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The Schedule for Meaning in Life Evaluation (SMiLE)
Martin Fegg
Description
The Schedule for Meaning in Life Evaluation (SMiLE) is a reliable and validated
respondent-generated instrument for the assessment of individual meaning-in-life
(MiL). It assesses three aspects by asking subjects:
a) to name three to seven domains that they judge to be important to their
individual meaning-in-life
b) to rate their current level of satisfaction in each of these domains using a
seven-point Likert scale (range, -3 to +3) and
c) to rate the importance of each of their chosen areas using a eight-point
adjectival scale (range, 0 to 7).
Administration
The Schedule for Meaning in Life Evaluation (SMiLE) is a paper-pencil-test, but it is
possible to do the assessment as an interview, for example with palliative care
patients who are not able to fill out the test by themselves. There is an online-version
of the SMiLE at lebenssinn.net or meaninginlife.info available, too.
The standardized test instruction describes in short form what is meant by meaning in
life and points out that respondents should refer to their present situation.
Prior to each step of the SMiLE there is a short instruction:
Please nominate 3 to 7 areas which give meaning to your life, regardless of how
satisfied or unsatisfied you are with these areas at the moment. The order of your
answers is not important.
The search for meaning in life is important for most people. This question comes up in
different phases of life, including both happy and unhappy situations.
In the following section we would ask you to nominate those areas of life which in your
opinion give meaning to your life. These areas can be characterised as those which
give you “grounding” in life, and give importance to your life. In short, things “worth living
for“.
These areas obviously differ from person to person. Therefore, there are no “correct” or
“wrong” answers to this question. The best way to answer is to be as truthful as possible
and to think exactly about your individual areas. Refer to your present situation.
Please rate how satisfied or unsatisfied you are with each nominated area. That is,
how much - positively or negatively - the area affects your total meaning in life.
Please rate how important each area is for your total meaning in life. Try to distinguish
between the areas as best possible by considering all numbers.
Schedule for Meaning in Life Evaluation (SMiLE) - Manual
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The complete SMiLE is annexed in its german, english, japanese, spanish and french
version.
Procedures
Step 1 (area listing): In the SMiLE, the respondents first indicate areas that provide
meaning to their lives in their current situation. The respondents are asked to name a
minimum of three and maximum of seven areas (n = number of areas) but that is only
a suggestion (respondents are free to name more or less areas).
Step 2 (level of satisfaction): Next, the respondents rate their current level of
satisfaction with each area (s1…sn) on a seven-point Likert scale, ranging from -3
″very unsatisfied“ to +3 ″very satisfied“.
Step 3 (weighting): Finally, the importance of each area (w1…wn) is rated with an
eight-point adjectival scale, ranging from 0 ″not important“ to 7 ″extremely important“,
with 3 presenting ″important“ and 6 presenting ″very important“.
Analysis
The Index of Satisfaction (IoS) indicates the mean satisfaction or dissatisfaction
with the individual MiL areas (range, 0−100, with higher scores reflecting higher
satisfaction). To obtain a clear index, varying from 0 to 100, the satisfaction ratings si
are recalculated (s’i). ″Very unsatisfied” (si = -3) is set to s’I = 0 and ″very satisfied”
(si = +3) is set to s’i = 100, with the levels of 16.7, 33.3, 50, 66.7, and 83.3 in
between.
n
s
IoS
n
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The Index of Weighting (IoW) indicates the mean weighting of the MiL areas (range,
0−100, with higher scores reflecting higher weights).
100
7
1
n
w
IoW
n
i
i
∑
=
=
In the total SMiLE index (Index of Weighted Satisfaction; IoWS), the ratings for
importance and satisfaction are combined (range, 0−100, with higher scores
reflecting higher MiL).
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Levels and weights assigned to particular areas are theoretically independent and
can change independently. A person may be satisfied in a particular area but assign
little importance to it, whereas another area may be described at a high level of both
importance and satisfaction. An area that is going badly for an individual but is of little
importance will have less implication for the individual MiL than an area that is going
badly but at the same time is perceived as very important. This is reflected in the
IoWS (total SMiLE index).
In addition, raw scores can be grouped into categories for analysis. The first
nationwide survey on individual MiL in a randomly selected, representative sample of
Schedule for Meaning in Life Evaluation (SMiLE) - Manual
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1,004 Germans was conducted in July 2005. 3,521 areas of MiL were listed and
assigned to the following categories:
Category
Description
1.
Family
family, children, grandchildren, siblings, parents,
relatives, wellbeing of the family
2.
