics within the
scale: exercise, relaxation, drinking, oral hygiene, sleep patterns,
and eating habits. Though these concepts may contribute to one’s
overall physical fitness, it may have been difficult to respond in a
consistent manner to all of these dimensions. Since the principle of
homogeneity has been violated, the scale is not internally

consistent (Anastasi, 1982).

119

The Low Risk subscale had two major deficits: the scale
consisted of only five questions and dealt with five different
issues-highway speed limit, smoking, seatbelt usage, drinking, and
physical examinations. This subscale violated two principles of
reliability, homogeneity and length (number of questions in
subscale). Looking at the response patterns to this subscale also
indicated that this subscale did not measure a unidimensional
construct. For example, a group of respondents reported that they
never smoked, yet consistently exceeded the speed limit. The test
author could improve the reliability of the subscale by adding
additional questions and/or addressing the issues that are the most
interrelated.

Out of seven subscales of the LCI, five of them indicated high
internal consistency above .74. According to Mehrens 8 Lehmann
(1984) a high intercorrelation of subscales is an indicator of
content reliability. These results also indicate that the author is
measuring a unidimensional concept since the distribution was
reasonably normal rather than a bimodal or skewed distribution,
except for the Low Risk subscale which showed a bimodal distribution.

Equivalent Form Reliability

 

Another means of addressing the issue of reliability is through
the use of equivalent form reliability. The equivalent form estimate
of reliability is obtained by giving two or more forms (with equal
content, means and variances) of a test to the same group on the same
day and correlating these results (Mehrens 8 Lehmann, 1984). With

this procedure we are determining how confidently one can generalize

120

a person’s score to what s/he would receive if s/he took a test
composed of similar but different questions.

One of the questions this research study was interested in
determining was whether these three instruments, WI, LAQ and LCI,
could be classified as equivalent forms. The high intercorrelation
coefficients between the three inventories indicate that all three
inventories are sampling a similar domain of knowledge (Anastasi,
1982).

Reliability Summary

 

In the three tests, the majority of the subscales showed high
internal reliability (.74 and above). Lower correlation coefficients
were primarily due to lack of homogeneity in the subscale items, too
few test questions within a scale, and the overlooking of
developmental issues. The high intercorrelation between tests
support equivalent form reliability. One may conclude that there is
sufficient evidence to support the premise that the WI, LAQ, and LCI
are reliable measures of wellness.

Validity of the Instrument

 

Another important dimension of a test is the validity of the
instrument. Validity can be defined as the extend to which certain
inferences can be made from test scores or other measurement (Mehrens
and Lehmann, 1984). Validity is the overall degree of justification
of test interpretations and use. In this research study, content and

construct validity were addressed.

121

Content Validity

 

Content validity involves the systematic examination of the test
content to determine whether it covers a representative sample of the
behavior domain to be measured (Anastasi, 1982). One difficulty in
establishing content validity is that of adequately sampling the item
universe. The domain under consideration should be fully described
in advance. Content validity is built into a test from the outset
through the choice of appropriate items.

Content validity for the three wellness inventories, WI, LAQ,
and LCI, was established by basing the inventories’ questions on a
theoretical orientation, that of wellness. The authors of the WI
(Travis, 1981), LAQ (The National Wellness Institute, 1983), and LCI
(Hinds, 1983) each agreed that the standard instruments to access
health, such as Health Risk Appraisals (HRA), were based on mortality
statistics, and therefore, inappropriate. Each of the authors
decided to focus on well being and the root causes of the high risk
behaviors as quantified by the HRAs. Each of the authors sampled a
similar domain of information that included lifestyle, nutrition,
drug use, exercise, environment, problem solving, psychosocial
habits, life purpose, emotional well being, cognitive processes,
work/play, and the spiritual dimension. Because of the similar
theoretical background and domain of information, the premise of
content validity can be supported. Further support for content
validity was provided by the high intercorrelations among the
instruments (refer to Table 4.1 for additional statistics). The

establishment of content validity for the wellness instruments helps

122

to operationalize the definition of wellness, and as such, is an
important contribution to the field of research in wellness.

Construct Validity

 

Steps for construct validation of the concept of wellness and
the WI, LAQ, and LCI were also undertaken in the present study. The
term wellness has been attributed to Dr. Alfred Dunn, who in the
19508 began lecturing and writing articles about an idea he called
"high level wellness" (Ardell, 1984). Since that time, other
theorists have taken Dunn’s concept and further expanded upon it
(Ardell, 1977; Hinds, 1983; Jourard, 1963; Travis, 1981). Beginning
in 1979, several instruments were developed to access wellness
(Pelletier, 1979). Since then, various studies have been completed
using wellness instruments (Jeney, 1985; The National Wellness
Institute, 1983; Richter, 1985), but none of these studies have
addressed the issue of construct validity from either a theoretical
or statistical point of view. This research study was the first
initial attempt to address the question of whether instruments
measuring wellness have construct validity.

Construct validity, defined as the extent to which an instrument
measures a theoretical construct or trait, is not as easy to
establish as is content validity. Construct validation of an
instrument requires the gradual accumulation of information from a
number of sources (Anastasi, 1982). There are several different
techniques that contribute to construct validation. The following
methods were used in this research study: correlations with other

tests and internal consistency.

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Correlations with other tests. Correlations between a new test

 

and similar earlier tests are sometimes cited as evidence that the
new test measures approximately the same general area of behavior as
other tests designated by the same name. These correlations should
be moderately high, but not too near unity, E.‘ 1.00 (Anastasi,
1982). In this research study the three wellness instruments were
correlated with each other. This was the first time that all three
instruments had been given simultaneously to the same research
population. The correlation coefficients ranged from .70 between the
LAQ and LCI, to .79 between the WI and LAQ, and .82 between the WI
and LCI.

The observation that two variables tend to simultaneously vary
in a certain direction does not always imply the presence of a direct
relationship between them. It may be possible that a third variable,
sometimes called a lurking variable, is actually causing the observed
correlation between the inventories. The false correlation
that it produces is called spurious correlation (Bhattacharyya 8
Johnson, 1977).

Since the study has used three instruments, correlation with a
third unknown (lurking) variable is unlikely. The reasonably normal
distribution of the subscales, also indicate that the instruments are
measuring a unidimensional trait. These two observations discount
the existence of a spurious correlation. From the results of the
data analysis and examining what factors might be a lurking variable,
it is possible to say that these three instruments are measuring a

similar construct.

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Internal Consistency. Internal consistency validity is

 

essentially a measure of homogeneity. Because it helps to
characterize the behavior domain or trait sampled by the test, the
degree of homogeneity of a test has some relevance to its construct
validity (Anastasi, 1982). One way of determining internal
consistency involves the correlation of subtest scores with the total
score. In the construction of tests, the scores on each subtest are
often correlated with the total score, and any subtest whose
correlation with total score is too low is eliminated. The
correlations of the remaining subtests with the total score are then
reported as evidence of the internal consistency of the entire
instrument. As discussed in the section on content reliability, the
subscales of the three inventories were correlated with the total
test scores. Because of the high number of subscales that
correlated with the total scores, it can be said that these
instruments are internally consistent and therefore support internal
consistency validity.

Clearly, the present study has just begun the task of
establishing construct validity for instruments measuring the concept
of wellness. At this point there is evidence to point to the premise
that the WI, LAQ, and LCI are measuring a unidimensional construct
called wellness. Therefore, there is evidence to support the
validity of the trait labeled wellness.

Validity Summary

 

An important dimension of a test is the validity of the

instrument. In this research study, content and construct validity

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were addressed. The premise of content validity can be supported
because of the similar theoretical background and domain of
information and by the high intercorrelations among the instruments.
At this point there is evidence to point to the premise that the WI,
LAQ, and LCI are measuring a unidimensional construct called
wellness. From the results of the data analysis, it is possible to
say that these three instruments are measuring a similar construct.
The high number of subscales that correlated with the total scores,
support the premise that these instruments are internally consistent
and have internal consistency validity.

The establishment of content and construct validity for the
wellness instruments helps to operationalize the definition of
wellness. Also, there is evidence to support the validity of the
trait labeled wellness. As such, this is an important contribution
to the field of research in wellness.

Differences Between Users and Non-users

 

In comparing the two groups, users and non-users of counseling
center services, it was found that there were no differences between
the groups in terms of total wellness scores. There are several
possible explanations for this outcome.

In the studies using Health Risk Appraisals (the behavioral
counterparts of the wellness inventories) to assess health behaviors
of college students, one of the problems encountered is that college-
age students are already healthy (Cottrell 8 St. Pierre, 1983; Dunton
8 Rasmussen, 1977; Nagelberg, 1981). A major component of a wellness

instrument addresses students’ health behaviors. Since college

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students as a group are already healthy individuals, this may be a
possible explanation why there were no differences between users and
non-users.

