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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 42
| Issue : 4 | Page : 151-155 |
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Swasthya Assessment Scale (SAS)-Ayurveda based health assessment tool-insights on its development and validation
Jaiprakash Bholanath Ram1, Babita Yadav1, V Ashwathykutty1, Sophia Jameela1, Azeem Ahmad1, Saket Ram Thrigulla1, Sakshi Sharma2, Rakesh K Rana1, Richa Singhal1, Bhogavalli Chandrasekhara Rao1, N Srikanth1, KS Dhiman1
1 Central Council for Research in Ayurvedic Sciences, New Delhi, India
2 CARI, New Delhi, India
| Date of Submission | 01-Mar-2021 |
| Date of Decision | 04-Jan-2023 |
| Date of Acceptance | 24-Feb-2023 |
| Date of Web Publication | 17-May-2023 |
Correspondence Address:
V Ashwathykutty
Central Council for Research in Ayurvedic Sciences, Jawahar Lal Nehru Bhartiya Chikitsa Avum Homeopathy Anusandhan Bhavan, No. 61–65, Institutional Area, Opposite “D” Block, Janakpuri, New Delhi - 110 058
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ayu.ayu_40_21
 Abstract | | |
Introduction: Ayurveda has a unique way of understanding the body, health, and diseases. Various determinants, including biological, ecological, medical, psychological, sociocultural, spiritual, and metaphysical factors, which depend on each other, have their role in determining health in Ayurveda. Currently, no validated health assessment scale, based on the principles of Ayurveda is available. This article, for the first time, reports the development, validation, and reliability testing of the Swasthya assessment scale - a health assessment tool developed in Ayurveda. Materials and methods: A thorough literature search and expert consultations were done to draft the items encompassing the concept of health in Ayurveda. A group of experts assessed the content validity of the drafted items. Cognitive de-briefing and pretesting were performed to modify the language and the content again. Reliability testing was done with an inter-observer agreement in a sample of 183 individuals. Results: The content validity index for items and the scale-level content validity index (S-CVI) were calculated. S-CVI for scale was excellent, with 85% agreement. The S-CVI/universal agreement was 0.45, and S-CVI/Average was 0.95. In inter-rater reliability, the percentage agreement was 73.7%. Pearson correlation coefficient was 0.808 showing a strong correlation. Conclusion: Following appropriate validation, the scale can be widely used in clinical practice to assess the patient's health status, guide the treatment plans, and monitor the progress of the health. It can also be used as a sensitive tool in the research of Ayurveda to assess the changes in patients brought about by Ayurveda interventions.
Keywords: Ayurveda, health assessment tool, reliability, Swasthya assessment scale, validation
How to cite this article:
Ram JB, Yadav B, Ashwathykutty V, Jameela S, Ahmad A, Thrigulla SR, Sharma S, Rana RK, Singhal R, Rao BC, Srikanth N, Dhiman K S. Swasthya Assessment Scale (SAS)-Ayurveda based health assessment tool-insights on its development and validation. AYU 2021;42:151-5 |
How to cite this URL:
Ram JB, Yadav B, Ashwathykutty V, Jameela S, Ahmad A, Thrigulla SR, Sharma S, Rana RK, Singhal R, Rao BC, Srikanth N, Dhiman K S. Swasthya Assessment Scale (SAS)-Ayurveda based health assessment tool-insights on its development and validation. AYU [serial online] 2021 [cited 2023 Jun 3];42:151-5. Available from: https://www.ayujournal.org/text.asp?2021/42/4/151/377201 |
| Introduction | |  |
Ayurveda, the ancient Indian medical science, has unique ways of understanding the body, health, and diseases. Having an entirely different epistemological and ontological basis from biomedicine, it has a history of several centuries of use in the health-care system of India.
