Measuring Quality of Life

This paper considers quality of life (QOL) to be a global, yet unidimensional, subjective assessment of one's satisfaction with life. This conceptualization is consistent with viewing QOL assessments as resulting from the interaction of multiple causal dimensions, but it is inconsistent with proposals to limit QOL to health-related quality of life (HRQOL). We test the unidimensional yet global conceptualization of QOL using data from coronary artery bypass graft (CABG) patients. The Self-Anchoring Striving Scale (SASS) and four other indicators derived from the literature, all seemed to function as indicators of a single concept (QOL) that was repeatedly drawn upon as the patients determined their responses to these indicators. However, only about half the variance in each indicator was attributable to that common QOL source. Several structural equation models are used to assess whether the superior performance of the Life 3 indicator is an artifact of the repetition of an item within this indicator. The data convincingly indicate that the superior performance is not a memory artifact, and that even the repetition of an identically worded item prodded the patients into drawing yet again upon the same QOL factor that grounded all the other measures.     

Marketing and Quality of Life: A Model for Improving Perinatal Health Status

Introduction: A marketing/business model using non-traditional Quality of Life measures was developed to assess perinatal health status on a micro-geographic level. This perinatal health status needs assessment study for Georgia South Central Region was conducted for the years 1994–1999. The model may be applied to any geographic unit in the U.S. – from a block group level to a state or a region. Methodology: An Infant Health Risk Score was created for each county and census tract by calculating the Z-scores of various Medical, Lifestyle, and Access variables so as to construct a Quality of Life Index. The scores identified the areas in the region that were at high risk for certain medical, lifestyle, and access variables (i.e., high risk for preterm births, low education levels, and poor access to perinatal services). A marketing tool, Claritas PRIZM Clusters, was used to identify a specific cluster and associated marketing information for each census tract within the region. Results: The Infant Health Quality of Life Risk Scores were linked with the PRIZM cluster marketing data to target areas in the region that exhibit high risk medical, lifestyle, and access scores. Health promotion and disease prevention strategies were developed using a marketing/business model. Specifically, media usage and consumer behavior purchasing patterns were identified and processed for every high risk area in the region. The categories for media usage were television, radio, and magazines and the categories for consumer behavior included restaurants, food items, and shopping locations. Discussion: The Perinatal Region is developing strategies to implement the media usage and consumer behavior marketing information to focus their prevention efforts to the high risk areas in the region based on the Quality of Life Measurements. Linking marketing business tools with a Quality of Life health status needs assessment has significant potential for improving the planning, the evaluation, and the focus of prevention efforts.     

Marketing and Quality of Life: A Model for Improving Perinatal Health Status

Introduction: A marketing/business model using non-traditional Quality of Life measures was developed to assess perinatal health status on a micro-geographic level. This perinatal health status needs assessment study for Georgia South Central Region was conducted for the years 1994–1999. The model may be applied to any geographic unit in the U.S. – from a block group level to a state or a region. Methodology: An Infant Health Risk Score was created for each county and census tract by calculating the Z-scores of various Medical, Lifestyle, and Access variables so as to construct a Quality of Life Index. The scores identified the areas in the region that were at high risk for certain medical, lifestyle, and access variables (i.e., high risk for preterm births, low education levels, and poor access to perinatal services). A marketing tool, Claritas PRIZM Clusters, was used to identify a specific cluster and associated marketing information for each census tract within the region. Results: The Infant Health Quality of Life Risk Scores were linked with the PRIZM cluster marketing data to target areas in the region that exhibit high risk medical, lifestyle, and access scores. Health promotion and disease prevention strategies were developed using a marketing/business model. Specifically, media usage and consumer behavior purchasing patterns were identified and processed for every high risk area in the region. The categories for media usage were television, radio, and magazines and the categories for consumer behavior included restaurants, food items, and shopping locations. Discussion: The Perinatal Region is developing strategies to implement the media usage and consumer behavior marketing information to focus their prevention efforts to the high risk areas in the region based on the Quality of Life Measurements. Linking marketing business tools with a Quality of Life health status needs assessment has significant potential for improving the planning, the evaluation, and the focus of prevention efforts.     

