Single-item vs multiple-item measures of health-related quality of life

Many survey instruments measure health-related quality of life. Researchers can choose from instruments ranging in length from one to several hundred items. A small sample of 35 chronically ill adults self-administered the Short-form General Health Survey of the Medical Outcomes Study, a 20-item health-related quality-of-life measure with established reliability and validity. One specific item on the MOS questionnaire can serve as a single-item measure of health-related quality of life. This one item correlated positively and significantly with the over-all score for health-related quality of life. The results of this analysis support the use of this single-item measure of health-related quality of life when multiple-item instruments are not suitable due to limitations of resources or sample size.     

Measure development and the hermeneutic task

I examine the dynamics of measure development using two case studies: temperature, and health-related quality of life. I argue, following Bas van Fraassen and Leah McClimans that in each case these dynamics have a hermeneutic structure. Measure development is plagued by epistemic circularity, as is the task of interpreting a text, and similar strategies can be used in both measure development and hermeneutics to overcome that circularity. I show that Hans Georg Gadamer’s philosophical hermeneutics in particular are an effective lens through which to examine the development of the temperature standard as described by Hasok Chang. Despite similar grounding in hermeneutics, I note an important difference between measure development for temperature and for health-related quality of life. Namely, while the meaning of temperature can be standardized, the meaning of health-related quality of life cannot. This standardization of meaning for the temperature concept represents a limit to the analogy with hermeneutics. Finally, I argue that the indeterminacy we find in health-related quality of life measurement is a result not only of analogy with the hermeneutic task, but of full-fledged participation in it.

     

Motives and health-related behaviour: incremental prediction by implicit motives

The study assessed whether implicit motives, which operate largely outside of conscious awareness, can provide any incremental prediction of health-related behaviour over that provided by explicit motives. In a cross-sectional survey study, 251 young adults completed measures of sun exposure behaviour, sun protection behaviour and risk-related sexual behaviour, participatory motives for these behaviours, life goals (representing explicit dispositional motives), and the Single Category Implicit Association Test adapted to measure implicit motives. Analysis was by structural equation modelling. Power life goal (the goal of asserting oneself and seeking social status) predicted sun exposure behaviour and risk-related sexual behaviour. Altruism life goal (acting for the welfare of others) predicted sun protection behaviour and inversely predicted risk-related sexual behaviour. These effects of life goals were mediated by participatory motives. Implicit dispositional achievement motive (the largely unconscious need to succeed at challenging tasks) inversely predicted sun exposure behaviour, this effect being mediated by a reduction in appearance-related participatory motive for sun exposure. Implicit dispositional achievement motive also inversely predicted risk-related sexual behaviour, this effect being direct. It is concluded that implicit dispositional motives can provide some incremental prediction of health-related behaviour. Possibilities for further research, including the experimental manipulation of motive engagement, are discussed.     

Health-Related Quality of Life and Adaptive Behaviors of Adolescents with Sickle Cell Disease: Stress Processing Moderators

The objective of this study was to examine resilience among adolescents with sickle cell disease (SCD), focusing on the interaction of health-related quality of life with stress processing to explain adaptive behavior. Forty-four adolescents with SCD completed paper-and-pencil measures of health-related quality of life, appraisals (hope), pain coping strategies (e.g. adherence), and adaptive behavior. Self-reported health-related quality of life was significantly associated with adaptive behavior, as was adherence. Findings for moderation were mixed. Pain coping strategies moderated the association of health-related quality of life with adaptive behavior such that at lower levels of Coping Strategies Questionnaire (CSQ) Adherence, better quality of life was associated with higher adaptive behavior. Similarly, at higher levels of hope, better quality of life was associated with higher adaptive behavior, and poorer quality of life was associated with lower adaptive behavior. Adolescents with SCD showed resilience, particularly in terms of personal adjustment, that may be explained by their appraisals and stress processing strategies. Interventions to support an optimistic or hopeful outlook and improve adherence to recommendations for medical management of sickle cell pain may result in improved resilience/adaptive behavior.     