Sushruta, a great surgeon in Ayurveda defined health as “a state of equilibrium of Tridosha (three regulatory functional factors of the body), Agni (digestive/metabolic factors), Dhatu (major structural components of the body), uninterrupted excretory processes and the optimal functional state of sense organs, mind, and the soul.”[1]
The principles of Ayurveda recognize body, mind, and soul as interrelating and interacting facets of the same system. The determinants of health are biological, ecological, medical, psychological, sociocultural, spiritual, and metaphysical, all dependent on each other. The outcome of harmonizing and integrating these determinants in a complex system is health.[2]
Interestingly, the United Nations' World Health Organization's definition of health (1948) as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” is nearly a reflection of the definition mentioned in Ayurveda.[3] Western medicine has begun investigating these aspects with exciting findings in various research studies.
The human body can reflect even the slightest deviation from the state of health through various signs and symptoms. Ayurveda explicitly describes these signals of ill health. In ancient times, people were sensitive enough to listen to these signals in their bodies and report them to physicians who tried to interpret them to find any imminent pathology. Over time, when man ceased paying attention to his body, a significant shift in the health-care system led to a new trend in medicine where objective health criteria (markers) began to take precedence over subjective health indicators. However, several physiological symptoms and indicators appear before the (detectable) objective parameters/markers. To correct the physiological derailment and play a significant part in disease prevention, doctors use these subjective markers to determine the steps (dietary and lifestyle adjustments with or without medications).
The irony is that despite the depth and relevance of the Ayurveda concept of health, there was a lack of a validated health assessment scale in Ayurveda research. Hence, it is the need of the time to develop a valid and reliable health assessment scale based on Ayurveda principles, to evaluate a person for their physical and mental well-being. This article reports the development, validation, and reliability testing of Swasthya assessment scale (SAS) - A health assessment tool. The terminologies of Ayurveda used in this study are in accordance with the standard Ayurveda terminologies given in National Ayush Morbidity and Standardized Terminologies Electronic Portal (NAMASTE Portal), Ministry of Ayush, and Goverenment of India.[4]
| Materials and methods | | |
An extensive literature search was done to explore the various references which discuss the concept/definition of health in Ayurveda. Kashyapa Samhita has elaborated the definition of Sushruta explicitly with the signs of health such as healthy digestion, proper expulsion of urine and feces, lightness of body, pleasant sensory faculties, sound sleep, good state of mind, and Agni.[5] Charaka Samhita also mentions similar signs to indicate the normal state of Dhatus, indicating good health.[6] Based on these references and consultation with expert physicians, five domains were identified that indicated the concept of health in Ayurveda, i.e., digestion, sleep, excretion, voice, complexion, built and nourishment, mind and intellect, and cognitive functions. The methodology of the study is summarized in [Figure 1].
Draft items
Items that are indicators of health in Ayurveda were identified under each domain. The items were phrased in the form of questions, framed in simple language, asking about intensity, frequency, capacity, or satisfaction of signs, symptoms, and feelings where appropriate.[7] The Likert scale was used to record the response in most of the questions with exceptions in a few (Question no: 4.6, 4.7, 10.1) where other appropriate response formats were used. Subjects could rate the items with responses fixed in ordinal scales with descriptors. Under each domain, 3–8 items were drafted. Based on the drafted items, a detailed user manual was prepared to assist the physicians in selecting the appropriate response.
Review of the drafted items by clinicians
Ninety-two items were generated initially. Based on the experiences of the authors and the physicians who participated in the informal Delphi process, the items were reduced to 80. A pool of eighty items was subjected to content validity, and based on the statistical evaluation, six items were removed to form the final structure with 74 items. An expert panel that consisted of 20 physicians, including clinicians, academicians, and policy-makers, was formed. A 1-day expert panel meeting was held, and the experts were requested to comment on each item drafted and the ways to improve them. The criteria used by the experts for retention or deletion of items included clarity of expression, suitability for the construct being measured, and potential for differentiating the target population. The experts offered comments and suggestions about whether some items should be added, removed, or modified.
Experts evaluated the level of relevance of each item for its corresponding construct on a four-point scale as irrelevant; (1) moderately relevant; (2) relevant; (3) highly relevant; (4) the content validity index for items (I-CVI), and scale-level content validity index (S-CVI) were computed to indicate the content validity. The items that had low I-CVI were removed. With input from the experts, a revised set of items were developed for the process of cognitive debriefing.
