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Chikumbu E, Katiti V, Bunn C, Msoka EF, Sichali J, Yongolo NM, McIntosh E, Mmbaga BT, Wyke S, Coast J. A more equitable approach to economic evaluation: Directly developing conceptual capability wellbeing attributes for Tanzania and Malawi. Soc Sci Med 2024; 355:117135. [PMID: 39029442 DOI: 10.1016/j.socscimed.2024.117135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/24/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
Capability wellbeing can potentially provide a holistic outcome for health economic evaluation and the capability approach seems promising for African countries. As yet there is no work that has explored the evaluative space needed for health and care decision making at the whole population level and procedures that merely translate existing measures developed in the global north to contexts in the global south risk embedding structural inequalities. This work seeks to elicit the concepts within the capability wellbeing evaluative space for general adult populations in Tanzania and Malawi. Semi-structured interviews with 68 participants across Tanzania and Malawi were conducted between October 2021 and July 2022. Analysis used thematic coding frames and the writing of analytic accounts. Interview schedules were common across the two country settings, however data collection and analysis were conducted independently by two separate teams and only brought together once it was clear that the data from the two countries was sufficiently aligned for a single analysis. Eight common attributes of capability wellbeing were found across the two countries: financial security; basic needs; achievement and personal development; attachment, love and friendship; participation in community activities; faith and spirituality; health; making decisions without unwanted interference. These attributes can be used to generate outcome measures for use in economic evaluations comparing alternative health interventions. By centring the voices of Tanzanians and Malawians in the construction of attributes that describe a good life, the research can facilitate greater equity within economic evaluations across different global settings.
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Affiliation(s)
- Edith Chikumbu
- Malawi Epidemiology and Intervention Research Unit, P.O Box 46, Chilumba, Malawi.
| | - Victor Katiti
- Kilimanjaro Christian Medical University College, Kilimanjaro Clinical Research Institute, Box 2240, Moshi, Tanzania.
| | - Christopher Bunn
- University of Glasgow, School of Social and Political Science, University Avenue, Glasgow, G12 8QQ, UK.
| | - Elizabeth F Msoka
- Kilimanjaro Christian Medical University College, Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical Centre, P.O.BOX 2236, Moshi, Tanzania.
| | - Junious Sichali
- Malawi Epidemiology and Intervention Research Unit, P.O Box 46, Chilumba, Malawi.
| | - Nateiya Mmeta Yongolo
- Kilimanjaro Clinical Research Institute, P. O Box 2236, Sokoine Road, Moshi, Tanzania.
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8TB, UK.
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical Centre, P.O.BOX 2236, Moshi, Tanzania.
| | - Sally Wyke
- University of Glasgow, School of Social and Political Science, University Avenue, Glasgow, G12 8QQ, UK.
| | - Joanna Coast
- Health Economics and Health Policy @ Bristol, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
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Brinkmann C, Stargardt T, Brouwer WBF. From Health to Well-Being: Toward a Monetary Valuation of a Well-Being-Adjusted Life-Year. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:857-870. [PMID: 38447745 DOI: 10.1016/j.jval.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Economic evaluations using broader measures to capture benefits beyond improved health can inform policy making, but only if the monetary value of gains measured using these instruments is understood. This study explored contingent valuation as a method to estimate the monetary value of a well-being-adjusted life-year (WALY) as measured by ICEpop Capability Measure for Adults (ICECAP-A). METHODS In a large online survey of representative samples from 7 European countries, participants valued a change in the ICECAP-A from their current health state to a randomly assigned hypothetical state. Participants were instructed that an unspecified treatment could avoid a loss or produce a gain in well-being and were asked for their willingness to pay (WTP) for this treatment. WTP per WALY was calculated using an aggregated approach that used ICECAP-A tariffs from the United Kingdom. RESULTS We analyzed a sample of 7428 observations, focusing on avoided losses (n = 6002) because the results for gains were not theoretically valid. Different cutoff points for a marginal change were explored. Depending on the definition of a marginal change, WTP per WALY averaged between €13 323.28 and €61 375.63 for avoided losses between [0, 0.5] and [0, 0.1], respectively, for 1 month. Mean WTP per WALY varied across the countries as follows: Denmark (€17 867.93-€88 634.14), France (€10 278.35-€45 581.28), Germany (€12 119.39-€54 566.56), Italy (€11 753.69-€52 161.25), The Netherlands (€14 612.88-€58 951.74), Spain (€11 904.12-€57 909.17), and United Kingdom (€13 133.75-€68 455.85). CONCLUSION Despite the inherent limitations of our study, it offers valuable insights into methods for eliciting the WTP for changes in capability well-being as measured with ICECAP-A.
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Affiliation(s)
- Carolin Brinkmann
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany.
| | - Tom Stargardt
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Zuid-Holland, Rotterdam, The Netherlands
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Bohorquez NG, Malatzky C, McPhail SM, Mitchell R, Lim MHA, Kularatna S. Attribute Development in Health-Related Discrete Choice Experiments: A Systematic Review of Qualitative Methods and Techniques to Inform Quantitative Instruments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02401-X. [PMID: 38851483 DOI: 10.1016/j.jval.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES This review sought to identify the qualitative methods and techniques that researchers have used in the past decade to develop attributes and inform health-related discrete choice experiments (DCEs) surveys from a patient perspective. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews. An adapted appraisal tool following guidelines for reporting qualitative research for quantitative instruments and criteria for attribute development in DCEs was applied for quality assessment and data extraction. A narrative approach was used to synthesize data. This examination included consideration of issues pertaining to sampling, data collection, data analysis, attribute list reduction, wording, methodological adaptations to capture patient preferences, and testing the pre-experimental design decisions of the DCE survey. RESULTS Of 8505 articles identified for abstract screening, 680 were included for full-text screening, 36 of which met the inclusion criteria. Practices to improve methodological robustness included pre-data collection materials to inform instruments, data collection methods specific for decision-making scenarios, purposeful selection of data analysis methods to address the research question, and participants' involvement in reducing the list of attributes. Examples of methodological adaptations for patients were noted. CONCLUSIONS DCEs have the potential to become a mixed-method approach in which the qualitative phase informs a reduced list of attributes for a survey, serves the predesign decisions of the experiment by testing trade-offs, overlapping, understandability, face, and content validity and provides explanations of the quantitative results. Establishing guidelines for using qualitative methods for DCE attribute development may help to broadly enhance the methodological robustness of DCEs.
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Affiliation(s)
- Natalia Gonzalez Bohorquez
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Christina Malatzky
- Centre for Justice and Centre for Decent Work and Industry, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Megumi Hui Ai Lim
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
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Scazufca M, Nakamura CA, Seward N, Didone TVN, Moretti FA, Oliveira da Costa M, Queiroz de Souza CH, Macias de Oliveira G, Souza Dos Santos M, Pereira LA, Mendes de Sá Martins M, van de Ven P, Hollingworth W, Peters TJ, Araya R. Self-help mobile messaging intervention for depression among older adults in resource-limited settings: a randomized controlled trial. Nat Med 2024; 30:1127-1133. [PMID: 38486075 PMCID: PMC11031393 DOI: 10.1038/s41591-024-02864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/12/2024] [Indexed: 04/21/2024]
Abstract
Scalable solutions to treat depression in older adults in low-resourced settings are urgently needed. The PRODIGITAL-D pragmatic, single-blind, two-arm, individually randomized controlled trial assessed the effectiveness of a mobile messaging psychosocial intervention in improving depressive symptomatology among older adults in socioeconomically deprived areas of Guarulhos, Brazil. Older adults (aged 60+ years) registered with 24 primary care clinics and identified with depressive symptomatology (9-item Patient Health Questionnaire (PHQ-9) scores ≥ 10) received the 6-week Viva Vida intervention based on psychoeducation and behavioral activation (n = 298) or a single message (n = 305). No health professional support was offered. The primary outcome was improvement from depressive symptomatology (PHQ-9 < 10) at 3 months. Of the 603 participants enrolled (mean age = 65.1 years; 451 (74.8%) women), 527 (87.4%) completed the follow-up assessment. In the intervention arm, 109 of 257 (42.4%) participants had an improved depressive symptomatology, compared with 87 of 270 (32.2%) participants in the control arm (adjusted odds ratio = 1.57; 95% confidence interval = 1.07-2.29; P = 0.019). No severe adverse events related to trial participation were observed. These results demonstrate the usefulness of a digital messaging psychosocial intervention in the short-term improvement from depressive symptomatology that can potentially be integrated into primary care programs for treating older adults with depression. Brazilian Registry of Clinical Trials registration: ReBEC ( RBR-4c94dtn ).
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Affiliation(s)
- Marcia Scazufca
- Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
| | - Carina Akemi Nakamura
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Nadine Seward
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Thiago Vinicius Nadaleto Didone
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Saúde Coletiva, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, Brazil
| | - Felipe Azevedo Moretti
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Neuroscience Research Group, Institute D'Or for Research and Teaching, São Paulo, Brazil
| | - Marcelo Oliveira da Costa
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Monica Souza Dos Santos
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luara Aragoni Pereira
- Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Pepijn van de Ven
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - William Hollingworth
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, and Bristol Dental School, University of Bristol, Bristol, UK
| | - Ricardo Araya
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Long SO, Hope SV. What patient-reported outcome measures may be suitable for research involving older adults with frailty? A scoping review. Eur Geriatr Med 2024:10.1007/s41999-024-00964-5. [PMID: 38532081 DOI: 10.1007/s41999-024-00964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The need to develop and evaluate frailty-related interventions is increasingly important, and inclusion of patient-reported outcomes is vital. Patient-reported outcomes can be defined as measures of health, quality of life or functional status reported directly by patients with no clinician interpretation. Numerous validated questionnaires can thus be considered patient-reported outcome measures (PROMs). This review aimed to identify existing PROMs currently used in quantitative research that may be suitable for older people with frailty. METHOD PubMed and Cochrane were searched up to 24/11/22. Inclusion criteria were quantitative studies, use of a PROM, and either measurement of frailty or inclusion of older adult participants. Criteria were created to distinguish PROMs from questionnaire-based clinical assessments. 197 papers were screened. PROMs were categorized according to the domain assessed, as derived from a published consensus 'Standard Set of Health Outcome Measures for Older People'. RESULTS 88 studies were included. 112 unique PROMs were used 289 times, most frequently the SF-36 (n = 21), EQ-5D (n = 21) and Barthel Index (n = 14). The most frequently assessed outcome domains included Mood and Emotional Health and Activities of Daily Living, with fewer assessments of Participation in Decision-Making and Carer Burden. CONCLUSIONS PROM usage in frailty research is highly heterogeneous. Frequently used PROMs omit important outcomes identified by older adults. Further research should evaluate the importance of specific outcomes and identify PROMs relevant to people at different stages of frailty. Consistent and appropriate PROM use in frailty research would facilitate more effective comparisons and meaningful evaluation of frailty interventions.
