How Can We Measure Flow for Presence Questionnaire

Patient Tools

Read, save, and share this guide

Use these quick tools to make this medical article easier to read, print, save, or share with a family member.

How Can We Measure Flow for Presence Questionnaire
Patient Mode

Understand this article easily

Switch between simple English and easy Bangla patient notes. This is for education and does not replace a doctor consultation.

Someone caught up in their actions might say, "I'm in the zone." Positive psychologists use a similar term for this state: 'Flow.' Flow refers to the positive experience of complete absorption in an activity that is both spontaneous and effortless (Csikszentmihalyi, 2000; Nakamura & Csikszentmihalyi,...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

এই তথ্য শিক্ষা ও সচেতনতার জন্য। এটি ডাক্তারি পরীক্ষা, রোগ নির্ণয় বা প্রেসক্রিপশনের বিকল্প নয়।

Article Summary

Someone caught up in their actions might say, "I'm in the zone." Positive psychologists use a similar term for this state: 'Flow.' Flow refers to the positive experience of complete absorption in an activity that is both spontaneous and effortless (Csikszentmihalyi, 2000; Nakamura & Csikszentmihalyi, 2014). In other words, during a flow state, one is so happily absorbed in what they are doing that their...

Key Takeaways

  • This article explains How Can We Measure Flow? in simple medical language.
  • This article explains The Flow for Presence Questionnaire in simple medical language.
  • This article explains The Flow State Scale in simple medical language.
  • This article explains 20 More Useful Assessments in simple medical language.
Educational health guideWritten for patient understanding and clinical awareness.
Reviewed content workflowUse writer and reviewer profiles for stronger trust.
Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

3

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

Before reading

RX Patient Tools

Use these quick guides before reading the article, or return to them when you need help preparing questions for a doctor.

Start here Choose the right pathway for symptoms, reports, medicines, or urgent warning signs. Disease article roadmap Read this topic step by step: meaning, symptoms, warning signs, diagnosis, treatment, prevention, and follow-up. Treatment planner Prepare questions about treatment choices, benefits, risks, side effects, and follow-up. Family & caregiver guide Organize symptoms, reports, medicines, questions, and follow-up safely. Nutrition & diet guide Prepare food, hydration, supplement, and medicine-timing questions safely. Prevention guide Organize risk factors, protective habits, screening, and warning signs. Recovery guide Prepare a safe plan for activity, rehabilitation, warning signs, and follow-up.
Definition

Someone caught up in their actions might say, “I’m in the zone.” Positive psychologists use a similar term for this state: ‘Flow.’

Flow refers to the positive experience of complete absorption in an activity that is both spontaneous and effortless (Csikszentmihalyi, 2000; Nakamura & Csikszentmihalyi, 2014).

In other words, during a flow state, one is so happily absorbed in what they are doing that their thoughts and actions flow freely. Given that a flow state is optimal for many aspects of life (i.e., work, creativity, learning, etc.), researchers are keen to identify how to best measure it.

In this article, we will examine science-based methods designed to measure flow.

These science-based exercises will explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the well-being of your clients, students, or employees.

How Can We Measure Flow?

Flow is a subjective experience, which creates a challenge in identifying psychometrically sound measurements (Jackson, Martin, & Eklund, 2008). Moreover, because the enjoyable flow experience represents both the reason for and outcome of engaging in an activity (Seifert & Hedderson, 2009), its measurement represents an additional challenge for researchers.

Given its subjectivity, the most common way to measure flow is by asking respondents about their experiences, which has been achieved via the following methods:

  1. Interview questionnaires;
  2. Experience sampling methods; and
  3. Self-report questionnaires.

Let’s take a closer look at each of these approaches.

1. Interview Measures

Interviewing techniques are particularly suited to qualitative investigations of subjective constructs, such as flow. This is because interviewing aids researchers in refining or devising a way to measure a concept.

Semi-structured interviews, which involve a combination of predetermined questions and evolve out of participants’ responses, were often used in earlier research examining flow (Nakamura & Csikszentmihalyi, 2014).

This approach, which may be conducted during an actual flow experience, enables rich and detailed exploratory analyses of a concept (Nakamura & Csikszentmihalyi, 2014). Accordingly, semi-structured interviewing has contributed significantly to understanding flow (Seifert & Hedderson, 2009).

To increase construct validity, interview techniques are sometimes combined with observation methods. For example, in their examination of intrinsic motivation related to flow during skateboarding, Seifert, and Hedderson (2009) employed an ethnographical approach.

Researchers first invested much time at a local skateboard park observing skaters and recording notes. Following the natural observation period, a randomly chosen skateboarder was administered a semi-structured, open-ended interview— thus combining observation and interview methodologies.

This approach was beneficial for delving deeply into the flow experience and thus revealing a more vivid account of how participants perceived it (Seifert & Hedderson, 2009).

2. Experience Sampling

Experience sampling is a self-report approach in which participants write diary notes describing their experiences as they happen (Csikszentmihalyi, Larson, & Prescott, 1977). Although there is variability in how this method is applied, diary notes are often entered over a week (Jackson et al., 2008).