Another possible explanation for no differences between users
and non-users on the major hypothesis, is that health behaviors are
not good measures of differences between users and non-users. In the
research studies using HRAs as the assessment instruments in pre- and
post-treatment studies of college students enrolled in health
classes, it was found that health behaviors did not change with
treatment (Cottrell 8 St. Pierre, 1983; McClaran 8 Sarris, 1985).
This indicates that health behaviors may be homogenous for various
groups of college students. In the current study, there were no
statically significant differences between the user and non-user
groups in subscales measuring specific physical health behaviors
(physical fitness, eating, high/low risk activities) as opposed to
those subscales which measured the psychological and spiritual
dimensions of wellness. If the subscales dealing with physical
health behaviors (physical fitness, nutrition, high/low risk
activities) were eliminated, the trend of the data would lean more
toward significant differences between users and non-users. Overall,
the user group showed a higher level of wellness than the non-user
group. This would support the explanation that physical health
behaviors are not the variable that differentiate users and non-users

of counseling center services.

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Supplementary Descriptive Analyses

 

Supplementary descriptive analyses were performed to determine
whether the subscales identified differences between users and non-
users of counseling center services. In this study, the following
nine subscales, Cognitive Emotional (LCI), Emotional Awareness (LAQ),
Social (LAQ), Emotional Cognition (LAQ), Self (WI), Feeling (WI),
Thinking (WI), Play/Work (WI), and Finding Meaning (WI) showed
significant differences between the two groups. Though the major
hypothesis did not show differences between the two groups, it was
found that users of counseling centers have a higher level of
wellness on eight of the significant subscales.

Wellness level of users. The first finding of the descriptive

 

analyses showed users of counseling center services to have a higher
level of wellness in the areas of finding meaning in life, self
exploration, emotional awareness, emotional cognitions, play/work,
thinking and feelings. In the previous section, it was noted that
issues pertaining to specific physical health behaviors did not
differentiate between the two groups. The subscales that do
differentiate are those that address the development of attitudes,
communication skills, psychological attributes, and lifestyles, which
foster an enhanced sense of personal well-being (Travis, 1981).

A possible explanation for these results is that users are more
aware of their internal thoughts and processes and therefore score
higher on these subscales. As Travis (1981) described in his model
of the illness-wellness continuum, the step that separated illness

from health was awareness. Awareness is an opportunity for the

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individual to see how s/he is presently conducting his/her life.
Awareness leads to education, which is a time to explore options;
looking within oneself as well as receiving from others. The final
phase of the wellness continuum is growth-trying out some of the
options. The underlying constant of the model is re-evaluation which
leads to new awareness, education, and growth. As the users become
aware of their internal processes and parts of themselves they wish
to develop and/or change, they begin to search for places that can
enhance this stage of wellness. One possible alternative is using
the services offered by the university’s counseling center. This may
be one of the reasons that users are now seeking therapy because of
their heightened level of awareness.

Counseling Readiness. Wellness may be another term for

 

counseling readiness; people are able to acknowledge and identify
psychological discomfort. Since both groups have similar health
skills, what differentiates users and non-users is the ability to
admit that one needs assistance (Doleys, 1964). For example, the WI
asks questions about issues that contribute to counseling readiness
including: It is OK for me to ask for help; I allow myself to
experience a full range of emotions-anger, fear, sadness, and joy--
and find constructive ways to express them; I feel OK about crying
and allow myself to do so. The user group may have a higher level of
psychological sophistication. When they experience psychological
discomfort and are having difficulty coping, they are more willing to
respond and seek assistance. In general, students who seek

counseling may have a lower level of denial, are more introspective,

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are able to ask for and accept assistance, and are looking for a
meaning or purpose to life. If help-seeking is illustrative of
wellness, the higher degree of wellness and awareness, the more
likely there will be an increased usage of mental health services
rather than a decrease. Since the two groups are not different
demographically, the users may be more aware of their mental health
needs.

Lifestyle Coping Inventory (LCI). Of the three wellness

 

instruments, the LCI is the only one which emphasized coping
behaviors. The primary purpose of the LCI is to assist clients in
identifying personal health care behaviors and stress reduction
strategies that would lead to a wellness lifestyle (Hinds, 1983).
The supplementary data analysis found that non-users of counseling
center services had a higher level of wellness in emotional and
cognitive coping skills as identified by the LCI. This was the only
subscale that was statistical significant for the non-users group.
These results would support Doleys’ findings (1964) who found that
the non-users of counseling center expressed significantly fewer
total problems on the Mooney Problem List in the areas of: Health
and Physical Development; Living Conditions and Employment; Social-
Psychological Relations; Personal-Psychological Relations; and
Adjustment to College Work. If this trend was true, it would seem
that the user group would have a higher level of wellness in similar
areas as measured by the LAQ and W1.

Since the primary purpose of the LCI is to assist clients in

identifying personal health care behaviors and stress reduction

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strategies that would lead to a wellness lifestyle (Hinds, 1983), a
possible explanation for the higher level of wellness among non-users
is that the LCI may be assessing personal health care behaviors which
are only a part of the variables that contribute to wellness. This
would support the findings of Mendelsohn and Kirk’s study (1962)
using the Myers-Briggs Type Indicator. Mendelsohn and Kirk found
that non-users of counseling center services relied on overt,
concrete stimuli to order their world. The Cognitive Emotional (LCI)
subscale measures concrete personal health care behaviors and stress
reduction strategies, an aspect of wellness. These findings indicate
that non-users have a higher need for ways to structure their
environment and thinking patterns. The LCI will show a high level of
wellness for non-users because of its use of concrete behaviors to
assess wellness.

One of the difficulties in using non-cognitive tests is that
they are susceptible to response set, i.e., to the tendency of an
individual to reply in a particular direction, almost independent of
content (Mehrens 8 Lehmann, 1984). An individual exhibiting response
set will answer identical questions (but presented in different
formats) differently. For example, s/he may be predisposed to select
the neutral category if a disagree-agree continuum is used. The
response set that has been of most concern in noncognitive
measurement is social desirability. This is the tendency for an
individual to respond favorably to the items that s/he feels are
socially acceptable. Here, the subject may answer not on the basis

of how s/he truly feels but on the basis of what s/he thinks is a

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socially acceptable or desirable answer. This type of response
pattern would shift the response scale towards the middle range.

In reviewing the data, the non-users scored lower than the user
group on other subscales asking similar questions in the area of
emotional and cognitive wellness except for the LCI. This may
indicate that the non-user group were responding to the questions in
a socially acceptable or desirable answer. The non-users may be more
apt to mark a middle (score of 3) response rather than a below
average response to the instruments. When the scores are totaled,
the non-users group would have a higher level of wellness due to the
need to present themselves in a socially desirable manner.

Another difference between the LCI and the other two inventories
is that a portion of the responses of the LCI were scored in the
reverse direction. In the Cognitive Emotional subscale these items
could be considered "confessional" in nature (i.e. I maintain
perfectionistic self-standards; I use "should" and "should nots" in
my self-statements; I make negative generalizations about myself, e.
g., I’m dumb, ugly, a failure, etc.; I make negative statements about
others). These "R" scored responses may have the effect of lowering
the wellness total scores by building in a suppressor scale that was
measuring quasi-neurotic behaviors.

If users are more aware and are more honest about their negative
thoughts and feelings, the LCI suppressor scale has a negative effect
on the wellness levels of users. For example, if a person seeks
feedback on his/her behavior, s/he is probably aware of some of the

negative consequences such as, using "shoulds," making negative

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generalizations, and taking things personally. The WI presents
similar questions in the feeling and thinking dimensions (for
example, I dwell on the past; I think in terms of absolutes, e.g.
rights and wrongs, good and bad; I am aware that I make judgments
where I believe I am "right" and others are "wrong") as does the
LCI. If the respondent admits that s/he is having problems with
emotional concerns or negative perceptions of the self, this
awareness contributes to a higher wellness score. This discrepancy
in scoring may attribute to the non-users’ higher level of wellness
on the LCI subscale.
Summary

Carskadon (1975) in reviewing the literature concerning help-
seeking behaviors found that helpseekers are more psychologically
minded than non-helpseekers, more questioning, and more introspective
(p. 132). Though there were no statistical significant differences
between the user and non-user groups in this study, however the
subscales of the test tend to support the findings that users are
more aware of their internal processes and issues, seek ways to
enhance their psychological well being, and use therapy as one of the
means to do so.

The results of this research study challenge the assumption of
the medical model that the seeking of counseling services is a sign
of ill health. It may be true that these individuals are in need of
assistance, yet awareness of the signs and symptoms of psychological
discomfort is the first step to enhancing one’s sense of wellness

(Travis, 1981). Therapy not only increases the client’s level of

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wellness on the psychological dimension, but also in the physical
realm (Dunn, 1961; Ferguson, 1980; Flynn, 1981; Gross, 1980; Kysar,
1966; Ryan 8 Travis, 1981; Travis, 1981; Van Ness, 1981). Due to
their heightened level of psychological awareness, clients will
readily respond to psychological and educational interventions. This
would again support the conclusion that wellness is a
multidimensional approach that incorporates personal growth, internal
control, and health-related activities and habits (Ardell, 1979;
Bruhn, et al., 1977; Hettler, Elsenrath, 8 Leafgren, 1980; Hinds,
1983; Travis, 1981).

In the wellness community, there has been an emphasis on health
behaviors (Montgomery 8 Dalton, 1986). The results of the study
indicates that health behaviors are a constant variable within the
college age population. The issues that need to be addressed during
the college experience are those that transcend health. It is
important that the mental health issues of college students be
addressed in a proactive manner. Increasing the college student’s
level of awareness about feelings and self perceptions, may, over
time, prevent major illness (Kysar, 1966). These findings also show
the importance in having mental health professionals involved in the

wellness movement and as part of the university community.