Cognitive debriefing
Cognitive testing was undertaken with 30 physicians to evaluate the thought process they followed to answer the questions and identify items that were not well understood. The questions that were not comprehended well were revised for their language and content.
Item and domain scores
The SAS contained 74 questions. The maximum score of 74 was divided among five domains. The weighted scores of five domains such as digestion, sleep, excretion, nourishment and immunity and psychological and spiritual domains were 18.5, 11.1, 18.5, 7.4, and 18.5, respectively, which was further equally divided among the questions under each domain. Based on the score, the health status was divided into five categories: excellent, good, average, poor, and very poor.
Pretesting
Drafted items total mailed to total 140 practitioners across India; out of them, 108 responded. They were asked to give their comments in a structured reply form indicating if they agreed on the domains and the items for their relevance. They were asked to give suggestions to improve, add or remove new items. No questions were added or removed after pretesting, but some were redrafted for their language.
Reliability testing
Reliability was assessed by checking the internal consistency and interrater reliability testing. Internal consistency was assessed using Cronbach's alpha test. Interrater reliability was assessed in 183 individuals. The general characteristics of the participants are given in [Table 1]. Considering the agreement between the two investigators as 70% (p), it was assumed that the relative margin of error (ε) is 10%. The sample size was calculated from the formula given below;
Where Z (1.96) is the standard normal variate at 95% confidence level. The calculated sample size was 165. A nonresponse rate of 10% was considered in the study, so the final sample size was 165 + 16 = 181 (approximately 185). Two physicians assessed the same individual for inter-rater reliability, and the final scores were analyzed for percentage agreement and Pearson correlation coefficient. The analysis was done using the statistical software SPSS 15.0 (developed by SPSS Inc. (IBM), Chicago, Illinois, United States).
Final structure of Swasthya assessment scale
Basic information about participants was collected, and few questions related to the general health, ailments present, and some other medications were asked. Subjects were also asked to comment on their health status by answering the questions on self-perceived health status and rating it on a scale of 0–10. Based on this preliminary information, the physician was asked to report his opinion regarding the inclusion of the participant for further assessment.
The final SAS had 74 questions, with a maximum score of 74 [supplementary material-1]. Based on the health score, the health status analog score was also calculated for easier understanding. Patients suffering from acute ailments were not considered eligible for assessment of health using this scale. For eligible candidates, domain-wise evaluation of the individual was done and the final score was calculated. Interpretations of the scores are given in [Table 2].
Inclusion criteria
Participants were included if they could adequately respond to the tool's questions and excluded if their health prevented them from doing so. Hence, the participants could be apparently healthy individuals, individuals who are on regular medications for chronic illnesses (e.g. sciatica, hypertension, diabetes, and chronic bronchitis) but wish to know their health status.
Exclusion criteria
Conditions that incapacitate the participant to respond to the questionnaire include acute ailments (e.g. acute asthma and myocardial infarction), any acute onset of symptoms as in diseases with periodic/seasonal aggravation (epilepsy and bronchial asthma), and psychiatric illnesses are excluded from the study. Individuals who do not agree to provide informed consent are also excluded.
| Results | | |
Content validity
The I-CVI; S-CVI were computed to indicate the content validity. Scale-level content validity is found to have 85%. The S-CVI/universal agreement is 0.45. The S-CVI/Average is 0.95, and it is not calculated for each item or domain. The content validity indices for different items (I-CVI) are given in [Table 3].
Reliability
Internal consistency was assessed using the cronbach s alpha test, and cronbach s alpha was found to be 0.74. In total, 183 participants were assessed for inter-observer agreement. The demographic information of these participants is summarized in [Table 1]. The mean difference (standard deviation [SD] of difference) between the scores of the two raters was 2.58, with an SD of difference of 4.117. The percentage agreement was 73.7%. The Pearson correlation coefficient was 0.808, which showed strong correlation between the scores of 2 different raters.