Experience sampling has been used quite a bit for the study of flow because it provides valuable information regarding the dynamics of emotions or subjective states (Magyaródi, Nagy, Soltész, Mózes, & Oláh, 2013).

On the other hand, it is a time-consuming approach that is limited by selective answers, which can create issues surrounding privacy or illegal behaviors (Magyaródi et al., 2013).

An example of experience sampling used to measure flow was conducted by Clarke and Haworth (1994). They used diary questions to examine whether optimal experiences occurred in situations where the challenge matched skill.

While experience sampling has been around for a long time, it has been innovated over recent years by adding physiological measures and cell phone and computer applications (Magyaródi et al., 2013).

3. Self-report Questionnaires

Self-report (aka paper and pencil) measures provide a valuable way for researchers to measure flow when “… the goal is not to identify but instead to measure dimensions of the flow experience or differences in its occurrence across contexts or individuals” (Nakamura & Csikszentmihalyi, 2009, p. 93).

In other words, self-report measures are not exploratory; but enable the researcher to examine the construct’s relationship to various qualities of interest (i.e., gender, ethnicity, age, occupation, setting, etc.).

Self-report measures are also advantageous because they are both efficient and amenable to various types of analysis methods. A significant limitation of self-report measures, however, is response bias (e.g., the tendency for individuals to avoid truthful or accurate responses).

Similarly, the value and utility of self-report measures are contingent upon their psychometric quality (e.g., validity and reliability). This article will describe several self-report tools that have been applied for measuring flow, beginning with ‘The Flow for Presence Questionnaire‘ and ‘The Flow State Scale.’

The Flow for Presence Questionnaire

The ‘Flow for Presence Questionnaire’ (FPQ) assesses the presence and flow state, with a company defined as “a sophisticated but covert form of monitoring action and experience, transparent to the self but critical for its existence” (Redaelli & Riva, 2011, p. 6). The rationale for focusing on presence concerning flow is that the company’s degree is predicted to control action and experience.

The FPQ is designed to measure flow for the presence within a synthetic environment; or, in other words, among users of technical devices. It is thus helpful in determining flow states among individuals working in industrial settings (Redaelli & Riva, 2011) or involved in virtual reality technologies (Jennett et al., 2008).

The FPQ is composed of three sections:

  1. Descriptions of the optimal experience (e.g., flow condition); with a focus on cognitive, affective, motivation, and skills and challenge categories;
  2. Point-ratings of daily life experiences; and
  3. The anti-flow expertise is included to enhance instrument validity (Redaelli & Riva, 2011).

A 5-point Likert scale assesses the degree of agreement with each question. This innovative instrument provides essential data regarding well-being among individuals working within technological environments.

Although more testing is needed, the scale has been examined in Italy, Estonia, and Korea. Researchers have suggested that multiple-scale improvements are required (i.e., clear and immediate feedback; clear goals; and increased participant sense of control) to increase the validity and reliability of this instrument (Redaelli & Riva, 2011).

The Flow State Scale

The purpose of ‘The Flow State Scale (FSS; Jackson & Eklund, 2002; Jackson & Marsh, 1996) is to measure flow experiences during physical activity. The scale is available in two formats: The original extended version and a modified short version.

The original version contains 36 items using a 5-point Likert scale to assess the degree of agreement with each item. The FSS includes the following dimensions:

  1. Challenge-skill balance;
  2. Action-awareness merging;
  3. Clear goals;
  4. Unambiguous feedback;
  5. Concentration on the task at hand;
  6. Sense of control;
  7. Loss of self-consciousness;
  8. Time transformation; and
  9. Autotelic experience (Jackson et al., 2008).

The extended version of the FSS helps investigate the incidence and influence of the above flow dimensions for different people and contexts.

Each dimension contains four questions, for example, in the domain of Action-awareness merging: ‘I do things spontaneously and automatically without having to think;’ and, in the field of Concentration on the Task at Hand: ‘I am entirely focused on the task at hand (Jackson et al., 2008).

The shorter version of the FSS also contains nine dimensions but only one question per dimension. The shorter scale, which uses the same response format as the original version, is handy for situations where the more extended version is not practical. Validation research has indicated good psychometric properties for both versions (Jackson et al., 2008).

Whether self-report, interview, observational, or experience sampling is used, it is essential to note that multimethod approaches that involve qualitative and quantitative measures are optimal for enabling a comprehensive understanding of flow (Jackson & Marsh, 1996).

This approach of using more than one type of measurement for a single construct, also termed ‘triangulation,’ enhances the validity of one’s research study by cross-verifying two or more sources.