Conceptualizing and Measuring Quality of Life for National Policy

The interests in social indicators andsocial reporting started in the 1960s with thenew awareness of poverty in the midst ofaffluence. In this paper I first discuss thepoverty concept and its implication for socialpolicy strategy. The poverty concept should bebut one in a system of concepts that throwslight on the whole distribution of income andwealth and how income from labor as well asincome from capital is generated. The centralconcepts in the system are income and economicstandard, which I explain in differentperspectives on command over resources.The command-over-resources concept is usedto get from a narrow concept of materialwelfare that can be measured in money to awider concept of welfare that includes theuniversal common social concerns. I confess tobeing intrigued by the fact that a list ofsocial concerns can be agreed upon that seemsto be relevant across cultures, politicalsystems and times. I suggest that thissurmised universality springs from the great``life projects'' that all humans face over thelife cycle.I then discuss the role of social indicatorsand social reporting as continuous informationon these common concerns in the context of anepistemology of the democratic process. Socialreporting would serve the democratic processbest if it answers ``how it is'' and leaves theanswers on ``how it ought to be'' and ``whatshould be done'' to come about throughdiscussion among citizens.     

Objective and Subjective Quality of Life: an Interactive Model

This paper reviews the relationship between objective and subjective quality of life indicators. It proposes that the interaction of these variables occurs within a system that homeostatically maintains subjective quality of life within a narrow range. Due to the capacity of this system to adapt to varying environmental circumstances, the objective and subjective indicators are normally poorly correlated. However, it is also proposed that very poor objective conditions can defeat homeostasis and, once this occurs, the objective and subjective indicators display stronger covariation. Empirical data are provided to support this model and the implications for understanding the QOL construct are discussed.     

Health and the Quality of Life

The aim of this investigation was to explain theimpact of peoples self-reported health on theirlevels of satisfaction with their health, and theimpact of these things plus satisfaction with otherspecific domains of their lives on the perceivedquality of their lives. The latter was operationalized as general happiness, satisfactionwith life as a whole and overall satisfaction with thequality of life. Seven hundred and twenty-three (723)usable questionnaires returned from a mailout randomsample of 2500 households of Prince George, BritishColumbia in November 1998 formed the working data-setfor our analyses. Among other things, mean respondentscores on the SF-36 health profile were found to belower than published norms from the UK, USA,Netherlands and Sweden, but higher than scores fromAberdeen, Scotland. Mean scores on the CES-Ddepression scale also indicated that our respondentstended to have more depressive symptoms thancomparison groups in Winnipeg and the USA. A review oftrends in mean scores on 17 quality of life items(e.g., satisfaction with family life, financialsecurity, recreation, etc.) from 1994, 1997 and 1998revealed that there were only 7 statisticallysignificant changes across the four year period andthey were all negative. Multivariate regressionanalysis showed that health status measured with avariety of indicators could explain 56% of thevariation in respondents reported satisfaction withtheir health. A combination of health status plusdomain satisfaction indicators could explain 53% ofthe variation in respondents reported happiness, 68%of reported life satisfaction and 63% of reportedsatisfaction with the overall quality of life. Sixtypercent of the explained variation in happiness scoreswas attributable to self-reported health scores, whileonly 18% of the explained variation in satisfactionwith life and with the overall quality of life scoreswas attributable self-reported health scores.     

