Developing a scale of work-related quality of life for adult social care staff: Phase One


Wellbeing at work has been increasingly recognised as important to an individual’s physical and emotional well-being and for organisational and work outcomes, such as turnover and quality of work. In the health and social care sector, which involves emotional and physical labour, staff wellbeing is likely to have a significant impact on the quality of service provided, and outcomes related to patients and service users. Understanding the aspects of care workers’ quality of life most affected by social care work should therefore have positive implications for workers’ physical and psychological health, organisational outcomes and improved quality of care to services users. Ultimately, understanding how we can improve care staff wellbeing at work can lead to organisational and economic gains by improving staff morale and reducing turnover rates and the associated recruitment costs. This study is the first step to finding a way of measuring how social care workers’ quality of life is affected by their work. While there are some scales to measure well-being at work, these usually focus on job characteristics such as wages, patterns of work and supportive environment yet ignore emotional rewards from caring. Further, they do not examine the impact of care work on workers’ own quality of life, which seems critical to workers' wellbeing and motivation. A measure sensitive to the impact of care work on staff well-being is likely to enhance understanding of the workforce factors influencing care quality and delivery.


National Institute for Health Research for Patient Benefit (NIHR RfPB)


Start year: 2019 End year: 2021

Aims and Objectives

This study aims to develop a way of measuring the impact of care work on care worker’s quality of life (‘care work-related quality of life’). We will do this by looking at it from the perspective of care workers and others working in this field in England. Specifically, we will:
  1. Review and appraise current wellbeing at work scales that are relevant to social care work;
  2. Identify key domains necessary to develop a care work-related quality of life tool that is specific to the adult social care workforce in England;
  3. Identify potential ‘at work’ support mechanisms likely to improve care staff wellbeing.


The study adopts a multi-method approach, conducted over three stages: (1) A review, using a systematic search methodology: We will look at the research that has been done before to determine the gaps in knowledge and identify key aspects of care work that have the most impact on workers’ wellbeing; (2) Focus groups and individual interviews with key stakeholders: We will conduct focus groups with frontline care staff and managers in the domiciliary and care home sectors in addition to interviews with other relevant parties and policymakers. This will help us to identify the most important aspects that need to be included in the measure and consider how these might be used to inform policy and practice within the sector; and (3) Synthesising and validating the findings: After the focus groups and interviews we will come up with a list of factors (domains) that could be included in the measure, and they will be sent out in a survey to all participants from focus groups and interviews, advisory group members and other experts identified throughout the study. This will enable us to reduce the number of items on the list and ensure they reflect the priorities of stakeholders.

Anticipated Impact

Robust evidence of the ways in which care work affects staff quality of life should begin to stimulate wider debate around working conditions and strategies for improving wellbeing at work in this sector.


We anticipate two peer-review journal articles and one academic conference. We also plan to present at carers and providers' events and share findings through sector partners, as pathways to wider impact.

Project Team

Nadia Brookes

Nadia is a Senior Research Fellow at CHSS within the University of Kent’s School of Social Policy, Sociology and Social Research (SSPSSR). She has worked on a number of European, national and local research projects funded for example by the NIHR School for Social Care Research, European Commission FP7 programme and the Norwegian Research Council. She has a BA in Applied Community Studies and MSc in Social Research and Evaluation, she is currently in the final year of a social policy doctorate looking at the nature, extent and process of innovation in adult social care.

Nadia works as a project manager on the project.

Shereen Hussein

Shereen is a Professor of Health and Social Care Policy at the London School of Hygiene and Tropical Medicine

Shereen’s background is in Medical Demography and Population Science, with a Masters degree from the LSHTM, and a PhD from the London School of Economics. Before joining the LSHTM in January 2021, she was a Professor of Care and Health Policy Evaluation and Associate Director of the PSSRU at the University of Kent. Prior to this, she was a Chair at King’s College London. Shereen maintain honorary professorships at the University of Kent, KCL and University of Southern Queensland, Australia.

Shereen is the Principal Investigator on the project.