20 More Useful Assessments

There are numerous additional self-report instruments for assessing flow. For ease of readability, these scales, along with those described above, are displayed in the following table:

Scale Authors Description
12 Item Flow Scale Mayers, 1978 Measures the frequency of flow experiences in specified activities. Contains 12 items and uses an 8-point semantic differential scale. Item examples include: ‘I clearly know what I am supposed to do;’ ‘I feel I can handle the demands of the situation;’ ‘I feel self-conscious;’ and ‘I enjoy the experience, and/or the use of my skills.’ It is unclear whether the scale has been validated.
Witmer and Singer Presence Questionnaire (PQ) Witmer & Singer, 1998 Measures presence following the use of immersive virtual environments. Factor analysis results for a 29-item version of the scale include the following domains: Involvement, Sensory fidelity; Adaptation/immersion; and Interface quality. Item examples include: ‘How responsive was the environment to actions that you initiated (or performed)?;’ ‘How compelling was your sense of moving around inside the virtual environment?;’ and ‘Were there moments during the virtual environment experience when you felt completely focused on the task or environment?‘ Validity analyses for this 29-item version have shown promise.
Immersive Tendencies Questionnaire (ITQ) Witmer & Singer, 1998 Measures deep engagement in activities, with the main focus on media use. Contains 18 items using a 7-point Likert scale. Item examples include: ‘Do you ever become so involved in a video game that it is as if you are inside the game rather than moving a joystick and watching the screen?‘ and ‘Do you ever become so involved in a television program or book that people have problems getting your attention?‘ Preliminary validation studies have shown promise.
Online Flow Questionnaire (OFQ) Chen, Wigand, & Nilan, 1999 Measures flow experiences during web use. Respondents are first asked both the number of years they’ve used the web and the number of hours they use the internet over a week. They are then asked to read a paragraph that contains several statements indicative of flow during web use, such as: ‘I am so involved in what I am doing;’ ‘I am really quite oblivious to my surroundings after I get going;’ and ‘The world seems to be cut off from me.’ Respondents then answer seven follow-up questions in which they indicate whether or not flow responses such as those above have occurred. If they respond ‘yes,’ they are asked to elaborate on their feelings during such experiences. Validation studies have shown satisfactory results for this scale.
The Flow State Scale (FSS; long version) Jackson & Eklund, 2002; Jackson & Marsh, 1996 Measures flow experiences during physical activity. The original extended version contains 36 questions designed to provide a fine-grained description of flow characteristics. The FSS uses a 5-point Likert scale. Item examples pertain to an event that has just happened include: ‘I know clearly what I want to do;’ ‘Things just seemed to be happening automatically;‘ and ‘I found the experience extremely rewarding.’ The scale has been validated.
The Flow State Scale (FSS; short version) Jackson & Eklund, 2002; Jackson & Marsh, 1996 Shortened (9-item) version of the FSS with one item per dimension. The scale has been validated.
Dispositional Flow Scale (DFS; long version) Jackson & Eklund, 2002; Jackson & Marsh, 1996 Measures the propensity to experience flow in a particular domain. The original extended version contains 36 questions with the same format as the FSS. Item examples pertain to a specific experience include: ‘I knew what I wanted to achieve;’ ‘It was no effort to keep my mind on what was happening;‘ and ‘I am not concerned with what others may be thinking of me.’ The scale has been validated among various groups, including internet gamers (Wang, Liu, & Khoo (2009) and musicians (Sinnamon, Moran, & O’Connell (2012).
Dispositional Flow Scale (DFS; short version) Jackson & Eklund, 2002; Jackson & Marsh, 1996 As with the FFS, the more extended version of the DFS was shortened to 9 items (one question per dimension). The scale has been validated.
Flow Short Scale Rheinberg, Vollmeyer, & Engeser, 2003 Contains 13 flow items measured on a 7-point Likert scale. The first ten items measure aspects of the flow experience, for example: ‘I feel just the right amount of challenge;’ ‘I am totally absorbed in what I am doing;’ and ‘I am completely lost in thought.’ The last three items measure perceived importance or outcomes of the flow experience, for example: ‘Something important to me is at stake here;’ and ‘I am worried about failing.’ The scale has been validated.
The Utrecht Work Engagement Scale (UWES) Schaufeli & Bakker, 2003 Measures degree of engagement in the work setting. Contains the following three dimensions: Vigor, Dedication, and Absorption. Includes 17 items and uses a 7-point Likert scale. Item examples include: ‘At my work, I feel bursting with energy;’ ‘To me, my job is challenging;’ and ‘Time flies when I’m working.’ The scale has been validated.