Partnership
relationship, marriage, husband, wife, boyfriend,
girlfriend, partner, love, sexual activity
3.
Social relations
friends, neighborhood, human/social/interpersonal
relations, sociability, community, acquaintances
4.
Occupation/Work
professional success, job, work, working place,
employment, job security, education, school,
university, career, business
5.
Leisure time/Relaxation
all hobbies (e.g. cinema, car), holiday/travelling, all
sports/exercise
6.
Home/Garden
gardening, homestead, house, apartment, quality
of living, housing
7.
Finances
income, assets, financial condition, money, to earn
money, financial security/independence, luxury,
prosperity, no financial burden, wealth, tangible
goods, property, living standard
8.
Spirituality/Religion
God, church, faith, Jesus, Christianity
9.
Health
physical and mental health/well-being
10.
Satisfaction
harmony, luck, (private) happiness, to be
satisfied/happy,
complete/personal/emotional/mental
satisfaction/well-being
11.
Nature/Animals
closeness to nature, nature-love, pets, animals in
general, fond of animals
12.
Social commitment
altruism, honorary office, community service,
readiness to help others, helping others,
helpfulness, volunteer work
13.
Hedonism
consumption, to have a nice time, to enjoy
something, partying, good food, to eat out,
pleasure, enjoyment, fun, joy, vitality, lust for life
14.
Art/Culture
literature, reading, books, music, all musical
instruments, to make music, cultural events,
theater, painting, creativity
15.
Growth
permanent education, learning, inquisitiveness,
self-actualization, self-realization, self-fulfillment,
self-development, self-awareness
Originally just 13 categories were identified by the cluster analyses. After
deliberations with regard to contents the categories „Art/Culture“ and „Growth“ were
added for providing a more precise categorization. The description of each category
is useful for grouping the answers of the respondents to their representing category.
For each category, a mean value of Satisfaction can be calculated by summing up
the Satisfaction ratings for the areas which belong to one category and dividing that
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by the number of areas. Calculating a mean value of Weight for each category is
analogous to these steps.
For unclear answers of the respondents, following rules are helpful for the
categorization:
a) If two or more categories are named explicitly in one area, the raw score
should be grouped in each named category. For example the respondent
names in area 1 „family and friends“. In this case each raw score (for
satisfaction and for importance) should be grouped both to the category
„family“ and to the category „social relations“.
b) If two or more categories are named implicit in one area, the raw score should
be grouped in the most significant category. In this case the rater has to
decide which category seems to be more important for the respondent. For
example the respondent names in area 1 „horseriding with a friend”. In this
case „horseriding“ seems to be the essential activity rather than the
mentioning „with a friend“. Each raw score (for satisfaction and for importance)
should be grouped just in the category „leisure time/relaxation“.
c) If there is named anything in one area that doesn´t fit in any category (for
example „memories“) or if the grouping to one category seems to be too
uncertain, it should be grouped in a „specific category“. The raw scores of this
area are neglected for the categorial analysis. For the analysis of IoS, IoW and
IoWS, however, the raw scores are included.
Interpretation: Psychometric Properties
The psychometric properties of the SMiLE were evaluated in a study (Fegg et al.,
2008) with 599 students of the Ludwig-Maximlians University, Munich, and the Royal
College of surgeons, Dublin (response rate, 95.4%). In addition, 93 patients
(response rate, 80.6%, N=75) treated for advanced cancer or amyotrophic lateral
sclerosis at the Interdisciplinary Center for Palliative Medicine, Ludwig-Maximilians
University, Munich were asked to complete the SMiLE, as well as some feasibility
and acceptability questions, in a cross-sectional study.
The psychometrics of the SMiLE was reported according to the recommendations of
the Scientific Advisory Committee of the Medical Outcome Trust.
Objectivity
Objectivity was enhanced by a standardized administration procedure.
Feasibility and Acceptability
The feasibility and acceptability of the SMiLE was evaluated with the dropout rate,
the time to complete the questionnaire, and ratings on the following items (numeric
rating scales [NRS], ranging from 0 to 10):
• How well do you think this questionnaire measures your individual meaning in
life?
• How distressing was the questionnaire?
• How time-consuming was the questionnaire?
All students and patients who agreed to participate were able to complete the SMiLE.
The time for completion was on average 8.2+3.0 minutes in university students and
26.2+14.1 minutes in palliative care patients. The instrument was neither distressing
(1.3+1.9) nor time-consuming (1.9+1.9).