Development of web application
The SAS has also been developed as a web application for physicians to support accurate and standardized data collection, which is available at the URL ccras.res.in/ccras.sas/. [Figure 2] The web portal helps in data entry, scoring, and generating reports. The user interface was designed so that it is easy to use, simple, visually appealing, and allows quick access to all relevant data of the person. The software also helps to export data to standard statistical software packages for easy statistical analysis. At present, extensive data collection is going on at different centers using the web portal.
| Discussion | | |
When different medical systems across the world struggled to delineate a comprehensive definition for health, Ayurveda clearly identified the spirit of the term “health” and has clear definitions. Based on these definitions, a health assessment scale has been developed. This is the first of its kind in research of Ayurveda. Its validity has been established in different stages.
Face validity was assessed with a group of Ayurvedic physicians and was found to be satisfactory. The content validity was assessed with a panel of 20 experts who represented different disciplines of Ayurveda. The results showed that experts strongly agreed with most of the items. Pretesting of the tool with a sample of 108 Ayurveda physicians also showed that most of the items represented were highly relevant in assessing health.
The internal consistency of the tool was calculated using Cronbach's alpha. There are different reports about the acceptable values of alpha, ranging from 0.70 to 0.95.[8],[9] The closer Cronbach's alpha coefficient is to 1.0, the greater the internal consistency of the items in the scale. The value of Cronbach's alpha in this study was 0.74, which shows that the internal consistency of the questionnaire is acceptable. The Pearson Correlation coefficient value in this study was 0.808. The strength of the relationship can be anywhere between −1 and +1. The stronger the correlation, the closer the correlation coefficient comes to ±1.[10] Hence, in this study, it was found to have a strong correlation between the observations of two raters.
Limitations of the study
Validation and reliability testing of the scale could only be done for content validity and inter-rater reliability. Further studies may be conducted to explore the scale's construct validity, concurrent validity, and test-retest reliability. Furthermore, the tool was developed in English and was administered in different states across India for field tests without validating the versions in regional languages. However, backward and forward translation was not done in the study to ensure cross-cultural equivalence.
Plans for validation
Extensive data collection can be done at different centers using the web application. Known group validity can be established when the testing is done in unhealthy and healthy individuals. Furthermore, the responsiveness of the scale can be tested when it is used to assess health status in various clinical trials before and after the interventions.
Applied scope of the scale
The concept of health in Ayurveda essentially differs from that of western medicine. Hence, the existing tools for health assessment in western medicine do not effectively reflect the crucial aspects such as digestion, sleep, the routine of urine and bowel, complexion etc., that are considered important indicators of health in Ayurveda. Hence, different research studies of Ayurveda, when assessed using the health assessment tools in western medicine, do not reflect the efficacy of Ayurveda. When validated, the SAS scale would be more sensitive to health changes brought about by the treatment done in Ayurveda. Assessment of health using the various parameters described in the tool help sensitize the patient and the physician to early the signs and symptoms of ill health. It would help prevent the progression and help manage them in the prodromal stage. The individual can be effectively advised for their diet and lifestyle modifications based on the patient's responses in respective domains promoting the concept of personalized medicine. When used in clinics, the tool can effectively monitor health status. Also, it would help to determine the optimal duration and efficacy of any Ayurvedic intervention as it aids in assessing the level of the normalcy of Dhatus, which is the endpoint for any Ayurvedic intervention. Comparing the results with various hematological and biochemical investigations can help design a few correlation studies exploring the association between the laboratory parameters and the individual's health status. These are the possible future applications of the scale, which can be explored after further validation by incorporating it in various clinical studies. Data from future studies will help to substantiate the proposed scopes of the scale.
| Conclusion | | |
Following appropriate validation, the SAS can be widely used in clinical practice to assess the patient's health status, guide the treatment plans, and monitor the progress of the health in individuals. It can also be used as a sensitive tool in Ayurvedic research to assess the changes in patients achieved by Ayurvedic interventions.
Financial support and sponsorship
Ministry of AYUSH.
