Convergent validity of the EQ-5D-3L in a randomized-controlled trial of the Housing First model

Determinants of health-related quality of life (HRQoL) among homeless individuals during the COVID-19 pandemic

OBJECTIVE

Thus far, there is very limited knowledge regarding homeless individuals during the COVID-19 pandemic, particularly related to the health-related quality of life (HRQoL). Thus, our aim was to evaluate HRQoL and to clarify the determinants of HRQoL among homeless individuals during the COVID-19 pandemic in Germany.

METHODS

Data were taken from the national survey on psychiatric and somatic health of homeless individuals during the COVID-19 pandemic-NAPSHI (n = 616). The established EQ-5D-5L was used to quantify problems in five health dimensions, and its visual analogue scale (EQ-VAS) was used to record self-rated health status. Sociodemographic factors were included in regression analysis.

RESULTS

Pain/discomfort was the most frequently reported problem (45.3%), thereafter anxiety/depression (35.9%), mobility (25.4%), usual activities (18.5%) and self-care (11.4%). Average EQ-VAS score was 68.97 (SD: 23.83), and the mean EQ-5D-5L index was 0.85 (SD: 0.24). Regressions showed that higher age and having a health insurance were associated with several problem dimensions. Being married was associated with higher EQ-VAS scores.

CONCLUSIONS

Overall, our study findings showed a quite high HRQoL among homeless individuals during the COVID-19 pandemic in Germany. Some important determinants of HRQoL were identified (e.g., age or marital status). Longitudinal studies are required to confirm our findings.

Factors That Influence Quality of Life in People Experiencing Homelessness: A Systematic Mixed Studies Review

BACKGROUND

An emerging category of morbidity in research among people experiencing homelessness (PEH) is quality of life (QoL). The Commission on Social Determinants of Health (CSDH) framework was used to explain the relationship between the resulting factors and their impact on QoL among PEH.

AIMS

The purpose of this systematic mixed studies review was to explore the factors that are associated with QoL among homeless individuals.

METHOD

A systematic mixed studies review was conducted using CINAHL, Medline, PubMed, and SocIndex databases. Quantitative, qualitative, and mixed methods studies were included and synthesized employing results-based convergent synthesis design.

RESULTS

The initial search resulted in 757 studies with 55 studies meeting the inclusion criteria. Thematic analysis revealed themes influencing QoL among PEH categorized by the CSDH determinants of structural, social cohesion and social capital, and intermediary determinants. Among these themes, higher social status, strong relationships, better reported physical and mental health, and a positive life outlook were associated with increased QoL. Social isolation, substance use, poorer life outlook, increased years spent homeless, and perceived quality of housing were associated with decreased QoL. Age, sex, and housing programs revealed inconsistent results on QoL.

CONCLUSIONS

While the factors presented in this review indicate some consistent relationships with QoL in PEH, this review has shown QoL among this population is complex and multifactorial. Future research should focus on relationships between the CSDH determinants, particularly the psychosocial factors and the QoL priorities defined by PEH, and how they may influence QoL among PEH.

Game of Mirrors: Health Profiles in Patient and Physician Perceptions

The relationship between general practitioners and patients is privileged. The aim of this study was to assess the concordance between the health profile perceived by the patient and the one described by the doctor. We conducted a cross-sectional study between 2019–2020. Patients completed the 5d-5L (EQ-p) and clinicians completed it “from the patient’s perspective” (EQ-d), also consulting the clinical diary. Statistical analysis was performed using Stata 14 (Cohen’s kappa; Fisher’s exact test). The sample consisted of 423 patients. The mean age was 56.7 ± 19.2. There were significant differences by gender in usual activities, pain, and anxiety/depression (74.6% of men had no limitation in usual activities versus 64.5% of women (p < 0.01), 53.9% of men had no pain versus 38.5% of women (p < 0.01), and 60.3% of men had no anxiety/depression versus 38.5% of women (p < 0.01)). Physicians did not detect these differences. The concordance between EQ-p and EQ-d was substantial for mobility (k = 0.62; p < 0.01), moderate for self-care (k = 0.48; p < 0.01) and usual activities (k = 0.50; p < 0.01). Concordance was fair for pain/discomfort (k = 0.32; p < 0.01), anxiety/depression (k = 0.38; p < 0.01), and EQ Index (k = 0.21; p < 0.01). There was greater agreement for “objective “dimensions (mobility, self-care, and usual activities). A good doctor, to be considered as such, must try to put himself in the “patient’s pajamas” to feel his feelings and be on the same wavelength.

Determinants of health-related quality of life among homeless individuals during the COVID-19 pandemic

OBJECTIVE

To clarify which variables are associated with the health-related quality of life (HRQoL) among homeless individuals during the COVID-19 pandemic.

STUDY DESIGN

Cross-sectional research.

METHODS

Data were taken from the Hamburg survey of homeless individuals (n = 151). HRQoL was assessed using the EQ-5D tool. More precisely, the EQ-5D-5L questionnaire was used to quantify problems in five health dimensions (i.e. mobility, self-care, usually activities, pain/discomfort, anxiety/depression), and its visual analog scale (EQ-VAS) was used to record the according self-rated health status. Explanatory variables include sex, age, education, marital status, country of origin, health insurance, and chronic alcohol consumption.

RESULTS

With regard to HRQoL, most frequently, problems were reported as pain/discomfort (47.3%), followed by anxiety/depression (32.4%), mobility (29.7%), usual activities (20.7%) and self-care (4.6%). The mean EQ-VAS score was 75.34 (SD 22.23; range 1-100), and the mean EQ-5D-5L index was 0.84 (SD 0.23; range 0.32-1). Regressions showed increasing problems in mobility and self-care with higher age, whereas EQ-VAS was positively associated with younger age. Furthermore, EQ-5D-5L index was positively associated with younger age and higher education. Summarized, among this cohort, a higher age is associated with a lower HRQoL.

CONCLUSION

Remarkably high EQ-VAS values and rather few problems in the five dimensions investigated here were reported among the homeless individuals during the COVID-19 pandemic particularly compared with the general population. Moreover, study findings particularly stress the link between higher age and lower HRQoL among homeless individuals. This knowledge is important to address homeless individuals at risk of poor HRQoL. Longitudinal studies are required to confirm the given findings.