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Reliability
The satisfaction ratings (si) had a Cronbach’s alpha of 0.71, and the importance
ratings (wi) had a Cronbachs’s alpha of =.49. Spearman’s Rhos for the test-retest
reliability were 0.71 for the IoS (p<0.001), 0.60 for the IoW (p<0.001) and 0.72 for the
IoWS (p<0.001). Of the areas listed at T1, 85.6% were listed again at T2 (7 days
after initial assessment).
Validity
Criterion validity was tested concurrently with the Purpose in Life Test (PIL), the Self-
Transcendence Scale (STS), the Idler Index of Religiosity (IIR, subscale private
religiousness), and a seven-point Likert scale on global MiL satisfaction (MiL_NRS).
The mean PIL score was 107.7 +13.1, the MiL_NRS 1.7+1.2, the STS 46.5+5.0, and
the IIR 4.2+1.5. No differences between two samples were found, except for the IIR,
which was higher in the RCSI sample (4.6+1.3 vs. 4.0+1.5; p<0.001).
Convergent validity was demonstrated with the Purpose in Life test (r=0.48,
p<0.001), the Self-Transcendence Scale (r=0.34, p<0.001), and a general numeric
rating scale on MiL (r=0.53, p<0.001).
Divergent validity was demonstrated with the Idler Index of Religiosity (IIR). There
was no correlation of the SMiLE with the IIR.
In addition, a posteriori cognitive interviews were conducted with a subset of 10
students to assess how they interpret and complete the SMiLE. In this subgroup, the
SMiLE was again rated as only moderately valid (5.6+2.5; range 3-9).
Preliminary data from palliative care patients suggest that the instrument may yield
new approaches in MiL assessment and outcome measurement of novel
psychotherapeutic interventions in end-of-life care.
The study “Meaning in life assessed with the “Schedule for Meaning in Life
Evaluation” (SMiLE): a comparison between a cancer patient and a student sample”
(Stiefel et al., 2007) assessed the individual meaning in life (MiL) in a mixed sample
of cancer patients with the SMiLE, evaluated the acceptability of its French version,
and compared it to a student sample. Patients most often indicated areas related to
relationships as providing MiL, while material things were listed less often. Since
satisfaction with relevant areas was high, cancer patients reported the same level of
weighted satisfaction (IoWS) as a healthy student sample, assessed with the SMiLE
in a prior validation study. Patients judged the SMiLE as reflecting well their MiL, not
distressing to fill in and were moderately positive with regard to its helpfulness.
In conclusion, the SMiLE might become a useful tool for research and an opener to
communication between patients and clinicians about this highly relevant topic in
cancer care.
Standardization
The first nationwide survey on individual MiL in a randomly selected, representative
sample was conducted in July 2005. 1,004 Germans were randomly selected and
interviewed (inclusion rate 85.3%). 3,521 areas of MiL were listed and assigned to 13
a-posteriori categories. The mean IoS was 81.9+15.1, the mean IoW was 84.6+11.9,
and the mean IoWS was 82.9+14.8. In youth (16-19 y/o), “friends” were most
important for MiL, in young adulthood (20-29 y/o) “partnership”, in middle adulthood
(30-39 y/o) “work”, during retirement (60-69 y/o) “health” and “altruism”, and in
advanced age (70 y/o and more) “spirituality/religion” and “nature
experience/animals”.
All standardization tables are annexed.
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Area/range/scope of application/use
The SMiLE has a wide range of application. For example, in previous studies the
SMiLE was used to assess meaning in life in chronical or terminally ill patients.
Repeated measurements within subject demonstrate that the SMiLE detects
response shift, defined as the redefinition or re-conceptualization of some domains
as a function of contextual changes in patients’ lives (Fegg, 2006).
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References
1. Fegg MJ, Kramer M, Bausewein C, Borasio GD (2007) Meaning in Life in the
Federal Republic of Germany: results of a representative survey with the Schedule
for Meaning in Life Evaluation (SMiLE). Health and Quality of Life Outcomes 5:59.
2. Fegg MJ, Kramer M, L’hoste S, Borasio GD (2008) The Schedule for Meaning in
Life Evaluation (SMiLE): Validation of a new instrument for meaning-in-life research.
Journal of Pain and Symptom Management 35(4):356-364.
3. Stiefel F, Krenz S, Zdrojewski C, Stagno D, Fernandez M, Bauer J, Fucina N, Lüthi
F, Leyvraz S, Borasio GD, Fegg MJ (2008) Meaning in life of cancer patients
assessed with the “Schedule for Meaning in Life Evaluation” (SMiLE). Supportive
Care in Cancer 16:1151-1155.