Petra Mäkelä

Petra is a medical sociologist with a clinical background in rehabilitation medicine. Prior to her academic posts at the University of Oxford and London School of Hygiene & Tropical Medicine, she led interdisciplinary teams in the provision of holistic care for adults living with complex disabilities. Her research interests encompass the organisation, provision and experience of health care and social care for people living with long term conditions.

Petra joined the project team as a Research Fellow in March 2021.

Sinead Palmer

Sinead is currently working on two NIHR School for Social Care Research-funded projects: Measuring outcomes of care homes (MOOCH); and Shared lives costs and effectiveness (SLEE).

Sinead is a Co-Investigator on the project.

Ann-Marie Towers

Ann-Marie joined Centre for Health Services Studies as a Senior Research Fellow in April 2019, after sixteen years at the Personal Social Services Research Unit (PSSRU) at the University of Kent. She is a collaborator for the NIHR Research Design Service South East, a panel member for NIHR Research for Patient Benefit (South East) and lead a programme of work to develop, test and support the Adult Social Care Outcomes Toolkit (ASCOT).

Ann-Marie is a mixed-methods researcher, using both qualitative and quantitative techniques. She has a special interest in how we might employ qualitative methods, such as observations, supported interviewing techniques and forms of adapted communication, to try and ascertain the views and experiences of care home residents and people with cognitive and communication difficulties.

Ann-Marie is a Co-Investigator on the project.

Barbora SIlarova

Barbora is a Research Associate who joined the Personal Social Services Research Unit (PSSRU) in September 2019. Barbora’s background is in clinical and health psychology and her research at PSSRU focuses on two projects: ‘Developing a scale of work-related wellbeing at work for adult social care staff’ led by Professor Shereen Hussein; and ‘Measuring the social care outcomes of people with dementia and their carers’ led by Stacey Rand. Before joining the University of Kent, Barbora worked at the University of Exeter and University of Cambridge, where her main research interest centered on understanding how we can use digital tools to support people to have a healthy lifestyle in order to decrease their risk of getting cardiovascular disease, cancer and dementia.

Project Advisory Group


Nadra has been involved in the field of social care for over 36 years, initially as the registered manager of her services. She has been Chairman of National Care Association since 2001 and recently stepped down as a Trustee of Parkinson's UK in October 2018. Nadra is the Co-Convenor of the Cavendish Coalition which was set up to represent the Health and Social Care issues during the Brexit negotiations. She is a member of a number of advisory committees in the Department of Health and Home Office, including a number at Ministerial level, and served on government Taskforces. Nadra has recently been working on parts of the Green paper and the Mental Capacity (Amendment) Bill. She holds various positions within voluntary organisations, delivering services to vulnerable people in the community and in 2006 was awarded the OBE for her services to Social Care. Nadra is also a Kent Ambassador and Deputy Lieutenant of Kent.


Jennifer’s interest in social care research stems from her own interest in health research as a patient with a long term condition requiring ongoing secondary care and her role as carer to her late father who used social care services. Jennifer is the Independent Ethics Lead for RDS London and also Chair of the Public Advisory Group and Decision Maker for the Enabling Involvement Fund. She has been working in research ethics for over 10 years, is visiting lecturer teaching at KCL medical and dental schools. She was a founding member of the Marie Stopes Research Ethics Committee (REC). She is currently Vice Chair of an NHS REC and Deputy Chair of the Save the Children Research Evaluation Ethics Committee which reviews international humanitarian aid research.


Sara is Professor of Work, Gender & Regulation in the School of Management at RMIT University in Melbourne Australia. She is Director of the Centre for People, Organisation & Work in RMIT College of Business. Much of Sara’s recent research has focused on paid care work. She is currently co-investigator on an Australian Research Council project ‘Markets, Migration and Care in Australia’, led by Emeritus Prof Deb Brennan (UNSW). Sara leads an ARC project ‘Decent Work & Good Care: International Approaches to Aged Care’ and is co-investigator on a Canadian Social Sciences and Humanities Research Council project ‘Imagining Age–Friendly “Communities” within Communities: International Promising Practices’ led by Prof Tamara Daly (York).