Longitudinal Associations Between Parental SES and Adolescent Health-Related Quality of Life Using Growth Curve Modeling

We evaluate how two aspects of socioeconomic status, parental objective and subjective social status, are associated with health-related quality of life in three racial/ethnic groups during pre- to mid-adolescent development, using growth curve modeling. In a longitudinal cohort study, 4,048 Black, Latinx, or White adolescents were assessed in 5th, 7th and 10th grade. Objective social status (OSS) was based on parent-reported highest household educational attainment and total household income, and subjective social status (SSS) was measured with the MacArthur Scale, through which parents indicated their social standing in reference to community and national norms. Adolescents completed the Pediatric Quality of Life Inventory to measure their physical and psychosocial health-related quality of life. Based on growth curve modeling of the intercept, adolescents whose parents have higher OSS levels reported better health-related quality of life, whereas parental SSS was not associated with adolescent health-related quality of life in 5^th grade. These findings were largely consistent across racial/ethnic groups. Based on growth curve modeling of the developmental slopes (or growth curves), higher objective social status was associated with a slower positive growth of health-related quality of life from 5^th to 10^th grade, which was largely consistent across racial/ethnic groups. The opposite appeared for parental SSS and physical health-related quality of life, and only for Latinx, where higher parental perceived social status was associated with an acceleration of positive change. Family income and education may influence health-related quality of life at the start of adolescence, but its effect appears to diminish as youth mature. However, in Latinx youth, parents’ perceived social status may continue to influence improvement in their physical health-related quality of life as they mature.

     

Reliance on God’s Help as a Measure of Intrinsic Religiosity in Healthy Elderly and Patients with Chronic Diseases. Correlations with Health-Related Quality of Life?

Within the context of coping, we analyze whether Reliance on God’s Help, as a measure of intrinsic religiosity, is associated specifically with SF-12’s health-related quality of life. Data of 5,248 individuals (63.1 ± 10.6 years; 14% chronic diseases, 16% cancer, 8% had experienced acute diseases, and 62% healthy elderly as a control group) were enrolled. Although about half of the individuals had a strong belief that God will help and prayed to become healthy again, Reliance on God’s Help was not generally associated with better physical or mental health-related quality of life. Just in distinct subgroups we found some marginal associations. Regression analyses confirmed that physical or mental health were not among the predictors of Reliance on God’s Help. Nevertheless, intrinsic religiosity was utilized by several individuals, particularly by patients with higher age and cancer. It should be regarded as a resource to cope (meaning-focused coping) rather than an independent contributor to health-related quality of life.     

The relationship of perceived self-efficacy to quality of life in chronic obstructive pulmonary disease.

From a biomedical perspective, variations in the quality of life of chronic obstructive pulmonary disease (COPD) patients may be attributed to changes in pulmonary function; thus, an increase in lung function should be correlated with an increased score on a health-related quality-of-life measure. However, inconsistent results regarding correlations between various measures of pulmonary function and quality of life have been reported in the literature. The authors evaluated a social cognitive model of quality of life among persons with COPD by analyzing relationships among biomedical measures, self-efficacy measures, and quality-of-life measures in a recursive path model. Path analysis results indicated that the association of pulmonary function and symptoms with quality of life was mediated by perceived self-efficacy for functional activities.     

Relationship Between Morbidly Obese Subjects’ Attributions of Low General Well-being, Expectations and Health-Related Quality of Life

Low health-related quality of life among morbidly obese subjects is well-known. However, the relationship may not be simple. We aim to examine the association between pre-operative expectations and health-related quality of life and long-term changes in health-related quality of life after gastric banding. The questionnaires were answered twice: before and five years after gastric banding. Short Form-36 assessed health-related quality of life. Obesity specific questions were used to assess the subjects' attribution of impairment to morbid obesity and their expectations to changes as a result of weight loss. The subjects attribute morbid obesity as a major reason for their impairments in state of health, physical activity, pain and work capacity. As a result of weight loss, the subjects expect improvements even within fields which they did not consider to be impaired due to morbid obesity. We found an inverse association between high expectations and mental component summary score at baseline. At follow-up having expectations fully fulfilled was associated with a higher mental component summary score than having expectations fulfilled only to a fair extension and not having expectations fulfilled. Physical component summary was statistically significant improved at follow-up Morbidly obese subjects' attributions of low general well-being combined with their expectations may be a central part of understanding the mechanisms involved in the association between morbid obesity and low health-related quality of life. Furthermore the impact of morbid obesity on health-related quality of life may be reduced if healthprofessionals bridge the gap between morbidly obese subjects' expectations and their experience.     

