Frequently asked questions

ASCOT stands for the Adult Social Care Outcomes Toolkit. ASCOT is a suite of instruments designed to measure social care-related quality of life (SCRQoL), i.e. the quality of life that can be attributed to the interventions or actions of social care. ASCOT is not a measure of general quality of life. It specifically measures peoples’ quality of life defined as those aspects (domains) that can be affected by social care services (e.g. homecare, day centres, residential care).

There is further general information about the ASCOT measures available on our website and here.

ASCOT tools are tailored for different care groups and care settings. Which ASCOT tool is most suitable for your project/study will depend on who will take part in your project, e.g. older people, people with learning disabilities and autism, carers of people in receipt of services, etc., and/or the care setting, e.g. community-based care, residential care, home care, etc. It is also important to think about (1) the level of cognitive impairment (is the sample you are studying able to self-complete?) and (2) the aims of your study (if you want demonstrate impact of services – termed ‘gain’ – then the tools which measure gain may be more suitable for your study (i.e., INT4 or CH4).

ASCOT has been developed over a series of research projects over 20 years. The development work included creating the questionnaires and developing preference weights, which allows use of ASCOT in economic evaluations. Some of this work is described in the references and guidance for each of the ASCOT measures.

Yes, each ASCOT instrument has an accompanying guidance document. The guidance for every ASCOT tool is available to view on our website under the ASCOT Tools section.

University of Kent is the copyright and Intellectual Property holder.

No. If you would like additional training or support, please see ‘What support is available?’ below

Yes. Please see the ASCOT-CH4 tool page (under ASCOT Tools) for further information.

The ASCOT team is a network of academics based at the University of Kent and other Universities. We are not funded on an ongoing basis to provide general advice and support for ASCOT, but we provide information on our website and in the guidance for each measure.

We may be able to work with organisations (e.g. care providers, local authorities) to provide training, advice and support on a consultancy basis. If you would like to explore this option, please contact ascot@kent.ac.uk about your requirements. Please include ASCOT consultancy in the subject line of your email.

Yes. A license is required for any use of ASCOT. The license will give you permission to use ASCOT for the purpose you set out in your application.

For further detail and to obtain a license, please refer to these descriptions of the licensing process for-profit and not-for-profit use. The registration forms gather information on the intended use of ASCOT. This information is used to prepare the licence for permission to use ASCOT. It is important that this information is accurate and correct.

The form includes the T&Cs of the licence. The person completing the form must agree the T&C’s on behalf of their organisation and project team. They must ensure that they have the authority to do so. If they do not have the authority to agree the T&C’s on behalf of their organisation and project team, they must seek a person in their organisation who does have authority to agree the T&C’s. The form includes questions about the name and job title of this authorised person.

Yes, anyone wishing to use ASCOT must be licensed to use it.

Yes. Terms and conditions (T&Cs) are part of the registration process and you will be required to agree to them when completing the online form. The T&Cs can be found here.

The organisation where the person or project team is based will be the Licensee. Therefore, the T&C’s must be agreed by someone with authority to consent to these on behalf of the organisation. This person’s name must be provided during registration and they will be asked to confirm they agree to the T&C’s.

It is the responsibility of the person completing the registration form to ensure that they have sought appropriate authorisation in order to consent to the T&C’s.

Not-for-profit use. ASCOT is free of charge for not-for-profit use but a license is required. To obtain a license you must complete and submit one of the forms from this page. The person completing the form must agree the T&C’s on behalf of their organisation. Therefore, they must ensure that they have their organisation’s approval to agree the T&C’s. If they have not go the authority to agree the T&C’s on behalf of their organisation, then they must seek a person in their organisation who has the authority to agree the T&C’s.

For-profit use. To enquire about for-profit licensing and fees, please refer to the information and form here.

How you use ASCOT will depend on the goals of your project or on what you are trying to demonstrate.

Before deciding which ASCOT tool to use, you will need to reflect carefully on your aims/objectives and what you are trying to acheive. This will then shape how you use the measure(s).

Make sure to read all the information on this website and view this video to better understand when to use the different ASCOT tools.

Yes. Some ASCOT measures have preference weights and can be used in economic evaluations.