Conflicts of interest
There are no conflicts of interest.
| Supplementary material 1 | | |
1. Participant's Consent*
Do you wish to participate voluntarily in the assessment of your health through this Ayurvedic Health Questionnaire? # Yes/No
2. Participant's Basic Information
2.1 Title
2.2 Name
2.3 Age (in Years)
2.4. Gender
2.5 Qualification
2.6 Address (State)
2.7 Address (District)
2.8 E-mail
2.9 Contact Number
2.10 Aadhar Card Number
*Required
3. General Questions
3.1 Do you consider yourself healthy?Yes/No
3.1.1 If yes, then how will you rate your health on a scale of 0 – 10. ___________
0- Worst health status 10-Excellent health status
3.2 Do you have any health issue, for which you are taking treatment or wish to take treatment?Yes/No
3.2.1 If Yes, please provide details
3.3 Had you any major medical or surgical problem before?Yes/No
3.3.1 If Yes, please specify
3.4 Are you on any regular medicine/treatment?Yes/No
3.4.1 If Yes, for what?
As treatment for some disease OR I am healthy, but to maintain/improve my health
3.4.2 Name of medicine/treatment?____________
3.4.3 Duration of medicine intake______________
3.4.4. Disease for which medicine is taken______________
3.5*Do you have any sort of addiction? (An addiction is anything that if withdrawn, a person faces some physical, physiological or psychological problems. So do you have any such habits?)
Yes/No
3.5.1 If, Yes select from the list
Alcohol//Tobacoo/Paan/Bidi/Cigarrate/Tea/coffee/Mobile/Internet/TV/Other:
3.6 Physician's opinion regarding inclusion of person for further assessment *
Apparently healthy
Person is having some minor ailments and wish to know his/her Health Status
Person is on regular medications for chronic illness (like backache, Hypertension, Diabetes, Chronic bronchitis etc) but wish to know his/her Health Status
Person is suffering from acute ailments, so not fit for this Health Assessment at present
(Health Indicators)
4. – Health Indicator-Digestion-
Desire for food intake
1 What do you feel about your hunger?
It is usually good
It is usually moderate
It is usually very mild
It varies -some time strong, some time poor
Mostly I do not feel hungry at the usual time of meals also
2 Do you feel the appetite (urge/desire to have food) at your regular meal times?
Most of the time
Sometimes
Rarely
Never
Ability to perceive taste
3 How often you don't enjoy the taste of food?
Most of the time
Sometimes
Rarely
Never
Proper and timely digestion of ingested food
4. Does the food (normal diet) get digested properly without any discomfort?
Most of the time
Sometimes
Rarely
Never
5. Do you feel hunger at the time of your next meal?
Most of the time
Sometimes
Rarely
Never
6. *How would you describe your eating schedule and habits? (You can select one or multiple options)
Usually, I feel hungry at usual time and take my food at regular time.
Usually, I do not get good appetite but still take meals regularly.
Usually, I cannot tolerate skipping meals.
Usually, I can easily tolerate skipping one or two meals.
Usually, my meal time is very irregular.
I sometimes skip meals due to my poor appetite/digestion.
I am careless about food habits.
I am very conscious and careful about my diet.
Other:
7. Do you notice any of the below mentioned problems after taking meal, during digestion or otherwise:
Options: Most of the time/Frequently/Rarely/Never
- Distention of abdomen/Tightness in abdomen:
- Pain in abdomen
- Burning sensation/heart burn
- Heaviness in abdomen
- Nausea
- Belching (excessive/sour)
- Urge for defecation soon after having meal
*4.11.1 If any other discomfort, please specify it and its frequency
5. Health Indicator- Sleep
(Timely and proper sleep)
- *Are you satisfied with your sleep?
Most of the time/Sometimes/Rarely/Never
- Do you fall asleep at night comfortably/unassisted?
Most of the time/Sometimes/Rarely
- How often do you need any medicine/any other supportive measure to get sleep?
Most of the time/Frequently/Sometimes/Rarely/Never
Pleasant/comfortable awakening
- After waking up, do you feel fresh and active?
Most of the time/Sometimes/Rarely
- Do you feel sleepy or drowsy during day time, even while doing work? (apart from drowsiness for sometime after having Lunch)
Most of the time/Sometimes/Rarely
Occurrence of perturbing dreams (unpleasant dreams)
- Do you get unpleasant dreams?
Most of the time/Sometimes/Rarely/Never
6. Health Indicator -Flatus
Proper expulsion of Flatus
- *Do you pass flatus normally?
Most of the time/Frequently/Sometimes/Rarely/Never
- Does the abdomen get distended due to flatus?
