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Integrating Positive Outcomes into Healthcare: Validation of the Pleasurable Affect Levels Scale
Preston Long1, Valentin Ritschl1, Tanja Stamm1
1Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
Patient Preference and Adherence
|June 15, 2026
Summary
A new scale, the Pleasurable Affect Levels Scale (PALS), was developed to measure pleasure, a key aspect of wellness. This patient-reported outcome measure (PROM) offers a novel way to assess positive factors in healthcare beyond symptom reduction.
Area of Science:
- Health Psychology
- Psychometrics
- Value-Based Healthcare
Background:
- Value-based healthcare (VBHC) necessitates measuring patient wellness, including positive factors like pleasure.
- Existing instruments lack direct assessment of pleasure, a crucial component of quality of life.
- A gap exists in quantifying pleasure for clinical decision-making.
Purpose of the Study:
- To develop and preliminarily validate the Pleasurable Affect Levels Scale (PALS).
- To create a novel, generic patient-reported outcome measure (PROM) for pleasure.
- To enable quantification of pleasure in clinical settings.
Main Methods:
- Scoping literature review to identify relevant scales and inform development.
- Iterative pilot testing with patient feedback and expert consensus.
- Exploratory factor analysis (EFA) for construct validity and item reduction.
- Reliability assessment using Cronbach's alpha.
Main Results:
- Literature review identified scales focused on anhedonia, not pleasure.
- The final 23-item PALS demonstrated a robust four-factor structure (functional maintenance, sensory input, social interaction, leisure).
- Excellent internal consistency (α = 0.942) and strong sampling adequacy (KMO = 0.941) were observed.
Conclusions:
- The PALS shows strong preliminary psychometric performance.
- Assessing pleasure can enhance clinical practice, research, and health policy.
- Incorporating pleasure measurement promotes a more holistic approach to patient care.
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