Matthew works as a National Officer for the UK’s largest trade union UNISON. UNISON serves more than 1.3 million members. They represent full-time and part-time staff who provide public services, although they may be employed in both the public and private sectors. They represent members, negotiate and bargain on their behalf, campaign for better working conditions and pay and for public services.


Margaret is a Project Manager – Evidence and Impact at Skills For Care. Margaret have done most of the research and evaluation work linked to workforce development over the past 25 or so years. Over the last 5 years she has worked closely with the Standards, Learning, Qualifications and Apprenticeships team on a whole range of projects consulting on what is available or needed in terms of workforce development in the adult care sector and measuring the impact of learning and development on the workforce. Margaret also has expertise in developing instruments to measure employee job satisfaction and health and wellbeing.


Karolina has worked as a care worker for over 12 years. She is proud to represent the social care workforce as the CEO of the National Association of Care & Support Workers. She believes that everybody deserves outstanding care and that care workers should be expected to deliver care with respect and dignity only if they receive them themselves. The National Association of Care & Support Workers (NACAS) is a professional body for the social care workforce. NACAS represents the workforce on a national level and gives the workforce a voice that is essential in social care policymaking. NACAS campaigns for registration of social care workforce, vastly improved training frameworks, better pay and working conditions, and more respect and recognition of the highly skilled and demanding job that caring is.
Social media: @Nacas @KGerlich777


Lyn has 30 years’ experience of direct support, development and management roles in the health and social care sector. A significant amount of that time has been spent working with people who have learning disabilities in the self-advocacy movement including a spell as coordinator of the National Forum of People with Learning Disabilities. She is currently Development Lead for Learning Disability at NDTi (the National Development Team for Inclusion), a social change agency that works with communities, policy makers and health and social care professionals to enable people at risk of exclusion to live the life of their choice.


Teppo is Professor of Social and Public Policy at the Department of Social Sciences and Philosophy of the University of Jyväskylä, Finland. He leads the Center of Excellence in Research on Ageing and Care (CoE AgeCare), which is funded by the Academy of Finland in 2018-2025. Teppo’s research analyses care policy from local, comparative and global perspectives. He has drafted new conceptual perspectives for the analysis of care policy, including the concepts of welfare municipality, weak universalism, dedomestication, demographic panic, care capital and care poverty.


Dr Sarah Markham is the patient representative for the ASCOT project. She is a long-term mental health service user who has benefitted from support from social workers as both an inpatient and in the community. Sarah is also a Visiting Researcher at the IoPPN, King's College London and her research interests concern risk assessment and management in secure and forensic mental health settings.


Allister McGregor is Professor of Political Economy in the Department of Politics and an Fellow of the Sheffield Political Economy Research Institute (SPERI) at the University of Sheffield, UK. He has written extensively on the concept of human wellbeing and methodologies for operationalizing it for public policy and practice. He is the leader for the overarching workpackage on ‘Care, Sustainability and Wellbeing’ which guides the development of a conceptual and analytical framework for studying wellbeing in care policy and practice, for the ESRC funded programme Sustainable Care: Connecting People and Systems.


Ann, who is now retired, was the Director of the Personal Social Services Research Unit (PSSRU) at the University of Kent and the Department of Health-funded policy research unit in Quality and Outcomes of person-centred care (QORU) until 2013. She was also a founder member of the NIHR School for Social Care Research (SSCR), Professor of Social Welfare at the University of Kent, and is still a member of the Academy of Social Sciences. She led the programme of work that developed the Adult Social Care Outcomes Toolkit (ASCOT) and the early series of volumes of Unit Costs of Health and Social Care. Her research interests include the measurement of outcome, costs and quality in social care, housing and care of older people, and economic evaluation of social welfare interventions, including criminal justice. She is a trustee for the Elderly Accommodation Counsel.


Clark is an Economic Adviser at the Department of Health and Social Care. His work focusses on understanding the drivers of demand for adult social care services and developing the evidence base for investing in health and social care. In his previous role at the Health and Safety Executive he co-authored several research reports, most recently the Costs to Britain of Work-related Cancer.