Most of the time/Frequently/Sometimes/Rarely/Never
7. Health Indicator -Micturition
Proper voiding of urine
1 Do you pass urine easily without any difficulty?
Most of the time/Sometimes/Rarely/Never
1.1 Have you noticed any of the below mentioned conditions while passing urine?
Options: Most of the time/Frequently/Sometimes/Rarely/Never
- Discontinuous flow
- Pain while voiding
- Burning sensation
- Foul smelling urine
- Have to strain for voiding
- Voiding urine frequently in large quantity
- Voiding urine in less quantity
- Post void residue (Incomplete bladder emptying)
1.2*Any other problem, specify the problem and its frequency
8. Health Indicator -Defecation
Proper/Proper bowel evacuation
1*Are you satisfied with bowel evacuation?
Most of the time/Sometimes/Rarely/Never
1.1 Do you notice any of the below mentioned problems while passing stools?
Most of the time/Frequently/Sometimes/Rarely/Never
- Hard stools
- Loose stools
- Mucoid or slimy appearing stools
- Worms in stools
- Pain during defecation
- Burning sensation during or after defecation
- Foul odour (abnormally excessive bad odour)
- Excessive straining required
- Frequent evacuation
- Bowel evacuation immediately after food
- Blood in stools/bleeding
2 Do you pass bowel easily without any strain or difficulty?
Most of the time/Sometimes/Rarely/Never
3 Do you feel lightness of your abdomen after evacuation of bowel?
Most of the time/Sometimes/Rarely/Never
4 Do you use any medicine/smoking/tobacco/tea-coffee/any other measure to aid bowel evacuation?
Most of the time/Frequently/Sometimes/Rarely/Never
4.1 If most of the times/frequently, provide details
Sexual Function: (for Men)
Do you have any problem related to Semen (Shukra) discharge? (Only for Men)
Yes/No?Not Applicable (child or very old age)
If Yes, pl give details
Early ejaculation (Premature ejaculation)/Late ejaculation (Delayed ejaculation)/No ejaculation/Other:
Menstrual History (only for women)
Do you have any problems related to the menstrual cycle? (only for women)
Yes/No/Not Applicable (child/post menopause)
If Yes, pl give details
Dysmenorrhea/Menorrhagia/Metrorrhagia/Amenorrhea/Premenstrual Syndrome (PMS)/Other:
9. Health Indicator -Voice, Complexion, Built and Nourishment.
9.1 Have you noticed any change in your voice?
No (This is my usual voice)
My voice has become feeble than my usual voice, but I do not suffer from any obvious throat problem
My voice has changed because I am/was suffering from some throat problem
9.2 Have you noticed any change in your complexion?
No (This is my usual complexion)
My complexion has become dull than my usual complexion, but I do not suffer from any skin problem
My complexion has changed because I am/was suffering from some health issue or skin problem
9.3 Have you noticed any change in your built or body weight?
No (This is my usual built)
I lost weight because now I have modified my diet and lifestyle to control my weight
I gained weight because now I have modified my diet and lifestyle to gain weight
I lost/gained weight because I am/was suffering from some health issue
I lost/gained weight but I don't know why
10. Health Indicator -Physical Strength and Immunity
- How often you feel energetic and enthusiastic for doing your daily activities?
Most of the time/Sometimes/Rarely/Never
Strength - Physical Efficiency
- According to me, my physical strength is
I think my physical strength is proper
I am healthy, but I think my physical strength is average and I need to improve it
My strength has reduced than my usual strength due to my poor diet and lifestyle
My strength has reduced because I am/was suffering from some health issue
My strength has reduced, but I don't know why
3. Are you able to do your regular work/physical activity without any problem (in terms of tiredness/weakness/breathlessness)?
Most of the time/Sometimes/Rarely/Never
4. *If not, what is the problem in doing your regular work/physical activity?