Limitations of the Study
The sample for this study was taken from a single Southwestern
university. With this unique characteristic of the sample noted,

generalization to a larger client population can be made using the

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Tukey-Cornfield Bridge argument (Glass 8 Stanley, 1970). This is a
logical argument allowing for inferences to be made from non-
randomized samples to populations of interest, provided that the
characteristics of the sample are described in detail. Use of this
argument allows for the generalization of these results to the larger
college student population. Generalizations beyond this population,
however, need to be made with caution. The results of the study may
not be generalizable to noncollege students.

In addition to sampling limitations, there are possible
limitations in the measures used and the method of data collection.
The self-report instruments in this study are accurate to the extent
that self-perceptions are accurate and to the extent that the
individual is willing to honestly express them (Sellitz, et. al.,
1976). The contents of the instruments used in this study were not
designed to be embarrassing, threatening, or sensitive to social
desirability. The effect of social desirability on these inventories
has been mentioned in previous research (Cottrel 8 St. Pierre,

1983). Therefore, the inventories were rotated in the packet
presentation to moderate the effect that social desirability may have
on student responses.

In this study there were no controls of the testing
environment. Each student responded to the inventories in a variety
of environments. The only test taking variables that were controlled
were the testing instruments and the presentation of the inventories
in the testing packet. Though there were no controls of the testing

environment, the reliability of all three instruments was high

135

(.93). This indicates that the variety of testing environment had
little influence on the reliability of the instruments.

The data collection process for this study was carried out
during a five month period (November, 1986 - March, 1987). The data
collection for the non-users groups was completed at the end of
January. An analysis of the two groups indicated that there were no
differences between the two groups on 18 demographic
characteristics. Statistically, users and non-users do not differ
though the data collection extended over two semesters.

Another potential limitation of the study was a theoretical
consideration. An issue addressed in this study was whether wellness
was a concept, and if so, can it be measured. The instruments used
to measure wellness did not have an extensive history of previous
research. Outcomes of the study indicated that the instruments (WI,
LAQ, and LCI) were found to be appropriate means of measuring
wellness. The results of the study support the findings that the
instruments are reliable and have content and construct validity.
Though construct validity is not something established in one
attempt, minimal construct validity was established in this initial
validation study, which needs to be considered in the interpretation
of the results.

Finally, this study is assessing wellness through the use of
paper and pencil instruments. The test itself is a subjective
measure versus an unobtrusive observation of each student to
determine his/her level of wellness through an actual behavioral

analysis. The results of the study indicate that the differences

136

between users and non-users are based on an internal process rather
than observable behaviors.

There are limitations to any research study, but the potential
ones here were not thought to be serious and may seem small when

considering the complex area under investigation.

Implications of the Research

The results of this research have several implications for the
field of counseling psychology. A major finding of the study
reported no differences between users and non-users of counseling
center services. This finding calls for major changes in the field
of counseling psychology including reassessing the assumptions about
those who use clinical services. The implications of the research
center around the use of wellness instruments in the field of
psychology, determining which variables influence students to use
counseling services, redefining how signs and symptoms of pathology
are viewed, developing psychoeducational programs as part of
counseling center services, and providing appropriate mental health
models for the field of counseling psychology.

Instrumentation

 

A clear implication of the research findings is that wellness
instruments are both reliable and valid when used with the college
population. Therefore, wellness instruments would provide the mental
health professional with a means to assess college students’ concerns

from a wholistic perspective. The use of these instruments would

137

also add to the psychological research on users and non-users of
counseling center services.

Of the three wellness instruments, the WI and the LAQ have the
greatest potential to differentiate between users and non-users of
counseling center services. Both of these instruments had high
internal consistency and equivalent form reliability. The
instruments also showed promise of content and construct validity.
Eight of the subscales, Emotional Awareness (LAQ), Social (LAQ),
Emotional Cognition (LAQ), Self (WI), Feeling (WI), Thinking (WI),
Play/Work (WI), and Finding Meaning (WI), were able to differentiate
between users and non-users of counseling center services and showed
that users had a higher level of wellness in these dimensions.

The third instrument, the LCI, also shows potential to
differentiate between users and non-users due to its high inter-
correlation coefficient with the other two instruments. The author
of the LCI needs to establish stronger reliability for several of the
subscales and further research the consequence of reverse scoring of
questions within the subscales.

Users and Non-Users of Counseling Center Services

 

The most significant finding of this study is that, using a
wholistic model, users and non-users of counseling center services
are similar groups. Of the nine subscales that differentiated
between the two groups, users had a higher level of wellness on eight
subscales. Previous studies had supported the premise that the non-
users group was more psychologically healthy (Cooke 8 Kiesler, 1967;

Danet, 1965; Doleys, 1964; Kleinmuntz, 1960; Palladino 8 Domino,

138

1978; Parker, 1961). This new finding challenges the assumption that
users of counseling services exhibit a more extensive degree of
pathology and is a departure from the majority of research concerning
users and non-users. These results provide a new direction in the
research literature concerning users and non-users, both in terms of
assessment instruments and the conclusion that users possess a higher
level of wellness.

The primary thrust of the wellness movement on campus has been
largely in the area of lifestyle issues such as fitness, diet, and
stress management (Montgomery 8 Dalton, 1986). This study found that
health behaviors are a homogenous variable among the college student
population and are not the variable that differentiates users and non-
users. This finding indicates that professionals in the fields of
counseling psychology and health education need to work together to
develop programs that have a wider range of emphasis. It is
especially important to develop programs that address psychological
awareness since this was the variable that increased the well being
of college students. Psychoeducational programs need to be based on
the premise that changes in attitudes and self-awareness precede any
possible long-term lifestyle adjustments, i.e. improved physical and
mental health (Klippel 8 Dejoy, 1984).

In order to accomplish this task, it is imperative that
counseling center professionals have skills in the area of program
development, preventative education, and consultation (Bosmajian 8
Mattson, 1980). This also implies that counseling centers need to

include as an integral part of their services, consultation and

139

outreach efforts. Counseling psychology’s heritage of
psychoeducational strategies, assumptions about the interactions
between people and their personal/social environments, and the
respected position of the individual as the actual change agent have
prepared the field for important work in the "promotion and
maintenance of health" (Klippel 8 Dejoy, 1984, p. 225). These types
of programs will increase the students’ psychological awareness and
therefore, well being.

The model used to look at signs and symptoms of psychological
discomfort influences the way they are interpreted. Psychological
concerns can either be viewed as an indicator of pathology or as a
means to increase psychological well being (Ardell, 1979; Ferguson,
1982; Hosler 8 Fadely, 1981; Papenfuss 8 Beier, 1984; Travis, 1981).
This study shows that a wholistic model, such as wellness, provides a
broader spectrum of behaviors which assist in the development of
positive mental health. The particular strengths of counseling
psychology as a scientific discipline include a focus on the healthy,
functioning aspects of an individual’s personality, and the use of
interventions tailored to the individual. The opportunity is at hand
for counseling psychology to move away from conventional medical
approaches and to move toward broad-based quality of life approaches
that are found in the wellness movement (Klippel 8 Dejoy, 1984).

Finally, the field of counseling psychology needs to address
which psychological model better represents its approach to mental

health. Since the wellness model may be a better fit, the wellness

140

philosophy needs to be incorporated into the training of counseling

psychologists.

Directions for Future Research

Inventory Revision Studies

 

Throughout this discussion section possibilities for the
revision of wellness instruments have been identified. Lower
correlation coefficients were primarily due to the lack of
homogeneity of the subscale items, an inadequate number of test
questions within a subscale, and the overlooking of developmental
issues of college students. Further research on the consequence of
reverse scoring of questions within the subscales is also needed. In
addition to possible test revisions, additional research is need to 5
further establish the initial construct validity of wellness.

Other Test Instrument Studies

 

The current wellness instruments have a strong emphasis on
health dimensions. Since these areas do not differentiate between
users and non-users, it is important to see what variables would
clarify psychological awareness. One possible study would be to
eliminate the three health scales of nutrition, physical fitness, and
low risk activities from the inventories. This type of a study may
provide a clearer distinction between users and non-users.

Within the psychological literature there are also a variety of
personality tests that, used together with the wellness instruments,
may clarify which specific variables differentiate between users and

non-users. Some of the possible subject areas that may be effective

141

in this type of research are: self actualization, helpseeking
behaviors, internal/external locus of control, life changes,
cognitive styles, self concept, and developmental stages.

Long Range Studies

 

College students as a group are in prime health. The
maintenance of this health for future years is contingent on the
degree to which students take responsibility for themselves
physically, emotionally, and spiritually. Previous research data
show that ill health is one of the precipitators for seeking
treatment in the later years of life (Pelletier, 1977 8 1979;
Travis, 1981). The lifestyle habits that students develop during
their college years will affect the length and quality of their lives
(Krivoski 8 Warner, 1986). A proposed longitudinal research study is
to follow users and non-users as a comparison group. According to
Kysar (1966), preventative measures are particularly effective at
crucial stages in the life cycle when the stresses on the person may
be great and vulnerability to breakdown high. Either the student’s
personality will crystallize in ways which promote future health and
productivity, or in ways that are maladaptive and set him/her on the
road to trouble. A longitudinal study between users and non-users
will assist counseling psychologists in determining if psychological
interventions in the college years not only continue to enhance
personal wellness, but also prevent other psychological and physical

illness from occurring.