Construct and Criterion Validity of a Norwegian Instrument for Health Related Quality of Life Among Elderly Women Living at Home

Purpose of the study: The aim of the current study is to validate an instrument consisting of five items and first used in the Nord-Trondelag Health Survey (HUNT-5), as a measure of health related quality of life (QOL) in a population of elderly women living at home. Design and methods: A random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) and living at home were interviewed using the HUNT-5 instrument, the 20-question version of the General Health Questionnaire (GHQ-20) and the respondents’ records of their health status and functional ability. Results: No significant relationships were found between age and the sumscores of GHQ-20 and HUNT-5. Factor analysis indicated that HUNT-5 is primarily unidimensional. The Cronbach α for HUNT-5 was 0.79 and that for GHQ-20 was 0.87. The correlation between the HUNT-5 and the GHQ-20 sumscores was 0.75 (p < 0.001). There were significant correlations between some of the health and function items and the two QOL instruments (ranging from 0.14 to 0.68). Implications: This evaluation supports the psychometric validity of HUNT-5 for elderly women living at home. It is important to take into consideration the women’s own experience of their health and functional ability in planning therapy and in obtaining the best possible QOL for them.     

Self Report Co-Morbidity and Health Related Quality of Life – A Comparison with Record Based Co-Morbidity Measures

The purpose of this projectwas to compare three hospital-based measures ofco-morbidity to patient self-reportco-morbidity and to determine the relativeproportion of outcome predicted by each of theco-morbidity measures in a population ofindividuals receiving major joint arthroplasty. Baseline measures using the SF-36 generalhealth questionnaire and the Western OntarioMcMaster Osteoarthritis Index (WOMAC) wereobtained from 518 persons undergoing total kneeor hip replacement. A second measure wasobtained six months post-surgery. Co-morbiditywas calculated by summing the self-reportedco-morbidity at baseline, using both thechart-based and administrative data version ofCharlson's Co-morbidity Index, and by summingthe number of International Classification ofDiseases – Version 9 (ICD-9) codes appearingin the electronic health record. Linearregression was used to determine how much ofthe variation in outcome was explained by eachof the co-morbidity measurement methods. Self-report co-morbidity explained as muchvariation in outcome as the hospital-basedindices. Self-report co-morbidity did notperform as well as the other methods inexplaining the variance in health systemutilization. It was concluded that self-reportco-morbidity is minimally as useful asrecord-based systems when measuring the impactof co-morbidity on health related quality oflife (HRQL). This is an important finding, asprivacy legislation, the time until data isavailable and cost are all barriers to usingrecord-based co-morbidity measures.     

Quality of Work Life: Theoretical and Methodological Problems, and Presentation of a New Model and Measuring Instrument

Purpose: Ever since the concept of Quality of Work Life (QWL) was first used over 30 years ago, a range of definitions and theoretical constructs have succeeded each other with the aim of mitigating the many problems facing the concept. A historical overview of the concept of QWL is presented here. Given the lack of consensus concerning the solutions that have been developed to date, a new definition of QWL is suggested, inspired by the research on a related concept, general Quality of Life (QOL) which, as the literature shows, has faced the same conceptualization and definition problems as QWL. Based on the suggested definition of QOL, a definition of QWL is provided and the measuring instrument that results therefrom (the Quality of Working Life Systemic Inventory – QWLSI) is presented. Finally, the solutions that this model and measuring instrument provide for the above-mentioned problems are discussed.     

Techniques For Developing Health Quality of Life Scales for Point of Service Use

Clinical and health policy research frequently involves health status measurement using generic or disease specific instruments. These instruments are generally developed to arrive at several scales, each measuring a distinct domain of health quality of life (HQOL). Clinical settings are starting to explore how to integrate patient perspectives of HQOL outcomes into patient care. However, the length of many HQOL instruments poses a challenge in terms of patient burden, as well as clinic flow time. The most popular paradigm for scale construction utilizes classical test theory methodology and can lead to excessive and redundant items in an effort to bolster reliability measurements such as Cronbach’s alpha above levels of accepted reliability. This paper presents techniques for utilizing item response theory to arrive at single item scales that are diagnostically informative and short enough to have clinical utility. A danger of such dramatic scale reduction is that validity might be compromised. This danger is addressed in terms of criterion related validity and sensitivity to clinical changes over a 36 months period. The reduction methods are illustrated using selected scales from the Arthritis Impact Measurement Scales 2 (AIMS2) with data obtained from the study Pharmaceutical Care Outcomes: The Patient Role (PCOPR).     