Questionnaire for measuring the flow state Choi & Kim, 2004 This brief (6-item) scale measures the flow state during online computer games using a 7-point Likert scale. Item examples include: ‘I was entirely absorbed while playing the online game;’ ‘I felt curious while playing the online game;’ and ‘playing the online game was interesting in itself.’ The psychometric qualities of this brief measure are unclear.
Situation-Specific Flow Questionnaire Oláh, 2005 Measures flow experience using 20 items, with 11 in the domain of Skills and Challenges; and nine in the field of Absorption and Activity. A 5-point Likert scale is used. Item examples include: ‘I felt I could meet the requirements of the situation;’ ‘My mind worked in total harmony with my body;’ and ‘Time passed faster than I thought it did.’ This scale has been validated.
GameFlow questionnaire Kiili &
Lainema, 2008
Measures flow experience in educational games. Contains 18 items using a 5-point Likert scale. The questionnaire comprises three parts: Flow antecedents, Flow state, and Flow consequences. Reliability is inconsistent between indicators. Scale development is still underway for this measure.
Work-Related Flow Inventory (LF) Bakker, 2008 Measures positive experiences and mental state during the workday. Contains 13 items and uses a 7-point Likert scale. Includes the following three components: The experience of complete absorption, Enjoyment, and Intrinsic motivation. Item examples include: ‘When I am working, I think about nothing else;’ ‘I do my work with a lot of enjoyment;’ and ‘I find that I also want to work in my free time.‘ The scale has been validated.
Core Flow Scale Martin & Jackson, 2008 The global measure is drawn from a larger scale that assesses task absorption and enhanced subjective experience. Contains nine items and uses a Likert scale. Item examples, which refer to participating in an activity, include: ‘I have a strong sense of what I want to do;’ ‘I have a feeling of total control;’ and ‘The experience is extremely rewarding.’ This brief measure has achieved adequate validation for use in certain situations (i.e., music, sports, and work).
Short Flow Scale Martin & Jackson, 2008 Measures the subjective flow experience itself. Contains ten items and uses a Likert scale. Item examples include: ‘I am in the zone,’ ‘It feels like I am in the flow of things;’ and ‘I am totally focused on what I am doing.’ The scale is correlated with the Core Flow Scale and has achieved adequate validation for use in certain situations (i.e., extracurricular, math, sport, and public school).
EGameFlow Fu, Su, & Yu, 2009 Measures learners’ Enjoyment of e-learning games. Helps inform scale developers about how to improve users’ flow experiences. Uses a 7-point Likert scale with 56 items within the following eight dimensions: Immersion, Social interaction; Challenge; Goal clarity; Feedback; Concentration, Control, and Knowledge improvement. Item examples include: ‘Generally speaking, I can remain concentrated in the game;’ ‘I enjoy the game without feeling bored or anxious;’ and ‘I forget about time passing while playing the game.’ The scale has been validated.
Game Engagement Questionnaire (GEQ) Brockmeyer et al., 2009 Measures deep engagement in video game playing and is beneficial for assessing the negative impact of violent games. Contains 19 items with a Likert response scale. Item examples include: ‘Playing seems automatic;’ ‘If someone talks to me, I don’t hear them;’ and ‘I feel like I just can’t stop playing.’ Preliminary validity studies show promising results.
Guo and Poole’s Inventory Guo & Poole, 2009 Measures flow during immersive human-computer interaction. Includes three precursors: Clarity of goals, Feedback, and Balance of challenge and skill. The following six dimensions of flow are included: Concentration, Perceived control; Mergence of action and awareness; Transformation of time; Transcendence of self; and Autotelic experience. The scale has been validated.
The Activity Flow State Scale (AFSS) Payne, Jackson, Noh, & Stine-Morrow, 2011 (adapted from Jackson & Marsh, 1996) Measures flow state using 34 items and a 5-point Likert scale. The AFSS was primarily adapted from Jackson’s FSS (Jackson & Marsh, 1996). Participants rate recent enjoyable activities. Item examples include: ‘I did things spontaneously without having to think;’ ‘I had a good idea while I was performing about how well I was doing;’ and ‘The experience was extremely rewarding.’ Preliminary research shows acceptable validity among older adults.
Flow for Presence questionnaire Redaelli & Riva, 2011 Measures presence and flow state among individuals working within a technological environment. Uses a 5-point Likert scale. It is a promising tool for today’s increased use of technology within a work setting. Preliminary validation studies have shown promise.
Flow State Questionnaire of the Positive Psychology Lab (PPL-FSQ) Magyaródi, Nagy, Soltész, Mózes, & Oláh, 2013 Measures the basic meta-dimensions of flow. Includes 20 items with a 5-point Likert scale. Item examples include: ‘Time passed faster than I thought it did;’ ‘The activity totally engrossed my attention;’ and ‘I knew exactly what I had to do, and I acted accordingly.’ Exploratory factor analyses have yielded promising results.

