Artifact in client satisfaction assessment: experience in community mental health settings

Artifact in client satisfaction assessment is discussed and the results of a study of three factors thought to mediate client satisfaction ratings; (a) general life satisfaction, (b) mode of administration, and (c) psychological symptomatology, are reported. A standard client satisfaction questionnaire (CSQ) was modified to yield parallel forms and was administered orally and in writing to 92 clients in two mental health day treatment programs. Satisfaction ratings obtained from these clients were quite similar to out-patient ratings obtained in previous studies conducted in this setting and using the same measures. Oral administration of the CSQ produced 10% higher satisfaction ratings than written administration (p less than .05) and less missing data (p less than .01). Satisfaction ratings were also obtained using a simple graphic instrument. Graphic ratings were comparable to CSQ ratings. Satisfaction with life in general and level of psychiatric symptoms together accounted for 25% of CSQ variance. The implication of these findings for future client satisfaction research is discussed.     

Post-traumatic stress disorder and health-related quality of life in female victims of intimate partner violence

The association between post-traumatic stress disorder (PTSD) and health-related quality of life (QOL) in female victims of intimate partner violence (IPV) was examined. The Short-Form Health Survey (SF-36) was used to evaluate health-related QOL. IPV victims with PTSD (IPV/PTSD+; n = 18), IPV victims without PTSD (IPV/PTSD-; n = 22), and a non-abused control group (NA; n = 30) were compared. Multiple Analyses of Covariance (covarying for socioeconomic status and age) indicated that the three groups scored significantly differently on health-related QOL, and the IPV/PTSD- group was significantly more impaired than the NA group. IPV/PTSD+ subjects were significantly more impaired than IPV/PTSD- subjects on physical functioning, mental health, vitality, role limitations due to emotional health, and social functioning. Multiple regression analyses indicated that PTSD severity was a significant statistical predictor of SF-36 mental health composite scores (but not of physical health composite scores), after controlling for depressive symptomatology and extent of physical and psychological abuse.     

Quality of life in the evaluation of community support systems

As a result of the authors' experience in conducting an evaluation of the community support system (CSS) program in New York State, they have identified five reasons for focusing on quality of life (QOL) as a desired outcome for programs for the chronically ill. These reasons are presented and problems in QOL evaluative research are discussed. Psychological indicators are distinguished from social indicators of QOL, and two methods of operationalizing perceived QOL, the psychological well-being and life domains methods, are examined. A conceptual model is presented and the results of an exploratory study of the QOL of 118 chronic psychiatric patients receiving CSS services are presented.     

A validity scale for the Sharp consumer satisfaction scales.

Because of the apparently inflated scores commonly reported for consumer satisfaction with mental health services, we developed a 5-item validity scale for the SHARP questionnaire. The scale discriminated significantly (P less than .001) between those former clients who offered suggestions for improvement of services and those who did not (N = 38). In another experiment, the scale significantly improved the ability to predict the 46 clients' true scores from their obtained scores via stepwise regression (p less than .01). Weights were obtained from that sample of former clients, which significantly reduced the deviation of the obtained satisfaction scores from the true scores, with all p less than .05. In two successive experiments (N = 49 and 26), weights were applied to new samples, significantly reducing deviation from the criterion scores for 5 of the 6 scales (p less than .05), and new weights were then derived. A final set of weights was derived from the combined samples of the three experiments, (N = 121) which significantly improved prediction of the criterion and lowered the mean on all scales, with all p less than .05.     

The influence of acculturation level and family relationships on quality of life among U.S. Chinese older adults

ABSTRACT

The present study examined the influence of acculturation level and family relationships (i.e., positive family support and negative family strain) on quality of life (QOL), using the data from the Population Study of ChINese Elderly (PINE) in Chicago (N = 3159). Controlling for sociodemographic variables and health status, it was found that individuals’ acculturation level and positive family support were positively related to QOL, whereas negative family strain was negatively associated with QOL. More importantly, higher acculturation levels were associated with increased protective effects of positive family support and reduced risk effects of negative family strain on QOL among U.S. Chinese older adults.     

The validity of assessing mental health needs with social indicators.