I feel very tired/I feel breathless/I feel pain/I already suffer from physical ailment like backache or joint pain etc., so I am unable/Other:
5. Can you do brisk walking for about 30 min?
Yes, without any difficulty
Yes, but with some difficulty (though i do not have any pain or any other joint related problems)
No, it is very difficult for me (though i do not have any pain or any other joint related problems)
I have pain or joint related problems so I am unable to do this much walking or climbing
Strength - Immunity
6. How often do you fall ill during seasonal variations?
Frequently/Sometimes/Rarely/Never
7. How easily do you recover if you get afflicted with diseases?
Easily/Get cured with difficulty
11. Health Indicator- Mind and Intellect
1. How much are you satisfied (happy) with your life?
Satisfied/Less satisfied/Dissatisfied
2. Please rate the level of following feelings in your life
Too much - if you think that it is in excess and you cannot control it; so it affects your personal, family or social life adversely
Moderate - if you think that it is in excess but you can control it and it does not affect your personal, family or social life adversely
Options: Too much/Moderate/Little/No (Never)
- Disturbance by unnecessary thoughts
- Anger
- Fear
- Anxiety
- Stress Level
- Depression
3. How contented (satisfied) are you with the following aspects of your life
Satisfied/Less satisfied/Dissatisfied
- How contented are you with your personal life?
- How contented are you with your family life?
- How contented are you with your social life?
- How contented are you with your financial situation?
4. How contented (satisfied) are you with your marital life?
Satisfied/Less satisfied/Dissatisfied/(Widow/Divorcee etc)/Worrying for not getting married/Not Applicable (Either minor or never wanted to marry)
5. How contented (satisfied) are you with your offsprings (Children)?
Satisfied/Less satisfied/Dissatisfied/Worried because do not have children/Not Applicable (Unmarried/never wanted to have a child/do not worry for not having child)
6. Do you behave with others exactly the way you want others to behave towards you?
Most of the time/Sometimes/Rarely/Never
7. Do you easily get hurt emotionally?
Frequently/Sometimes/Rarely/Never
8. Can you forgive others?
Most of the time/Sometimes/Rarely/Never
9. How do you feel when you see children/women/elderly persons (especially people unrelated to you) suffering?
Usually ignore or avoid/Feel despair/Feel despair and do try to extend help within your limitations
10. How do you handle yourself during any adversity/misfortune?
Mostly, I handle myself quite well without anybody else's much help
Mostly, I handle myself well with somebody else's help
Mostly, I suffer the pain for long period of time
Cannot handle myself at all
Unimpaired intellect
11.Do you feel that you are able to take decisions on crucial matters of life independently (by your own)?
Most of the time/Sometimes/Rarely/Never
12. How frequently you need to change your decisions?
Frequently/Sometimes/Rarely/Never
13. Do you have any addiction (s)?Yes/No
12. Health Indicator -Cognitive Senses
1 Do you think that your 5 sense organs i.e. Eyes (for Vision), Ears (for Hearing), Nose (for sense of Smelling), Tongue (for Taste) and Skin (for Touch) are healthy and functioning normally?
Yes, my all 5 sense organs are healthy and functioning normally
No, I have some 'minor' problem but does not affect my daily routine activities
No, I have some 'major' problem and it affects my daily routine activities significantly
1.1*If 'No' (major or minor), select from the following
Vision/Hearing/Smell/Taste/Touch
1.2*If any major issue, please provide detail
2 Do you have any problem (like pain/restricted movements/painful movements/weakness etc) in your hands, legs, back, neck or any other part of the body which troubles you in walking, sitting, standing, exercising, playing, talking or doing daily work etc?
Yes, I have such problems and it affects my activities
Yes, but only a little or occasionally and it does not affect my activities
No, I do not have any such problems
12.2.1*If yes, please provide details
3*Is there any other problem that is troubling you and you want to mention?Yes/No
3.1*If yes, Please provide details
| References | | |
| 1. | Acharya YT, editor. Sushruta Samhita of Acharya Sushruta, Sutra Sthana. Ch. 15, Ver. 41. 8 th ed. Varanasi: Chaukhamba Orientalia; 2005. p. 75.  |
| 2. | Morandi A, Tosto C, Roberti di Sarsina P, Dalla Libera D. Salutogenesis and Ayurveda: Indications for public health management. EPMA J 2011;2:459-65. |
| 3. | |
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
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