Measuring Quality of Life in Small Areas Over Different Periods of Time

The purpose of this paper is todescribe an index methodology for measuringquality of life, understood multidimensionally,in a set of very different municipalities,units of measurement, and time periods.Although certain technical problems arise whensmall areas (municipalities) are considered,cross and serial comparison is completed. Themethodology was applied in 314 municipalitiesof the province of Barcelona (Spain).     

The Impact of Globalization on a Country's Quality of Life: Toward an Integrated Model

The purpose of the paper is to develop a set of theoretical propositions to explain the impact of globalization on a country's quality of life (QOL). In this paper, we describe how globalization impacts the quality of life of residents of a country by first articulating the globalization construct (in terms of inflows and outflows of goods, services, capital, technology, and workers), second, articulating the country's QOL construct (in terms of economic, consumer, social, and health well being), and showing the relationships between globalization and a country's QOL. We develop a set of theoretical propositions to capture these relationships. Finally, we discuss the public policy and research implications of this study.     

Measuring Stability and Change: Methodological Issues in Quality of Life studies

The aim of the paper is to show how the variety of approaches to study social change may result in a challenging complexity for the social scientist, starting from the difficulty of defining the concept of “change” itself and managing it through observed data. This is particularly true in presence of complex phenomena, such as those defining and composing the quality of life. What should be pointed out is that quality of life studies not only are focused on the present time but have also long term perspectives. This represents the link between studies on quality of life and forecasting. When applied to the field of quality of life, the typical logical approach to forecasts, based upon inferential statistics, could reveal its limits. Those limits are related to different aspects: e.g., the forms of relationships between different aspects of the phenomenon, which can be linear and non-linear; the dimensionality of phenomenon, which can turn out to be very complex; the causality, which could be direct or indirect; the entity of change, which implies the idea that also small change can have great impact; the perspective of observation, which can be internal or external and local or global. Consequently, the study of change related to quality of life needs, in addition to the traditional statistical tools as well as the tradition of social indicators, a different approach. Although the Futures Studies are not a proper science, nevertheless their approach to social research may ensure the requested accuracy of a scientific forecasting process.     

A Behavioral Model to Optimize Financial Quality of Life

The purpose is to present a behavioral model to enable individuals tochange self-defeating behavior patterns to reduce financial stress andoptimize financial quality of life. Strategies for reducing financial stressinclude identifying and naming the source of financial stress as well asidentifying behavioral and financial strategies to reshape behavior tocreate an optimal quality of life. The paper discusses how behavior patternsare learned, how emotional distortions evolve, and how emotional distortionscan be dissolved.     

A. Bowling,Measuring Health: A Review of Quality of Life Measurement Scales; I. McDowell and C. Newell,Measuring Health: A Guide to Rating Scales and Questionnaires

Social Indicators Research -     

上海市高龄老人生活质量及其社会政策支持

本文利用上海市老龄科研中心1999年进行的"中美高龄老人比较研究调查"的数据资料,对上海市高龄老人的生活现状进行了多因素分析,研究了高龄老人生活满意度与其文化程度、经济状况、健康状况和邻里熟识程度的关系,并对上海市目前高龄老人的政策支持状况进行了分析.     

Perceived Quality of Life and Self-Rated Health among First-Year University Students

This study compares health status and qualityof life assessments of first-year universitystudents with those of their same-age workingcounterparts. Subjects and materials for eachgroup were gathered in 1999 from twocross-sectional data sets from the Swedishregion of Östergötland, covering malesand females aged 20–34 years. Subjects'perceived quality of life (QoL) and self-ratedhealth (SRH) were assessed on a 10-point scale(Ladder scale) and a five-point scale,respectively. Gender-based comparison revealedthat, for both males and females, first-yearuniversity students' average perceived QoL waslower than that of their working counterparts(p < 0.0001 in all instances). A higherproportion of students than expected ratedtheir health as ``average' or as ``low'(p < 0.0001). Perceived QoL was significantlycorrelated with SRH in both groups. Differencesin perceived QoL and SRH exist between studentsand their full-time working peers, and thedeterminants of these differences deservesgreater attention. Knowledge of thedeterminants of SRH and perceived QoL amonguniversity students might then be translatedinto sound and effective public-health practiceand intervention programs.     