ASCOT-SCT4/INT4 was developed as a preference-based measure. Please see Netten A, Burge P, Malley J, Potoglou D, Towers A, Brazier J, Flynn T, Forder J, Wall B (2012) Outcomes of Social Care for Adults: Developing a Preference-Weighted Measure, Health Technology Assessment, 16, 16, 1-165 DOI: http://dx.doi.org/10.3310/hta16160

Preference weights have also bee developed for ASCOT-Carer SCT4/INT4. Please see Batchelder L, Malley J, Burge P, Lu H, Saloniki E.-C, Linnosmaa I, Trukeschitz B, Forder J (2019). Carer social care-related quality of life outcomes: estimating English preference weights for the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer). Value in Health, 22(12), P1427-1440. DOI: https://doi.org/10.1016/j.jval.2019.07.014

You could use the interview version of ASCOT, INT4, which measures the current SCRQoL and the expected SCRQoL score (what the individual’s quality of life would be in the absence of the service studied). ASCOT INT4 also measures the gain in SCRQoL, which is the impact of the service on the individual’s quality of life. The current SCRQoL scores provide an overview of what the service users’ quality of life that can be attributed to the services is like. The average SCRQoL score is 0.86. Any scores below this figure would indicate SCRQoL lower than the average, with scores below 0 being worse than dead. Any scores above 0.86 would indicate SCRQoL above the average. You could investigate the different domains of SCRQoL to check if service users have worse or better quality of life in certain areas. This information could serve as a basis for further investigation (for example through interviews) of the reasons behind low SCRQoL scores in these areas of quality of life. Based on the information gathered through the interviews, interventions to improve care recipients’ quality of life could be developed and implemented.

ASCOT INT4 can also be used to demonstrate impact of the services through the SCRQoL gain scores – gain is the difference between the current and expected SCRQoL score. The higher the gain, the more the service is doing to improve service users’ quality of life in the areas affected by social care.

Yes. Many people ask other questions alongside the ASCOT measures (excluding ASCOT-CH4) when they are used in surveys or interviews.

This is fine. However, you should pilot the longer interview schedule first to check how long it takes to complete. We strongly advise that you keep the ASCOT questions as a block of questions. Do not change their order.

You will be asked to tell us how you plan to use the ASCOT questions during the licencing process. you will need to fill out for two here. You will also need to acknowledge ASCOT in any publications from your research.

No. You are free to use only the questions that are of use to you.  However, without a full set of questions it is not possible to calculate the overall measure score.

Please inform us if you plan to use only a selection of the questions when completing the appropriate form (not-for-profit or for-profit).

Details of how to score ASCOT measures are included in the guidance documents accompanying each ASCOT instrument, which are shared upon approval of the registration form.

You may also wish to refer to the preview and information available on our website under ASCOT tools.

It is possible to score the ASCOT measures yourself, following the information in the guidance. This is easier if you use statistical software (e.g. SPSS, STATA, R).

As some organisations or teams do not have access or resources to score the measures themselves, we provide data entry tools for some of our measures (SCT4, INT4, Carer SCT4, Carer INT4 and Easy Read).

These MS Excel files generate social care-related quality of life (SCRQoL) scores for each individual based on data entry of the scores from the ASCOT questionnaire/interview.Where available, the data entry tools apply preference weights. The SCRQoL score for each person is automatically calculated.

The tools also produce a summary of responses for each ASCOT question (frequencies and percentages) and charts.

There are data entry tools for some ASCOT instruments: SCT4, INT4, Carer SCT4, Carer INT4 and Easy Read.

You can purchase the data entry tools here.

If there are any missing data (missing answers to questions, coded as ‘-9’ in the data entry tools), SCRQoL scores will not be calculated.

No, the data entry tools have been programmed to calculate SCRQoL using the weights for each response option.

No. ASCOT measures have undergone extensive development and testing. Making changes to the wording, format or order may jeopardise the reliability and integrity of the tool.

ASCOT-CH4 is more flexible than other ASCOT measures, in terms of its administration, owing to the needs of the people we are collecting data about. The two-day training course, which is required for licensing and use of ASCOT-CH4, takes you through the options available to you.

No. Any use of the ASCOT questions or measures must acknowledge our copyright and intellectual property. If you include the ASCOT in a questionnaire with other questions, you are required to reference this accordingly. This requirement forms part of T&Cs of use, to which you be required to agree in order to access ASCOT tools.