4. Fegg MJ, Kramer M, Stiefel F, Borasio GD (2008) Lebenssinn trotz unheilbarer
Erkrankung? Zeitschrift für Palliativmedizin 4(9):238-245.
5. Fegg MJ, Kögler M, Brandstätter M, Jox R, Anneser J, Haarmann-Doetkotte S,
Wasner M, Borasio GD (2010). Meaning in life in patients with amyotrophic lateral
sclerosis. Amyotrophic Lateral Sclerosis 11(5):469-474.
6. Fegg MJ, Brandstätter M, Kramer M, Kögler M, Haarmann-Doetkotte S, Borasio
GD (2010). Meaning in life in palliative care patients. Journal of Pain and Symptom
Management 40(4):502-509.
7. Monforte-Royo C, Tomás-Sábado J, Villavicencio-Chávez C, Balaguer A
(accepted) Psychometric properties of the Spanish form of the Schedule for Meaning
in Life Evaluation (SMiLE). Quality of Life Research.
Schedule for Meaning in Life Evaluation (SMiLE) - Manual
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Appendix
A. SMiLE – english version
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B. SMiLE – german version
Schedule for Meaning in Life Evaluation (SMiLE) - Manual
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C. SMiLE – french version
Schedule for Meaning in Life Evaluation (SMiLE) - Manual
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D. SMiLE – japanese version
Schedule for Meaning in Life Evaluation (SMiLE) - Manual
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E. SMiLE – Spanish version
ESCALA DE EVALUACIÓN DEL SENTIDO DE LA VIDA
La búsqueda del sentido de la vida es importante para la mayoría de las
personas. Esta cuestión se plantea en los diferentes períodos de la vida, tanto en
los momentos de felicidad como de tristeza.
A continuación le pedimos que escriba aquellas áreas o aspectos de la vida que
en su opinión dan sentido o significado a su vida. Aquellos aspectos que dan
soporte o importancia a su vida. En resumen, aquellas cosas por las que
considera que merece la pena vivir.
Naturalmente estas áreas o aspectos son diferentes para cada persona. Por lo
tanto no hay respuestas correctas o incorrectas. Procure contestar lo más
sinceramente posible y pensar exactamente en estos aspectos concretos
referidos a su actual situación en la vida.
Escriba entre 3 y 7 áreas o aspectos que dan sentido a su vida,
independientemente del grado de satisfacción o insatisfacción que en
ellos tenga en este momento. No importa el orden de sus respuestas.
Área 1: _____________________________________________
Área 2: _____________________________________________
Área 3: _____________________________________________
Área 4:
_____________________________________________
Área 5:
_____________________________________________
Área 6:
_____________________________________________
Área 7:
_____________________________________________
Asegúrese de que el orden de las áreas en las respuestas siguientes coincida con
el de la página anterior. Valore cada una de las áreas según su situación actual.
Indique su grado de satisfacción o insatisfacción en cada aspecto o área, es
decir, la intensidad con la que el significado global de su vida se ve afectado –
positiva o negativamente- por cada una de estas áreas.
Qué grado de
satisfacción Muy Regular Muy
encuentra en… insatisfecho satisfecho
Área 1 -3 -2 -1 0 +1 +2 +3
Área 2 -3 -2 -1 0 +1 +2 +3
Área 3 -3 -2 -1 0 +1 +2 +3
Área 4 -3 -2 -1 0 +1 +2 +3
Área 5 -3 -2 -1 0 +1 +2 +3
Área 6 -3 -2 -1 0 +1 +2 +3
Área 7 -3 -2 -1 0 +1 +2 +3
Indique qué importancia tiene cada aspecto en el significado global de su vida.
Intente distinguir lo mejor posible entre los diferentes aspectos,
considerando todas las opciones posibles de 0 a 7.
Qué grado de
importancia tiene Nada Importante Muy Extremadamente
para usted… importante importante importante
Área 1 0 1 2 3 4 5 6 7
Área 2 0 1 2 3 4 5 6 7
Área 3 0 1 2 3 4 5 6 7
Área 4 0 1 2 3 4 5 6 7
Área 5 0 1 2 3 4 5 6 7
Área 6 0 1 2 3 4 5 6 7
Área 7 0 1 2 3 4 5 6 7
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F. SPSS Syntax: SMiLE data examination
*** Examination if data is complete: Does „number1“ (manually entered number of
areas) correspond with „number_weight“ and „number_satisfaction“ ***
** For how many areas was weight rated? **
**Recoding the ratings of weight (0-7) into 1 and 0 **
RECODE
p1w1 p1w2 p1w3 p1w4 p1w5 p1w6 p1w7
(0 thru 7=1) INTO p1w1ja p1w2ja p1w3ja p1w4ja p1w5ja p1w6ja p1w7ja.