Selection of the appropriate number and types of social indicators for use in mental health planning has been a perennial problem. Social indicators have been associated with several concepts (quality of life, community disorganization, populations at risk) of varying relevance for planning mental health services, and abstracting social indicators from these conceptual domains poses a variety of validity issues. The issues are discussed, and the viability of social indicators in mental health planning is reexamined.     

The dysfunctional side effects of quantitative indicator production: illustration from mental health care (a message from Chicken Little)

In the current context of economic conservation, accountability and retrenchment from social programs, justification is required in order to maintain human service capacity. In this effort, evaluation is a key component. Yet desire to base action upon information resulting from evaluation must be tempered by increased attention to the effects of the evaluation process. All too often premature application of quantitative indicators formerly used for individual assessment and research to bureaucratic decision making produces side effects that are dysfunctional in nature. Frequently these side effects influence service delivery directly. More insidious, because they are less easily discerned, are distortions introduced into the data by evaluation pressure. These not only delay effects on service but also impair understanding of the very process they are meant to illuminate. In order to illustrate this phenomenon, the author reviews a general literature and utilized examples from mental health care. Common themes are identified and a tentative theory of side effect generation proposed.     

Quality of Life and Subjective Well-Being

Abstract

There is a propensity in the social work profession to base programmatic theories on knowledge derived from other disciplines. A term that has found wide acceptance in the profession of social work is the concept of quality of life (QOL). Over the last two decades QOL has emerged as an organizing framework for assessing health indices within the medical and mental health fields. In relation to QOL, there is a need for a comprehensive understanding of the concept in order to ascertain its congruence with, and potential shaping of, the values and ethos of the profession. The paper gives a clear and straightforward introduction to a range of work. The main objective is to examine the individual work of certain researchers and thinkers in their independent search for the methods of measuring subjective states. A review of these separate efforts will reveal an internal coherence and overlap of work that is responsible for the way QOL is presently conceptualized.     

Relationship of sleep quality and attention deficit hyperactivity disorder symptoms with quality of life in college students

Abstract

Objective: Attention deficit hyperactivity disorder (ADHD) negatively influences various aspects of life such as social relations, adaptive skills, and occupation. In addition, many university students experience sleep problems, academic failure, and low quality of life (QOL). We investigated the relationship among ADHD symptoms, sleep quality, and QOL of college students, and identified the factors related to their QOL. Participants and Methods: Using a survey questionnaire, data were collected from 195 students from March–May 2017. Results: QOL of students was related to ADHD symptoms and sleep quality. Factors significantly associated with better QOL were fewer ADHD symptoms, good sleep quality, male sex, high academic performance, and high economic status. The explanatory power of these variables on QOL was 32.0%. Conclusion: To improve the QOL of college students, a multifaceted approach that includes assessment of ADHD symptoms and sleep quality is needed.     

Bildung und Gesundheitsungleichheit im Alter: Divergenz, Konvergenz oder Kontinuit?t?

It is well established that health at an old age is influenced by education acquired earlier in life. Empirical evidence on the extent of health decline across educational levels, however, is heterogeneous. It remains unclear whether the health gap between individuals with high and low levels of education increases in old age (divergence), decreases (convergence), or whether it remains constant (continuity). In the present study, we investigate the effects of education on health changes with data from two waves (2004, 2007) of the Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents aged 50?C80. We estimate OLS regression models drawing on 12 indicators of physical, mental and cognitive health. Our aim is to obtain more generalizable results about the age trajectories of health inequality. We find that divergence is the main pattern of health decline across educational levels: The health gap between individuals with high and low educational levels increases for the indicators of grip strength, limitations of general and of instrumental activities of daily living, mobility limitations, depressive symptoms, numerical ability, and time orientation. For single indicators, however, we also observe continuous (chronic diseases, subjective health assessment, memory) and convergent (fluency of speaking) patterns.     

Evaluation of quality of life in patients undergoing surgery for benign prostatic hyperplasia

Abstract

Introduction: Benign prostatic hyperplasia (BPH) is one of the most common diseases in the world and also one of the most common causes of urinary complaints that occur with increasing age. Thus, BPH should be addressed with surgical procedures. To contribute to the relevant literature, the present study aims to investigate the effects of surgical therapies for BPH on the patients quality of life.