Commonly Asked Questions on Flow

As we understand the concept of flow, a few questions often arise, and we discuss them below.

1. Are there physiological ways to measure flow?

Flow researchers are increasingly interested in addressing the physiological correlates of flow. For example, Harmat et al. (2015) examined users’ frontal cortical oxygenation and sympathetic and parasympathetic activity during a self-reported flow state while playing the video game TETRIS.

Researchers found that flow state was associated with more considerable respiratory depth and increased parasympathetic activity. Similarly, researchers interested in cardiac and respiratory activity during video game flow states found that flow was related to faster respiratory depth, deeper respiration, moderate heart rate, moderate heart rate variability, and moderate skin conductance (Tian et al., 2017).

Combining physiological measures such as these with self-report tools makes a more comprehensive and objective view of flow experiences possible.

2. What are the various types of flow that researchers have measured?

Researchers have developed various measures as being ‘in the flow is a construct that applies to multiple situations.

For example, extant instruments have assessed flow in the workplace, during general computer use, during web use, video gaming, during educational gaming, during public media use (i.e., television watching), during various physical activities, during sports, during musical performances, during general school activities, during specific school subjects such as math, during creative endeavors, and during extracurricular activities.

Many additional flow scales are likely to be developed or adapted in many situations where a person may feel happily and spontaneously absorbed in a task.

3. How do I know which measure to use?

When considering the type of flow measure to choose, it is essential first to review your research questions. Suppose you wish to explore the flow construct in a way that captures rich subjective experiences and possibly enables new aspects of the concept to be discovered. In that case, a more qualitative approach (i.e., open-ended interviews, diary use, etc.) is needed.

On the other hand, if you would like to study the impact of flow between people or settings, then a self-report measure would represent a more suitable choice. As there are several self-report measures from which to choose, you will need to identify the best one for your study in terms of

  1. psychometric properties (e.g., whether the instrument has demonstrated validity and reliability among populations similar to yours);
  2. feasibility (e.g., whether the length and nature of the questionnaire are sensible for your study and participants); and
  3. your specific area of interest (e.g., whether the instrument adequately captures your construct; for example, flow at work, flow during computer use, flow during sports, etc.).

Researchers sometimes adapt an existing measure to their research questions when an ideal action does not yet exist. However, as this approach modifies the original scale, validity analyses will need to be conducted for the newly adapted scale.

A Take-Home Message

Human beings are generally inclined toward experiences that promote happiness, creativity, and productivity; achieving a flow state represents a natural objective for many. Positive psychology researchers interested in advancing ways to measure flow experiences have developed several instruments and methods available for applied use.

Also, because flow experiences contribute to positive school and workplace experiences, assessment and promotion of flow states represent important objectives for educators and employers. Methods that capture flow during human-computer interaction are especially salient today, given the current pace of technological advancements.

As flow studies provide crucial information about how best to foster psychological and emotional well-being, continued innovative and psychometrically rigorous methods for capturing flow states will continue to emerge.

REFERENCES
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Orthopedic doctor, rheumatologist, or physiotherapist depending on cause.

What to tell the doctor

  • Write which joints hurt, swelling, morning stiffness duration, fever, injury, and walking difficulty.
  • Bring X-ray, uric acid, ESR/CRP, rheumatoid factor, or previous reports if available.

Questions to ask

  • Is this injury, osteoarthritis, rheumatoid arthritis, gout, infection, or another cause?
  • Which exercises, supports, or lifestyle changes are safe?
  • Do I need blood tests or X-ray?

Tests to discuss

  • Joint examination and range of motion
  • X-ray when chronic arthritis or injury is suspected
  • ESR/CRP, uric acid, rheumatoid tests when inflammatory arthritis is suspected

Avoid these mistakes

  • Do not ignore hot swollen joint with fever.
  • Avoid repeated steroid injections/tablets without a clear diagnosis and follow-up.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: How Can We Measure Flow for Presence Questionnaire

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

How Can We Measure Flow?

Flow is a subjective experience, which creates a challenge in identifying psychometrically sound measurements (Jackson, Martin, & Eklund, 2008). Moreover, because the enjoyable flow experience represents both the reason for and outcome of engaging in an activity (Seifert & Hedderson, 2009), its measurement represents an additional challenge for researchers. Given its subjectivity, the most common way to measure flow is by asking respondents about their experiences, which has been achieved via the following methods: Interview questionnaires; Experience sampling methods; and…