Helen is a retired teaching assistant with Literacy specialism, and have a degree in English and American Literature from the University of Kent. Previous work included working as a secretary in London for private banks. She has 10 years’ experience looking after her parents, initially her mother who had dementia and more recently her elderly father. Also, Helen worked as a research advisor on the Measuring outcomes of care homes (MOOCH) project for researchers at University of Kent.


Care work is characterised by unfavourable working conditions, including poor wages, insecure contracts and increasingly fragmented working arrangements. A significant number of workers leave their jobs every year and levels of stress and burnout are concerning. While there are some scales to measure well-being at work, they do not examine the impact of care work on workers’ own quality of life, which seems critical to workers' wellbeing and motivation.

Objectives To identify the domains of quality of life most affected by care work in the social care sector. Specifically:
  1. Review and appraise current wellbeing at work scales that are relevant to social care work.
  2. Identify key domains necessary to develop a care work-related quality of life tool that is specific to the adult social care workforce in England.
  3. Identify potential ‘at work’ support mechanisms likely to improve care staff wellbeing.
Methods A multi-method study, using deductive and inductive approaches, was undertaken:
  1. A systematic review of published studies and assessment scales of care staff wellbeing (drawing on formal and family carer quality of life measures) and organisational support mechanisms to enhance wellbeing at work.
  2. Interviews (n=16), focus groups (3 groups with n=11 participants) and written responses (n=2) to gather the views of frontline care workers (n=10), managers (n=7) and key social care stakeholders and policymakers (n=12) and explore the utility of a care work-related quality of life scale.
  3. An online survey (n=35) to explore the content validity of the proposed domains and items and reach a consensus of what would be important to include.
Key Findings

We identified the domains and subdomains of a scale specific to the context of social care work in England to include seven domains with 23 sub-domains. Three factors (organisational features, nature of care work, recognition of care work) impact three elements of WRQoL (financial, mental, physical) and impact the workers’ lives through a process of work-life spillover.

Outputs, Impact and Dissemination

Two peer-reviewed manuscripts have been submitted (one accepted and the other waiting) and two more are under preparation, we have also contributed to one international conference. To support wider impact, a ‘Practice Guide’ summarising the findings and making recommendations to the sector on ways to improve care worker quality of life, is being co-produced with our lay research advisors and sector representatives.


Some of the domains/subdomains of the proposed scale intersect with existing WRQoL scales, while others are specific to the context of social care. Previous scales did not recognise the importance of financial wellbeing, which was one of the most important domains as identified by the participants in this study.

Future Plans

To disseminate the findings including the guide and to seek further funding to complete the development of the scale

  1. Hussein, S., Towers, A., Palmer, S., Brookes, N., Silarova, B. and Makela, P. (2022). Developing a Scale of Care Work-related Quality of Life (CWRQoL) for Long-Term Care workers in England. International Journal of Environmental Research and Public Health. 2022, 19(2), 945;
  2. Silarova,B., Bookes, N., Palmer, S., Towers, A. & Hussein, S. (2022). Understanding and measuring the work-related quality of life among those working in adult social care: A scoping review. Health and Social Care in the Community.
  3. Towers, A. Palmer, S. Brookes, N. Markham, S. Salisbury, H. Silarova, B. Mäkelä, P. Hussein, S. (2022). Quality of Life at Work - What it means for the adult social care workforce in England and recommendations for actions. University of Kent, Canterbury

NIHR Research for Social Care (RfSC) Workshop Programme 7th October 2020

Click here for Shereen Hussein's presentation Or Listen and see the slides on YouTube

Research Design Service South East Event 16th September 2020

Developing a scale of work-related quality of life for adult social care staff: Phase One - Sep 2019- March 2021
For more information about the project please contact Ann-Marie Towers or Professor Shereen Hussein:
Ann-Marie Towers
Professor Shereen Hussein

Personal Social Services Research Unit The University of Kent Cornwallis Central, Canterbury, Kent, CT2 7NF