Validation of the Personal Wellbeing Index for People with End Stage Kidney Disease

The quality of life of people with end stage kidney disease (ESKD) has traditionally been measured using instruments that emphasise objective health status. The present study validates an alternative measure, the Personal Wellbeing Index (PWI), which measures subjective wellbeing. An Australian ESKD sample (N?=?172, Mean age?=?64.04, SD?=?14.82) completed the PWI as well as health-specific quality of life measures. The PWI was subject to confirmatory factor analysis, and a series of regressions and between-group comparisons were performed to reveal that it is a psychometrically appropriate measure for this sample. The PWI and health-specific measures each yield different and complementary results. Thus, the PWI is proposed as a complement to existing health-related quality of life tools, in order to broaden understanding of the patient’s subjective experience. The resulting profile is argued to better inform targeted interventions to improve the quality of life of people with ESKD.     

Impact of low-level expression dermatological diseases on the quality of life as a function of its level of specificity

The impact of dermatological diseases on the quality of life is relatively well established, although some results do not support this relationship. Whereas a few studies indicate a decrease in various indicators of quality of life in conditions of disease, in other studies, this effect has not been observed. These differences can be explained by the use of different concepts of quality of life and/or the comparison of different severity levels of the diseases. The purpose of this paper is to analyze the impact of low-level expression dermatological diseases on various concepts of quality of life. Two hundred-ninety-nine participants completed a questionnaire about symptoms, psychological and psychosocial impact, and general and specific satisfaction. Results show that minor dermatological diseases affect health-related quality of life, but not quality of life considered as well-being.     

Measuring meaning in life: An examination of three scales

Meaning in life is an important construct for psychological theory which has received little empirical investigation, partly because of uncertainty about measurement scales. This paper examines the factor structure of three scales to measure meaning in life, the purpose in life (PIL) test, the life regard index (LRI) and the sense of coherence (SOC) scale. Results suggest that meaning in life can be regarded as a multidimensional construct, with meaning able to be attained in several different ways. Oblique factor solutions were accepted, and higher-order analyses conducted for all three scales. A general second-order meaning in life dimension was identified only for PIL and it is suggested that this scale may be the best general measure of the construct. It is concluded that further work should be undertaken to explore the specific dimensions of meaning in life.     

Psychosocial Factors Associated with Quality of Life Among Individuals Attending Genetic Counseling for Hereditary Cancer

The aim of this multicenter study was to explore associations between psychosocial factors (general self-efficacy, perceived availability of social support, cancer-related distress) and health-related quality of life, among individuals at risk for hereditary cancer. One-hundred and twenty one participants with a family history of breast-cancer or colorectal cancer answered a questionnaire 2-4 weeks prior to genetic counseling. The two dimensions of the health-related quality of life measure, mental and physical health were both used as outcome variables. Multiple regression (linear) analyses revealed that increasing degrees of cancer-related distress was related to decreasing degrees of mental health whereas increasing degrees of self-efficacy and social support were related to increasing degrees of this outcome variable. Self-efficacy, self-esteem support and tangible aid seemed to moderate the relationship between cancer-related distress and mental health. These results suggest that self-efficacy and certain resources of social support buffer the negative association between cancer-related distress and mental health, and might be suitable for interventional efforts. Implications for genetic counseling practice are discussed.     

Parental knowledge and adolescent adjustment: substance use and health-related quality of life

This study analyses two models (maternal and paternal) in which parental care and sources of parental knowledge moderated the relationship between parents' knowledge about their adolescents' lives and adolescents' substance use and health-related quality of life. The sample was made up of 15942 Spanish adolescents who participated in the 2006 edition of Health Behavior in School-aged Children Study. Results showed that increased parents' knowledge about their adolescents' lives reduced adolescents' substance use and increased their quality of life. With respect to the moderation relationship, a limited effect was found. However, parental care and sources of parental knowledge used by both parents generally had main effects on adolescents' substance use and health-related quality of life, with care being the most relevant variable in the health-related quality of life, while knowledge was the most relevant one for substance use.     

The challenge of cross-cultural quality of life assessment

Abstract

As a result of an increased international cooperation in the health care field, the demand for cross-culturally applicable, patient-oriented instruments to assess the need for and to evaluate the outcome of medical interventions has also grown. However, basic problems exist in assessing health-related quality of life—one of the most prominent outcomes—across cultures. Conceptually it is unclear to which extent the quality of life construct is transferable from one cultural context to another. Methodologically, ways to assess the construct have to be sensitive to different cultures and practically, application of quality of life measures may be difficult. The current paper addresses these issues, presenting the current state of the art in cross-cultural development of health-related quality of life assessment instruments as well as a critical review thereof. Examples are provided from internationally active working groups in terms of the translation, psychometric testing and norming of quality of life questionnaires.     

