Eliciting a value set for the Swedish Capability-Adjusted Life Years instrument (CALY-SWE).

PURPOSE: Our aim was to elicit a value set for Capability-Adjusted Life Years Sweden (CALY-SWE); a capability-grounded quality of life instrument intended for use in economic evaluations of social interventions with broad consequences beyond health. METHODS: Building on methods commonly used in the quality-adjusted life years EQ-5D context, we collected time-trade off (TTO) and discrete choice experiment (DCE) data through an online survey from a general population sample of 1697 Swedish participants. We assessed data quality using a score based on the severity of inconsistencies. For generating the value set, we compared different model features, including hybrid modeling of DCE and TTO versus TTO data only, censoring of TTO answers, varying intercept, and accommodating for heteroskedasticity. We also assessed the models' DCE logit fidelity to measure agreement with potentially less-biased DCE data. To anchor the best capability state to 1 on the 0 to 1 scale, we included a multiplicative scaling factor. RESULTS: We excluded 20% of the TTO answers of participants with the largest inconsistencies to improve data quality. A hybrid model with an anchor scale and censoring was chosen to generate the value set; models with heteroskedasticity considerations or individually varying intercepts did not offer substantial improvement. The lowest capability weight was 0.114. Health, social relations, and finance and housing attributes contributed the largest capability gains, followed by occupation, security, and political and civil rights. CONCLUSION: We elicited a value set for CALY-SWE for use in economic evaluations of interventions with broad social consequences.

An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire.

INTRODUCTION: Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities. MATERIAL AND METHODS: For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities. RESULTS: The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion. CONCLUSION: We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.

Knowing, being or doing? A comparative study on human service professionals' perceptions of quality in day-to-day encounters with clients and students with intellectual disabilities.

What does it mean to decide, act and behave in a professional manner towards people with intellectual disabilities? This article analyses how professionals from three welfare organizations describe quality in daily encounters with people with intellectual disabilities. Four hundred and twenty-one respondents participated in the study. Our empirical data consisted of written excerpts exclusively. Findings revealed that quality in encounters with people with intellectual disabilities was associated with personal attributes, pertinent knowledge, professional actions and ideological awareness. Findings also show differences in responses, both quantitatively (frequency) and qualitatively (content), which seem to be associated with organization. This reflects that human service organizations, as normative environments, underpin ideas about relevance and appropriateness in day-to-day situations, forming actions and perceptions among its members. Our conclusion is that organizational context needs to be considered to enhance our knowledge on how different categories of professionals view quality and moral worth when working with people with intellectual disabilities.

Understanding eldercare users' views on quality of care and strategies for dealing with problems in Swedish home help services.

The aim of the present study was to gain a deeper understanding of eldercare users' strategies for dealing with problems in the quality of care and care satisfaction in relation to home help services. Based on earlier research and evaluations, it was assumed that users would express satisfaction and gratitude, and also be unwilling to complain. The specific research questions were: (i) What, if any, quality of care problems do the users mention? (ii) How do the users explain the reasons for these problems? and (iii) What strategies do the users employ to deal with these problems? A total of 35 interviews were conducted in November 2013 with 15 men and 20 women (66-92 years). The data were analysed using thematic and qualitative content analysis. The results showed that almost all users expressed overall satisfaction with their care. However, all but one also mentioned problems. The users stated very clearly and explicitly the reasons for these problems, and in most cases, they referred to the work conditions, work organisation and lack of other resources in the eldercare organisation. Two strategies were commonly used to deal with these problems: trivialisation and adaptation. A third strategy was expressed dissatisfaction, where the problem led to actions or plans to take action. One interpretation of the findings is that what is actually measured in official quality assessments and follow-ups may be care users' understanding of the work conditions and work organisation of eldercare. The understanding attitude may prevent care users from complaining because it lowers their expectations.

From thought to action: young parents' reasons for participation in parenting support groups at child welfare centers.

In this article the focus is on young parents' engagement process in relation to participation in parenting support groups carried out at child welfare centers. This qualitative study focuses not only on young parents' reasons for participating or not participating in parenting support groups during different phases in their engagement process, but also on examining the circumstances that may contribute to such changes. The results show that these reasons can be divided into four categories: the staff, other participants, the social network, and practical circumstances. It also appears that these reasons change between different phases of their engagement process. Primarily three different circumstances contributed to variation in parents' reasons: difficulty in predicting the value of participation, increased closeness in relationships with staff and other parents, and the specific life phase in which young parents find themselves. The results have important implications for policy makers and practitioners in their work in formulating and updating parenting support; they also indicate what may be important to focus on in the recruitment of young parents, and also what may be crucial in regard to them completing their engagement in parent support groups.