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Affiliation(s)
- S O Long
- University of Exeter, Exeter, UK
| | - S V Hope
- University of Exeter, Exeter, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
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Kwon J, Squires H, Young T. Incorporating frailty to address the key challenges to geriatric economic evaluation. BMC Geriatr 2024; 24:155. [PMID: 38355461 PMCID: PMC10868084 DOI: 10.1186/s12877-024-04752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The multidimensional and dynamically complex process of ageing presents key challenges to economic evaluation of geriatric interventions, including: (1) accounting for indirect, long-term effects of a geriatric shock such as a fall; (2) incorporating a wide range of societal, non-health outcomes such as informal caregiver burden; and (3) accounting for heterogeneity within the demographic group. Measures of frailty aim to capture the multidimensional and syndromic nature of geriatric health. Using a case study of community-based falls prevention, this article explores how incorporating a multivariate frailty index in a decision model can help address the above key challenges. METHODS A conceptual structure of the relationship between geriatric shocks and frailty was developed. This included three key associations involving frailty: (A) the shock-frailty feedback loop; (B) the secondary effects of shock via frailty; and (C) association between frailty and intervention access. A case study of economic modelling of community-based falls prevention for older persons aged 60 + was used to show how parameterising these associations contributed to addressing the above three challenges. The English Longitudinal Study of Ageing (ELSA) was the main data source for parameterisation. A new 52-item multivariate frailty index was generated from ELSA. The main statistical methods were multivariate logistic and linear regressions. Estimated regression coefficients were inputted into a discrete individual simulation with annual cycles to calculate the continuous variable value or probability of binary event given individuals' characteristics. RESULTS All three conceptual associations, in their parameterised forms, contributed to addressing challenge (1). Specifically, by worsening the frailty progression, falls incidence in the model increased the risk of falling in subsequent cycles and indirectly impacted the trajectories and levels of EQ-5D-3 L, mortality risk, and comorbidity care costs. Intervention access was positively associated with frailty such that the greater access to falls prevention by frailer individuals dampened the falls-frailty feedback loop. Association (B) concerning the secondary effects of falls via frailty was central to addressing challenge (2). Using this association, the model was able to estimate how falls prevention generated via its impact on frailty paid and unpaid productivity gains, out-of-pocket care expenditure reduction, and informal caregiving cost reduction. For challenge (3), frailty captured the variations within demographic groups of key model outcomes including EQ-5D-3 L, QALY, and all-cause care costs. Frailty itself was shown to have a social gradient such that it mediated socially inequitable distributions of frailty-associated outcomes. CONCLUSION The frailty-based conceptual structure and parameterisation methods significantly improved upon the methods previously employed by falls prevention models to address the key challenges for geriatric economic evaluation. The conceptual structure is applicable to other geriatric and non-geriatric intervention areas and should inform the data selection and statistical methods to parameterise structurally valid economic models of geriatric interventions.
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Affiliation(s)
- Joseph Kwon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, OX2 6GG, Oxford, England.
| | - Hazel Squires
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, S1 4DA, Sheffield, England
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, S1 4DA, Sheffield, England
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Mendoza-Jiménez MJ, van Exel J, Brouwer W. On spillovers in economic evaluations: definition, mapping review and research agenda. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01658-8. [PMID: 38261132 DOI: 10.1007/s10198-023-01658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024]
Abstract
An important issue in economic evaluations is determining whether all relevant impacts are considered, given the perspective chosen for the analysis. Acknowledging that patients are not isolated individuals has important implications in this context. Increasingly, the term "spillovers" is used to label consequences of health interventions on others. However, a clear definition of spillovers is lacking, and as a result, the scope of the concept remains unclear. In this study, we aim to clarify the concept of spillovers by proposing a definition applicable in health economic evaluations. To illustrate the implications of this definition, we highlight the diversity of potential spillovers through an expanded impact inventory and conduct a mapping review that outlines the evidence base for the different types of spillovers. In the context of economic evaluations of health interventions, we define spillovers as all impacts from an intervention on all parties or entities other than the users of the intervention under evaluation. This definition encompasses a broader range of potential costs and effects, beyond informal caregivers and family members. The expanded impact inventory enables a systematic approach to identifying broader impacts of health interventions. The mapping review shows that the relevance of different types of spillovers is context-specific. Some spillovers are regularly included in economic evaluations, although not always recognised as such, while others are not. A consistent use of the term "spillovers", improved measurement of these costs and effects, and increased transparency in reporting them are still necessary. To that end, we propose a research agenda.
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Affiliation(s)
- María J Mendoza-Jiménez
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Facultad de Ciencias Sociales y Humanísticas, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador.
| | - Job van Exel
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Nishio M, Haseda M, Inoue K, Saito M, Kondo N. Measuring functional ability in Healthy Ageing: testing its validity using Japanese nationwide longitudinal data. Age Ageing 2024; 53:afad224. [PMID: 38275093 PMCID: PMC10811647 DOI: 10.1093/ageing/afad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The United Nations Decade of Healthy Ageing 2021-2030 suggests nations should monitor functional ability as an indicator of healthy ageing progress. Functional ability is the attribute of people to do something they value and consists of five domains. We examined its validity in terms of a construct, cross-validation across multiple waves' data, and predictivity for subsequent well-being. METHODS Using panel data from 35,093 community-dwelling adults aged ≥65 years from the Japan Gerontological Evaluation Study, we performed factor analyses to explore the construct of functional ability domains in both 2013 and 2016. A modified Poisson regression analysis was employed to test their associations with well-being (subjective health and happiness) in 2019. RESULTS The mean age (standard deviation) of participants was 72.1 (5.0) years, and 52.0% were women. A total of 85.0% reported good subjective health, and 50.6% reported high happiness levels. Factor analyses with 31 logically checked candidate items from 2016 data suggested a three-factor model comprising 24 items, which were compatible with the 2013 data results. Based on the World Health Organization's original domains, we named domains as domain #1: ability to build and maintain relationships; domain #2: ability to meet basic needs + ability to move around and domain #3: ability to learn, grow and make decisions + ability to contribute. All three domains predicted both subjective health and happiness in 2019. CONCLUSIONS Empirical data from Japan supports the functional ability concept among older individuals. Validating this concept with data from other nations is warranted.
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Affiliation(s)
- Marisa Nishio
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Maho Haseda
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Masashige Saito
- Department of Social Welfare, Nihon Fukushi University, Mihama, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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McCaffrey N, Ratcliffe J, Currow D, Engel L, Hutchinson C. What Aspects of Quality of Life are Important from Palliative Care Patients' Perspectives? A Framework Analysis to Inform Preference-Based Measures for Palliative and End-of-Life Settings. THE PATIENT 2024; 17:39-52. [PMID: 37975965 DOI: 10.1007/s40271-023-00651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving specialised palliative care services to help determine if the development of a new condition-specific preference-based outcome measure is warranted. METHODS In-depth face-to-face interviews were conducted with 18 participants recruited from palliative care services in South Australia. Data were analysed using a framework analysis drawing on findings from a systematic review of international qualitative studies investigating the quality-of-life preferences of patients receiving palliation (domains identified included cognitive, emotional, healthcare, personal autonomy, physical, preparatory, social, spiritual). Participants identified missing or irrelevant domains in the EQ-5D and QLU-C10D questionnaires and ranked the importance of domains. RESULTS A priori domains were refined into cognitive, environmental, financial, independence, physical, psychological, social and spiritual. The confirmation of the eight important quality-of-life domains across multiple international studies suggests there is a relatively high degree of convergence on the perspectives of patients in different countries. Four domains derived from the interviews are not covered by the EQ-5D and QLU-C10D (cognitive, environmental, financial, spiritual), including one of the most important (spiritual). CONCLUSIONS Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.
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Affiliation(s)
- Nikki McCaffrey
- Institute for Health Transformation, Deakin Health Economics, SHSD, Faculty of Health, Deakin University, Geelong, VIC, Australia.
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Kalra K, Moumneh MB, Nanna MG, Damluji AA. Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease. Front Cardiovasc Med 2023; 10:1276370. [PMID: 38045910 PMCID: PMC10690830 DOI: 10.3389/fcvm.2023.1276370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.
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Affiliation(s)
- Kriti Kalra
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Mohamad B. Moumneh
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Lorimer K, Greco G, Lorgelly P. A new sexual wellbeing paradigm grounded in capability approach concepts of human flourishing and social justice. CULTURE, HEALTH & SEXUALITY 2023; 25:1402-1417. [PMID: 36565149 DOI: 10.1080/13691058.2022.2158236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Over the last twenty years, there has been a growing interest in measuring sexual wellbeing, including by a WHO/UNFPA working group in 2007, which sought clarity on key dimensions and asked for indicators of these to be devised. However, there remains a lack of conceptual clarity surrounding the concept of sexual wellbeing, which may create variation in what is being assessed and to what we are referring. This paper proposes one way in which to achieve conceptual clarity might be through the utilisation of a Capability Approach, thereby posing a new set of normative questions about what sexual wellbeing is. The central argument in this paper is for researchers, theorists and practitioners to focus more fully on a person's freedom to achieve sexual wellbeing within a particular social and cultural context. We suggest the kinds of data that might need to be captured to operationalise and measure such an understanding. By offering new critical insights, we hope to drive forward empirical and methodological development in the evaluation of sexual wellbeing.
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Affiliation(s)
- Karen Lorimer
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Giulia Greco
- Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Paula Lorgelly
- Department of Economics, University of Auckland, Auckland, New Zealand
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12
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O'Toole S, Moazzez R, Wojewodka G, Zeki S, Jafari J, Hope K, Brand A, Hoare Z, Scott S, Doungsong K, Ezeofor V, Edwards RT, Drakatos P, Steier J. Single-centre, single-blinded, randomised, parallel group, feasibility study protocol investigating if mandibular advancement device treatment for obstructive sleep apnoea can reduce nocturnal gastro-oesophageal reflux (MAD-Reflux trial). BMJ Open 2023; 13:e076661. [PMID: 37620257 PMCID: PMC10450077 DOI: 10.1136/bmjopen-2023-076661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Just under half of patients with obstructive sleep apnoea (OSA) also have gastro-oesophageal reflux disease (GORD). These conditions appear to be inter-related and continual positive airway pressure (CPAP) therapy, the gold standard treatment for OSA to prevent airway collapse, has been shown to reduce GORD. As the impact of mandibular advancement devices, a second-line therapy for OSA, on GORD has yet to be investigated, a feasibility study is needed prior to a definitive trial. METHODS This will be a single-centre, single-blinded, tertiary-care based, interdisciplinary, parallel randomised controlled study. Potential OSA participants presenting to the sleep department will be pre-screened for GORD using validated questionnaires, consented and invited to receive simultaneous home sleep and oesophageal pH monitoring. Those with confirmed OSA and GORD (n=44) will be randomly allocated to receive either CPAP (n=22) or MAD therapy (n=22). Following successful titration and 3 weeks customisation period, participants will repeat the simultaneous sleep and oesophageal pH monitoring while wearing the device. The number of patients screened for recruitment, drop-out rates, patient feedback of the study protocol, costs of interventions and clinical information to inform a definitive study design will be investigated. ETHICS AND DISSEMINATION Health Research Authority approval has been obtained from the Nottingham 2 Research Ethics Committee, ref:22/EM/0157 and the trial has been registered on ISRCTN (https://doi.org/10.1186/ISRCTN16013232). Definitive findings about the feasibility of doing 24 hour pH oesophageal monitoring while doing a home sleep study will be disseminated via clinical and research networks facilitating valuable insights into the simultaneous management of both conditions. TRIAL REGISTRATION NUMBER ISRCTN Reg No: 16013232.