EXECUTE .
RECODE
p1w1ja p1w2ja p1w3ja p1w4ja p1w5ja p1w6ja p1w7ja
(SYSMIS=0) .
EXECUTE .
** number of weight ratings **
COMPUTE number_weight = SUM(p1w1ja,p1w2ja,p1w3ja,p1w4ja,p1w5ja,p1w6ja
,p1w7ja) .
EXECUTE .
** For how many areas was satisfaction rated? **
**Recoding the ratings of satisfaction (-3 to +3) into 1 and 0**
RECODE
p1l1 p1l2 p1l3 p1l4 p1l5 p1l6 p1l7
(SYSMIS=0) (-3 thru 3=1) INTO p1l1ja p1l2ja p1l3ja p1l4ja p1l5ja
p1l6ja p1l7ja .
EXECUTE .
** number of satisfaction ratings **
COMPUTE number_satisfaction = SUM(p1l1ja,p1l2ja,p1l3ja,p1l4ja,p1l5ja,p1l6ja
,p1l7ja) .
EXECUTE .
*** TEST: Compare „number1“ with „number_weight“ and „number_satisfaction“ ***
* If test1_number_weight is 0, there is no rating of weight missing.*
* If test2_number_satisfaction is 0, there is no rating of satisfaction missing.*
COMPUTE test1_number_weight = (number1 - number_weight) .
EXECUTE .
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COMPUTE test2_number_satisfaction = (number1 – number_satisfaction) .
EXECUTE .
**Selecting valid cases**
USE ALL.
COMPUTE filter_$=(number_satisfaction > 0 AND number_weight > 0).
VARIABLE LABEL filter_$ 'number_satisfaction > 0 AND number_weight>'+
' 0 (FILTER)'.
VALUE LABELS filter_$ 0 'Not selected' 1 'Selected'.
FORMAT filter_$ (f1.0).
FILTER BY filter_$.
EXECUTE .
OUTPUT SAVE NAME=Dokument1
OUTFILE='Q:\SMiLE'.
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G. SPSS Syntax: SMiLE Syntax short and effective
*** Has the respondent named a category?***
RECODE
p1xlfamily p1xlpartner p1xlsocial p1xlwork p1xlleisure p1xlhome p1xlspir p1xlhealth
p1xlsatisfaction p1xlfinances p1xlnature p1xlsoccom p1xlhedonism p1xlculture,
p1xlgrowth
(SYSMIS=0) (-3 thru 3=1) INTO p1xjafamily p1xjapartner p1xjasocial p1xjawork
p1xjaleisure p1xjahome p1xjaspir p1xjahealth p1xjasatisfaction p1xjafinances
p1xjanature p1xjasoccom p1xjahedonismus .
EXECUTE .
***Mean satisfaction***
** Convert satisfaction into proportional value per MiL area**
RECODE
p1l1 p1l2 p1l3 p1l4 p1l5 p1l6 p1l7
(-3=0) (-2=16.66) (-1=33.33) (0=50) (1=66.66) (2=83.33) (3=100) (sysmis = sysmis)
INTO p1l1prop p1l2prop p1l3prop p1l4prop p1l5prop p1l6prop p1l7prop .
EXECUTE .
** Calculation of mean satisfaction IoS**
COMPUTE p1ltot_new =
Mean(p1l1prop,p1l2prop,p1l3prop,p1l4prop,p1l5prop,p1l6prop,p1l7prop) .
VARIABLE LABELS p1ltot_new 'mean satisfaction IoS'.
EXECUTE .
**Calculation of mean importance IoW **
COMPUTE p1wtot = 100 *
(Mean(p1w1,p1w2,p1w3,p1w4,p1w5,p1w6,p1w7,p1w8,p1w9,p1w10,p1w11,p1w12,p
1w13,p1w14)) / 7 .
VARIABLE LABELS p1wtot 'mean importance IoW'.
**SMiLE Score (weighted satisfaction)***
COMPUTE p1smile = ((SUM((p1l1prop * p1w1),(p1l2prop * p1w2),(p1l3prop *
p1w3),(p1l4prop * p1w4),(p1l5prop * p1w5),(p1l6prop * p1w6),(p1l7prop * p1w7))) /
p1wtot) .
EXECUTE .
VARIABLE LABELS p1smile 'mean weighted satisfaction IoWS'.
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H. Standardized Tables
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