142

Studies Based on Student Development Theories

 

Sandford (1962) emphasized that the development of the student
as a person is the central aim of education and that all of our
resources in higher education should be put into the service of that
aim. This has been a powerful foundation for student development
philosophy. The ultimate goal of student development is the optimum
human functioning of the individual.

The definition of wellness takes into consideration the whole
person and meets Sandford’s goals for deveIOping the student. The
wellness model is consistent with student development philosophy, and
defines it operationally in a manner that contributes to students’
awareness and understanding (Leafgren 8 Elsenrath, 1986). The
premises of the student development model is to improve the overall
health of students. These two models have not been studied
concurrently. Such a study would assist student personnel
professionals in implementing the student development model in a

concrete manner though addressing wellness behaviors.

Conclusion
The wellness instruments were found to be both reliable as
measured by coefficient alpha and valid with this college student
population. There were no statistically significant differences as
measured by MANOVA between users’ and non-users’ level of wellness.
In addition, supplementary descriptive analyses were performed with
the subscales of the inventories. Nine of the twenty-nine wellness

inventories subscales did showed statistically significant

143

differences. On eight of these subscales, the users had a higher
level of wellness than non-users. These subscales showed users of
counseling center services to have a higher level of wellness in the
areas of finding meaning in life, self exploration, attitudes towards
play/work, cognitions and emotions. Users are more aware of their
internal processes and issues, seek ways to enhance their
psychological well being, and use therapy as one of the means to do
so. The subscale results indicate that certain aspects of wellness
may be related to the utilization of counseling center services which
are counter to the traditional interpretation of pathology as assumed

by the medical model.

APPENDICES

APPENDIX A
NON-USERS REQUEST TO PARTICIPATE LETTER

AND CONSENT FORM

144

Jlrizona State University

Counseling and Consultation
Tempe, Arizona 85287
602/965-6146

Dear Friend:

I received your name from a list of students who are currently enrolled at Arizona
State University. I am conducting a research study on the mental and physical
health of college students. The results of this research study will provide
Counseling and Consultation with additional information to assist in the
development of psycho-educational programs for the coming academic year.

I am looking for 70 students to complete three inventories. By volunteering to
participate in this study and returning a packet of completed inventories to me
within one week, you will have A GANCE TO WIN $100.00. When you return the
packet, you will he entered in a cash drawing with a prize of $100.00 which I will
provide.

Your responses to the inventories will he kept strictly confidential. I will keep
separate the inventories from your Consent Form so that your name will not be
attached to the inventories. You are under no obligation to participate in this
study and may withdraw your consent to participate by contacting me.

The inventories should take you about 90-120 minutes to complete. If you decide to
participate, you can obtain the testing packet from either the receptionist at the
Student Life Office (lower level of the Memorial Union) or by requesting the packet
to be mailed to you directly. If you would like the packet to be mailed directly
to you, please read and sign the attached Consent Form. Return the signed form to
me in the enclosed envelope. When I receive your signed consent form, I will mail
a packet of inventories to you.

In the packet will be a Background Information Sheet, the inventories, and a return
envelope for the completed inventories. Please include your completed Background
Information Sheet along with the completed inventories. When I receive the
completed inventories, your name will he entered in the $100.00 cash drawing.

Your help is very much needed, and I hope you can find the time to complete the
inventories. If you have any questions, please feel free to call me at 965-6146.
I thank you for your time and energy.

Sincerely,

Barbara Palombi, M.A.

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CONSENT FORM

I have read the explanation of the purpose
’(please print name)

and procedure for this study and agree to participate. I understand that my

participation is voluntary, that my results will be kept confidential and that I

may withdraw'my participation at any time by contacting the researcher.

 

Thur Signature

I agree to participate in this research study by picking up the packet of
inventories at the Student Life Office, Lower Level of the Memorial Union.

PLEASE RETURN THIS FORM THE STUDENT LIFE OFFICE
IN PERSON TO: LOWER LEVEL OF THE MEMORIAL UNION
ARIZONA STATE UNIVERSITY

OR

I agree to participate in this research study by having the test packet
sent to me by mail. YES NO

 

 

 

 

RETURN NY MAIL TO: - BARBARA FALOMEI
2 COUNSELING AND CONSULTATION
112 AGRICULTURE EUILDING
ARIZONA STATE UNIVERSITY

I would like feedback on the inventories. YES NO

APPENDIX B

RESPONDENT’S QUESTIONNAIRE PACKET

146

Jlrizona tState University

Counseling and Consultation
Tempe, Arizona 85287
602/ 965-6146

Dear Friend:

Thank you for being willing to participate in this study. Your response will
help Counseling and Consultation to provide psycho-educational programs that
will meet the needs of the ASU student.

Enclosed in your packet are three inventories. You will need to complete each
of them. There is no time limit. Answer each of the inventories according to
the directions attached to each inventory. All responses to the inventories
will be confidential.

Please make sure that you complete the Demographic Information Shset that is
included in the packet. This sheet will provide us with additional
information concerning the needs of A811 students.

After you have completed the three inventories and the Demographic Information
Sheet, place them and the Lottery Card in the enclosed postage paid envelope.
If the three inventories or the Demographic Information Sheet is not completed
and returned within four work“ days, I will be unable to include your name
in the 8100 lottery.

If you have any questions concerning the inventories or the Demographic
Information Sheet, please feel free to call me at 965-6146. Again, I want to
thank you for your time and energy.

Sincere ly ,

Barbara Palombi , M.A.

 

 

 

147

Demographic Information

Instructions

This section of questions are asked so that we can camera the opinions n! experiences of peOple of different
backgrounds; i.e., younger peOple with older people and people with different ethicatimal levels. Please circle
the alternative that best describes you.

1.

flat is your sex?
(1) male
(2) farale

Hut is your age?
(1) 18-20
(2) 21-24
(3) 25-30)
(4) 31-40
(5) 41—50

Hat is your current mital status?
(1) single, never nrried

(2) carried

(3) divorced, widaled or separated

Ibywhavedependentsuflertleageof lByears
old living with you?

(1) No

(2) Yes

lhat is your current living arrmagmxent?

(1) Live in residence hall

(2) Live in fraternity/sorority

(3) Rent apsrnlent/hmse with roammte (s) or fanily
(4) Peat aparment/house alone

(5) 0m ham 8 live with roammte or fmnily

(6) am ham 8 live alorg

waarisyun’mrrmtresidencefranthemincnpis
of ASU?

(1) live a: canals

(2) less than smile frm teams

(3) 1-3 miles

(4) 4-5 miles

(5) 6-10 miles

(6) 11-15 miles

(7) Dre than 15 miles

lintisyourcurrentclassrmkatAaJ?
(1) Freshmm

(2) Soflmre

(3) Jmior

(4) Senior

(5) lhclassified Undergraduate

7.1: 50.1.1 Security No.

 

8. bhat college/school are you currently

«rolled in At N?

(1) Architectm'e Ill Elvirumntal Design
(2) Mines

(3) Education

(4) Wittering 8 Applied Sciences
(5) Fine Arts

(6) Lu

(7) Liberal Arts 8 Sciences

(8) Musing

(9) Public Program
(10) Social lbrk

9. lint is your current enrollnent status
It ASJ?
(1) less than 9 hams
(2) 9-11 hours
(3) 12 or more hours

hiring the last 12 months, have you
participated regularly in any of the
following activities?

YES m

10. Salient organizations or advocacy
groups 1 1
11. Sttalent goverrment l 2
12. A regular fitness program 1 2
l3. Patronage of bars or niy1tclubs l 2

14. kligious affiliation or

spiritual discipline 1
15. 'Tartying" 1 2
16. Mip in a Greek organiza-

tion I 2

N

17. (Indoor recreational activ- -
ities or intrmlural program I 2
18. Played intercollegiate athletics l 2

19. Performing arts (bards, choral
grmps, dance, etc.) I 2

20. Have youeverused the follow-

ing kntal lhalth Services?
150'. Carmeling center

Psydiiatrist/Psydiologist
at Lil's Student Health Center

Off tapas mtal health agency

148

BY JOHN TRAVIS

DIRECTIONS:
Set aside time for yourself to complete this inventory. Using the five headings of the

columns on the right side of each page as a guide, circle the number alongside which best
indicates how true the statement is for you at this time.