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Affiliation(s)
- Saoirse O'Toole
- Centre for Clinical, Oral and Translational Sciences, King's College London, London, UK
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Rebecca Moazzez
- Restorative Dentistry, University of the Pacific Arthur A Dugoni School of Dentistry, San Francisco, California, USA
| | | | - Sebastian Zeki
- Oesophageal Physiology Laboratory, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Jafar Jafari
- Oesophageal Physiology Laboratory, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - Andrew Brand
- NWORTH (North Wales Organisation for Randomised Trials in Health), School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Zoe Hoare
- NWORTH (North Wales Organisation for Randomised Trials in Health), School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Suzanne Scott
- Queen Mary University of London Wolfson Institute of Population Health, London, UK
| | - Kodchawan Doungsong
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Panagis Drakatos
- Oesophageal Physiology Laboratory, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Joerg Steier
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Medicine, King's College London, London, UK
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Ajitsaria P, Lott N, Baker A, Lacey J, Magnusson M, Douglas JL, Healey P, Tan-Gore E, Szwec SV, Barker D, Deeming S, Tavener M, Smith S, Gani J, Attia J. Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach - a Randomised controlled Trial in the Older adult Population considering Surgery. BMJ Open 2023; 13:e070159. [PMID: 37407039 DOI: 10.1136/bmjopen-2022-070159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION The Australian population presenting with surgical pathology is becoming older, frailer and more comorbid. Shared decision-making is rapidly becoming the gold standard of care for patients considering high-risk surgery to ensure that appropriate, value-based healthcare decisions are made. Positive benefits around patient perception of decision-making in the immediacy of the decision are described in the literature. However, short-term and long-term holistic patient-centred outcomes and cost implications for the health service require further examination to better understand the full impact of shared decision-making in this population. METHODS We propose a novel multidisciplinary shared decision-making model of care in the perioperative period for patients considering high-risk surgery in the fields of general, vascular and head and neck surgery. We assess it in a two arm prospective randomised controlled trial. Patients are randomised to either 'standard' perioperative care, or to a multidisciplinary (surgeon, anaesthetist and end-of-life care nurse practitioner or social worker) shared decision-making consultation. The primary outcome is decisional conflict prior to any surgical procedure occurring. Secondary outcomes include the patient's treatment choice, how decisional conflict changes longitudinally over the subsequent year, patient-centred outcomes including life impact and quality of life metrics, as well as morbidity and mortality. Additionally, we will report on healthcare resource use including subsequent admissions or representations to a healthcare facility up to 1 year. ETHICS AND DISSEMINATION This study has been approved by the Hunter New England Human Research Ethics Committee (2019/ETH13349). Study findings will be presented at local and national conferences and within scientific research journals. TRIAL REGISTRATION NUMBER ACTRN12619001543178.
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Affiliation(s)
- Pragya Ajitsaria
- Department of Anaesthesia, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Natalie Lott
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Angela Baker
- Department of Anaesthesia, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeanette Lacey
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Monique Magnusson
- Department of Anaesthesia, John Hunter Hospital, Newcastle, New South Wales, Australia
| | | | - Paul Healey
- Department of Anaesthesia, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Eileen Tan-Gore
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Stuart V Szwec
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Daniel Barker
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Simon Deeming
- Health Research Economics, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Meredith Tavener
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Steve Smith
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Jon Gani
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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14
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Osstyn SL, Handels R, Boots LMM, Balvert SCE, Evers SMAA, de Vugt ME. The effectiveness and health-economic evaluation of "Partner in Balance," a blended self-management program for early-stage dementia caregivers: study protocol for a cluster-randomized controlled trial. Trials 2023; 24:427. [PMID: 37349828 DOI: 10.1186/s13063-023-07423-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Informal caregivers of people with dementia are crucial in dementia care. However, they are insufficiently supported and report caregiver burdens, which urges the need for cost-effective interventions aimed at supporting caregivers. This paper presents the design of a study evaluating the effectiveness, cost-effectiveness, and cost-utility of a blended self-management program for early-stage dementia caregivers. METHODS/DESIGN A pragmatic, cluster randomized controlled trial with a shared control group will be conducted. Participants will be informal caregivers of people with early-stage dementia and will be recruited by local care professionals. Randomization will be carried out at the level of the care professional level in a ratio of 35% to 65% (control arm vs. intervention arm). Participants in the control arm will receive care as usual and the intervention arm will receive the blended care self-management program "Partner in Balance" within a usual care setting in the Netherlands. Data will be collected at baseline and at 3-, 6-, 12-, and 24-month follow-ups. The primary outcome for effectiveness (part 1) is care management self-efficacy. For the health-economic evaluation (part 2) total care costs and the quality of life for individuals with dementia (cost-effectiveness) and quality-adjusted life years (cost-utility) will be the base case analysis. Secondary outcomes (parts 1 and 2) will include depression, anxiety, perceived informal caregiving stress, service-use self-efficacy, quality of life, caregivers' gain, and perseverance time. A process evaluation (part 3) will investigate the internal and external validity of the intervention. DISCUSSION In this trial, we plan to evaluate the effectiveness, cost-effectiveness, and cost-utility of "Partner in Balance" among informal caregivers of people with dementia. We expect to find a significant increase in care management self-efficacy, and the program to be cost-effective, and provide valuable insights to stakeholders of "Partner in Balance." TRIAL REGISTRATION ClinicalTrials.gov, NCT05450146. Registered on 4 November 2022.
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Affiliation(s)
- Sander L Osstyn
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Ron Handels
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Lizzy M M Boots
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Sanne C E Balvert
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
- Centre of Economic Evaluations & Machine Learning, Trimbos Institute, Utrecht, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands.
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Ran X, Mao Z, Yang Z. A head-to-head comparison of well-being of older people (WOOP) and EQ-5D-5L in patients, carers and general public in China. Sci Rep 2023; 13:6270. [PMID: 37069328 PMCID: PMC10110531 DOI: 10.1038/s41598-023-33248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/10/2023] [Indexed: 04/19/2023] Open
Abstract
Recently, well-being of older people measure (WOOP) was developed and validated in a Dutch population. Although WOOP was developed targeting the older people, it has the potential for use in a wider population. In this study, we aimed to examine the relationship between WOOP and EQ-5D-5L and compared their psychometric properties in a sample of patients, carers and healthy general public covering a wider age group. We conducted a cross-sectional study in Guizhou Province, China between July and August 2022. Data was collected using paper and pencil. We analysed and reported the acceptability, item response distribution, the Spearman correlation coefficients of all items, the Exploratory Factor Analysis (EFA) of all items, the known-group validity and the convergent validity of EQ-5D-5L utility and WOOP utility. A total of 322 participants completed the survey with 105 patients, 101 carers and 116 healthy general public. 9% of participants had at least one missing response. Three items of WOOP did not have any level 5 responses and EQ-5D-5L had more level 1 responses. The correlations were low between EQ-5D-5L and WOOP items and the three-factor EFA showed these two instruments had only one shared factor and the other two factors were only related to WOOP items. Younger people had lower missing response rate and a different response distribution for three items. WOOP measures a broader construct beyond health while EQ-5D-5L is a more sensitive instrument when health is considered alone. There is a potential of using WOOP in a wider population.
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Affiliation(s)
- Xun Ran
- Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerpe, Belgium
| | - Zhihao Yang
- Department of Health Services Management, Guizhou Medical University, Guiyang, China.
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China.
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16
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Contreras M, Khondoker M, Mioshi E, Kishita N. Factors affecting the quality of life of family carers of people with dementia: the role of carer anxiety. PSYCHOL HEALTH MED 2023; 28:843-853. [PMID: 35769020 DOI: 10.1080/13548506.2022.2093926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The role of anxiety on the quality of life of family carers of people with dementia is somewhat neglected in the carer literature. The current study aimed to investigate the impact of common risk factors (i.e., care recipient's neuropsychiatric symptoms, carer depression, and burden) and anxiety on QoL. This cross-sectional study recruited 89 family carers. Most of the participants were looking after a spouse with Alzheimer's or mixed dementia. A multiple regression analysis was conducted with carer QoL as a dependent variable. All risk factors (i.e., people with dementia's neuropsychiatric symptoms, carer depression, anxiety, and burden) were entered into the model simultaneously as independent variables. The model's R2 was 33%. The results demonstrated that anxiety was the only significant independent variable predicting carer QoL (β = - 0.34, p = 0.03, 95% CI: - 0.64 to - 0.04). These results indicated that having more symptoms of anxiety was associated with worse QoL as measured by the ICEpop CAPability measure for Older people (ICECAP-O). These findings suggested that improving carer's anxiety may be particularly important in promoting QoL among family carers of people with dementia. Future interventions should target this variable to achieve the desired result of improving carer QoL.
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Affiliation(s)
- Milena Contreras
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Naoko Kishita
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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17
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Rand S, Towers AM, Malley J, Silarova B. Exploring the structural characteristics of the Adult Social Care Outcomes Toolkit (ASCOT) and ASCOT-Carer. NIHR OPEN RESEARCH 2023; 2:21. [PMID: 37881301 PMCID: PMC10593358 DOI: 10.3310/nihropenres.13259.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 10/27/2023]
Abstract
Background Measurement models inform the approach to assess a measure's validity and also how a measure is understood, applied and interpreted. With preference-based measures (PBMs), it is generally accepted that they are formative; however, if they are applied without preferences, they may be reflective, formative or mixed. In this study, we sought to empirically test whether the reflective, formative or mixed measurement model best describes PBMs of social care-related quality of life (SCRQoL) - specifically, the ASCOT and ASCOT-Carer. We also explored the network approach, as an alternative. Methods ASCOT and ASCOT-Carer data were analyzed using confirmatory factor analysis and Multiple Indicators Multiple Causes models to test reflective, formative or mixed measurement models, respectively. Network analysis of partial correlations using the Gaussian graphical model was also conducted. Results The results indicated that the reflective measurement model is the worst fit for ASCOT and ASCOT-Carer. The formative or mixed measurement models may apply to ASCOT. The mixed measurement model was the best fit for ASCOT-Carer. The network analysis indicated that the most important or influential items were Occupation and Personal cleanliness and comfort (ASCOT) and Time and space and Self-care (ASCOT-Carer). Conclusions The ASCOT and ASCOT-Carer are best described as formative/mixed or mixed measurement models, respectively. These findings may guide the approach to the validation of cross-culturally adapted and translated versions. Specifically, we recommend that EFA be applied to establish structural characteristics, especially if the measure will be applied as a PBM and as a measure of SCRQoL. Network analysis may also provide further useful insights into structural characteristics.
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Affiliation(s)
- Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Juliette Malley
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Barbora Silarova
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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18
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Gottschalk S, König HH, Nejad M, Dams J. Measurement properties of the EQ-5D in populations with a mean age of ≥ 75 years: a systematic review. Qual Life Res 2023; 32:307-329. [PMID: 35915354 PMCID: PMC9911506 DOI: 10.1007/s11136-022-03185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Healthcare interventions for middle-old and oldest-old individuals are often (economically) evaluated using the EQ-5D to measure health-related quality of life (HrQoL). This requires sufficient measurement properties of the EQ-5D. Therefore, the current study aimed to systematically review studies assessing the measurement properties of the EQ-5D in this population. METHODS The databases PubMed, Cochrane library, Web of Science, Embase, and EconLit were searched for studies providing empirical evidence of reliability, validity, and/or responsiveness of the EQ-5D-3L and EQ-5D-5L in samples with a mean age ≥ 75 years. Studies were selected by two independent reviewers, and the methodological quality was assessed using the COSMIN Risk of Bias checklist. Results were rated against updated criteria for good measurement properties (sufficient, insufficient, inconsistent, indeterminate). The evidence was summarized, and the quality of evidence was graded using a modified GRADE approach. RESULTS For both EQ-5D versions, high-quality evidence for sufficient convergent validity was found. Known-groups validity was sufficient for the EQ-5D-5L (high-quality evidence), whereas the results were inconsistent for the EQ-5D-3L. Results regarding the reliability were inconsistent (EQ-5D-3L) or entirely lacking (EQ-5D-5L). Responsiveness based on correlations of change scores with instruments measuring related/similar constructs was insufficient for the EQ-5D-3L (high-quality evidence). For the EQ-5D-5L, the available evidence on responsiveness to change in (Hr)QoL instruments was limited. CONCLUSION Since the responsiveness of the EQ-5D in a population of middle-old and oldest-old individuals was questionable, either using additional instruments or considering the use of an alternative, more comprehensive instrument of (Hr)QoL might be advisable, especially for economic evaluations.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Mona Nejad
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Judith Dams
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Formica MB, Gianoudis J, Nowson CA, O'Connell SL, Milte C, Ellis KA, Daly RM. Effects of a Multi-component, Resistance-Based Exercise Program Combined with Additional Lean Red Meat on Health-Related Quality of Life in Older Adults: Secondary Analysis of a 6-Month Randomized Controlled Trial. J Nutr Health Aging 2023; 27:421-429. [PMID: 37357325 DOI: 10.1007/s12603-023-1915-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/14/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES To assess whether consumption of lean red meat on three exercise training days per week can promote greater improvements than exercise alone in health-related quality of life (HR-QoL) in community-dwelling older adults. DESIGN This study is a secondary analysis from a 6 month, two-arm, parallel randomized controlled trial conducted in 2014 and 2015. SETTING Community-dwelling older adults living in metropolitan Melbourne, Australia. PARTICIPANTS One hundred and fifty-four men and women aged ≥65 years. INTERVENTION All participants were enrolled in a multi-component, resistance-based exercise program (3 d/week) and randomly allocated to either a group asked to consume lean red meat (2x80g cooked servings/day) on each of the three training days (Ex+Meat, n=77) or a control group asked to consume one serving of carbohydrates (1/2 cup rice/pasta or 1 medium potato; Ex+C, n=77). MEASUREMENTS HR-QoL was assessed using the Short-Form (SF)-36 health survey. RESULTS Overall 62% of the participants were female, the mean age was 70.7 years (range 65 to 84 years), approximately 67% of participants were classified as either overweight or obese, and the average number of chronic conditions was two. A total of 145 participants (94%) completed the study. Mean baseline HR-QoL scores were comparable to the mean for the Australian population [Global HR-QoL (mean ± SD): Ex+Meat, 49.99 ± 6.57; Ex+C, 50.49 ± 5.27]. General Linear Mixed Models examining within and between group changes over time revealed that after 6 months, there were no within-group changes in either Ex+Meat or Ex+C nor any between-group differences for any measure of HR-QoL, with the exception that the mental health subscale improved in Ex+C versus Ex+Meat [net difference for change, -2.32 (95% CI), -4.73, 0.09, P=0.048] after adjusting for relevant covariates and the physical function subscale improved in Ex+Meat relative to baseline [mean change (95% CI), 1.88 (0.37, 3.39), P=0.011]. CONCLUSION A multi-component resistance-based training program performed with and without the provision of lean red meat in line with current Australian dietary guidelines on each of the three training days, did not improve HR-QoL in healthy community-dwelling older adults.
