Analysis and evaluation of developed and used health scores.

ABSTRACT

This systematic review provides an overview of existing multidimensional health scores, including an assessment of their holistic value (coverage of all determinants and dimensions of health), and a systematic comparison of their properties. The review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature searches were conducted in English (PubMed, Scopus, Web of Sciences) and German databases (BISp-Surf, BIBNET). All scores that considered health multidimensional on an individual level were included. Two independent reviewers screened and identified articles. The Quality assessment tool for studies with diverse design was used to assess study quality. Scores were recorded in a criteria grid to make their properties comparable, and the multidimensionality of the individual scores was evaluated using radar chart visualizations. Twenty-six studies met the inclusion criteria. Study quality was strong in eight, fair in twelve, and weak in six studies. Among the 26 studies, 21 different questionnaire-based scores were included, which all covered at least three of the five health dimensions (Five dimensions have been identified in a former literature research). Three scores covered all dimensions, but none covered all of the previously defined determinants. Thus, according to this works created definition (holistic = cover all dimensions with all determinants), no holistic health score exists, only multidimensional scores covering different dimensions and determinants. This review offers good comparability, as all the instruments were questionnaires, and could be used as a basis for future research. A universal (holistic) health construct should be defined and developed to improve the quantification of health.

What is health? The concept of health is very complex. Therefore, although several models and scientific studies exist, the entire theme has not yet been fully explored. With the goal to understand health holistically, this work investigated the multidimensional health scores developed to date. Health scores need to be valid, easy to grasp and use, efficient, and scalable. They should provide a reliable statement regarding an individual's health status as well as their future health chances. The basic architecture of the health score should contain more than one dimension of health. A total of 26 studies comprising 21 different health scores were identified with the above criteria. However, according to the definition, none of the health scores were holistic (matching all health dimensions and determinants); rather, they were multidimensional scores covering different dimensions and determinants.