 

 

 

 

 

Choice 1 - Never (02 of the Time)
Choice 2 - Rarely (0-251 of the Time)
Choice 3 - Occasionally (252 - 50 X of the Time
Choice 4 - Often (50% - 752 of the Time)
Choice 5 - Very Often (75% - 1002 of the Time)
Almost Always -—
Often
Occasionally ___.
Rarely
Never
SECTION 1-SELF RESPONSIBILITY AND LOVE
1. flow I live my life is an important factor in determining my
state of health. 1 2 3 4 5
2. I take an active interest in community, national and world
events. 1 2 3 4 5
3. I feel financially secure. 1 2 3 4 5
4. I don’t waste energy and materials at home or at work. 1 2 3 4 5
5. I take measures to protect my living area from fire and safety
hazards (such as improper sized fuses and storage of volatile
chemicals). 1 2 3 ‘ 5
6. I use dental floss and a soft toothbrush, and have been
instructed in their proper use. 1 2 3 8 5
70 I don't .Msz l 2 3 l. 5
8. I wear a safety belt when I ride in a car. 1 2 3 4 5
9. I see a big difference between blaming myself for a problem and
simply being responsible for that problem. 1 2 3 4 5
10. I experience love for many pe0ple and things around me. 1 2 3 5
SECTION 2-BREATHING
l. I stop during the day to become aware of the way I am breathing. l 2 3 4 5
2. I meditate or relax myself for at least 15 to 20 minutes
each day. l 2 3 4 5

3. I can touch my hands to my toes easily when standing with
knees straight. I 2 3 4 5

4.

5.
6.
7.
8.
9.
10.

149

Often
Occasionally

Rarely

Almost

Always-——

 

 

Never

In temperatures of over 70 degrees F., my fingertips feel warm
when I touch my lips.

I am at peace with myself.

My work is not overly stressful.

My personal relationships are satisfying.

I take time out for deep breathing several times a day.

I don't bite or pick my nails.

I don't feel tired and rundown (except after strenuous work).

SECTION 3-SENSING

10.

I take long walks, hikes and/or outings to actively explore

my surroundings.

I give myself presents, treats, or nurture myself in other ways.
I enjoy getting backrubs or massages.

I enjoy touching and hugging other people.

I enjoy being touched and hugged by others.

At times I like to be alone.

I like getting compliments and recognition from other people.
It is easy for me to give other people sincere compliments and
recognition.

Hy place of work has largely natural lighting or full-spectrum
light. a

I avoid extremely noisy areas (or wear protective earplugs.)

SECTION 4-EATING

l.

I am aware of the difference between refined carbohydrates
(white flour, sugar, Etc.) and complex (natural) carbohydrates.
I am satisfied with my diet.

I have fewer than five alcoholic beverages per week and fewer
than three cups of coffee or tea per day (except of

herbal teas).

I don't take medications, including prescription drugs.

I drink fewer than five soft drinks per week.

I all little or no salt to my food.

I read the labels for the ingredients of the foods I buy.

I eat at least two raw fruits or vegetables each day.

I have a good appetite and maintain a weight within 152 of my
ideal weight.

I know and feel the difference between ”stomach hunger" and
"mouth hunger."

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150

Almost Always .
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SECTION 5-HDVING

l.
2.

3.

6.
5.
6.
7.

9.
10.

I climb stairs rather than ride elevators.

My daily activities include moderate physical effort (such as
rearing young children, gardening, scrubbing floors, or work
which involves being on my feet, etc.).

My daily activities include vigorous physical effort (such as
heavy construction work, farming, moving heavy objects by hand
etc.).

I run a least one mile five times a week (or equivalent
aerobic exercise).

I run at least three miles four times a week or equivalent

(if this statement is true, mark the item above true as well).
I do some form of stretching/limbering exercise for 10 to 20
minutes at least three times per week.

I do yoga or some form of stretching exercise for 15 to 20
minutes at least four times a week (if this statement is

true, mark the statement above true as well).

I enjoy exploring new and effective ways of caring for myself
through movement of my body.

I enjoy stretching, moving, and exerting my body.

I am aware of and respond to messages from my body about
it needs for movement.

SECTION 6-FBBLING

l.

I allow myself to experience a full range of emotions-
anger, fear, sadness, and joy- and find constructive ways
to express them.

I am able to say ”no" to people without feeling guilty.

It is easy for me to laugh.

I feel OR.about crying and allow myself to do so.

I listen to and think about criticism of me by others rather
than react defensively.

l have at least five close friends.
I like myself and look forward to the future.

I find it easy to express concern, love, and warmth to those
I care about.

It is OK for me to ask for help.

I don't swallow or store my anger; I express it in a way
which solves problems.

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151

Occasionally ——

Almost Always -- ‘
Often

 

 

Rarely
Never

 

SECTION 7-TBINKING

l.
2.

3.
4.

5.
6.
7.
8.
9.

I am aware of the subject matter and emotional content of

I, thought. a

I am aware that I make judgements where I believe I am
”right" and others are wrong.”

It is easy for me to concentrate.

I am aware of changes in my body (breathing, muscle tension,
skin moisture, etc.) in response to certain thoughts.

I notice that my perceptions of the world are colored by my
thoughts at any given time.

I notice that my thoughts are influenced by my environment at
any given time.

I use positive attitudes and thoughts to make things happen
the way I want them to.

Rather than worry about a problem I can temporarily shelve
it and enjoy myself.

I approach life with the attitude that no problem is too big
to solve.

10. I am creative.

SECTION 8-PLATING AND UOIKING

l.
2.

I enjoy expressing myself through art, dance, music, drama,
sports, etc., and make time to do it.

I enjoy spending time without planned or structured activities
and make time to do it.

I am aware of the value of play for adults.

I can approach tasks from a playful point of view.

At times, I allow myself to do ”nothing.”

The work I do for income is rewarding to me.

I have people around me who support my playfulness.

I have at least one hobby or area of interest which makes
no demands on me.

I am satisfied with my abilities to work.

10. I am satisfied with my abilities to play.

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SECTION 9-CONHUNICATING

152

Almost Always
Often -7

Occasionally r
Rarely

Never

 

 

 

 

 

 

 

l. I can introduce a difficult topic and stay with it until i L

I’ve received a satisfactory response from the other person. 1 2 3 4 5
2. I enjoy silence. 1 2 3 4 5
3. I consider my thoughts and feelings with care before

responding to others. 1 2 3 4 5
4. I communicate clearly with friends and family. 1 2 3 4 5
5. I assert myself to get what I need rather than feel resentment

towards others for taking advantage of me. 1 2 3 4 5
6. I admit my mistakes to others when I am aware of them. 1 2 3 4 5
7. I am a good listener. l 2 3 4 5
8. I don’t interrupt or finish others' sentences for them. 1 2 3 4 5
9. I let go of mental labels and judgments I attach to persons

and things in my environment, and instead see them for what

they are. l 3 5
10. I am aware of the psychological "games" I play with others. 1 2 3 5
SECTION lO-SEX
l. I feel comfortable touching and exploring my body. 1 2 3 4 5
2. I think it's OK to masturbate if one chooses to do so. 1 2 3 4 5
3. My sexual education is adequate. l 2 3 4 5
4. I feel good about the degree of closeness I have with men

in my life. 1 2 3 4 5
5. I feel good about the degree of closeness I have with women

in my life. 1 2 3 4 5
6. I am content with my level of sexual activity. 1 2 3 4 5
7. I fully experience the various stages of lovemaking rather

then focus on an orgasm. 1 2 3 4 5
8. I experience a desire to grow closer to other people. 1 2 3 4 5
9. I am aware of the difference between loving someone and

needing someone’s love. 1 2 3 4 5
10. I am able to love others without dominating or being

dominated by them. 1 2 3 4 5

SECTION ll-PINDING MEANING

l.
2.

I thing that my life has meaning and direction, thought
I may not always see it clearly. I 2 3 4 5
I think my life is challenging and exciting. I 2 3 4 5

153

Often
Occasionally

Almost Always

 

 

Rarely
Never *1 ‘

I have goals and objectives in my life.

I think I am achieving my goals.

I am able to talk about the death of someone close to me
with family and friends.

I am able to talk about my death with family and friends.
I am prepared for and unafraid of death.

I see my death as a step in my evolution.

I look forward to the future as an opportunity for further
growth.

10. I live in the "here and now" rather than in the past or future.

SECTION 12-TRANSCENDING

l.
2.
3.
4.
5.
6.
7.
8.
9.

10.

I perceive problems as opportunities for growth.

I experience synchronistic events in my life (coincidences
which appear to have no cause-effect relationship but happen
more often than chance would dictate).

I believe there are dimensions of reality beyond verbal
description or human comprehension.

Confusion and paradox seem a necessary part of my growth
though I may at times not be comfortable with them.

The concept of "god" has a personal definition and meaning
to us

I experience a sense of wonder and awe when I contemplate

the universe.

I have abundant expectancy rather than specific expectations.
I do not pressure others to accept my beliefs.

I use the messages interpreted from my dreams to better

live my waking life.

I enjoy practicing a spiritual discipline or allowing time

to sense the presence of a greater force in guiding my
passage through life.

1

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154

TestWell
A Self-Scoring

Physical Fitness

1.

10.

lexsrciss aerobically (continuOus. vigorous exercise producing
sweat for a minimum of thirty minutes) at least ._ per smelt.
1 Ifivetimes 2Itourtimss 3Ithrsstimss

sItwotimes 5Ilsssthsntwice t

ANSWER I

. My resting pulse rate is _ beats per minute.

1-401055 2I561069 3-701079
4IoOorsbove SIdon'tltnow 1

ANSWER I

2846

. I avoid the extremes of loo much or too little exercise.

