Towards patients' understanding of health-related quality of life-a mixed-method study in psoriasis and multiple sclerosis

PURPOSE

Patients' individual understanding of health-related quality of life (HRQoL) varies widely, making the measurement of this complex and subjective construct challenging. Anchoring vignettes, i.e., descriptions of fictive patients may provide insights into patients' individual questionnaire reference frames, assessment processes, and understanding of HRQoL. This study analyzes how patients assess HRQoL of vignettes.

METHODS

This exploratory mixed-method study included 100 patients with a chronic disease (50 multiple sclerosis (MS); 50 psoriasis). Sixteen vignettes, two for each domain of the SF-12v2, were developed based on literature recommendations and pretested in a convenience sample of seven healthy individuals. Patients assessed their own HRQoL and HRQoL of the vignettes on the SF-12v2. In semi-structured interviews, they justified their assessments. We quantitatively analyzed associations of vignette assessments with individual characteristics using linear regression models and qualitatively analyzed assessment justifications.

RESULTS

Patients' age and disease were significant (p < 0.05) predictors for ten and seven vignette assessments, respectively. Older patients assessed vignettes being less extreme; patients diagnosed with MS rated them more positively. Overall, adjusted R² values ranged from 0.033 to 0.172. Qualitatively, most of the ratings were based on the evaluation of symptoms or impairments in daily life. Fewer participants ranked different dimensions of HRQoL in a personal hierarchy or assumed impairments beyond the vignette description.

CONCLUSIONS

The understanding of HRQoL may vary substantially and is associated with individual characteristics, individual assessment strategies, and probably other intrinsic factors as explained variance was quite low. Therefore, usage of generic instruments only allows for limited comparison across groups.

Inequality in disability-free life expectancies among older men and women in six countries with developing economies

Background

It is unclear whether the increase in life expectancy (LE) globally is coupled with a postponement of morbidity and disability. Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in LE, disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies.

Methods

This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health (SAGE) in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007–2010. Disability was measured with the activity of daily living (ADL) instrument. The DFLE was estimated using the Sullivan method based on the standard period life table and ADL-disability proportions.

Results

The disability prevalence ranged from 13% in China to 54% in India. The prevalence of disability was highest and occurred at younger age in both sexes in India. Women were more disadvantaged with higher prevalence of disability across all age groups, and the situation was worst among older women in Mexico and the Russian Federation. Though women had higher LE, their proportion of remaining LE free from disability was lower than men.

Conclusions

There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.

Health and ageing in Nairobi's informal settlements-evidence from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH): a cross sectional study

BACKGROUND

Much of the focus on population ageing has been in high-income counties. Relatively less attention is given to the world's poorest region, Sub-Saharan Africa (SSA) where children and adolescents still comprise a high proportion of the population. Yet the number of adults aged 60-plus in SSA is already twice that in northern Europe. In addition, SSA is experiencing massive rural to urban migration with consequent expansion of informal urban settlements, or slums, whose health problems are usually unrecognised and not addressed. This study aims to improve understanding of functional health and well-being in older adult slum-dwellers in Nairobi (Kenya).

METHODS

The study sample comprised men and women, aged 50 years and over, living in Korogocho and Viwandani, Nairobi, Kenya (n = 1,878). Data from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) and the WHO Study on global AGEing and adult health (SAGE Wave 1) were analysed. The prevalence of poor self-reported quality of life (QoL) and difficulties in domain-specific function is estimated by age and sex. Logistic regression investigates associations between difficulties in the domains of function and poor QoL, adjusting for age, sex and socio-demographic factors. Statistical significance is set at P<0.05.

RESULTS

Women reported poorer QoL and greater functional difficulties than men in all domains except self-care. In the multivariable logistic regression the odds of poor QoL among respondents with problems or difficulties in relation to affect (OR = 7.0; 95%CI = 3.0-16.0), pain/discomfort (OR = 3.6; 95%CI = 2.3-5.8), cognition (OR = 1.8; 95 %CI = 1.2-2.9) and mobility (OR = 1.8; 95%CI = 1.1-2.8) were statistically significant.

CONCLUSIONS

The findings underscore differences in the domains of functional health that encapsulate women and men's capacities to perform regular activities and the impact of poor functioning on QoL. Investing in the health and QoL of older people in SSA will be crucial in helping the region to realise key development goals and in opening opportunities for improved health outcomes and sustainable economic development.

Bonding, Bridging, and Linking Social Capital and Self-Rated Health among Chinese Adults: Use of the Anchoring Vignettes Technique

Three main opposing camps exist over how social capital relates to population health, namely the social support perspective, the inequality thesis, and the political economy approach. The distinction among bonding, bridging, and linking social capital probably helps close the debates between these three camps, which is rarely investigated in existing literatures. Moreover, although self-rated health is a frequently used health indicator in studies on the relationship between social capital and health, the interpersonal incomparability of this measure has been largely neglected. This study has two main objectives. Firstly, we aim to investigate the relationship between bonding, bridging, and linking social capital and self-rated health among Chinese adults. Secondly, we aim to improve the interpersonal comparability in self-rated health measurement. We use data from a nationally representative survey in China. Self-rated health was adjusted using the anchoring vignettes technique to improve comparability. Two-level ordinal logistic regression was performed to model the association between social capital and self-rated health at both individual and community levels. The interaction between residence and social capital was included to examine urban/rural disparities in the relationship. We found that most social capital indicators had a significant relationship with adjusted self-rated health of Chinese adults, but the relationships were mixed. Individual-level bonding, linking social capital, and community-level bridging social capital were positively related with health. Significant urban/rural disparities appeared in the association between community-level bonding, linking social capital, and adjusted self-rated health. For example, people living in communities with higher bonding social capital tended to report poorer adjusted self-rated health in urban areas, but the opposite tendency held for rural areas. Furthermore, the comparison between multivariate analyses results before and after the anchoring vignettes adjustment showed that the relationship between community-level social capital and self-rated health might be distorted if comparability problems are not addressed. In conclusion, the framework of bonding, bridging, and linking social capital helps us better understand the mechanism between social capital and self-rated health. Cultural and socioeconomic factors should be considered when designing health intervention policies using social capital. Moreover, we recommend that more studies improve the comparability of self-rated health by using the anchoring vignettes technique.

Depressed Mood in Middle-Aged and Older Adults in Europe and the United States: A Comparative Study Using Anchoring Vignettes

OBJECTIVE

To compare self-ratings of depressed mood in middle-aged and older adults in the United States and nine European countries after adjustment by anchoring vignettes.

METHOD

Samples were drawn from three large surveys of middle-aged and older adults: the U.S. Health and Retirement Study, the English Longitudinal Study of Aging (ELSA), and the Survey of Health, Ageing and Retirement in Europe. Self-ratings of depressed mood were compared across countries before and after adjustment by anchoring vignettes depicting cases with different levels of depressed mood.

RESULTS

Compared with Europeans as a group, Americans rated both the cases presented in the vignettes and themselves as more depressed. However, after adjustment by vignette ratings, Americans appeared to be less depressed than their counterparts in all but two European countries.

DISCUSSION

Cultural differences in mental health norms reflected in vignette rating may partly explain between-country differences in self-reported depressive symptoms and perhaps other psychiatric complaints.