Health-related quality of life
The CDC defines the health-related quality of life (HRQL) on the individual level as physical and mental health perceptions and how they correlate with health risk conditions, functional capacity, social support, and socioeconomic status (CDC,2018). Furthermore, HRQOL on the community level includes resources available, conditions, policies, and practices that govern the populations’ perceptions of health and functional status. The CDC also lists multiple measures for health-related quality of life, such as the Healthy Days Core Module, Activity Limitations Module, and Healthy Days Symptoms, which are questions assessing a person’s perceptions and current physical and mental health (CDC, 2018)
HRQOL is a multidimensional concept that includes many components such as an individual’s physical, and psychological health, perception of independence, social relationships, and environmental factors that are important to that individual (Lin et al., 2013). Furthermore, Lin et al. (2018) state that criticisms of HRQOL measures stem from a lack of conceptual clarity and measurement feasibility. HRQOL measures can be adequately measured if these measures are both specific such as measuring specific disease (heart disease, cancer), and complement more generic measures assessing someone’s overall physical, mental, and social health.
CDC. (2018). Health-related quality of life : Methods and measures. Centers for Disease Control and Prevention. https://www.cdc.gov/hrqol/methods.htm
Lin, X., Lin, I., Fan, S. (2013). Methodological issues in measuring health-related quality of life. Tzu Chi medical journal 25(1), 8-12. https://doi.org/10.1016/j.tcmj.2012.09.002
Epidemiology and Public Health Week 08 Discussion
Following their implementation, quality of life (QOL) measures metamorphosed and became integral to health outcomes and the associated appraisals. It availed a meaningful avenue to assess the effects of healthcare when the cure was not possible, particularly for populations with chronic ailments (Zucoloto & Martinez, 2019). In the past, multiple instruments were created purporting to measure QOL, but they measured causal indicators instead. The ideal scale currently comprises a 16-item instrument that evaluates five conceptual domains of life, including personal development and fulfillment. Others entail physical well-being, recreation, community and civic practices, and social relationship with others. Later, another domain was added independence, after incorporating what perceptions individuals with chronic conditions harbored about quality of life following descriptive research (Zucoloto & Martinez, 2019). Thus, to gain more insights into QOL measures, the text argues that the approach cannot be applied to adequately measure health-related quality of life, drawing illustrations from physical wellbeing.
In a clinical setting, the underpinning justification for using QOL measures borders on the need to ensure that treatment interventions and evacuations are directed toward patients. Unfortunately, this is often not the case because caregivers and healthcare facilities focus on ailments. In this view, quality of life, including physical wellbeing, cannot be the only avenue to assess patient-centered outcomes. Alternatively, there is the need to incorporate other factors to evaluate the outcomes, such as psychological wellbeing, social interaction and support, and measures of disability (Bourdel et al., 2019). Instead of being an adjunct to assessing outcomes linked to ailments, QOL measures focus on being a substitute, which is not ideal. For instance, rheumatologists fail to treat rheumatoid arthritis using antirheumatic medications based on the quality-of-life scores. In this case, health-related quality of life is not adequately measured when the primary emphasis is solely on physical wellbeing.
Another proof that QOL measures are inadequate to measure health-related quality of life is that they are less effective and accurate. Since the approach is broad and multidimensional and comprises 16-items, it tends to be less responsive, unlike methods specific to patient outcomes (Zucoloto & Martinez, 2019). For instance, emphasizing the physical wellness of individuals majorly means that other aspects, such as conditions leading to anxiety and depression, are neglected. In this regard, one may suppose that the approach is a highly individual concept. The quality-of-life measure does not capture all characteristics of life that are critical to the survival of a patient. However, the only merit to the method is that systems in which individuals may postulate at least some of the features may probably come closest (Zucoloto & Martinez, 2019). Thereupon, the realization behind some of the shortcomings of QOL measures should be an eye-opener to expand the model to incorporate all aspects of quality of life.
From a personal perspective, the inadequacy to measure health-related quality of life based solely on physical wellness results in various ethical concerns. As a concept, the main idea behind the quality of life entails that health problems can be revealed, including those at the periphery of the usual remit of medical care. For example, focusing on a particular aspect breeds the expectation that clinicians may influence it; otherwise, what would be the objective behind assessing it? The downside to this attitude is that in situations where caregivers cannot control outcomes; the process measurement may seem to harm patients. Another ethical concern is that some pressure groups may oppose the clinical measurement of quality of life, citing ‘overmedicalization.” Thus, QOL measurements need to integrate all aspects into practice, including social support and relationships.
Bourdel, N., Chauvet, P., Billone, V., Douridas, G., Fauconnier, A., Gerbaud, L., & Canis, M. (2019). Systematic review of quality-of-life measures in patients with endometriosis. PLoS One, 14(1), e0208464.
Zucoloto, M. L., & Martinez, E. Z. (2019). General aspects of quality of life in heterogeneous populations: notes on Flanagan’s Quality of Life Scale (QoLS). Trends in psychiatry and psychotherapy, 41, 268-275.
Health-related quality of life (HRQoL) is a valuable indicator of overall health because it captures an individual’s perception of physical and mental health status and the impact on their quality of life (Yin et al., 2016). Furthermore, Yin et al. (2016) explain that HRQoL is assessed through multiple indicators of self-perceived health status and physical and emotional functioning. These measures “provide a comprehensive assessment of the burden of preventable diseases, injuries, and disabilities “ (p.2).