1 I strongly agree 2 I agree 3 I neutral/not sure
s-dissgree SIstronglydissgrse t a a a s

ANSWER I

. law'osch exercise in a relaxed manner.

1 I slmost always 2 I very frequently
4 I occasionally

3Ifrsquantly
SIalrnostnsvsr i 2 s s s

ANSWER I

. I stretch before exercising.

1 I almost always 2 I very frequently
4 I occasionally

3 I frequently
6Islmofl never 1 2 s s s

ANSWER I

. I stretch after exercising.

1 I almost always 2 I very frequently
4 I occasionally

3Ifrsqusntly
bIslmostnsver t a a . s

ANSWER I

. I increase my exercise by walking or biking whenever possible.

1Istronglysgrse 2Isgrse 3Insutrsl/notsurs

sIdissgrss SIstronglydissgree t 2 s 4 s
ANSWER I
. lgst an adsquate amount of sleep.
1 I almost always 2 I very frequently 3 I frequently
dIoccssionally 5Islmostnsver I 2 s s s
ANSWER I

. My exercise program includes an adequate amount of each of

fhs three major fitness cornponsnts — endurance. strength.
and flexibility.

1Islrnostslwsys 2Ivsryfrsquently 3Ifraqusntly
eIoccssionslly 5Islmostnever t a a a ti
ANSWERI

lllsmnotlnshspe.lsvoidsporadic(oncsswsskorlsss)
strenuous exercise.

1Islrnostslwsys 2Ivsryfrsqusntly 3Ifrsqusntly
4Ioccasionslly bIslmostnsvsr | a a . s
ANSWER-

Nutrition
Chsck 1 I almost always 2 I very frequently 3 I frequently
4 I occasionally 5 I almost never i 2 a 4 s
ANSWER I

1. When choosing nonovsgetsble protein. i select lean cuts at

r nfth
msst.poulty.ad s ‘ 2 3 ‘ 5

mswen - EU]:

1 2 3 s s
ANSWER I | E ll 1 - i
3. I eat fruit and vegetables fresh and uncooked

2. l minimize salt intake

2345
I

ANSWER I

4. last breakfast
1 2 a . 5

mswsn- [CECE

5. I intentionally include fiber in my diet on s daily ”5;: 3 ‘ s
I

ANSWER I
8. I drink snOugh fluid to keep my urine light yellow, 5

2 s I
mswsa- m

7. I plan my diet to insure an adequate amount of Vitamins and

minerals.
1 a s a s

ANSWER I

8 l minimize foods in my diet that contain large amounts of refined
W (bleached white flour. typical store bread. cakes. ’etc‘.) 5
1

ANSWER I

9. l minimize my intake of fats and oils including margarine and

animslfsts.
i 2 1 I s

mswen - [21:13:13

10. I avoid adding sugar to my food and l minimize my intake or
prssweatened foods such as sugar-coated cereals. syrups.

chocolate millt. and most processed and fast fonds2 ‘ s

ANSWER - ‘__l____ ll“

Sell Cars

Cheek. 1 I slrnost always 2 I very frequently 3 I frequently
4 I occasionally 5 I almost never 1 2 a a t

ANSWER I
1. I maintain an up-to—date immunization record

a
ANSWER I 1.4.3.44—

2. I examine my breasts or testes on a monthly basis 2 ‘

3 a
ANSWER- 1::

Self Care (continued)

Check 1 I almost always 2 I very frequently 3 I frequently
4 I occasionally 5 I almost never

3. I take action to minimize my exposure to tobacco s;no:e.‘ ‘

ANSWER I

4. When I'm experiencing illness or injury. ltake necessary steps

tocorrecttheproolem.
t 2 s e s

ANSWER-
S. l brush my teeth after eating.
i 2 s e s
ANSWER I
6. l floss my teeth alter eating.
i 2 2 e s
ANSWER-
7. My resting pulse is 60 or less.
i 2 s e s
ANSWER I

a, lgeranadaquateamountollleeo- , 2 , , ,

ANSWER I

9. I keep my blood pressure in a range that minimizes my chances
of disease. (e.g. stroke. heart attack and kidney disease) .

ANSWER I

to. I keep my cholesterol level. high density lipids and triglycerides

in a range that minimizes my chances of disease. . a ‘ ‘

ANSWER I

Drugs and Driving

Ouestrbns 1 through 9.
Check. 1 I strongly agree 2 I agree 3 I neutral/not sure
4 I disagree 5 I strongly disagree

1. ldonotoparatevehiclesundertheinfluencaofalcoholorothar
drugs.
1 2 s e s
ANSWER-

2. ldonothdawifhvehiclaoperatorswhoaraundertheintluence
of alcohol or other drugs

1 2 3 4 I
ANSWER I
3. istsywitninthsspeeelimit. ‘ 2 ’ ‘ ‘
ANSWER I
4. lmaintainaaafe driving distance between carsbasgdon speed
ANSWER I
5. Vehicles which I drive are maintained to assure 3“”,- ‘ .
ANSWER I
6. lavoidtheuseoftobacco. ‘ 2 3 ‘ .
ANSWER I

7. ldonotconsumemorethantwoalcoholicdrink’spgrday.‘ ’

ANSWER I

155

s lavoidusingdrugaobtaihedfromunlicansadaources.

i2 2 4 s
ANSWER-

o. lconsider alternatives to drugs.
1 2 3 4 5

ANSWER-
1o. ltollowthe instructions provided with any drug I take.

1 I almost always 2 I very frequently 3 I frequently
4Ioccasionally SIalmostnever l 2 s i s
ANSWER I

Social
Check 1 I strongly agree 2 I agree 3 I neutral/not sure
4 I disagree 5 I strongly disagree

1. I take steps to conserve energy in my place of resigenfe.‘

S
ANsWER- [ICED

2. I contribute to the feeling ot acceptance within my lzanyly.‘ s

ANSWER I
3 When I see a safety hazard. ltake action (warn others or correct
the problem).
i 2 3 a 3
ANSWER I

4. lavoid unnecessary radiation.
r 2 J i s

ANsWER - [EDI

5. l contribute time and [or money to community projeacts’.
1

‘ 5
ANSWERI [III]:

e. luse mycreativity in construch ways. ' 2 i ‘ s

ANSWER I. Ell—1:3
7. My behavior reflects fairness and justice.

ANSWER I

a. When possible. I choose an environment which is tree of noise
pollution. ‘ 2 a ‘ s

ANSWER I

9. When possible. I choose an environment which is free of air

lli.
pouton 12345

ANSWER - Ell—U:

to. ldomy part to promote clean air. ' 2 a ‘ s
l t

ANSWER I '

Emotional Awareness

1. i am comfortable in my relationships with others.
1 I strongly agree 2 I agree 3 I neutral/not sure
4 I disagree 5 I strongly disagree i 2 a a s

ANSWER - CECE

Emotional Awareness (continued)

Questions 1 through 2.

Check 1Istronglyagree 2Iagrae 3Ineutral/notsure

4 I disagree 5 I strongly disagree
2. lfsel positive about myself.
1 2 s 4 I
ANSWER I
3. I feel there is an appropriate amount of excitement’in my tiles
1 4
ANSWER - [33333
4. My emotional ills is stable
1 2 s 4 S
ANSWER I
5. When I make mistakes. I learn from them. 2 s s
1 4
ANSWER I
6. Heel enthusiastic about my life.
1 2 3 4 S
ANSWER I
7. lfind it easy to laugh.
1 2 3 4 S
ANSWER I
B. IOijOy my file.
1 2 1 4 I
ANSWER I
9. l have plenty of energy.
1 I almost always 2 I very frequently 3 I frequently
4Ioccasionally 5Ialmostnever 1 2 a 4 s
ANSWER I
10. My sleep is restful.
1 I almost always 2 I very frequently 3 I frequently
4 I occasionally 5 I almost never i 2 s 4 s
ANSWER I
Emotional Control
Questions 1 through 5.
Check 1 I strongly agree 2 I agree 3 I neutral/not sure
4 I disagree 5 I strongly disagree
1. lcanexpressmyfeelingsolanger. ‘ 2 i ‘ 5
ANSWER I
2. t can say 'NO’ without feeling quilty.
i 2 s a s
ANSWER I
3. I make decisions with a minimum of stress and worzry., ‘ .
1
ANSWER I
4. There is an appropriate amount of time urgency in my daily
routine.
1 2 3 4 3
ANSWER I
5

.lincluderelaxationtimeaspartofmydailyrouti‘r'ie.I ' ‘ ’
ANSWER-

156

Questions 6 through 10.
Check 1 I almost always 2 I very frequently 3 . frequently
4 I occasionally 5 I almost never