1. Interview Measures Interviewing techniques are particularly suited to qualitative investigations of subjective constructs, such as flow. This is because interviewing aids researchers in refining or devising a way to measure a concept. Semi-structured interviews, which involve a combination of predetermined questions and evolve out of participants' responses, were often used in earlier research examining flow (Nakamura & Csikszentmihalyi, 2014). This approach, which may be conducted during an actual flow experience, enables rich and detailed exploratory analyses of a concept (Nakamura & Csikszentmihalyi, 2014). Accordingly, semi-structured interviewing has contributed significantly to understanding flow (Seifert & Hedderson, 2009). To increase construct validity, interview techniques are sometimes combined with observation methods. For example, in their examination of intrinsic motivation related to flow during skateboarding, Seifert, and Hedderson (2009) employed an ethnographical approach. Researchers first invested much time at a local skateboard park observing skaters and recording notes. Following the natural observation period, a randomly chosen skateboarder was administered a semi-structured, open-ended interview— thus combining observation and interview methodologies. This approach was beneficial for delving deeply into the flow experience and thus revealing a more vivid account of how participants perceived it (Seifert & Hedderson, 2009). 2. Experience Sampling Experience sampling is a self-report approach in which participants write diary notes describing their experiences as they happen (Csikszentmihalyi, Larson, & Prescott, 1977). Although there is variability in how this method is applied, diary notes are often entered over a week (Jackson et al., 2008). Experience sampling has been used quite a bit for the study of flow because it provides valuable information regarding the dynamics of emotions or subjective states (Magyaródi, Nagy, Soltész, Mózes, & Oláh, 2013). On the other hand, it is a time-consuming approach that is limited by selective answers, which can create issues surrounding privacy or illegal behaviors (Magyaródi et al., 2013). An example of experience sampling used to measure flow was conducted by Clarke and Haworth (1994). They used diary questions to examine whether optimal experiences occurred in situations where the challenge matched skill. While experience sampling has been around for a long time, it has been innovated over recent years by adding physiological measures and cell phone and computer applications (Magyaródi et al., 2013). 3. Self-report Questionnaires Self-report (aka paper and pencil) measures provide a valuable way for researchers to measure flow when "… the goal is not to identify but instead to measure dimensions of the flow experience or differences in its occurrence across contexts or individuals" (Nakamura & Csikszentmihalyi, 2009, p. 93). In other words, self-report measures are not exploratory; but enable the researcher to examine the construct's relationship to various qualities of interest (i.e., gender, ethnicity, age, occupation, setting, etc.). Self-report measures are also advantageous because they are both efficient and amenable to various types of analysis methods. A significant limitation of self-report measures, however, is response bias (e.g., the tendency for individuals to avoid truthful or accurate responses). Similarly, the value and utility of self-report measures are contingent upon their psychometric quality (e.g., validity and reliability). This article will describe several self-report tools that have been applied for measuring flow, beginning with 'The Flow for Presence Questionnaire' and 'The Flow State Scale.' The Flow for Presence Questionnaire The 'Flow for Presence Questionnaire' (FPQ) assesses the presence and flow state, with a company defined as "a sophisticated but covert form of monitoring action and experience, transparent to the self but critical for its existence" (Redaelli & Riva, 2011, p. 6). The rationale for focusing on presence concerning flow is that the company's degree is predicted to control action and experience. The FPQ is designed to measure flow for the presence within a synthetic environment; or, in other words, among users of technical devices. It is thus helpful in determining flow states among individuals working in industrial settings (Redaelli & Riva, 2011) or involved in virtual reality technologies (Jennett et al., 2008). The FPQ is composed of three sections: Descriptions of the optimal experience (e.g., flow condition); with a focus on cognitive, affective, motivation, and skills and challenge categories; Point-ratings of daily life experiences; and The anti-flow expertise is included to enhance instrument validity (Redaelli & Riva, 2011). A 5-point Likert scale assesses the degree of agreement with each question. This innovative instrument provides essential data regarding well-being among individuals working within technological environments. Although more testing is needed, the scale has been examined in Italy, Estonia, and Korea. Researchers have suggested that multiple-scale improvements are required (i.e., clear and immediate feedback; clear goals; and increased participant sense of control) to increase the validity and reliability of this instrument (Redaelli & Riva, 2011). The Flow State Scale The purpose of 'The Flow State Scale (FSS; Jackson & Eklund, 2002; Jackson & Marsh, 1996) is to measure flow experiences during physical activity. The scale is available in two formats: The original extended version and a modified short version. The original version contains 36 items using a 5-point Likert scale to assess the degree of agreement with each item. The FSS includes the following dimensions: Challenge-skill balance; Action-awareness merging; Clear goals; Unambiguous feedback; Concentration on the task at hand; Sense of control; Loss of self-consciousness; Time transformation; and Autotelic experience (Jackson et al., 2008). The extended version of the FSS helps investigate the incidence and influence of the above flow dimensions for different people and contexts. Each dimension contains four questions, for example, in the domain of Action-awareness merging: 'I do things spontaneously and automatically without having to think;' and, in the field of Concentration on the Task at Hand: 'I am entirely focused on the task at hand (Jackson et al., 2008). The shorter version of the FSS also contains nine dimensions but only one question per dimension. The shorter scale, which uses the same response format as the original version, is handy for situations where the more extended version is not practical. Validation research has indicated good psychometric properties for both versions (Jackson et al., 2008). Whether self-report, interview, observational, or experience sampling is used, it is essential to note that multimethod approaches that involve qualitative and quantitative measures are optimal for enabling a comprehensive understanding of flow (Jackson & Marsh, 1996). This approach of using more than one type of measurement for a single construct, also termed 'triangulation,' enhances the validity of one's research study by cross-verifying two or more sources. 