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Affiliation(s)
- M B Formica
- Professor Robin M. Daly, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, Australia 3215, , ORCID ID: 0000-0002-9897-1598
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20
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Penton H, Dayson C, Hulme C, Young T. A Qualitative Investigation of Older Adults' Conceptualization of Quality of Life and a Think-Aloud Content Validation of the EQ-5D-5L, SF-12v2, Warwick Edinburgh Mental Wellbeing Scale, and Office of National Statistics-4. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2017-2027. [PMID: 35760713 DOI: 10.1016/j.jval.2022.04.1735] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Old age is characterized by declining health, comorbidities, and increasing health and social care service use. Traditionally, patient-reported outcome measures (PROMs) including the EQ-5D-5L and SF-12v2 have focused on health. Nevertheless, aged care often aims to improve broader elements of quality of life (QoL), captured by well-being measures, such as the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Office of National Statistics-4 (ONS-4). This study investigates older adults' conceptualization of QoL and the content validity of the EQ-5D-5L, SF-12v2, WEMWBS, and ONS-4 in measuring their QoL. METHODS Qualitative cognitive think-aloud interviews were undertaken with older adults aged 75+, exploring their views on what was important to QoL and, for each measure, the relevance, acceptability, and interpretation of items; suitability of response options; and the comprehensiveness of the measure. Conceptualization of QoL was analyzed thematically and content validity using framework analysis. RESULTS Twenty interviews were undertaken. Older adults' conceptualization of QoL centered on health, ability to perform usual activities, social contact, and emotional functioning. Possible response shift was observed, as older adults assessed their health relative to lower health expectations at their age or to people in worse states. Participants questioned the relevance of negatively phrased mental items and often preferred the functioning-focused EQ-5D-5L to more subjective ONS-4 and WEMWBS items. Domains suggested to improve comprehensiveness included social contact, coping, security, dignity, and control. CONCLUSIONS These findings are useful to researchers developing new PROMs for older adults or for the developers of included PROMs considering permanently adapting or bolting-on domains to improve content validity in older adults.
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Affiliation(s)
- Hannah Penton
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Christopher Dayson
- Centre for Regional Economic and Social Research, Advanced Wellbeing Research Centre, Sheffield, England, UK
| | - Claire Hulme
- Institute of Health Research, South Cloisters, University of Exeter, Exeter, England, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
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Trajectories and prognostic factors for recovery after hip fracture: a longitudinal cohort study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2913-2926. [PMID: 36066616 DOI: 10.1007/s00264-022-05561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/18/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this study was to determine recovery trajectories and prognostic factors for poor recovery in frail and non-frail patients after hip fracture. METHODS Patients with a hip fracture aged 65 years and older admitted to a hospital in the Netherlands from August 2015 to November 2016 were asked to complete questionnaires at one week and one, three, six, 12, and 24 months after injury. The questionnaires included the ICEpop CAPability measure for older people, Health Utility Index, and the Hospital Anxiety Depression Scale. Latent class trajectory analysis was used to determine trajectories of recovery. Patient and injury characteristics for favourable and unfavourable outcome were compared with logistic regression. RESULTS In total, 696 patients were included of which 367 (53%) patients were frail. Overall, recovery trajectories in frail patients were worse compared to trajectories in non-frail patients. In frail patients, poor recovery was significantly associated with dementia. Lower age was a prognostic factor for good recovery. Immobility, loneliness and weight loss were prognostic for respectively poor capability and symptoms of anxiety and depression. In non-frail patients, recovery after hip fracture was associated with loneliness and the type of hip fracture. CONCLUSION Although frailty is associated with poor recovery in older patients with hip fracture, a large proportion of frail patients show good recovery. Loneliness determines poor recovery with anxiety and depressive symptoms. TRAIL REGISTRATION ClinicalTrials.gov identifier: NCT02508675 (July 27, 2015).
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Ratcliffe J, Bourke S, Li J, Mulhern B, Hutchinson C, Khadka J, Milte R, Lancsar E. Valuing the Quality-of-Life Aged Care Consumers (QOL-ACC) Instrument for Quality Assessment and Economic Evaluation. PHARMACOECONOMICS 2022; 40:1069-1079. [PMID: 35922616 PMCID: PMC9550725 DOI: 10.1007/s40273-022-01158-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVE This paper reports on the valuation of the classification system for the Quality-of-Life Aged Care Consumers (QOL-ACC) instrument using a discrete choice experiment (DCE) with duration with a large sample of older people receiving aged care services. METHODS A DCE with 160 choice sets of two quality-of-life state-survival duration combinations blocked into 20 survey versions, with eight choice sets in each version, was designed and administered through an on-line survey to older Australians receiving aged care services in home and via interviewer facilitation with older people in residential aged care settings. Model specifications investigating preferences with respect to survival duration and interactions between QOL-ACC dimension levels were estimated. Utility weights were developed, with estimated coefficients transformed to the 0 (being dead) to 1 (full health) scale to generate a value set suitable for application in quality assessment and for the calculation of quality-adjusted life-years for use in economic evaluation. RESULTS In total, 953 older people completed the choice experiment with valid responses. The estimation results from econometric model specifications indicated that utility increased with survival duration and decreased according to quality-of-life impairment levels. An Australian value set (range - 0.56 to 1.00) was generated for the calculation of utilities for all QOL-ACC states. CONCLUSION The QOL-ACC is unique in its focus on measuring and valuing quality of life from the perspective of older people themselves, thereby ensuring that the preferences of aged care service users are the primary focus for quality assessment and economic evaluation.
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Affiliation(s)
- Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia.
| | - Siobhan Bourke
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Jinhu Li
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
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Scazufca M, Nakamura CA, Seward N, Moreno-Agostino D, van de Ven P, Hollingworth W, Peters TJ, Araya R. A task-shared, collaborative care psychosocial intervention for improving depressive symptomatology among older adults in a socioeconomically deprived area of Brazil (PROACTIVE): a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial. THE LANCET. HEALTHY LONGEVITY 2022; 3:e690-e702. [PMID: 36202129 PMCID: PMC9529612 DOI: 10.1016/s2666-7568(22)00194-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is an urgent need to reduce the burden of depression among older adults in low-income and middle-income countries (LMICs). We aimed to evaluate the efficacy of a task-shared, collaborative care psychosocial intervention for improving recovery from depression in older adults in Brazil. METHODS PROACTIVE was a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial conducted in Guarulhos, Brazil. Primary care clinics (clusters) were stratified by educational level and randomly allocated (1:1) to either enhanced usual care alone (control group) or to enhanced usual care plus the psychosocial intervention (intervention group), which involved a 17-week psychosocial programme based on psychoeducation and behavioural activation approaches. Individuals approached for the initial screening assessment were selected randomly from a list of individuals provided by the Health Secretariat of Guarulhos. Face-to-face baseline assessments were conducted among adults aged 60 years or older registered with one of the primary care clinics and identified with clinically significant depressive symptomatology (9-item Patient Health Questionnaire [PHQ-9] score ≥10). Community health workers delivered the programme through home sessions, supported by a dedicated tablet application. Masking of clinic staff and community health workers who delivered the intervention was not feasible; however, research assistants conducting recruitment and follow-up assessments were masked to trial allocation. The primary outcome was recovery from depression (PHQ-9 score <10) at 8-month follow-up. All primary analyses were performed by intention to treat with imputed data. Adaptations to the protocol were made due to the COVID-19 pandemic; recruitment and intervention home sessions were stopped, and follow-up assessments were conducted by telephone. This trial is registered with the ISRCTN registry, ISRCTN57805470. FINDINGS We identified 24 primary care clinics in Guarulhos that were willing to participate, of which 20 were randomly allocated to either the control group (ten [50%] clusters) or to the intervention group (ten [50%] clusters). The four remaining eligible clusters were kept as reserves. Between May 23, 2019, and Feb 21, 2020, 8146 individuals were assessed for eligibility, of whom 715 (8·8%) participants were recruited: 355 (49·7%) in the control group and 360 (50·3%) in the intervention group. 284 (80·0%) participants in the control group and 253 (70·3%) in the intervention group completed follow-up at 8 months. At 8-month follow-up, 158 (62·5%) participants in the intervention group showed recovery from depression (PHQ-9 score <10) compared with 125 (44·0%) in the control group (adjusted odds ratio 2·16 [95% CI 1·47-3·18]; p<0·0001). These findings were maintained in the complete case analysis. No adverse events related to the intervention were observed. INTERPRETATION Although the COVID-19 pandemic altered delivery of the intervention, the low-intensity psychosocial intervention delivered mainly by non-mental health professionals was highly efficacious in improving recovery from depression in older adults in Brazil. Our results support a low-resource intervention that could be useful to reduce the treatment gap for depression among older people in other LMICs. FUNDING São Paulo Research Foundation and Joint Global Health Trials (UK Department for International Development, Medical Research Council, and the Wellcome Trust).