6. I am able to develop close. intimate relationships ,
1 4 S
ANSWER I I I I i i
7. lsatrealisticobiectivestormyself. 2 a
1 4 5
mswen - DIED:
8. I can relax my body and mind (without using drugs; 3 s
1 4
Answer. - EDIE
9. I accept responsibility for my actions. 2 a
1 a 5
ANSWER - 13:13:“
10 I accept the responsibility for creating my own feelings s
l 2 J 4
mswen - EDIE]:
Intellectual
Check 1 I strongly agree 2 I agree 3 I neutral/not sure
4 I disagree 5 I strongly disagree
1. I keep abreast of social and political issues. 2 3 s
1 4
mswea - (2:2:
2. I am interested in learning about scientific discoverziesa s
1 4
ANSWER - [:I:‘
3. I make an effort to maintain and improve my Wfbllzskllls 5
l 2 e
ANSWER . E:
4. l make an effort to maintain and improve my writing Skallls
1 2 4
ANSWER - ' * ~ ‘
5. i am satisfied with the entertainment choices I makze. 3 s
1 s
ANSWER - DE
6. l carefully select my movies and television choices? , ‘
ANSWER - ’
7. l maintain a continuing education program relative to my career
1 s
ANSWER - E:
a. lam satisfied with the amount and variety I read ‘ s
l s .
l—i—F—
ANSWER . i.__'._'_'_
9 lt's easy for me to apply knowledge gained in one situation to a

newsituation.
i 2 t i e

ANSWER I l '

*—
10. lam interested in understanding the view of others
i 2 .1 a i
r—.____
ANSWER I h—____‘

Occupational
Check 1 I strongly ages 2 I agree 3 I neutral/not sure
4 I disagree 5 I strongly disagree

‘ lenjoymy 1 z s 4 s

ANSWER - [[1333

2. I take advantage of opportunkias to learn new skillszin my work.
Answer: - CEEIZD

1 2 s 4 s
ANSWER-[33333

4. I feel my job responsibilities are consistent with 'myzvalaues ’

3. My work is challenging.

ANSWER I

5. llook forward todoingmy job.
i 2 s 4 s

ANSWER I
6. l am satisfied with the balance between my work time and
leisure time.
1 2 s 4 s
ANSWER I

7. i sin satisfied with my ability l0 9"" "W ”M“?- , , . s

ANSWER I
8 I receive adequate feedback to judge my work perfacirrraian‘ra.s
1

ANSWERI [33:[13

9. To the extent that I can. I create an environment which
minimizes my stress.
1 2 3 4 S
ANSWER I

To the extent that I can. I create an environment which
minimizes the stress at my organizational level or othe; level:
1 4

10.

ANSWER I

Spiritual

Check 1 I strongly agree 2 I agree 3 I neutral/not sure
4 I disagree 5 I strongly disagree

1. lam satisfiedwithmyspirituallile.
i 2 s i s

ANSWER . [1:13:13

2. Prayer. meditation. and/or quiet personal reflection ls/are

' nt ' .
imports partmolmylife ‘ 2 : ‘ ’

ANSWER I

3. My values guide mydaily life.
i 2 2 I s

ANSWER I

e This mestmire is also available on IBM Compatible Microcomputer Software.

157

10.

My spiritual growth is an important lifelong process.a

ANSWER I
I am concerned about humanitarian issues.

ANSWER-
lparticipate in discussionsaboulspiritualvalues , ’ ‘ s
1

ANSWER . [CECE]

. Contemplating my purpose in life is an important issuleor m:
1 4

ANSWER I

. I am satisfied with the degree to which my job is consistent with

myvalues.
1 2 1 2 s

ANSWERI Cl3333

. I am satisfied with the degree to which my leisure time activities

are consistent with my values.
i 2 a i s

ANSWERI [CUE

I am tolerant of the values and beliefs of others. 2 i . s

ANSWER - [33333

E This sell-scoring test is provided by the National Wellness Institute. copyright National Wellness Institute. 1933 No part of this moment my be reoroduced
without exoreaaed written permission from the National Wellness Institute. South Hall. University of Wisconsin-Stevens Point. Stevens Point. WI 54481

158

INVENTORY BY WILLIAM C. KINDS

DIRECTIONS:
1) Please neke your narks directly on this Inventory.

2) Circle on the Inventory one of the flve possible choices.

Choice 1 I Never (01 of the Tine)

Choice 2 I Rarely (0 I 25% of the Tine)

Choice 3 I Occasionally (251 I 502 of the Tine)
Choice 6 I Often (50! I 752 of the Tine)

Choice 5 I Very Often (75! I 1001 of the Tine)

Example: Question One. I eat two servings of vegetables daily.
Answer: Choice 2 I 251 of the Tine.

Question One 1 (:3 3 b 5

Please turn the page and begin.

10.

ll.
12.
13.
ill.
15.
16.

17.
18.
19.

20.

21.

159

Almost Always

Often
Occasionally
Rarely -———I
Never fl
l keep my living environment calm. l 2 3 lo 5
i eat two servings of vegetables daily. 1 2 3 a 5
i follow my own values, rather than change them to make
sure people like me. i 2 3 a 5
i let others make choices rather than try to get my
own way. i 2 3 u 5
i let other people know when I'm sick. i 2 3 la 5
l salt my food at the table. 1 2 3 0 5
i provide myself with rewards to keep myself motivated. l 2 3 a 5
l express my feelings of anger. i 2 3 ll 5
i use “shoulds” and "should nots" in my self-statements. l 2 3 a 5
l engage in an active sport, e.g. racquetball, swimming, golf,
touch football, tennis, etc. at least once a week. 1 2 3 b 5
i eat fish and poultry instead of red meat. 1 2 3 l: 5
l avoid trying to control other people. i 2 3 a 5
l balance work and play, instead of working most of the time. i 2 3 l: 5
l exceed the speed limit when i drive. 1 2 3 lo 5
1 build in self-improvement actions in my schedule. 1 2 3 4 5
i keep my weight within ten pounds of what 1 consider my
ideal weight. 1 2 3 a 5
l have brown rice rather than white rice. 1 2 3 h 5
i make sure to include fiber in my diet. 1 2 3 l4 5
i choose environments which have an artisitic
or esthetic value. 1 2 3 a 5
l relax and get interested, rather than get angry with people
who are slower than me. i 2 3 I: 5
1 seek out others for support at work or in the neighborhood. 1 2 3 l4 5

22..

23.

24.
25.

26.

27.
28.

30.

31.

32.
33.

35.
36.
37.

38.
39.
40.
41.
#2.

160

Almost Always

Often
Occasionally

Rarely

Never

1 avoid sugar and sweets (cookies, cakes, ice cream).

1 practice some form of relaxation at least fifteen minutes a
day, e.g. progressive relaxation, yoga, biofeedback,
meditation, imagery exercises or deep breathing exercises.

l avoid drinking or eating a lot before going to bed.

i make negative generalizations about myself, e.g. l‘m dumb,
ugly, a failure, etc.

i engage in activities that give me a sense of competency,
e.g. hobby, pasttime, avocation, etc.

I visit or talk to a good friend.
1 keep my living environment clean.
I avoid the use of tobacco.

1 make my own decisions, even though some people might not
like them.

i set my own standards, rather than worry about other's
standards for me.

I listen to advice from others.

1 share my experiences with other people.
i get out and talk with groups of people.

i engage in thoughts that relax my body.
i wear a seat belt when i drive.

I use coping strategies to avoid obsessing
over events which i can't control.

1 stick up for my own rights.

I invite people to my home for drinks or a meal.

When waiting in lines, 1 amuse myself, rather than get angry.
I take more than two alcoholic drinks a day.

1 seek feedback on my behavior.

1

2

NM

NNNNN

NNNNNN

NNNNNN

_—____'_'_—l__]

3

WW

U UUUU U

WUUUUU

U U U U U U .

&

.fi

1D

¢4§¢ b

k

“U!

MUM“ U:

UUIVUVUU! \ll

\IIUUUUIU

#3.
M.
45.
Q6.
Q7.
Q8.

49.

50.
51.
32.

58.

59.
60.
61.
62.
63.

161

Almost Always

Rarely

Never
1 get my teeth cleaned twice a year. i 2
i eat whole-grain bread instead of white bread. 1 2
i use pepper and herbs to season my food instead of salt. 1 2
i walk when possible rather than ride in an automobile. l 2
1 let others express what they are feeling. 1 2
i drink two cups or less of tea or coffee with caffeine
a day. l 2
i let myself be dependent, rather than appear tough and strcmg
most of the time. i 2
i believe that people are interested in what i say. i 2
l seekout others, rather than feel neglected or rejected. 1 2
l accept my worthiness as a person, and express it to
other people. i 2
i go out of my way to talk to strangers. l 2
i do activities with a social group. i 2
i make my living environment convenient, e.g. meals, laundry
services, telephone, etc. i 2
l substitute low calorie drinks for high calorie drinks. 1 2
l engage in exercise to tone and strengthen my muscles.
For example: weights or isometric exercise. 1 2
1 express and share with others a wide range of emotions,
e.g. anger, distress, fear, shame. i 2
1 maintain perfectionistic self-standards. l 2
i let myself cry. 1 2
1 seek out experiences where i will be alone. i 2
l‘m outgoing in new situations. 1 2
i trust others, rather than acting like the world is full of
hostile people. i 2

UUUUU

WUUUW

##Oth

i

“MUM“

“MUM“

64.
65.
66.
67.

69.
70.

7 l .
72.
73.
7h.
75.
76.

78.

79.

80.
81.
82.
83.
816.

162

Almost Always

Often

Occasionally

__I

Never ___.l

Rarely

i use positive imagination to approach fearful events.

1 worry about events that are out of my control.

1 store up my negative feelings, e.g. anger, distress, etc.
1 take things personally.

