Integrating Positive Outcomes into Healthcare: Validation of the Pleasurable Affect Levels Scale

As value-based healthcare (VBHC) continues to reshape global health systems, there is growing recognition that patient-reported outcomes should track not only disease but also positive factors like wellness. Despite the centrality of pleasure to motivation, resilience, and quality of life, no instruments directly assess this construct. To address this gap, the present study developed and preliminarily validated the Pleasurable Affect Levels Scale (PALS), a novel, generic patient-reported outcome measure (PROM) designed to quantify the experience of pleasure relevant for clinical decision making.

A scoping literature review was conducted to identify validated scales measuring pleasure or related constructs and inform the novel scale development. Four iterative rounds of pilot testing were carried out. Item generation and refinement were guided by patient feedback, expert consensus, and psychometric testing. Analyses included exploratory factor analysis (EFA) to examine construct validity, item reduction based on cross-loadings and redundancy, and reliability assessment via Cronbach's alpha.

The literature review identified three validated scales (DARS, SAAS, SHAPS), each focused on anhedonia rather than pleasure itself. Final refinement across pilots yielded a final 23-item scale. Factor analysis supported a four-factor structure-functional maintenance, sensory input, social interaction, and leisure-with strong sampling adequacy (KMO = 0.941), significant Bartlett's test (p < 0.05), and excellent internal consistency (α = 0.942).

Preliminary findings indicate strong psychometric performance. The assessment of pleasure could have important implications for clinical practice, research, and health policy by enabling clinicians to quantify and track patient health beyond symptom reduction, support treatment decisions, and potentially improve adherence. By incorporating pleasure into patient care and dialogue, it may promote a more comprehensive approach to healthcare, although these applications require validation through real-world clinical implementation and testing.