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Affiliation(s)
- Marcia Scazufca
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carina A Nakamura
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadine Seward
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Darío Moreno-Agostino
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK; Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Pepijn van de Ven
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - William Hollingworth
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Ricardo Araya
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Nakamura CA, Scazufca M, Moretti FA, Didone TVN, de Sá Martins MM, Pereira LA, de Souza CHQ, de Oliveira GM, da Costa MO, Machado M, da Silva Bitencourt E, Dos Santos MS, Murdoch J, van de Ven P, Seward N, Hollingworth W, Peters TJ, Araya R. Digital psychosocial intervention for depression among older adults in socioeconomically deprived areas in Brazil (PRODIGITAL-D): protocol for an individually randomised controlled trial. Trials 2022; 23:761. [PMID: 36071463 PMCID: PMC9449935 DOI: 10.1186/s13063-022-06623-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/02/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Depression in older adults is a challenge for health systems in most low- and middle-income countries (LMICs). Digital strategies for the management of this condition have been emerging worldwide, but the effectiveness of most of them is still unclear, especially among older adults. Thus, we aim to assess the effectiveness and cost-effectiveness of a digital psychosocial intervention to treat depression among older adults living in socioeconomically deprived areas in Guarulhos, Brazil. METHODS We will conduct a two-arm individually randomised controlled trial with 1:1 allocation ratio. Five hundred older adults aged 60 years or over with depressive symptomatology (9-item Patient Health Questionnaire score, PHQ-9 ≥ 10) and registered with one of the primary care clinics will be recruited to participate in this study. A 6-week digital psychosocial programme, named Viva Vida, will be delivered via WhatsApp to participants allocated to the intervention arm. The Viva Vida will send psychoeducational and behavioural activation audio and visual messages 4 days a week for 6 weeks. The control arm will only receive a single message with general information about depression. The primary outcome will be the proportion of depression recovery (PHQ-9 < 10) assessed at 3 months. The cost-effectiveness of the intervention will be assessed at 5 months. A detailed process evaluation will be used to explore context and important implementation outcomes. DISCUSSION This programme was based on the PROACTIVE intervention and designed to be delivered without face-to-face contact. If effective, it could be a simple treatment option, appropriate not only when social distancing is required, but it could also be included as a regular public health programme to initiate depression treatment, particularly in LMICs where resources allocated to mental health are scarce. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos (ReBEC), RBR-4c94dtn. Registered on 22 October 2021 (submitted on 03 August 2021).
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Affiliation(s)
- Carina Akemi Nakamura
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcia Scazufca
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Felipe Azevedo Moretti
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Luara Aragoni Pereira
- Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Marcelo Oliveira da Costa
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Monica Souza Dos Santos
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jamie Murdoch
- Department of Population Health Sciences, King's College London, London, UK
| | - Pepijn van de Ven
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Nadine Seward
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - William Hollingworth
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, and Bristol Dental School, University of Bristol, Bristol, UK
| | - Ricardo Araya
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Comprehensive geriatric assessment is associated with increased antidepressant treatment in frail older people with unplanned hospital admissions-results from the randomised controlled study CGA-Swed. BMC Geriatr 2022; 22:645. [PMID: 35931975 PMCID: PMC9354437 DOI: 10.1186/s12877-022-03324-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment. AIMS The aims of this study were threefold: to investigate the prevalence of depression in frail hospital patients, to identify factors associated with depression, and to compare depression management in patients receiving and not receiving Comprehensive Geriatric Assessment (CGA). METHODS This secondary analysis from the CGA-Swed randomized control trial included 155 frail older people aged 75 years and above. Instruments included Montgomery Åsberg Depression Rating Scale (MADRS), the ICE Capability measure for older people (ICECAP-O) and the Fugl-Meyer Life Satisfaction scale (Fugl-Meyer Lisat). Depression was broadly defined as MADRS score ≥ 7. Regression models were used to identify variables associated with depression and to compare groups with and without the CGA intervention. RESULTS The prevalence of a MADRS score indicating depression at baseline was 60.7%. The inability to do things that make one feel valued (ICECAP-O) was associated with a fourfold increase in depression (OR 4.37, CI 1.50-12.75, p = 0.007). There was a two-fold increase in odds of receiving antidepressant medication in the CGA intervention group (OR 2.33, CI 1.15-4.71, p = 0.019) compared to patients in the control group who received regular medical care. CONCLUSION Symptoms of depression were common among frail older people with unplanned hospital admission. Being unable to do things that make one feel valued was associated with depression. People who received CGA intervention had higher odds of receiving antidepressant treatment, suggesting that CGA improves recognition of mental health needs during unplanned hospital admissions in frail older people. TRIAL REGISTRATION ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.
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Parey B. Well-being among older persons with disabilities in Trinidad. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1101-e1111. [PMID: 34278639 DOI: 10.1111/hsc.13518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
Given the expected increase in the proportion of older persons and evidence of poverty among persons with disabilities in general, well-being among older persons with disabilities is an important issue. Using Sen's capability approach, this article examines well-being among older persons with disabilities in Trinidad. A multiphase mixed-methods design with three phases was employed. In the initial exploratory phase, functionings which are things people value doing or being were identified via 11 interviews. These functionings were used in the subsequent phase to develop an instrument with both closed- and open-ended questions. The instrument was then administered in the third phase to measure well-being and to identify its hindering factors. Responses from 31 participants revealed moderate-to-severe deprivations among older persons with disabilities in Trinidad including for functionings related to food, healthcare, information and transportation. The integrated findings suggested changes to social care and healthcare systems to promote well-being among older persons with disabilities in Trinidad, as well as the need to develop community interactions and public services regarding transportation, supportive devices, and therapy.
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Affiliation(s)
- Bephyer Parey
- Sir Arthur Lewis Institute of Social and Economic Studies, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Nakamura CA, Mitchell PM, Peters TJ, Moreno-Agostino D, Araya R, Scazufca M, Hollingworth W. A Validation Study of the EQ-5D-5L and ICEpop Capability Measure for Older People Among Older Individuals With Depressive Symptoms in Brazil. Value Health Reg Issues 2022; 30:91-99. [PMID: 35325703 DOI: 10.1016/j.vhri.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/03/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study aimed to assess the known-groups validity of the EQ-5D-5L and the ICEpop Capability Measure for Older People (ICECAP-O), 2 outcome measures used in economic evaluation, among older adults with depressive symptoms in socioeconomically deprived areas of Brazil. We also explored the role of education and income on responses to these measures. METHODS This cross-sectional study used baseline data from PROACTIVE, a cluster randomized controlled trial to evaluate a psychosocial intervention for late-life depression among older adults. Participants aged ≥60 years with a 9-item Patient Health Questionnaire score ≥10 were recruited from 20 primary healthcare clinics. Ordered logistic regression models assessed the association between depressive symptoms severity, income, and education and dimension-level responses on the EQ-5D-5L and ICECAP-O. Multivariable regression models investigated the ability of EQ-5D-5L and ICECAP-O scores to discriminate between depressive symptoms severity levels and other characteristics, including education level and household income. RESULTS A total of 715 participants were included in the study. Depressive symptoms severity was associated with all EQ-5D-5L and ICECAP-O dimensions, except the ICECAP-O enjoyment attribute. In contrast, household income was only associated with the ICECAP-O security attribute. Higher severity of depressive symptoms (9-item Patient Health Questionnaire scores) was also strongly associated with lower (ie, worse) scores on both measures in all models. Education level and household income showed no association with either EQ-5D-5L or ICECAP-O scores. CONCLUSIONS To best of our knowledge, this is the first study that investigated the validity of these 2 measures among older adults in Brazil. Both EQ-5D-5L and ICECAP-O showed evidence of validity in differentiating depressive symptom severity.
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Affiliation(s)
- Carina A Nakamura
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Paul M Mitchell
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Darío Moreno-Agostino
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Ricardo Araya
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Marcia Scazufca
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - William Hollingworth
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
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Aung MN, Koyanagi Y, Nagamine Y, Nam EW, Mulati N, Kyaw MY, Moolphate S, Shirayama Y, Nonaka K, Field M, Cheung P, Yuasa M. Digitally Inclusive, Healthy Aging Communities (DIHAC): A Cross-Cultural Study in Japan, Republic of Korea, Singapore, and Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126976. [PMID: 35742230 PMCID: PMC9223148 DOI: 10.3390/ijerph19126976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/10/2022]
Abstract
One out of three people in Japan will be an older person before 2040. Half of those currently do not utilize the internet, smartphone apps, or digital technology. On the other hand, more than 70% of seniors in Republic of Korea use the internet, and 55% in Singapore had access to it in 2019. The use of digital technology for health promotion has the potential to promote individual and community empowerment, advocating for healthy, active aging. Maintaining equity in health promotion practice requires the digital inclusion of every senior. Therefore, we propose a cross-cultural study to explain the contextual influences of digital inclusion and its consequences on healthy aging in Japan, Korea, Singapore, and Thailand. Quantitatively: digital skills, e-health literacy, participation in health promotion, and quality of life will be analyzed in structural equation models. Qualitatively: thematic analysis will be developed to identify cultural patterns and contextual factors, making sense of what older persons in different countries materialize, say, do, think, and feel to reveal deeper beliefs and core values about digital inclusion and healthy aging. Logics and methods from this protocol would be useful to replicate the study in many countries globally. Evidence from this study is expected to pave the way to digitally inclusive, healthy aging communities (DIHAC) across Japan and Asia.
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Affiliation(s)
- Myo Nyein Aung
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
- Advanced Research Institute for Health Sciences, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan
- Correspondence:
| | - Yuka Koyanagi
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
- Department of Judo Therapy, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan
| | - Yuiko Nagamine
- Department of Family Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
| | - Eun Woo Nam
- Department of Health Administration, Software Digital Healthcare Convergence College, Yonsei University, Wonju 26493, Korea;
| | - Nadila Mulati
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
| | - Myat Yadana Kyaw
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
| | - Saiyud Moolphate
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai 50300, Thailand;
| | - Yoshihisa Shirayama
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan
| | - Kumiko Nonaka
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
| | - Malcolm Field
- Faculty of Social Sciences, Kyorin University, Tokyo 181-8611, Japan;
- Faculty of International Liberal Arts, Waseda University, Tokyo 169-0051, Japan
| | - Paul Cheung
- Asia Competitiveness Institute (ACI), Lee Kuan Yew School of Public Policy, Singapore 259772, Singapore;
| | - Motoyuki Yuasa
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo Ku, Tokyo 113-8421, Japan; (Y.K.); (N.M.); (M.Y.K.); (Y.S.); (M.Y.)
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan
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Himmler S, Jonker M, van Krugten F, Hackert M, van Exel J, Brouwer W. Estimating an anchored utility tariff for the well-being of older people measure (WOOP) for the Netherlands. Soc Sci Med 2022; 301:114901. [PMID: 35325838 DOI: 10.1016/j.socscimed.2022.114901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Health economic evaluations using common health-related quality of life measures may fall short in adequately incorporating all relevant benefits of health and social care interventions targeted at older people. The Well-being of Older People measure (WOOP) is a broader well-being measure that comprises nine well-being domains. The objective of this study was to estimate a utility tariff for the WOOP, to facilitate its application in cost-utility analyses. METHODS A discrete choice experiment (DCE) with duration approach was set up and fielded among 2,012 individuals from the Netherlands aged 65 years and above. Matched pairwise choice tasks, colour-coding and level overlap were used to reduce the cognitive burden of the DCE. The choice tasks were created using a Bayesian heterogeneous D-efficient design. The estimation procedure accommodated for nonlinear time preferences via an exponential discounting function. RESULTS The estimation results showed that 'physical health', 'mental health', and 'making ends meet' were the most important well-being domains for older people, followed by 'independence' and 'living situation'. Of somewhat lesser importance were domains like 'social life', 'receiving support' and 'feeling useful'. The generated utility tariffs can be used to translate well-being states described with the WOOP to a utility score between -0.616 and 1. CONCLUSIONS This study established a tariff for the WOOP, which will facilitate its use in economic evaluations of health and social care interventions targeted at older people, first of all in the Netherlands.
