As an important motivational force, life goals contribute to health and well-being (Emmons, 1986, 1989). Being confronted with a disability such as visual impairment is likely to lead to interference with a person's involvement in important life domains, which can mean a significant disruption and blockage of the individual's goal pursuits. The pursuit of life goals is particularly critical in young as well as middle adulthood. For example, during young adulthood, life goals may involve getting an education, finding an occupation, selecting a partner, and starting a family. Middle adulthood may involve maintaining a career, meeting the demands of parenthood, nurturing one's marriage/relationship, and managing a household (Nurmi, 1992).
Because life goals and the implications of experiencing a disruption of life goals are so critical in early and middle adulthood, insights regarding which life domains are most affected by disability can be helpful to better understand adaptation to a disability such as vision loss, and may also provide cues for intervention planning. Specifically, it has been suggested that the perceived correspondence of rehabilitation goals and life goals enhances a person's motivation to participate in rehabilitation and to make the intervention relevant to the person's life (Sivaraman Nair, 2003). Furthermore, a recent study on life goals of people with neurological disabilities found that great significance was attached to partner and family relationships, life domains that are not typically included in defined rehabilitation goals (Sivaraman Nair & Wade, 2003).
Life Goal Study Part I:
The objectives of this study were to explore the relative importance of different life goals among adults with vision impairment, the extent to which vision impairment interferes with each, as well as the extent to and ways in which rehabilitation addressed and affected these life goals. Finally, the relationships between importance of life goals, goal interference, and mental health outcomes were also examined.
Participants were 86 working age adults (age 18-64 years) with vision impairment. Data were collected through telephone interviews that included structured assessments of life goal importance (0=no importance to 3=extreme importance), goal interference due to vision loss (0=not at all to 3=extremely), and mental health outcomes (depressive symptomatology and life satisfaction) as well as open-ended assessments of if and how rehabilitation programs addressed life goals. Descriptive analyses were conducted to explore participants' reports of goal importance and interference for the different life goals, as well as the ways in which these goals were addressed by rehabilitation. Correlational analyses were conducted to examine interrelationships between goal importance, interference, and mental health.
In addition to functional aspects of living, life goal importance ratings reflected that, relationships were a top priority for this study population. Functional compared to relationship goals were more commonly addressed in vision rehabilitation services. However, many participants felt that their vision impairment interfered with their relationships, and in the rare case that relationships were addressed in rehabilitation, it was never perceived as ineffective. In contrast, reports of a life goal being addressed in ineffective ways emerged for functional life goals.
All interference variables were significantly correlated with mental health outcomes. Those who reported higher levels of goal interference were also likely to report worse mental health. Of the three goal importance variables, only relationship importance was significantly linked with mental health. Those who rated the relationship domain as more important were also likely to report better mental health. Taken together, the consistent links between goal interference and well-being across life domains demonstrate that, among people with vision impairment, the perception of lesser goal interference was generally associated with better mental health. Unlike goal interference, goal importance was not consistently linked to mental health. Only those who attached more importance to their relationships also reported better mental health. These findings suggest that, in addition to functional life domains, relationship-related life goals may need to receive more attention in the context of rehabilitation for people with disabilities.
Boerner, K., & Cimarolli, V. (2005). Optimizing rehabilitation for adults with visual impairment: attention to life goals and their links to well-being. Clinical Rehabilitation, 19 (7), 790-798.
Cimarolli, V. R., & Boerner, K. (2005). Social support and well being in adults with visual impairment. Journal of Visual Impairment and Blindness, 99(9), 521-534.
Life Goal Study Part II:
Although findings from the first phase of this pilot study using a structured goal assessment approach provided valuable insights, it is possible that this approach missed important individual differences in personal goals, which an open-ended approach may be more likely to capture. Also, since so little is known about the interrelationships among life goals, vision rehabilitation, and psychological well being in young and middle-aged adults, it may be particularly interesting to pose open questions about life goals most important to participants, rather than to have them rate pre-established dimensions.
Employing an assessment focusing on if and how each type of vision rehabilitation service used may have addressed these most important goals is likely to provide more concrete insights into the relationship between life goals and vision rehabilitation service use than the structured assessment used in the first phase of this pilot.
Finally, since adjustments in important life domains often occur during the adaptation process (Boerner, 2004), life goals may or may not change when a person deals with vision loss, and if they do, the use of vision rehabilitation services may actually play a role in this change. Although change is best assessed longitudinally, retrospective data on changes in major life domains, and on the role of rehabilitation in these changes can provide valuable pilot data on this issue, on which we then can build in future studies.
Thus, the objectives of this second part of the life goal project were: 1) To identify participants' three most important personal goals, and then assess how vision impairment interferes with each; 2) To explore if and how each type of rehabilitation service received has addressed these most important goals; and 3) To explore if and how vision impairment and the use of vision rehabilitation services has changed participants' life goal or priorities.
The sample consists of 53 participants between the ages of 22 and 65 who had an age of onset of vision impairment 18 years of age or older. Data were collected through semi-structured telephone interviews. The interviews included questions about visual functioning and rehabilitation service history, an openended assessment of important life goals, and extent to/ways in which these were addressed in each of the specific types of rehabilitation received, as well as open-ended question on changes in life goals, sense of self, world views, and relationships to others resulting from vision impairment.
Results indicated that rehabilitation services that teach functional skills as well as psychosocial therapeutic-type services were instrumental in addressing life goals. Independence-related goals were most often addressed, whereas hobbies/leisure-related goals were least often addressed. When life goals were addressed, they were generally perceived as having been addressed effectively.
Results also demonstrated that positive, negative, and "in-between" types of change occurred across the four life domains to varying extents. Although negative changes seemed to be more prevalent than positive changes, the majority of changes were in-between changes. Links of occurrence and type of change with well-being were found for the self and world view domains. Regarding different facets of change, even though for most people change seemed to involve more of a gradual adjusting of individual aspects while retaining some degree of overall continuity, changes were certainly characterized as more drastic for some. Findings underscore the need to assess different types and aspects of life changes in order to better understand the impact of functional loss in young and middle adulthood.
Boerner, K., Wang, S., & Cimarolli, V. R. (2006). The impact of functional loss: Nature and implications of life goals. Journal of Loss & Trauma, 11, 265-287.
Cimarolli, V. R., Boerner, K., & Wang, S. (2006). Life goals in vision rehabilitation: Are they addressed and how? Journal of Visual Impairment and Blindness, 100(6), 343-352.
Project Team: Kathrin Boerner, PhD, Principal Investigator
Verena Cimarolli, PhD, Co-Investigator
Lauren Grunseid, Research Intern
Shu-wen Wang, Research Assistant
Funded by: Lighthouse International and a grant by Mr. Edward Ferris
Project period: 5/04 - 12/05