Data and Research
Chetty et al. (2016) explain a known correlation between higher income, longevity, and perceived quality of life and wanted to look into the causes of the variations. Why do lower-income populations have a reported perceived lesser quality of life? Researchers found significant differences related to health behaviors, access to health care, health literacy, workplace hazards or environments, income, and stress levels. Education seems to play a significant role in outcomes.
Measuring Health-Related Quality of Life
Gulis and Fujino (2015) discuss how micro and macro environments influence our perception of our quality of life. Everyone’s lives are influenced by political, environmental, social, cultural, educational, and coping factors. Health impact assessments (HIAs) are a way to measure how one evaluates the quality of their life. It is difficult to clearly state that an HIA can adequately measure one’s quality of life because so much of it is subjective and situational. HIAs add value to Epidemiology and attempts to quantify the impact that all of these influences have on our lives. The information indicates trends and adds value to epidemiology and population health. However, HRQoLs are a matter of perception and ultimately subjective.
Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016). The Association Between Income and Life Expectancy in the United States, 2001–2014. JAMA, 315(16), 1–31. https://doi.org/10.1001/jama.2016.4226
Gulis, G., & Fujino, Y. (2015). Epidemiology, Population Health, and Health Impact Assessment. Journal of Epidemiology, 25(3), 179–180. https://doi.org/10.2188/jea.je20140212
Yin, S., Njai, R., Barker, L., Siegel, P. Z., & Liao, Y. (2016). Summarizing health-related quality of life (HRQOL): development and testing of a one-factor model. Population Health Metrics, 14(1), 1–15. https://doi.org/10.1186/s12963-016-0091-3
Despite how the health-related quality of life (HRQoL) is defined, it involves more than physical and mental health-it gives individuals a sense of well-being (Centers for Disease Control and Prevention [CDC], 2018). According to the World Health Organization (WHO) (2012), “quality of life is related to humans’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns.” Jongen (2017) suggested that HRQoL is a patient-reported outcome that comprises a comprehensive subjective measure of the patient’s health status (p. 585). The concept of quality of life is essential in healthcare, especially when dealing with new diagnoses and treatments. This concept can be challenging to understand and measure because it can mean something different to various patients, affecting the provider’s prioritization of patients’ quality of life. Quality of life is personal, making it difficult to assess (Haraldstad et al., 2019, p. 2642). As stated by Buiting & Olthuis (2020), the reason for including quality of life measures in healthcare was the emerging necessity to consider people as “integrated and active beings, not just as biological organisms” (p. 1).
However, studies have proven that quality of life can be measured if the right tools are utilized. Polinder et al. (2010) revealed a wide variety in the use of HRQL instruments, study populations, and assessment time points used in studies measuring HRQL of general injury populations. This study demonstrated that disability, for example, which has been increasing in population’s health as result of injuries, can be measured by employing “functional instruments or generic or disease-specific HRQL measures, where disability represents the gap between measured and perfect HRQL” (p. 1.). Polinder et al. (2010) found that to learn the difference between groups affected by diseases and groups with good health, it is necessary to measure HRQL, for example, injuries’ consequences.
Kurtzke’s study suggested another example of an HRQL measure commonly used to determine MS-related disability, i.e., the Expanded Disability Status Scale (EDSS), scoring based on neurological examination and ambulation/mobility status. Overall, HRQL can be adequately measured despite being subjective (WHO, 2012), and results are primarily based on the extent of the impact diseases have on individuals (Polinder et al., 2010).
Buiting, H. M., & Olthuis, G. (2020). Importance of quality-of-life measurement throughout the disease course. Jama Network Open, 3(3), 200388. https://doi.org/10.1001/jamanetworkopen.2020.0388
Centers for Disease Control and Prevention (CDC). (2018, October 31). Health-related quality of life (HRQOL). https://www.cdc.gov/hrqol/concept.htm
Haraldstad, K., Wahl, A., Andenæs, R., Andersen, J. R., Andersen, M. H., Beisland, E., Borge, C. R., Engebretsen, E., Eisemann, M., Halvorsrud, L., Hanssen, T. A., Haugstvedt, A., Haugland, T., Johansen, V. A., Larsen, M. H., Løvereide, L., Løyland, B., Kvarme, L. G., Moons, P., Norekvål, T. M., … LIVSFORSK network (2019). A systematic review of quality-of-life research in medicine and health sciences. Quality of life research: An international journal of quality-of-life aspects of treatment, care, and rehabilitation, 28(10), 2641–2650. Quality of Life Research, 1-10, 1–10. https://doi.org/10.1007/s11136-019-02214-9
Jongen, P. J. (2017). Health-related quality of life in patients with multiple sclerosis: Impact of disease-modifying drugs. CNS Drugs, 31(7), 585-602. https://doi.org/10.1007/s40263-017-0444
Polinder, S., Haagsma, J., Belt, E., Lyons, R., Erasmus, V., Lund, J., & Beeck, E. (2010). A systematic review of studies measuring health-related quality of life of general injury populations. BMC Public Health, 10(1), 783-783. https://doi.org/10.1186/1471-2458-10-783
World Health Organization (WHO). (2012). WHOQOL: Measuring quality of Life. https://www.who.int/toolkits/whoqol