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Affiliation(s)
- Sebastian Himmler
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Marcel Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Frédérique van Krugten
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Mariska Hackert
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, the Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (ESHPM), Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands
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Mukuria C, Connell J, Carlton J, Peasgood T, Scope A, Clowes M, Rand S, Jones K, Brazier J. Qualitative Review on Domains of Quality of Life Important for Patients, Social Care Users, and Informal Carers to Inform the Development of the EQ-HWB. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:492-511. [PMID: 35365298 DOI: 10.1016/j.jval.2021.11.1371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To identify the themes to inform the content of a new generic measure, the EQ-HWB (EQ Health and Wellbeing), that can be used in economic evaluation across health, social care, and public health, based on the views of users and beneficiaries of these services including informal carers. METHODS A qualitative review was undertaken. Systematic and citation searches were undertaken focusing on qualitative evidence of the impact on quality of life from reviews for selected health conditions, informal carers, social care users, and primary qualitative work used in the development of selected measures. A subset of studies was included in the review. Framework analysis and synthesis were undertaken based on a conceptual model. RESULTS A total of 42 reviews and 24 primary studies were selected for inclusion in the review. Extraction and synthesis resulted in 7 high-level themes (with subthemes): (1) feelings and emotions (sadness, anxiety, hope, frustration, safety, guilt/shame); (2) cognition (concentration, memory, confusion, thinking clearly); (3) self-identity (dignity/respect, self-esteem); (4) "coping, autonomy, and control" relationships; (5) social connections (loneliness, social engagement, stigma, support, friendship, belonging, burden); (6) physical sensations (pain, discomfort, sleep, fatigue); and (7) activity (self-care, meaningful activities, mobility, communication, hearing, vision). Apart from physical sensations, most of the other themes and subthemes were relevant across both health and social care, including for informal carers. CONCLUSIONS The findings from this broad review identified themes that go beyond health and that are relevant to patients, informal carers, and social care users. The themes and subthemes informed the domains for the EQ-HWB.
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Affiliation(s)
- Clara Mukuria
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK.
| | - Janice Connell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Tessa Peasgood
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Mark Clowes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, England, UK
| | - Karen Jones
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, England, UK
| | - John Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
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Husbands S, Mitchell PM, Floredin I, Peters TJ, Kinghorn P, Byford S, Anand P, Bailey C, Coast J. The Children and Young People Quality of Life Study: A protocol for the qualitative development of attributes for capability wellbeing measures for use in health economic evaluation with children and young people. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17801.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Health services face difficult choices regarding how to allocate scarce health and social care resources. Economic evaluation can aid this process of decision making by allowing competing healthcare interventions or services to be compared in terms of their costs and consequences. However, existing use of economic evaluation of health services largely focuses on comparing interventions in terms of their impact on health only, missing factors potentially important to broader wellbeing. The capability approach measures outcomes in terms of what people are able to do and be. It provides an alternative evaluative space for economic evaluation, which may be especially beneficial for populations such as children and young people, for whom health might not be the only outcome of importance to their wellbeing. Study aims: This study aims to develop conceptual attributes and descriptive systems for capability wellbeing measures for children and young people to be used in economic evaluation, using qualitative methods with children and young people directly and their parents/guardians. Methods: Qualitative interviews will be used with children and young people and parents/guardians to develop the conceptual attributes (items) and wording for the capability wellbeing measures. Recruitment will be undertaken through organisations such as schools and charities and online using Facebook. Interviews will be face-to-face or online and will focus on identifying factors important to children and young people’s wellbeing to create an initial draft of the capability wellbeing measures. Subsequent interviews will focus on refining the wording used in the measures. Interviews will be analysed using methods of constant comparison, to explore similarities and differences in what participants considered important to children and young people’s wellbeing and to develop appropriate wording for the measures based on participant responses. Ethics: The study received approval from the University of Bristol Faculty of Health Sciences Research Ethics Committee (reference 77121).
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Bibi I, Polman R, Nyman SR. Reliability of the ICECAP-O Quality of Life Scale With Community-Dwelling People With Dementia. Gerontol Geriatr Med 2022; 8:23337214221086802. [PMID: 35340365 PMCID: PMC8943464 DOI: 10.1177/23337214221086802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Currently, measures of quality of life used with older people with dementia (PWD) are
mainly health related. Health is not an actual attribute of but a means to attain quality
of life. The Investigating Choice Experiments for the Preferences of Older People -
CAPability index (ICECAP-O) measures attributes of quality of life. While its construct
validity has been tested with PWD, no study has yet published data on the reliability of
this scale used directly with PWD. In this study, we tested the external (test-retest)
reliability of the ICECAP-O with 54 community-dwelling older PWD from the south of
England. The ICECAP-O had acceptable test-retest reliability (r = .68, p
< .01 and r = .56, p < .01 for raw and tariff scores,
respectively). This suggests that the ICECAP-O is both a reliable and valid measure of
quality of life for use directly with community-dwelling PWD.
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Affiliation(s)
- Iram Bibi
- Psychology Department, Bournemouth University, Bournemouth, Dorset, UK
| | - Remco Polman
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Samuel R. Nyman
- Department of Medical Science and Public Health, Bournemouth University, Bournemouth, Dorset, UK
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Meili KW, Månsdotter A, Sundberg LR, Hjelte J, Lindholm L. An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire. PLoS One 2022; 17:e0263231. [PMID: 35134053 PMCID: PMC8824323 DOI: 10.1371/journal.pone.0263231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Kaspar Walter Meili
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- * E-mail:
| | - Anna Månsdotter
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Living Conditions and Lifestyles, Public Health Agency Public Health Agency of Sweden, Stockholm, Sweden
| | | | - Jan Hjelte
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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McPherson L, Bhattacharya S. Measuring What Matters-A Holistic Approach to Measuring Well-Being in Endometriosis. Front Glob Womens Health 2022; 2:770366. [PMID: 34993506 PMCID: PMC8724039 DOI: 10.3389/fgwh.2021.770366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Endometriosis is a common condition which affects women in a number of ways and impairs their ability to live a full and meaningful life. Evaluative research has traditionally taken its cue from a medical approach which has forced women to choose one area of functioning as their primary concern, and tended to use a narrow definition of treatment success which ignores general well-being. While recent trials have included quality of life (QOL) measures as outcomes, these have not been able to capture the totality of the impact of the disease and its treatment on a woman's capability to do what she might want to do and be who she might want to be. A capability approach might overcome this barrier, but the available tools will need to be refined and validated in women with endometriosis before this can be integrated within everyday clinical and research practice.
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Affiliation(s)
- Lori McPherson
- Department of Obstetrics and Gynaecology, NHS Grampian, Aberdeen, United Kingdom
| | - Siladitya Bhattacharya
- Department of Obstetrics and Gynaecology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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Sawadogo AR, Nys JF, Tran E, Gayot C, Boyer S, Cardinaud N, Thebaut C, Tchalla A. Impact of the abandonment of assistive technologies for mobility on the incidence of serious falls in older adults living at home: Results of the ECOCAT study. J Rehabil Assist Technol Eng 2022; 9:20556683221110866. [PMID: 35770039 PMCID: PMC9234835 DOI: 10.1177/20556683221110866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose To examine the impact of discontinuing the use of assistive technology for
mobility (ATM) devices on the 6-months incidence of falls in older adults
(OA) living at home. Materials and methods A medico-socioeconomic survey was performed to collect information on the
quality of life and well-being of older adults, before and 6 months after
being loaned an ATM device. Personal data (medical, social, and economic)
were collected via a geriatric survey. Results In all, 102 OA participated in the study. Over the 6-months observation
period, 17 (n = 81) serious falls were recorded among
participants who were using their ATM device optimally; in those who
discontinued device use, 12 falls (n = 21) were recorded
(57.1%; p = 0.001). Factors significantly associated with
falls at home were living in an urban area (odds ratio [OR]: 11.46; 95%
confidence interval [CI]: 1.48; 88.98; p = 0.020), an
Instrumental Activities of Daily Living Scale score > 4 (OR: 34.04; 95%
CI: 1.59; 727.86; p = 0.024), and discontinuation of ATM
device use (OR: 17.41; 95% CI: 2.59; 117.02; p =
0.003). Conclusion Discontinuation of ATM device use was associated with an increased risk for
serious falls.
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Affiliation(s)
- Abdoul Razak Sawadogo
- Laboratoire VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
- Unité de Prévention, de Suivi et d’Analyse du Vieillissement (UPSAV), Pôle HU Gérontologie Clinique, CHU de Limoges, France
- Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
- Gerontopôle Nouvelle-Aquitaine, Limoges
| | - Jean-François Nys
- Laboratoire VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
| | - Estelle Tran
- Unité de Prévention, de Suivi et d’Analyse du Vieillissement (UPSAV), Pôle HU Gérontologie Clinique, CHU de Limoges, France
| | - Caroline Gayot
- Laboratoire VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
- Unité de Prévention, de Suivi et d’Analyse du Vieillissement (UPSAV), Pôle HU Gérontologie Clinique, CHU de Limoges, France
- Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Sophie Boyer
- Laboratoire VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
- Unité de Prévention, de Suivi et d’Analyse du Vieillissement (UPSAV), Pôle HU Gérontologie Clinique, CHU de Limoges, France
- Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Noëlle Cardinaud
- Laboratoire VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
- Unité de Prévention, de Suivi et d’Analyse du Vieillissement (UPSAV), Pôle HU Gérontologie Clinique, CHU de Limoges, France
- Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Clémence Thebaut
- UMR 1094 Neuroépidémiologie Tropicale (NET), Université Paris Dauphine, PSL, LEDA-Legos, Université de Limoges, France
| | - Achille Tchalla
- Laboratoire VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
- Unité de Prévention, de Suivi et d’Analyse du Vieillissement (UPSAV), Pôle HU Gérontologie Clinique, CHU de Limoges, France
- Unité de Recherche Clinique et d'Innovation (URCI) de Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
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Savvas S, Goh AMY, Batchelor F, Doyle C, Wise E, Tan E, Panayiotou A, Malta S, Winbolt M, Clarke P, Burton J, Low LF, Loi SM, Fairhall A, Polacsek M, Stiles J, Muliadi F, Chau N, Scherer S, Ames D, Sousa TV, Dow B. Promoting Independence Through quality dementia Care at Home (PITCH): a research protocol for a stepped-wedge cluster-randomised controlled trial. Trials 2021; 22:949. [PMID: 34930422 PMCID: PMC8687633 DOI: 10.1186/s13063-021-05906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Home care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home. Methods This study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs’ sense of competence in dementia care provision. Discussion Upskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs. Trial registration anzctr.org.au; ACTRN12619000251123. Registered on 20 February 2019.
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Affiliation(s)
- Steven Savvas
- The National Ageing Research Institute, Parkville, VIC, Australia.
| | - Anita M Y Goh
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Colleen Doyle
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Erica Wise
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Esther Tan
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Anita Panayiotou
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Sue Malta
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | | | | | | | - Lee-Fay Low
- University of Sydney, Sydney, NSW, Australia
| | - Samantha M Loi
- The University of Melbourne, Parkville, VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Meg Polacsek
- The National Ageing Research Institute, Parkville, VIC, Australia.,Benetas, Melbourne, VIC, Australia
| | - Jay Stiles
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Fenny Muliadi
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Nadia Chau
- The National Ageing Research Institute, Parkville, VIC, Australia
| | | | - David Ames
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | | | - Briony Dow
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
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Hutchinson C, Ratcliffe J, Cleland J, Walker R, Milte R, McBain C, Corlis M, Cornell V, Khadka J. The integration of mixed methods data to develop the quality of life - aged care consumers (QOL-ACC) instrument. BMC Geriatr 2021; 21:702. [PMID: 34911445 PMCID: PMC8672336 DOI: 10.1186/s12877-021-02614-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background This paper describes the collection and integration of mixed methods data to facilitate the final selection of items for the Quality of Life – Aged Care Consumers (QOL-ACC) instrument. The aim of the wider project is to develop a preference-based quality of life instrument that can be used for quality assessment and economic evaluation. Older people have been involved at every stage of the development of the QOL-ACC to ensure that the final instrument captures their perspectives and preferences. Methods Mixed methods data was collected on draft items for the QOL-ACC instrument across six key quality of life dimensions (mobility, pain management, emotional well-being, independence, social connections, and activities). Qualitative face validity data was collected from older people (aged 66 to 100 years) living in the community and in residential aged care via semi-structured interviews (n = 59). Quantitative data was collected from older people (aged 65 to 91 years) receiving aged care services in the community via an online survey (n = 313). A traffic light pictorial approach was adopted as a practical and systematic way to categorise and present data in a meaningful way that was easy for non-academic workshop members to understand and to be able to discuss the relative merits of each draft item. Results The traffic light approach supported the involvement of consumer and aged care provider representatives in the selection of the final items. Six items were selected for the QOL-ACC instrument with one item representing each of the six dimensions. Conclusions This methodological approach has ensured that the final instrument is psychometrically robust as well as meaningful, relevant and acceptable to aged care consumers and providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02614-y.