Health-related quality of life of preterm children and their caregivers

As advances in medical science have extended the limit of viability downward to 23 or 24 weeks gestation, interest has turned from long-term health outcomes to quality of life for survivors. During the last decade, the first studies of the health-related quality of life (HRQOL) of children and young adults who were born extremely preterm were published. Taken from the fields of anthropology, economics, sociology, and psychology, the foundation of HRQOL is formed by theories of functionalism, positive well-being, and utility. HRQOL can be defined as the physical, psychological, and social domains of health, which can be influenced by an individual's experiences and perception. HRQOL instruments are generally composed of multiple domains and measure physical functioning, mental health, and social role functioning in some form. Utilities, or preferences for health outcomes under conditions of uncertainty, are also used. Studies of HRQOL to-date indicate that preterm children have, on average, poorer health than their normal birthweight peers, but the majority do not perceive their quality of life as significantly different than others of their own age. Measures of HRQOL should not replace the traditional measures of morbidity, but should become part of the standard battery of tools used to assess a preterm child's health and well-being. Ultimately, studies of the HRQOL of preterm children should identify aspects of life, physical, psychological, or social, that could be improved with intervention.     

Measurement issues in health-related quality of life: Challenges for health psychology

Abstract

Quality of life assessment is a central element of clinical trials and related forms of evaluative research. Early efforts to establish appropriate methods of measuring quality of life drew on psychometric principles and emphasised the need for validated measures. However, it is increasingly clear that, whilst still a central requirement of quality of life measures, validity needs to be emphasised alongside a number of other essential properties that have become clearer as the field has developed. Moreover formal psychometric methodology has to be adapted to take account of the specific needs of evaluative research. Research is beginning to develop more appropriate methods of outcome assessment in this area. Further lines of research are suggested to examine psychometric with other approaches to measurement of health-related quality of life.     

Reliability and validation of a Chinese version of the Aging Males' Symptoms scale

This study was to assess whether the Chinese version of the Aging Males' Symptoms scale could measure aging men's symptoms as effectively as the English version. 176 psychiatric outpatient men were assessed to analyze internal consistency reliability and construct validity, and 45 male school staff were interviewed in estimating retest reliability. Cronbach alpha was .90, and the 3-wk. retest reliability was .72. Factor analysis yielded a two-factor structure. Construct validity was indicated by significant correlation between the two factors and the criterion variables. This scale is a validated and sensitive test for measuring symptoms in aging men in the Taiwanese Chinese-speaking population. It is suggested that the scale could be used to measure and compare health-related quality of life in groups of men over 40 years old.     

Pediatric Health-Related Quality-of-Life Measurement Technology: Intersections between Science, Managed Care, and Clinical Care

The demand for health care outcomes assessment is increasing, driven by the proliferation of managed care as a form of health care financing. Providers, consumers, and payers can use health care outcomes to improve the efficiency and quality of care, spur performance improvement, and demonstrate accountability. This review introduces health outcomes and focuses on one particular outcome—pediatric health-related quality of life (HRQOL), exemplified by the PedsQL, a brief, practical, reliable, valid, and responsive measure of pediatric HRQOL. HRQOL measurement has the potential, in pediatric clinical practice, to improve assessment, clinical management, and treatment evaluation if practical, conceptual, and empirical challenges are addressed. These issues are discussed and directions for future research are described that would demonstrate the value of HRQOL measurement in pediatric clinical settings.     

Religiosity and Social Support: Implications for the Health-Related Quality of Life of African American Hemodialysis Patients

The purpose of this study was to determine whether sociocultural differences have any effect on the health-related quality of life among African American hemodialysis patients. This study examined relationships between religiosity, social support, and the health-related quality of life of African American hemodialysis patients. Four hemodialysis units were selected for the study. The study population consisted of 176 African American hemodialysis patients who had been receiving hemodialysis treatments for at least 1 month. The religiosity variable was measured by the Measure of Religious Involvement. Social Support was measured by the Medical Outcomes Study Social Support Survey, and health-related quality of life was measured by the Medical Outcomes Study 36 Short Form Health Survey (SF-36v2). The investigators found that social support contributed to the emotional and physical health of African American hemodialysis patients in the sample, whereas religiosity was inversely related to the physical health of these patients.