Materials and methods: This study included 120 patients who underwent surgery for BPH at a Training and Research Hospital. The short-form health survey (SF-36) was administered to the patients before the surgery and at three months after the surgery. Eight parameters of the SF-36 and mental (MCS) and physical (PCS) component summary scores were calculated. The Student’s t-test, Wilcoxon, and chi-square test were used in the statistical analysis.

Results: When the eight parameters within the SF-36 health questionnaire were examined separately, the findings showed that patients quality of life increased significantly with respect to physical functioning, social functioning, and role limitations because of emotional problems , vitality, bodily pain, general health perceptions, and mental health domains three months after surgery (p?<?.001). The PCS and MCS significantly increased after surgery (p?<?.001).

Conclusion: The SF-36 questionnaire results showed that a significant improvement in the patients quality of life was observed in patients who underwent surgery for BPH. Our findings suggest that SF-36 could be considered a reliable evaluation test to be used in the patients with BPH after surgery.     

Adolescents’ Subjective Social Status Predicts Day‐to‐Day Mental Health and Future Substance Use

Adolescents’ subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross‐sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low‐SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18‐month follow‐up. Results showed that with each perceived step “up” the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.     

A learning collaborative approach to training school-based health providers in evidence-based mental health treatment

Collaborative care models among pediatric primary care and child and adolescent mental health providers are increasingly emphasized to improve quality of and access to mental health services. The current case example of a multi-site clinical training opportunity in school-based collaborative care settings illustrates the success of a learning collaborative approach to improve children's mental health care in schools. Quality improvement data from participating sites indicated an increase in use of evidence-based practices (i.e., “core skills”) and an improvement in quality service delivery indicators for children's mental health (i.e., screening, risk assessment, diagnostic processes, associated diagnostic coding, use of core skills, associated procedural coding, and follow-up assessment and referral) over time. Clinician self-report and chart review data are supplemented by qualitative data from site leader interviews conducted following completion of the project. Implications for mental health workforce development to improve the quality of care to children and adolescents in schools and other community mental health settings are discussed.     

A Mixed Methods Study of Recently Homeless Youth Efforts to Sustain Housing and Stability

This study examined the process of establishing post homeless lives among 51 recently homeless youth in two major urban centers in Canada. A mixed methods strategy was employed to characterize this process. Quantitatively, a range of mental health, community integration, and quality of life measures were employed four times over the course of 1 year to describe how these indicators of wellbeing shifted in this period. It was found that over the course of 1 year gains were not made in community integration, quality of life and mental health were highly variable, and hope declined significantly. Further, it was found that youth in supported housing arrangements experienced better mental health and community integration. Qualitatively, we identified three major stages in the process of exiting homelessness. These stages included a period of substantial fluctuation and instability, a period of gaining a basic level of stability but being demoralized due to difficulties making progress with life goals, and a period of making some gains with life goals which cultivated a sense of hope. Progress across these stages, which took place in a timeframe considerably longer than 1 year, was characterized by a range of setbacks, individual and systemic challenges, and trauma which were addressed through a persistent effort facilitated by youth resilience and key supports.     

The quality of life concept in sociology

An interdisciplinary concept, quality of life (QOL) has gained prominence in research in psychology, marketing, and several other disciplines. What is its status in sociology? Arising out of the social indicators“movement,” QOL has gained attention as both objective and subjective measures. Precursors of the concept figured in sociological research in the 1930s on level and plane of living. Now, it is recognized in one sociological encyclopedia, a textbook, and a few sociological monographs, but otherwise has gained little coinage in general sociology. One social problems text has adopted it as an organizing theme. With these modest inroads, the components of QOL, such as inequality, income, crime, the environment, etc., always have been prominent in sociology. When QOL is recognized in theory and when legislatures require its use in evaluation of public programs, the concept will become established in sociological research.     

Validating quality indicators. Quality as relationship between structure, process, and outcome

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.     

