Comprehensively Measuring Health-Related Subjective Well-Being: Dimensionality Analysis for Improved Outcome Assessment in Health Economics.

BACKGROUND: Allocation of inevitably limited financial resources for health care requires assessment of an intervention's effectiveness. Interventions likely affect quality of life (QOL) more broadly than is measurable with commonly used health-related QOL utility scales. In line with the World Health Organization's definition of health, a recent Delphi procedure showed that assessment needs to put more emphasis on mental and social dimensions. OBJECTIVE: To identify the core dimensions of health-related subjective well-being (HR-SWB) for a new, more comprehensive outcome measure. METHODS: We formulated items for each domain of an initial Delphi-based set of 21 domains of HR-SWB. We tested these items in a large sample (N = 1143) and used dimensionality analyses to find a smaller number of latent factors. RESULTS: Exploratory factor analysis suggested a five-factor model, which explained 65% of the total variance. Factors related to physical independence, positive affect, negative affect, autonomy, and personal growth. Correlations between the factors ranged from 0.19 to 0.59. A closer inspection of the factors revealed an overlap between the newly identified core dimensions of HR-SWB and the validation scales, but the dimensions of HR-SWB also seemed to reflect additional aspects. This shows that the dimensions of HR-SWB we identified go beyond the existing health-related QOL instruments. CONCLUSIONS: We identified a set of five key dimensions to be included in a new, comprehensive measure of HR-SWB that reliably captures these dimensions and fills in the gaps of the existent measures used in economic evaluations.

Domains of quality of life: results of a three-stage Delphi consensus procedure among patients, family of patients, clinicians, scientists and the general public.

PURPOSE: Our key objective is to identify the core domains of health-related quality of life (QoL). Health-related QoL utility scales are commonly used in economic evaluations to assess the effectiveness of health-care interventions. However, health-care interventions are likely to affect QoL in a broader sense than is quantifiable with traditional scales. Therefore, measures need to go beyond these scales. Unfortunately, there is no consensus in the scientific literature on the essential domains of QoL. METHODS: We conducted a three-stage online Delphi consensus procedure to identify the key domains of health-related QoL. Five stakeholder groups (i.e., patients, family of patients, clinicians, scientists and general public) were asked, on three consecutive occasions, what they perceive as the most important domains of health-related QoL. An analysis of existing (health-related) QoL and well-being measurements formed the basis of the Delphi-procedure. RESULTS: In total, 42 domains of QoL were judged, covering physical, mental and social aspects. All participants rated 'self-acceptance', 'self-esteem' and 'good social contacts' as essential. Strikingly, mental and social domains are perceived as more essential than physical domains across stakeholders groups. CONCLUSIONS: In traditionally used health-related QoL utility measures, physical domains like 'mobility' are prominently present. The Delphi-procedure shows that health-related QoL (utility) scales need to put sufficient emphasis on mental and social domains to capture aspects of QoL that are essential to people.

Cognitive self-affirmation inclination: an individual difference in dealing with self-threats.

The current research shows that people differ in their inclination to use positive self-images when their self is threatened (i.e., cognitive self-affirmation inclination, CSAI). Just as self-affirmation manipulations do, the use of positive self-images induces open mindedness towards threatening messages. The aim of the current studies was to show the meaning, stability, and effects of this new individual difference measure. A cross-sectional study among smokers (Study 1) showed that people with a strong CSAI perceived more negative consequences from smoking, suggesting open mindedness. Study 2 showed the stable and reliable character of the CSAI scale. Study 3 showed that the scale had an overlap of 18% with another self-related construct (self-efficacy) and no relation with self-consciousness. Study 4 showed that for induced self-threats a strong CSAI led to the same pattern of persuasion as found in earlier studies on self-affirmation manipulations. Study 5 showed that a self-affirmation manipulation did not have any effect for those participants with a strong self-affirmation inclination, probably because they already had access to positive self-images. Study 6 showed that self-reported positive self-images mediated the effect of self-affirmation inclination on persuasion.

Do behavioural health intentions engender health behaviour change? A study on the moderating role of self-affirmation on actual fruit intake versus vegetable intake.

OBJECTIVES: The purpose of this persuasion research was to show that self-affirmation (SA) increases intentions in the advocated direction and that these intentions predict actual health behaviour change. That is, these intentions not only serve the function of short-term relief of the threat caused by the persuasive message. We proposed that the effect of SA depends on the level of value-involvement. DESIGN: Participants were randomly assigned to one of two conditions (no SA vs. SA) of a between-subjects design. After the SA manipulation, all participants read a threatening health text about the consequences of insufficient fruit and vegetable intake. At pre-test, value-involvement was determined. METHODS: Participants included were undergraduate students. The SA manipulation consisted of a writing exercise. After reading the health message, participants reported their intention to eat sufficient fruit and vegetables (N= 537). After 1 week (N= 293) and 4 weeks (N= 261), participants completed self-reports of fruit and vegetable intake. RESULTS: No main effect was found for SA on any outcome measure. We did find that involvement moderated the effect of SA on cooked vegetables consumption. This effect was not present for raw vegetables/salad consumption or for fruit consumption. The moderated effect on cooked vegetable consumption was most evident after 1 week and the effect was mediated by the immediate intentions of participants. CONCLUSIONS: SA can lead to genuine intentions that predict actual behaviour, but the effect of SA depends on the type of behaviour and people's value-involvement.

The persuasive effects of framing messages on fruit and vegetable consumption according to regulatory focus theory.

According to Regulatory Focus theory (RFT), outcomes in persuasive messages can be framed in four different ways, as gains, non-gains, losses or non-losses. In study 1, the persuasiveness of all four frames was compared and the presence/absence effect that was expected on the basis of the feature-positive effect was verified: Statements about present outcomes (gain, loss) were more persuasive than those about absent outcomes (non-gain, non-loss). However, this study failed to support the prediction that a gain-framed message would be more persuasive than a loss-framed message when promoting a prevention behaviour. Study 2 was designed to examine the latter finding. It was hypothesised that the threat posed by the loss-framed message in study 1 was too low to elicit a defensive reaction. Therefore, in study 2, the personal relevance of the gain and the loss framed message was manipulated. Consistent with predictions, the gain-framed message was more persuasive than the loss-framed message, but only when the message was personalised to increase self-relevance. Moreover, the effect was due to a significant drop in persuasion in the loss condition, probably caused by a defensive reaction. These data shed a new light on the findings of past framing studies.