When i get into a stressed state, i take a break.

1 get an adequate amount of sleep.

i eat high-sodium foods (for example, ketchup, hot dogs, bacon,
dill pickles).

i eat two servings of fruit daily.

1 climb stairs rather than ride an elevator.

1 compare myself to other people.

i relax my body through my imagination.

1 choose environments free of air pollution.

l relax rather than try to control most situations.
1 share my emotions with other people.

1 state my needs to others, even though it may not make me
popular with them.

1 do things just for the enjoyment of doing them, even if i
have to "waste” some time.

1 choose environments that are relaxing.

i get together with my co-workers.

1 go to the park or visit a pleasant environment.

1 recognize what l'm feeling at the time i'm feeling it.

i set reasonable behavioral standards for myself so 1 can
meet my goals.

1
1

NNNNNN

NNNNNNNN

N

NNNNN

UWWUUUUU UUUUUU

U

UUUMUU

UUUIVUIUU

uuviuu

85.

86.

87.
88.

89.

90.
91.

92.
93.

90.
95.
96.
97.
98.
99.
100.
101.

102.
103.
100.

163

Almost Always
Often
Occasionally

Rarely
Never ————| I

i engage in active physical work, e.g. washing the car,

housework, chopping wood, at least twice a week. i 2 3 lo 5
i get physical exams at least once a year, e.g. heart, pap

smear, breast exam, prostate gland, etc. i 2 3 h 5
i eat processed and convenience foods. 1 2 3 a 5
i eat foods that are steamed, baked or boiled instead of pan

fried or french fried. l 2 3 I: 5
When l'm suffering from an illness or injury, 1 take time to

renew my physical health. 1 2 3 a 5
1 share my feelings with others. i 2 3 a 5
Once i have decided on an action, 1 worry about whether

people are going to criticize me. i 2 3 ll 5
i get away for a relaxing weekend or vacation twice a year. i 2 3 a 5
1 relax during meals and don't discuss business or

stressful subjects. 1 2 3 a 5
i eat low fat snacks. i 2 3 a 5
i choose environments with little noise pollution. l 2 3 l4 5
i use polyunsaturated margarine instead of butter. 1 2 3 a 5
i floss my teeth once a day. l 2 3 u 5
i let myself experience the distress of loss. 1 2 3 a 5
i think negative thoughts about events in my life. i 2 3 4 5
i understand the beliefs that motivate me. 1 2 3- 4 5
i listen to others opinions, rather than arguing for

my point of view most of the time. i 2 3 a 5
i get involved in group activities. 1 2 3 l: 5
l spontaneously express my feelings. ' l 2 3 a 5
i think about my strengths and skills, rather than worry about

being weak and helpless. i 2 3 a 5

105.

106.
107.
108.
109.
110.

111.

112.
113.
lilo.

115.
116.
117.
118.
119.
120.
121.
122.
123.

12¢.
125.

164

Almost Always

Often
Occasional iy

Rarely

Never

1 say twice as many positive statements to myself
as negative.

1 justify my actions and mistakes to myself and others.
1 walk a half an hour daily.

1 get together with a community group.

1 keep my living environment organized.

i read labels on foods and beverages so 1 know about their
nutritional contents.

1 spend twenty minutes three times a week engaged in aerobic
exercise, e.g. jogging, cycling, swimming, rebounding, etc.

1 dwell on the past.
1 accept the fact that others will not like me.

1 confront people, rather than wondering if they secretly
disapprove of me.

1 laugh and feel joyful.

1 reward myself for accomplishing tasks.

1 make negative statements about others.

i engage in stretching or limbering exercises once a day.
i eat low fat cheese instead of high fat cheese.

1 take time to play.

i drink beverages that contain little sugar.

1 think of the future with positive expectations.

1 think in terms of absolutes, e.g. rights and wrongs, good
and bad.

1 am assertive in a wide variety of situations.

1 face conflicts head on, rather than avoid frictions and
difficulties.

—'=fl

s— s-o .—
NNNNNNNNN N NNNNN

.—
N

UUUUW

U

U

uuuuuwuwu

UIUIUMMUUMUI u “MUM“

VI

126.
127.

128.
129.
130.
131.
132.
133.

134.
135.
136.

165

Rarely
Never

1 take breaks, rather than try to hurry through everything.

1'll let things sit, rather than try to do more than one thing
at once.

1 admit my mistakes to others.

1 get together with a political action group.

1 make an effort to be around friends and associates.

1 try to keep close relationships.

1 buy processed foods that are high in salt and preservatives.

1 accept my limitations and do not become discouraged when
other people do things well.

1 eat more than three eggs a week.
1 get involved in friendships with many people.

1 get together with a religious group.

List any other strategies you use to promote your own health.

137.
138.
139.

 

 

 

List your top three strategies for the relief of stress.

[#0.
1“.
102.

 

 

 

Almost Always

:fi—Ti

Often
Occasionally

1

2

NNNNNN

NNNN

3

UUUUUU

UUUW

UUUUUU

MUM“

166

 

NAME:

ADDRESS:

LOTTERY CARD

I have completed and enclosed the three inventories.

I have completed and enclosed the Demographic
Information Sheet.

I wish to receive information on the results of my
inventories.

 

 

 

 

APPENDIX C
USERS REQUEST TO PARTICIPATE LETTER

AND CONSENT FORM

167

flrizona 5tate University

 

Counseling and Consultation
Tempe, Arizona 85287
602/965-6146

Dear Priend:

I am conducting a research study on the physical and mental health of
college students. The results of this research study will provide
Counseling and Consultation with additional information to assist in the
development of psycho-educational programs for the coming academic

year. I am looking for 70 students to complete three inventories. By
volunteering to participate in this study and returning the packet of
conpleted inventories to within four days, you will have A CHANCE TO WIN
$100.00. When you return the packet, you will be entered in a cash
HEKFIEE with a prise of 8100.00 which I will provide. The winner of the
drawing will be notified confidentially.

 

Your responses to the inventories will he kept strictly confidential. I
will separate the inventories from the Consent Form so that your name
will not be attached to the inventories. Tour responses will not be
shared with your current counselor. You are under no obligation to
participate in this study and may withdraw your consent to participate
by contacting me.

The inventories should take you about 1/2I2 hours to complete. If you
decide to participate, please read and sign the Consent Porm below, and
return the signed form to the receptionist. The receptionist will
provide you with your packet of inventories. Please return your
Background Infornation Sheet with the completed inventories. A return
envelope is provided for the completed inventories. when I receive the
completed inventories, your name will be entered in the $100.00 cash
drawing. Your help is very much needed, and I hope you can find the
time to complete the inventories. If you have any questions, please
feel free to call me at 965-6166. I thank you for your time and energy.

.2--. W

Barbara Palomhi, ll.A.

APPENDIX D

PARTICIPANTS’ FOLLOWIUP LETTER

168

CONSENT PORN

I have read the explanation of the purpose
(please print nane)

and procedure for this study and agree to participate. I understand that my

participation is voluntary, that my results will be kept confidential and that

I may withdraw my participation at any tine by contacting the researcher.

 

Thur Signature

I agree to participate in this research study by picking up the packet of
inventories at Counseling and Consultation, 112 Agriculture Building.

PLEASE RETURN THIS FORM COUNSELING AND CONSULTATION
IN PERSON TO: 112 AGRICULTURE BUILDING
ARIZONA STATE UNIVERSITY

OR

I agree to participate in this research study by having the test packet
sent to me by mail. YES NO
ADDRESS:

 

 

 

 

RETURN BY NAIL TO: BARBARA PALONBI
1 COUNSELING AND CONSULTATION
112 AGRICULTURE BUILDING
ARIZONA STATE UNIVERSITY

I would like feedback on the inventories. YES NO

169

Jlrizona tState University

 

Counseling and Consultation
Tempe, Arizona 85287
602/965-6146

Dear Priend:

I recently sent you a letter asking you to participate in a study
sponsored by Counseling and Consultation on the mental and physical
health needs of college students. If you have completed your survey
and returned it, let me express my sincere appreciation for your
willingness to participate and your support of this important study!

.If you have not completed and returned the letter to participate,
please do so by Jammmry 26th. By completing the packet of the
inventories and returning them to me you will have an opportunity to
win $100.00. Some students who have already responded to the survey
have said that it was an interesting and valuable experience.

Please remember that this study will he of value only if everyone who
received a participation letter responds. You are one of only one
percent of the students at A80 who were randomly selected EE'EEEE—part
‘IE'EEIF'study. Therefore, your response is important for this study
to be truly representative of A80 students!

Remember, your response is absolutely confidential. When your survey
is returned, all records of any personally identifiable information
about you will be destroyed, i.e., name, address, etc.

In case you have misplaced your letter of intent, please call me at
965-6166 and the intent letter along with a packet of inventories will
be mailed to you directly. The results of the study will he made
available as soon as possible after we receive your survey.

Thank you again for your participation.
Sincerely,
Barbara J. Palonbi, H.A.

Counselor
Counseling and Consultation

 

LI ST OF REFERENCES

 

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Ardell, D. B. (1977). High level wellness: An alternative to
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171

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’—‘—:-——

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Jourard, S. M. (1963). Personal adjustment: An approach through the

 

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