Measuring Health: A Review of Quality of Life Measurement Scales

By Ann Bowling | Go to book overview

1
CONCEPTS OF FUNCTIONING, HEALTH, WELL-BEING AND QUALITY OF LIFE

Researchers in health and social care are increasingly focused on the measurement of the outcomes of service provision and interventions. The conceptualization and methods of measurement of outcomes is still controversial, although there is general recognition that meaningful measures of people–s health status and quality of life should be used.

In social care, the measurement of the effectiveness of services was relatively limited for many years. Attention was on performance and activity indicators (inputs and processes of care), rather than the outcomes for service users. But there was increasing concern that, for example, the number of hours of home care allocated to clients did not indicate how effectively their needs had been met (Nocon and Qureshi 1996). Changes in community care arrangements in the UK during the 1990s led to an increasing emphasis on service monitoring, setting service objectives, measuring people–s needs and met needs, and to the broadening of indicators of outcomes to clients– concerns, rather than just, for example, measuring their physical functioning.

In health care, where clinical interventions are usually more specific and invasive, outcome assessment has a long tradition. Most existing clinical indicators reflect a –disease– model. The –disease– model is a medical conception of pathological abnormality which is indicated by signs and symptoms. But a person–s –ill health– is indicated by feelings of pain and discomfort or perceptions of change in usual functioning and feeling. Illnesses can be the result of pathological abnormality, but not necessarily so. A person can feel ill without medical science being able to detect disease. Measures of health status need to take both concepts into account. What matters in the twenty-first century is how the patient feels, rather than how professionals think they feel. Symptom response or survival rates are no longer enough; and, particularly where people are treated for chronic or life-threatening conditions, the therapy has to be evaluated in terms of whether it is more or less likely to lead to an outcome of a life worth living in social and psychological, as well as physical, terms.

Moreover, there are multiple influences upon patient outcome, and these require a broad model of health to incorporate them. The non-biological factors which can affect recovery and outcome include patient psychology, motivation, adherence to therapy, coping strategies, access to health care, social support networks, individual values, cultural beliefs, health behaviours and socio-economic status. These are recognized in research on health behaviour (Becker 1974), and require recognition in other studies which aim to understand the factors influencing service outcomes.


MEASURING HEALTH OUTCOME

In order to measure health outcomes a measure of health status is required which needs to be based on a concept of health. The limitations of the widely

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