20 More Useful Assessments There are numerous additional self-report instruments for assessing flow. For ease of readability, these scales, along with those described above, are displayed in the following table: Scale Authors Description 12 Item Flow Scale Mayers, 1978 Measures the frequency of flow experiences in specified activities. Contains 12 items and uses an 8-point semantic differential scale. Item examples include: 'I clearly know what I am supposed to do;' 'I feel I can handle the demands of the situation;' 'I feel self-conscious;' and 'I enjoy the experience, and/or the use of my skills.' It is unclear whether the scale has been validated. Witmer and Singer Presence Questionnaire (PQ) Witmer & Singer, 1998 Measures presence following the use of immersive virtual environments. Factor analysis results for a 29-item version of the scale include the following domains: Involvement, Sensory fidelity; Adaptation/immersion; and Interface quality. Item examples include: 'How responsive was the environment to actions that you initiated (or performed)?;' 'How compelling was your sense of moving around inside the virtual environment?;' and 'Were there moments during the virtual environment experience when you felt completely focused on the task or environment?' Validity analyses for this 29-item version have shown promise. Immersive Tendencies Questionnaire (ITQ) Witmer & Singer, 1998 Measures deep engagement in activities, with the main focus on media use. Contains 18 items using a 7-point Likert scale. Item examples include: 'Do you ever become so involved in a video game that it is as if you are inside the game rather than moving a joystick and watching the screen?' and 'Do you ever become so involved in a television program or book that people have problems getting your attention?' Preliminary validation studies have shown promise. Online Flow Questionnaire (OFQ) Chen, Wigand, & Nilan, 1999 Measures flow experiences during web use. Respondents are first asked both the number of years they've used the web and the number of hours they use the internet over a week. They are then asked to read a paragraph that contains several statements indicative of flow during web use, such as: 'I am so involved in what I am doing;' 'I am really quite oblivious to my surroundings after I get going;' and 'The world seems to be cut off from me.' Respondents then answer seven follow-up questions in which they indicate whether or not flow responses such as those above have occurred. If they respond 'yes,' they are asked to elaborate on their feelings during such experiences. Validation studies have shown satisfactory results for this scale. The Flow State Scale (FSS; long version) Jackson & Eklund, 2002; Jackson & Marsh, 1996 Measures flow experiences during physical activity. The original extended version contains 36 questions designed to provide a fine-grained description of flow characteristics. The FSS uses a 5-point Likert scale. Item examples pertain to an event that has just happened include: 'I know clearly what I want to do;' 'Things just seemed to be happening automatically;' and 'I found the experience extremely rewarding.' The scale has been validated. The Flow State Scale (FSS; short version) Jackson & Eklund, 2002; Jackson & Marsh, 1996 Shortened (9-item) version of the FSS with one item per dimension. The scale has been validated. Dispositional Flow Scale (DFS; long version) Jackson & Eklund, 2002; Jackson & Marsh, 1996 Measures the propensity to experience flow in a particular domain. The original extended version contains 36 questions with the same format as the FSS. Item examples pertain to a specific experience include: 'I knew what I wanted to achieve;' 'It was no effort to keep my mind on what was happening;' and 'I am not concerned with what others may be thinking of me.' The scale has been validated among various groups, including internet gamers (Wang, Liu, & Khoo (2009) and musicians (Sinnamon, Moran, & O'Connell (2012). Dispositional Flow Scale (DFS; short version) Jackson & Eklund, 2002; Jackson & Marsh, 1996 As with the FFS, the more extended version of the DFS was shortened to 9 items (one question per dimension). The scale has been validated. Flow Short Scale Rheinberg, Vollmeyer, & Engeser, 2003 Contains 13 flow items measured on a 7-point Likert scale. The first ten items measure aspects of the flow experience, for example: 'I feel just the right amount of challenge;' 'I am totally absorbed in what I am doing;' and 'I am completely lost in thought.' The last three items measure perceived importance or outcomes of the flow experience, for example: 'Something important to me is at stake here;' and 'I am worried about failing.' The scale has been validated. The Utrecht Work Engagement Scale (UWES) Schaufeli & Bakker, 2003 Measures degree of engagement in the work setting. Contains the following three dimensions: Vigor, Dedication, and Absorption. Includes 17 items and uses a 7-point Likert scale. Item examples include: 'At my work, I feel bursting with energy;' 'To me, my job is challenging;' and 'Time flies when I'm working.' The scale has been validated. Questionnaire for measuring the flow state Choi & Kim, 2004 This brief (6-item) scale measures the flow state during online computer games using a 7-point Likert scale. Item examples include: 'I was entirely absorbed while playing the online game;' 'I felt curious while playing the online game;' and 'playing the online game was interesting in itself.' The psychometric qualities of this brief measure are unclear. Situation-Specific Flow Questionnaire Oláh, 2005 Measures flow experience using 20 items, with 11 in the domain of Skills and Challenges; and nine in the field of Absorption and Activity. A 5-point Likert scale is used. Item examples include: 'I felt I could meet the requirements of the situation;' 'My mind worked in total harmony