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Affiliation(s)
- Claire Hutchinson
- Caring Futures Institute, Flinders University, Adelaide, Australia. .,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jenny Cleland
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Ruth Walker
- Caring Futures Institute, Flinders University, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Candice McBain
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation (SA Branch), Adelaide, Australia
| | | | - Jyoti Khadka
- Caring Futures Institute, Flinders University, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, Australia
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38
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Crocker M, Hutchinson C, Mpundu-Kaambwa C, Walker R, Chen G, Ratcliffe J. Assessing the relative importance of key quality of life dimensions for people with and without a disability: an empirical ranking comparison study. Health Qual Life Outcomes 2021; 19:264. [PMID: 34906156 PMCID: PMC8670215 DOI: 10.1186/s12955-021-01901-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background In economic evaluation, the quality of life of people with a disability has traditionally been assessed using preference-based instruments designed to measure and value quality of life. To provide robust measurement of the effectiveness of programs designed to improve the quality of life of people living with a disability, preference-based measures need to be sufficiently sensitive to detect incremental changes in the quality of life dimensions that are most important to people who have a disability. This study sought to explore whether there was a difference in the ranked order of importance of quality of life dimensions between people with a disability and people without a disability. Methods An online survey was developed and administered Australia wide. The first sample (n = 410) comprised adults (aged ≥ 18 years) with a disability (n = 208) and family carers of person/s with a disability who were asked to respond on behalf of the person with a disability (n = 202). The second sample included adults without disability (n = 443). Respondents were asked to rank the importance of 12 quality of life dimensions extracted from the content of established preference-based quality of life measures (EQ-5D, AQoL and ASCOT). Results People with a disability placed relatively higher importance on broader quality of life dimensions (e.g. Control, Independence, Self-care) relative to health status focused dimensions (e.g. Vision, Hearing, Physical mobility). This distinction was less differentiable for those ‘without a disability’. The biggest differences in ranked importance of dimensions were in: Vision (‘with disability’ = 10th, ‘without disability’ = 4th), Self-care (‘with disability’ = 3rd, ‘without disability’ = 7th) and Mental well-being (‘with disability’ = 6th, ‘without disability’ = 2nd). Conclusions The relative importance of quality of life dimensions for people with a disability differs to people without a disability. Quality of life is a key outcome for economic evaluation and for assessing the impact of disability care policy and practice in Australia and internationally. It is important that the effectiveness of interventions is measured and valued in ways which are fully reflective of the quality of life preferences of people with a disability.
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Affiliation(s)
- Matthew Crocker
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Ruth Walker
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Melbourne, Caulfield East, VIC, 3145, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, GPO Box 2100, Adelaide, SA, 5001, Australia
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39
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Baji P, Farkas M, Dobos Á, Zrubka Z, Kovács L, Gulácsi L, Péntek M. Comparing the measurement properties of the ICECAP-A and ICECAP-O instruments in ages 50-70: a cross-sectional study on a representative sample of the Hungarian general population. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1453-1466. [PMID: 34091797 PMCID: PMC8558162 DOI: 10.1007/s10198-021-01325-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The ICECAP-A and ICECAP-O were validated as capability wellbeing measures of adults aged 18 + and 65 + years, respectively. We aimed to compare their measurement properties in age group 50-70. METHODS Data were derived from a cross-sectional survey among a sample representative for the adult Hungarian population. Respondents aged between 50 and 70 filled in both the ICECAP-A and ICECAP-O questionnaires. We assessed and compared feasibility, agreement, discriminatory power, convergent and content validity of the two instruments and explored the determinants of the differences between the two measures. RESULTS 707 respondents (99.4%) provided full answers to both questionnaires (46.3% women, average age 60.1 years). The instruments showed similar construct and convergent validity and discriminatory power. Pearson-correlations between instrument items were strong (r > 0.5). ICECAP-A and ICECAP-O scores could be calculated from each other with a good confidence (R2 = 0.69 and 0.71). ICECAP-O scores (mean 0.87, SD = 0.12) were systematically higher than ICECAP-A scores (0.85, SD = 0.15) in most subgroups. The difference increased with the deterioration of capability and health, and with age. Regression results showed that employment and health status had larger marginal effect on the ICECAP-A than on the ICECAP-O scores, and these effects were larger than the effect of age on both measures. CONCLUSION Validity of both instruments was confirmed in the age groups 50-70. Given that employment and health status are important determinants of the differences between the two instruments besides age, the possibility of linking the choice between ICECAP-A and ICECAP-O to these factors should be investigated by further research.
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Affiliation(s)
- Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
| | - Miklós Farkas
- School of Accounting and Finance, University of Bristol, Bristol, UK
| | - Ágota Dobos
- Corvinus Center for Foreign Language Education and Research, Corvinus University of Budapest, Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center-University Research and Innovation Center, Óbuda University, Budapest, Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Levente Kovács
- Physiological Controls Research Center-University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - László Gulácsi
- Health Economics Research Center-University Research and Innovation Center, Óbuda University, Budapest, Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center-University Research and Innovation Center, Óbuda University, Budapest, Hungary
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The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review. Arch Public Health 2021; 79:201. [PMID: 34794496 PMCID: PMC8600812 DOI: 10.1186/s13690-021-00729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background One of the most commonly used types of evaluation methods is cost-utility analysis (CUA), using the Quality Adjusted Life Year (QALY) indicator as a preference-based measure for assessing effects of a given programme. Such assessments are often translated into health-care provision priorities; therefore, effectively choosing the method of outcome evaluation is crucial for ensuring the best possible allocation of scarce resources. The main objective of this scoping review is to identify what kinds of problems and limitations may occur when the QALY indicator is used to assess the effects of health interventions in the older population. Methods To identify literature in a scoping review, the databases MEDLINE via PubMed and Scopus were searched. A manual search on relevant organizations’ and associations’ websites was also conducted (EUnetHTA, ISPOR and national governmental agencies responsible for allocation decisions). No limits concerning publication dates were set. All relevant data were extracted and analyzed, then a narrative summary was prepared. Results The database search identified 10,832 relevant items, finally 32 studies were included in the analysis. The main types of issues indicated in the studies were as follows: (1) lower life expectancy in the older population causes lower QALY gains; (2) an equal value of one QALY is used regardless of age; (3) poorer average health state causes lower QALY gains; (4) inadequate instruments to measure quality of life (QoL); (5) attributes of QoL used regardless of age; and (6) no beyond-health QoL aspects taken into account. Conclusions This review shows clearly that many problems of different types are connected with using QALY for the older population, but there is no consensus as to whether QALY discriminates against the older population or not – an opinion regarding this issue depends strongly on accepted principles, particularly the approach to equity and how one understands fairness. Health care resources should not be allocated solely on the basis of the health maximization rule because this can lead to discrimination against certain groups (e.g., older, disabled, and/or chronically ill people). To maintain the balance between efficiency and equity, the issues connected with age-based rationing should be widely discussed.
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Siette J, Knaggs GT, Zurynski Y, Ratcliffe J, Dodds L, Westbrook J. Systematic review of 29 self-report instruments for assessing quality of life in older adults receiving aged care services. BMJ Open 2021; 11:e050892. [PMID: 34794991 PMCID: PMC8603300 DOI: 10.1136/bmjopen-2021-050892] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Quality of life (QoL) outcomes are used to monitor quality of care for older adults accessing aged care services, yet it remains unclear which QoL instruments best meet older adults', providers' and policymakers' needs. This review aimed to (1) identify QoL instruments used in aged care and describe them in terms of QoL domains measured and logistical details; (2) summarise in which aged care settings the instruments have been used and (3) discuss factors to consider in deciding on the suitability of QoL instruments for use in aged care services. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PsycINFO, Cochrane Library and CINAHL from inception to 2021. ELIGIBILITY CRITERIA Instruments were included if they were designed for adults (>18 years), available in English, been applied in a peer-reviewed research study examining QoL outcomes in adults >65 years accessing aged care (including home/social care, residential/long-term care) and had reported psychometrics. DATA EXTRACTION AND SYNTHESIS Two researchers independently reviewed the measures and extracted the data. Data synthesis was performed via narrative review of eligible instruments. RESULTS 292 articles reporting on 29 QoL instruments were included. Eight domains of QoL were addressed: physical health, mental health, emotional state, social connection, environment, autonomy and overall QoL. The period between 1990 and 2000 produced the greatest number of newly developed instruments. The EuroQoL-5 Dimensions (EQ-5D) and Short Form-series were used across multiple aged care contexts including home and residential care. More recent instruments (eg, ICEpop CAPability measure for Older people (ICECAP-O) and Adult Social Care Outcomes Toolkit (ASCOT)) tend to capture emotional sentiment towards personal circumstances and higher order care needs, in comparison with more established instruments (eg, EQ-5D) which are largely focused on health status. CONCLUSIONS A comprehensive list of QoL instruments and their characteristics is provided to inform instrument choice for use in research or for care quality assurance in aged care settings, depending on needs and interests of users.
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Affiliation(s)
- Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- NHMRC Partnership Centre for Health Systems Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- NHMRC Partnership Centre for Health Systems Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Neumann S, Taylor J, Bamford A, Metcalfe C, Gaunt DM, Whone A, Steeds D, Emmett SR, Hollingworth W, Ben-Shlomo Y, Henderson EJ. Cholinesterase inhibitor to prevent falls in Parkinson's disease (CHIEF-PD) trial: a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson's disease. BMC Neurol 2021; 21:422. [PMID: 34715821 PMCID: PMC8556953 DOI: 10.1186/s12883-021-02430-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common complication of Parkinson's disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson's disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson's motor and non-motor symptoms, quality of life and cost-effectiveness. DISCUSSION This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson's disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population. TRIAL REGISTRATION REC reference: 19/SW/0043. EudraCT: 2018-003219-23. ISCRTN 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 PROTOCOL AT TIME OF PUBLICATION: Version 7.0, 20th January 2021.
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Affiliation(s)
- S Neumann
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - J Taylor
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Bamford
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - C Metcalfe
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - D M Gaunt
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Whone
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - D Steeds
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - S R Emmett
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - W Hollingworth
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - Y Ben-Shlomo
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - E J Henderson
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK.
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
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Older people's experiences of dignity and support with eating during hospital stays: analytical framework, policies and outcomes. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
There is growing recognition of the importance of dignity and support with eating as markers of high-quality and older-person-centred hospital services. We use data on these markers from the national Adult Inpatient Survey for England to build up statistical evidence on older people's experiences. We find that poor and inconsistent experiences of being treated with dignity and respect, and of receiving support with eating, affect a substantial proportion of inpatients across the vast majority of acute hospital trusts. There has been remarkably little change over time, although small improvements provide some grounds for optimism relating to policy developments in the period following the Francis Inquiry. Amongst people over 65, the prevalence of inconsistent and poor experiences of dignity and support with eating was higher amongst the ‘oldest of the old’ (inpatients aged over 80), individuals who experience a long-standing limiting illness or disability, and women. The highest rates of prevalence were observed amongst disabled women over 80. Perceptions of inadequate nursing quantity and quality, and lack of choice of food, stand out from logistic regression analysis as having consistent, large associations with lack of support with eating. These factors provide potential policy levers since they are within the control of hospitals to a certain extent. In drawing lessons from our analysis for inspection, regulation and monitoring, we highlight the importance of inequalities analysis – including systematic disaggregation and separate identification of at risk sub-groups (e.g. older disabled women) – rather than relying on a ‘population average approach’.