Measuring Subjective Issues of Well-Being and Quality of Life in the European Statistical System

Over the last decades, the European Statistical System has developed many European statistics and indicators to measure social progress and sustainable development. Initially only in a few cases the measuring instruments contained questions on subjective issues. With the adoption of its Communication on “gross domestic product and beyond” the Commission has given an impetus to the development of subjective social indicators. This has led to the establishment of a first set of indicators on quality of life and well-being and to a new instrument (the 2013 EU-SILC ad-hoc module for measuring subjective well-being). This new step in European statistics creates an important potential for researchers to engage in in-depth analysis and for national and European Union policy makers to use the resulting indicators—and in casu subjective well-being indicators—for developing and monitoring policy strategies and programmes.     

Health and Other Aspects of the Quality of Life of Older People

Celebrating the United Nations' International Year of Older Persons, in September 1999 a survey research project was undertaken throughout the Northern Interior Health Region (NIHR) of British Columbia. A total of 875 people completed 23-page questionnaires, the average age of the respondents was 69 and the range ran from 55 to 95 years. Responses to the SF-36 questionnaire indicated that for male respondents aged 55–64, the mean score for the 8 dimensions was 74.4. This mean was practically identical to that of the United States norm for such people (74.5) and lower than that for the United Kingdom (77.4). For male respondents aged 65 and older, the mean was 68.3. This was numerically higher but again practically the same as that of the norm for the United States (68.1). For females aged 55–64, the mean score for 8 dimensions was 73. This was superior to that of the United States norm of (70.6) for such people and lower than that for the United Kingdom (74.6). For female respondents aged 65 and older, the mean score was 65.4. This was practically identical to that of the United States (65.5).Comparing 18 average figures for our respondents on satisfaction with specific domains of life (e.g., financial security, health, friendships) and life as a whole with those of average adults in Prince George in November 1999, we found that in all but two cases the older people's scores were higher. Only in the cases of satisfaction with health and overall happiness were older people's scores lower, and the differences were not statistically significant.Eleven percent of our respondents reported that they had been a victim of a crime in the last year, compared to 38% in our 1997 adult victimization survey. Older people had a more benign view than ordinary adults of the growth of crime in their neighbourhood and city, although exactly 64% of both groups thought that crime had increased in Canada. Although older people had a more optimistic view than other adults of the increase in crime in their neighbourhoods, fewer of the former than the latter felt safe out at night. Nevertheless, compared to adults surveyed in 1997, the behaviour of respondents in our survey of older people was not as constrained by concerns of criminal victimization.Two or three of the 8 SF-36 health dimensions explained 37% of the variation in life satisfaction scores, 34% of variation in happiness scores, 34% in satisfaction with the overall quality of life scores and 22% in satisfaction with one's overall standard of living. In every case, Mental Health was the dimension that had the greatest impact on our four dependent variables.When all of our potential predictors were entered into a regression equation simultaneously, we found that they could explain 60% of the variance in life satisfaction scores, 44% in happiness scores, 58% in satisfaction with the overall quality of life scores and 59% in satisfaction with one's overall standard of living scores.     

Health,Quality of Care and Quality of Life: A Case of Frail Older Adults

This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two mediation hypotheses: one considering health as a mediator for quality of care of geriatric case management and quality of life, and the other considering quality of care of geriatric case management as a mediator for health and quality of life. The study findings show that quality of care of geriatric case management, measured by client satisfaction, was not a mediator between health and quality of life (measured by life satisfaction). There was a significant positive association between quality of care of geriatric case management and quality of life. Although the significant association between quality of care of geriatric case management and quality of life could not be mediated by either self-rated health or self-reported physical activity levels, it was completely mediated by health satisfaction. These findings provided preliminary empirical evidence to support a significant relationship between quality of care of geriatric case management and quality of life.