Lunacy revisited. The influence of the moon on mental health and quality of life

The idea that the stars and planets may influence human health and behavior can be traced to at least Roman times, and research suggests a high proportion of health professionals continue to hold this belief. Nevertheless, evidence for the supposed influence of the moon on human behavior has proved particularly elusive, and research has tended to suffer from weaknesses in methodology and data analysis. This article reports findings drawn from a re-analysis of data from a research study into the functioning of a sample of mentally ill people living in the community. The mental health and quality of life of a sample of 100 people were assessed on four occasions during a 30-month period. Data were aggregated to represent the span of one lunar month, with scores being allocated to the relevant week of the lunar cycle during which each assessment was made. Comparison of mean values across the weeks of the lunar cycle was preformed using the ANOVA, Results showed significant change at the time of the full moon only in subjects with a diagnosis of schizophrenia (n = 56), where deterioration was observed in three areas of psychopathology and one area of quality of life. Some implications for nursing practice are discussed, and it is suggested that future research into the possibility of a lunar effect on human life should focus on the direct measurement of functioning in people with schizophrenia.     

Health Information Seals of Approval: What do they Signify?

Much of the health information available to consumers on the Internet is incomplete, out of date and even inaccurate. Seals of approval or trustmarks have been suggested as a strategy to assist consumers in identifying high-quality information. Little is known, however, about how consumers interpret such seals. This study addresses this issue by examining assumptions about the quality criteria that are reflected by a seal of approval. This question is of particular importance because a wide variety of quality criteria have been suggested for online health information, including: core aspects of quality such as accuracy, currency and completeness; proxy indicators of quality such as the disclosure of commercial interests; and indicators that reflect the quality of the site or the interaction it affords, such as the availability of a search mechanism. The results of this study suggest that seals of approval are assumed to certify information quality primarily with respect to core quality indicators, aspects that subjects both consider to be important and feel relatively less able to evaluate for themselves (compared with their ability to rate proxy indicators of information or indicators of site or interaction quality). This assumption is largely inconsistent with practice: most seals of approval involve assessment of proxy indicators of information quality, rather than direct assessment of content. These results identify a problem that certification or accreditation bodies must address since, unless and until consumer expectations are congruent with evaluation practice, seals of approval will seem to promise more than they deliver.     

The Impact of Low Socioeconomic Status and Perceived Discrimination on Parental Perceptions of the Well-Being of Latino Children

This exploratory study examined the impact of low socioeconomic status (SES) and perceived discrimination on Latino parents’ perceptions of their children’s mental health issues. Anti-immigrant policies and negative public discourse lead to perceived discrimination among Latinos, which may impact mental health. Participants (106), surveyed in 2011, were Latino, predominantly female, had a mean of 14 years living in the United States, and less than 9 years of education. The results of multivariate ordinary-least-squares regressions indicated that participants with lower levels of SES had significantly greater (p < .05) perceptions that their children were angry, had separation anxiety from parents, were fearful, and avoided social situations. Higher levels of perceived discrimination were significantly related (p < .05) to participants’ perceptions of fear among their children. Social service providers must assess for possible mental health issues and develop culturally appropriate intervention strategies to effectively address these issues with parents and children.     

Improving physical and mental health in frontline mental health care providers: Yoga-based stress management versus cognitive behavioral stress management

The need for brief, low-cost, easily disseminable, and effective interventions to promote healthy lifestyles is high. This is especially true for mental health providers. The authors developed two studies to compare the impacts of Cognitive Behavioral Stress Management (CBSM) and Yoga-Based Stress Management (YBSM) interventions for health care professionals. Study 1 offered an 8-week YBSM intervention to 37 mental health care participants and collected health data pre- and post. Study 2 offered YBSM and CBSM classes to 40 randomly assigned mental health care providers and collected mental and physical health data at four time points. In Study 1, using t tests, the YBSM intervention affected a number of mental and physical well-being indices pre to post. In Study 2, using linear mixed modeling, YBSM and CBSM groups both improved significantly (p?p?F?=?4.34), physical activity (YBSM increased more, p?F?=?3.47), overall mental health (YBSM increased more, p?F?=?5.32), and secondary traumatic stress (YBSM decreased more, p?F?=?4.89). YBSM and CBSM appear to be useful for health care professionals’ mental and physical health. YBSM demonstrates some benefit above and beyond the extremely well studied and empirically supported CBSM, including increased physical activity, overall mental health, and decreased secondary traumatic stress benefits.