with my body;' and 'Time passed faster than I thought it did.' This scale has been validated. GameFlow questionnaire Kiili & Lainema, 2008 Measures flow experience in educational games. Contains 18 items using a 5-point Likert scale. The questionnaire comprises three parts: Flow antecedents, Flow state, and Flow consequences. Reliability is inconsistent between indicators. Scale development is still underway for this measure. Work-Related Flow Inventory (LF) Bakker, 2008 Measures positive experiences and mental state during the workday. Contains 13 items and uses a 7-point Likert scale. Includes the following three components: The experience of complete absorption, Enjoyment, and Intrinsic motivation. Item examples include: 'When I am working, I think about nothing else;' 'I do my work with a lot of enjoyment;' and 'I find that I also want to work in my free time.' The scale has been validated. Core Flow Scale Martin & Jackson, 2008 The global measure is drawn from a larger scale that assesses task absorption and enhanced subjective experience. Contains nine items and uses a Likert scale. Item examples, which refer to participating in an activity, include: 'I have a strong sense of what I want to do;' 'I have a feeling of total control;' and 'The experience is extremely rewarding.' This brief measure has achieved adequate validation for use in certain situations (i.e., music, sports, and work). Short Flow Scale Martin & Jackson, 2008 Measures the subjective flow experience itself. Contains ten items and uses a Likert scale. Item examples include: 'I am in the zone,' 'It feels like I am in the flow of things;' and 'I am totally focused on what I am doing.' The scale is correlated with the Core Flow Scale and has achieved adequate validation for use in certain situations (i.e., extracurricular, math, sport, and public school). EGameFlow Fu, Su, & Yu, 2009 Measures learners' Enjoyment of e-learning games. Helps inform scale developers about how to improve users' flow experiences. Uses a 7-point Likert scale with 56 items within the following eight dimensions: Immersion, Social interaction; Challenge; Goal clarity; Feedback; Concentration, Control, and Knowledge improvement. Item examples include: 'Generally speaking, I can remain concentrated in the game;' 'I enjoy the game without feeling bored or anxious;' and 'I forget about time passing while playing the game.' The scale has been validated. Game Engagement Questionnaire (GEQ) Brockmeyer et al., 2009 Measures deep engagement in video game playing and is beneficial for assessing the negative impact of violent games. Contains 19 items with a Likert response scale. Item examples include: 'Playing seems automatic;' 'If someone talks to me, I don't hear them;' and 'I feel like I just can't stop playing.' Preliminary validity studies show promising results. Guo and Poole's Inventory Guo & Poole, 2009 Measures flow during immersive human-computer interaction. Includes three precursors: Clarity of goals, Feedback, and Balance of challenge and skill. The following six dimensions of flow are included: Concentration, Perceived control; Mergence of action and awareness; Transformation of time; Transcendence of self; and Autotelic experience. The scale has been validated. The Activity Flow State Scale (AFSS) Payne, Jackson, Noh, & Stine-Morrow, 2011 (adapted from Jackson & Marsh, 1996) Measures flow state using 34 items and a 5-point Likert scale. The AFSS was primarily adapted from Jackson's FSS (Jackson & Marsh, 1996). Participants rate recent enjoyable activities. Item examples include: 'I did things spontaneously without having to think;' 'I had a good idea while I was performing about how well I was doing;' and 'The experience was extremely rewarding.' Preliminary research shows acceptable validity among older adults. Flow for Presence questionnaire Redaelli & Riva, 2011 Measures presence and flow state among individuals working within a technological environment. Uses a 5-point Likert scale. It is a promising tool for today's increased use of technology within a work setting. Preliminary validation studies have shown promise. Flow State Questionnaire of the Positive Psychology Lab (PPL-FSQ) Magyaródi, Nagy, Soltész, Mózes, & Oláh, 2013 Measures the basic meta-dimensions of flow. Includes 20 items with a 5-point Likert scale. Item examples include: 'Time passed faster than I thought it did;' 'The activity totally engrossed my attention;' and 'I knew exactly what I had to do, and I acted accordingly.' Exploratory factor analyses have yielded promising results. Commonly Asked Questions on Flow As we understand the concept of flow, a few questions often arise, and we discuss them below. 1. Are there physiological ways to measure flow?

Flow researchers are increasingly interested in addressing the physiological correlates of flow. For example, Harmat et al. (2015) examined users' frontal cortical oxygenation and sympathetic and parasympathetic activity during a self-reported flow state while playing the video game TETRIS. Researchers found that flow state was associated with more considerable respiratory depth and increased parasympathetic activity. Similarly, researchers interested in cardiac and respiratory activity during video game flow states found that flow was related to faster respiratory depth, deeper respiration, moderate…

2. What are the various types of flow that researchers have measured?

Researchers have developed various measures as being 'in the flow is a construct that applies to multiple situations. For example, extant instruments have assessed flow in the workplace, during general computer use, during web use, video gaming, during educational gaming, during public media use (i.e., television watching), during various physical activities, during sports, during musical performances, during general school activities, during specific school subjects such as math, during creative endeavors, and during extracurricular activities. Many additional flow scales are likely…

3. How do I know which measure to use?

When considering the type of flow measure to choose, it is essential first to review your research questions. Suppose you wish to explore the flow construct in a way that captures rich subjective experiences and possibly enables new aspects of the concept to be discovered. In that case, a more qualitative approach (i.e., open-ended interviews, diary use, etc.) is needed. On the other hand, if you would like to study the impact of flow between people or settings, then a…

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.