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Contreras M, Mioshi E, Kishita N. Factors predicting quality of life in family carers of people with dementia: The role of psychological inflexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peasgood T, Mukuria C, Carlton J, Connell J, Devlin N, Jones K, Lovett R, Naidoo B, Rand S, Rejon-Parrilla JC, Rowen D, Tsuchiya A, Brazier J. What is the best approach to adopt for identifying the domains for a new measure of health, social care and carer-related quality of life to measure quality-adjusted life years? Application to the development of the EQ-HWB? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1067-1081. [PMID: 33909157 PMCID: PMC8318935 DOI: 10.1007/s10198-021-01306-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
Economic evaluation combines costs and benefits to support decision-making when assessing new interventions using preference-based measures to measure and value benefits in health or health-related quality of life. These health-focused instruments have limited ability to capture wider impacts on informal carers or outcomes in other sectors such as social care. Sector-specific instruments can be used but this is problematic when the impact of an intervention straddles different sectors.An alternative approach is to develop a generic preference-based measure that is sufficiently broad to capture important cross-sector outcomes. We consider the options for the selection of domains for a cross-sector generic measure including how to identify domains, who should provide information on the domains and how this should be framed. Beyond domain identification, considerations of criteria and stakeholder needs are also identified.This paper sets out the case for an approach that relies on the voice of patients, social care users and informal carers as the main source of domains and describes how the approach was operationalised in the 'Extending the QALY' project which developed the new measure, the EQ-HWB (EQ health and wellbeing instrument). We conclude by discussing the strengths and limitations of this approach. The new measure should be sufficiently generic to be used to consistently evaluate health and social care interventions, yet also sensitive enough to pick up important changes in quality of life in patients, social care users and carers.
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Affiliation(s)
- Tessa Peasgood
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
- School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Clara Mukuria
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Janice Connell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nancy Devlin
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Karen Jones
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Rosemary Lovett
- National Institute for Health and Care Excellence (NICE), London, UK
| | - Bhash Naidoo
- National Institute for Health and Care Excellence (NICE), London, UK
| | - Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Aki Tsuchiya
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Department of Economics, University of Sheffield, Sheffield, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Contreras ML, Mioshi E, Kishita N. Factors Related to the Quality of Life in Family Carers of People With Dementia: A Meta-Analysis. J Geriatr Psychiatry Neurol 2021; 34:482-500. [PMID: 32394770 PMCID: PMC8326913 DOI: 10.1177/0891988720924713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This meta-analysis aimed to (1) quantitatively synthesize evidence of factors related to the quality of life (QoL) of family carers of people with dementia and (2) explore moderating factors that may influence the strength of the relationship between such potential predictive factors and carer QoL. METHODS Studies that investigated correlations between patient/carer factors and QoL in unpaid family carers of people with dementia and were published in English, Spanish, Portuguese, or Japanese were included. RESULTS Thirty-three studies were identified. The pooled correlations with carer QoL (effect size) were significantly large for depression (-0.58), significantly moderate for subjective burden (-0.47), and significantly small for people with dementia's neuropsychiatric symptoms (-0.24). These results indicated to be robust in the context of publication bias. The results of subgroup analyses demonstrated the social and economic development status of the country where study participants resided did not moderate these effects. CONCLUSION Carer depression, subjective burden, and people with dementia's neuropsychiatric symptoms may play a critical role in maintaining QoL of family carers regardless of the social and economic circumstances.
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Affiliation(s)
- Milena L. Contreras
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom,Naoko Kishita, School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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Mitchell PM, Husbands S, Byford S, Kinghorn P, Bailey C, Peters TJ, Coast J. Challenges in developing capability measures for children and young people for use in the economic evaluation of health and care interventions. HEALTH ECONOMICS 2021; 30:1990-2003. [PMID: 34036671 PMCID: PMC7614859 DOI: 10.1002/hec.4363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 05/26/2023]
Abstract
Methods for measuring outcomes suitable for economic evaluations of health and care interventions have primarily focused on adults. The validity of such methods for children and young people is questionable in areas including the outcome domains measured and how they are measured and valued, with most existing measures narrowly focusing on health. Novel methods for assessing benefits beyond health by focusing on a person's capability have also concentrated on adults to date. This paper aims to set out the rationale for capability measures in children and young people. It argues for the need to expand the evaluative space beyond health functioning towards broader capabilities, with children and young people playing an integral role in capability measure development. Drawing from existing literature, specific challenges related to the identification, measurement, and valuation of capabilities in children and young people are also discussed. Finally, the practical implications for conducting economic evaluation when measuring and valuing capabilities at different stages across the life-course are illustrated. We develop an alternative framework based on conceiving capabilities as evolving across the life-course. This framework may also be helpful in thinking about how to model health outcomes across the life-course.
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Affiliation(s)
- Paul Mark Mitchell
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Samantha Husbands
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Byford
- King's Health Economics (KHE), Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip Kinghorn
- Health Economics Unit (HEU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Coast
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Hackert MQN, van Exel J, Brouwer WBF. Content validation of the Well-being of Older People measure (WOOP). Health Qual Life Outcomes 2021; 19:200. [PMID: 34419061 PMCID: PMC8380379 DOI: 10.1186/s12955-021-01834-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Valid measures of the well-being of older people are important for the evaluation of health and social care services. The nine-item Well-being of Older People measure (WOOP) was based on a novel framework derived from a recent Q-methodology study, and was developed to capture a comprehensive set of well-being domains relevant to older people, as identified by themselves. This study introduces the WOOP and describes the qualitative assessment of its feasibility and content validity. METHODS Between December 2017 and January 2018, a sampling agency retrieved data from 269 adults aged 65 years and older in the Netherlands. Using an online survey, participants were asked to complete the WOOP and to indicate the importance of each item to their well-being. Open-ended questions were used to collect information about participants' own definition of well-being, their interpretation of the items of the WOOP, and their assessment of the descriptions and response options provided with each item. Data were analysed using inductive content analysis with the software package ATLAS.ti. RESULTS The WOOP closely resembled respondents' own description of what well-being means to them. The majority of the respondents reported no important well-being aspects to be missing from the WOOP, and indicated all WOOP items to be at least 'reasonably important' to their well-being. Many linked the WOOP items to well-being aspects as intended, and only a few had suggestions for improving the items' descriptions and response options. CONCLUSIONS Given these results, all nine items were retained, and no items were added to the measure. Based on respondents' feedback, minor changes were made to the wording of some descriptions and response options of items. Concluding, the feasibility and content validity of the WOOP seem satisfactory. Further validation of this new measure is required, in different health and social care settings and among subgroups of older people with potentially different views on what constitutes well-being.
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Affiliation(s)
- Mariska Q N Hackert
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Martinez FJ, Yow E, Flaherty KR, Snyder LD, Durheim MT, Wisniewski SR, Sciurba FC, Raghu G, Brooks MM, Kim DY, Dilling DF, Criner GJ, Kim H, Belloli EA, Nambiar AM, Scholand MB, Anstrom KJ, Noth I. Effect of Antimicrobial Therapy on Respiratory Hospitalization or Death in Adults With Idiopathic Pulmonary Fibrosis: The CleanUP-IPF Randomized Clinical Trial. JAMA 2021; 325:1841-1851. [PMID: 33974018 PMCID: PMC8114133 DOI: 10.1001/jama.2021.4956] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Alteration in lung microbes is associated with disease progression in idiopathic pulmonary fibrosis. OBJECTIVE To assess the effect of antimicrobial therapy on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, randomized, unblinded clinical trial conducted across 35 US sites. A total of 513 patients older than 40 years were randomized from August 2017 to June 2019 (final follow-up was January 2020). INTERVENTIONS Patients were randomized in a 1:1 allocation ratio to receive antimicrobials (n = 254) or usual care alone (n = 259). Antimicrobials included co-trimoxazole (trimethoprim 160 mg/sulfamethoxazole 800 mg twice daily plus folic acid 5 mg daily, n = 128) or doxycycline (100 mg once daily if body weight <50 kg or 100 mg twice daily if ≥50 kg, n = 126). No placebo was administered in the usual care alone group. MAIN OUTCOMES AND MEASURES The primary end point was time to first nonelective respiratory hospitalization or all-cause mortality. RESULTS Among the 513 patients who were randomized (mean age, 71 years; 23.6% women), all (100%) were included in the analysis. The study was terminated for futility on December 18, 2019. After a mean follow-up time of 13.1 months (median, 12.7 months), a total of 108 primary end point events occurred: 52 events (20.4 events per 100 patient-years [95% CI, 14.8-25.9]) in the usual care plus antimicrobial therapy group and 56 events (18.4 events per 100 patient-years [95% CI, 13.2-23.6]) in the usual care group, with no significant difference between groups (adjusted HR, 1.04 [95% CI, 0.71-1.53; P = .83]. There was no statistically significant interaction between the effect of the prespecified antimicrobial agent (co-trimoxazole vs doxycycline) on the primary end point (adjusted HR, 1.15 [95% CI 0.68-1.95] in the co-trimoxazole group vs 0.82 [95% CI, 0.46-1.47] in the doxycycline group; P = .66). Serious adverse events occurring at 5% or greater among those treated with usual care plus antimicrobials vs usual care alone included respiratory events (16.5% vs 10.0%) and infections (2.8% vs 6.6%); adverse events of special interest included diarrhea (10.2% vs 3.1%) and rash (6.7% vs 0%). CONCLUSIONS AND RELEVANCE Among adults with idiopathic pulmonary fibrosis, the addition of co-trimoxazole or doxycycline to usual care, compared with usual care alone, did not significantly improve time to nonelective respiratory hospitalization or death. These findings do not support treatment with these antibiotics for the underlying disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02759120.
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Affiliation(s)
| | - Eric Yow
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Kevin R. Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Laurie D. Snyder
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Michael T. Durheim
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
- Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Stephen R. Wisniewski
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank C. Sciurba
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ganesh Raghu
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle
| | - Maria M. Brooks
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel F. Dilling
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Hyun Kim
- Division of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis
| | - Elizabeth A. Belloli
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Anoop M. Nambiar
- Division of Pulmonary and Critical Care Medicine, University of Texas Health San Antonio
| | - Mary Beth Scholand
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City
| | - Kevin J. Anstrom
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville
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Golovchanova N, Boersma K, Andershed H, Hellfeldt K. Affective Fear of Crime and Its Association with Depressive Feelings and Life Satisfaction in Advanced Age: Cognitive Emotion Regulation as a Moderator? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094727. [PMID: 33946732 PMCID: PMC8126985 DOI: 10.3390/ijerph18094727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 01/07/2023]
Abstract
Fear of crime is a substantial problem for older adults and is associated with reduced subjective well-being. However, less is known about factors that could moderate the associations between fear of crime and mental health problems and well-being in advanced age. Cognitive emotion regulation could serve as a potentially buffering factor for adverse health outcomes related to fear of crime due to its potential importance in managing feelings when facing threatening situations. The current study investigated the associations between affective fear of crime with depressive feelings and life satisfaction and examined whether adaptive and maladaptive cognitive emotion regulation strategies moderated these associations in a sample of older adults (age 64–106) in Sweden (N = 622). The results showed that affective fear of crime was associated with more depressive feelings, less life satisfaction, and more frequent use of such maladaptive cognitive emotion regulation strategies as rumination, catastrophizing, and blaming others. Moreover, rumination and self-blame moderated the associations between affective fear of crime and life satisfaction. Adaptive emotion regulation strategies were not associated with affective fear of crime and did not decrease the strength of its association with depressive feelings and with life satisfaction. These findings allow us to conclude that maladaptive emotion regulation could be considered a vulnerability factor in the association of fear of crime with life satisfaction.
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