You can find a guide on how to reference ASCOT here.

Yes. To learn more about these translations, go to translations.

This guidance will help you understand the processes involved in an ASCOT translation, and should answer any questions you have, but if you still have questions the ASCOT Team, please contact ascot@kent.ac.uk.

No. Any translation of ASCOT must be done in consultation with, and  approval of, the ASCOT team. A licence is required. Any translations conducted without the approval of the ASCOT Team, and the appropriate licence, will be deemed as a breach of copyright and Intellectual Property.  The copyright holder, the University of Kent, reserves the right to take legal action in such situations.

No, you must have permission to translate ASCOT. As a patient-reported outcome measure (PROM), the translation of ASCOT must follow the rigorous translation methodology set out in this guidance. All translations must be discussed with and approved by the ASCOT team.

The guidance should answer any questions you have, but if you still have questions the ASCOT Team, please contact ascot@kent.ac.uk.

We estimate that it would take one researcher around two to three days to collect the data for approximately 10 residents. This is because of the time taken to carry out structured observations, speak to residents (sometimes using adapted communication), interview staff and possibly family members. This evidence is then collated into ratings, and additional time needs to be allowed for making the ratings.

CH4 is not a ‘quick’ methodology but it is inclusive (can be used with people living with dementia or other cognitive and communication difficulties) and provides researchers and/or providers with very rich data about the lives of residents.

In the dignity domain there are two questions: question 8 and question 9. The dignity question (question 9) measures how the way the care recipient is treated by staff affects his/her mental wellbeing. Question 8 is a filter question. During development it was found that some respondents were using question 9 to express that they did not like needing help with aspects of the life. However, the aim of the question was to understand how help was delivered and what kind of impact it had upon the respondent. Testing found that including question 8 in the survey not only allowed respondents to express unhappiness with needing help but helped them to answer question 9 in the way that the tool intended. As question 8 is a filter question, it should not be used in scoring.

Question 8 is a filter question designed to allow respondents to express their unhappiness with the fact that they need care and/or support. During development it was found that some respondents were using question 9 to express that they did not like needing help with aspects of the life. However, the aim of the question was to understand how help was delivered and what kind of impact it had upon the respondent. Testing found that including question 8 in the survey not only allowed respondents to express unhappiness with needing help but helped them to answer question 9 in the way that the tool intended. As question 8 is a filter question, it should not be used in scoring.

The way to deal with this is to omit both the dignity filter question (question 8) and the dignity question (question 9) at ‘pre’ intervention. You need answers to all the questions to be able to calculate a social care-related quality of life (SCRQoL) score (except for the dignity filter question which is not used in scoring) – if there are any missing data you will not be able to calculate the SCRQoL scores for your sample. Using the ‘no needs’ level weighting for the dignity question will ensure that SCRQoL scores can be calculated. The weighting for the ‘no needs’ response option (‘The way I’m helped and treated does not affect the way I think or feel about myself’) is in the SCT4 guidance document.

ASCOT is available for not-for-profit purposes free of charge with a licence requirement. Not-for-profit is defined as any use for the benefit of the public without generating income. For example, a local authority or municipality wishing to use ASCOT for evaluation or quality improvement is considered not-for-profit.

For-profit use requires a licence and a fee, which depends on a number of factors, e.g. the type of use, number of participants, the size of the study, etc. Generally, any use by a pharmaceutical company or consultancy (e.g. in a Patient Reported Outcome measure) or other commercial organisations (e.g. health and/or social care commercial providers) is considered for-profit.

To enquire about for-profit licensing and fees, please refer to the information and form here.

Generally, any use by a pharmaceutical company or consultancy (e.g. in a Patient Reported Outcome measure) or other commercial organisations (e.g. health and/or social care commercial providers) is considered for-profit. To enquire about for-profit licence and fee, please complete form 2 here: https://www.pssru.ac.uk/ascot/ascot-license-forms/

Not-for-profit is defined as any use for the benefit of the public without generating income. For example, a local authority or municipality wishing to use ASCOT for evaluation or quality improvement is considered not-for-profit.

The ASCOT measures are available on our website as a preview.

If you are planning to use ASCOT measures for for-profit purposes, you will be required to get a for-profit licence and pay a fee. Please refer to the for-profit webpage.