Measuring refugees' capabilities: translation, adaptation, and valuation of the OxCAP-MH into Juba Arabic for use among South Sudanese male refugees in Uganda

BACKGROUND

Forcibly displaced populations are highly vulnerable to psychosocial distress and mental disorders, including alcohol misuse. In an ongoing trial that seeks to develop a transdiagnostic intervention addressing psychological distress and alcohol use disorders among conflict-affected populations, we will carry out a cost-effectiveness evaluation using a capability-based Oxford Capabilities Mental Health (OxCAP-MH) measure. The OxCAP-MH is a 16-item questionnaire developed from the Capability Approach, that covers multiple domains of functioning and welfare. The aim of the current paper is to present the results of the translation, cultural adaptation and valuation of the OxCAP-MH into Juba Arabic for South Sudanese refugees living in Uganda. We adhered to the official Translation and Linguistic Validation process of the OxCAP-MH. To carry out the translation, the Concept Elaboration document, official English version of the OxCAP-MH, and the Back-Translation Review Template were used. Four independent translators were used for forward and back translations. The reconciled translated version was then piloted in two focus group discussions (N = 16) in Rhino refugee settlement. A most important to least important valuation of the sixteen capability domains covered in the OxCAP-MH was also done.

RESULTS

The Juba Arabic version of the OxCAP-MH was finalized following a systematic iterative process. The content of the Juba Arabic version remained unchanged, but key concepts were adapted to ensure cultural acceptability, feasibility, and comprehension of the measure in the local context of Rhino refugee settlement. Most participants had low levels of literacy and required support with filling in the tool. Participants suggested an additional capability that is currently not reflected in the OxCAP-MH, namely access to food. Furthermore, discussions around the valuation exercise of the sixteen domains led to two separate importance scales, which showed relevant differences.

CONCLUSIONS

In this context, the OxCAP-MH was considered culturally acceptable. The valuation exercise proved cognitively demanding. Participants voiced confusion over how to answer the questions on the OxCAP-MH instrument due to low levels of literacy. These concerns invite consideration for future research to consider how measures such as the OxCAP-MH can be made more accessible to individuals with low literacy rates in resource poor settings.

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

PURPOSE

Our aim was to elicit a value set for Capability-Adjusted Life Years Sweden (CALY-SWE); a capability-grounded quality of life instrument intended for use in economic evaluations of social interventions with broad consequences beyond health.

METHODS

Building on methods commonly used in the quality-adjusted life years EQ-5D context, we collected time-trade off (TTO) and discrete choice experiment (DCE) data through an online survey from a general population sample of 1697 Swedish participants. We assessed data quality using a score based on the severity of inconsistencies. For generating the value set, we compared different model features, including hybrid modeling of DCE and TTO versus TTO data only, censoring of TTO answers, varying intercept, and accommodating for heteroskedasticity. We also assessed the models' DCE logit fidelity to measure agreement with potentially less-biased DCE data. To anchor the best capability state to 1 on the 0 to 1 scale, we included a multiplicative scaling factor.

RESULTS

We excluded 20% of the TTO answers of participants with the largest inconsistencies to improve data quality. A hybrid model with an anchor scale and censoring was chosen to generate the value set; models with heteroskedasticity considerations or individually varying intercepts did not offer substantial improvement. The lowest capability weight was 0.114. Health, social relations, and finance and housing attributes contributed the largest capability gains, followed by occupation, security, and political and civil rights.

CONCLUSION

We elicited a value set for CALY-SWE for use in economic evaluations of interventions with broad social consequences.

Measurement invariance and adapted preferences: evidence for the ICECAP-A and WeRFree instruments

BACKGROUND

Self-report instruments are used to evaluate the effect of interventions. However, individuals adapt to adversity. This could result in individuals reporting higher levels of well-being than one would expect. It is possible to test for the influence of adapted preferences on instrument responses using measurement invariance testing. This study conducts such a test with the Wellbeing Related option-Freedom (WeRFree) and ICECAP-A instruments.

METHODS

A multi-group confirmatory factor analysis was conducted to iteratively test four increasingly stringent types of measurement invariance: (1) configural invariance, (2) metric invariance, (3) scalar invariance, and (4) residual invariance. Data from the Multi Instrument Comparison study were divided into subsamples that reflect groups of participants that differ by age, gender, education, or health condition. Measurement invariance was assessed with (changes in) the Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), and Root Mean Square Residual (SRMR) fit indices.

RESULTS

For the WeRFree instrument, full measurement invariance could be established in the gender and education subsamples. Scalar invariance, but not residual invariance, was established in the health condition and age group subsamples. For the ICECAP-A, full measurement invariance could be established in the gender, education, and age group subsamples. Scalar invariance could be established in the health group subsample.

CONCLUSIONS

This study tests the measurement invariance properties of the WeRFree and ICECAP-A instruments. The results indicate that these instruments were scalar invariant in all subsamples, which means that group means can be compared across different subpopulations. We suggest that measurement invariance of capability instruments should routinely be tested with a reference group that does not experience a disadvantage to study whether responses could be affected by adapted preferences.

Takes more than two to tango: Intrahousehold food system agency and its intricacies in South Africa

Intra-household food system agency is affected by individual physiology, environmental diversity, variations in social conditions, relational perspectives and distribution within families, resulting in differing capabilities and functionings which have a bearing on welfare. The study used the capability approach to assess intrahousehold food system agency, its determinants and welfare impact, taking a cross-sectional survey of 1184 households from three heterogenous study sites in South Africa. Poisson count regression, Propensity Score Matching and Monte Carlo Simulations were used in the study. Duration of stay within the community, tenure, employment status and household size were significant in the number of intrahousehold food system decisions made by female heads and none-nuclear family members, with however overall reduction in number of decisions made. Yet, when female heads showed agency in agricultural production and food expenditure, food security improved by 5 % and 6 %, respectively. On the other hand, it is reduced by between 4 % and 5 % for none-nuclear family members. Duration of stay in the community and age of household head had the highest contribution to agency variation. In conclusion, there are varied intrahousehold food system decisions made by various members of the households, resulting in varying degrees of food security. In addition, variations in the socio-economic factors of the households result in varied agency, especially for female household heads and other none-nuclear family members. Female-head intrahousehold food system agency should be promoted in lieu of their positive impact on food security, and their reduced decision-making capacity in hindsight.

The role of performativity in informal dementia carers' capability to be mobile

Informal carers are and will remain a vital part of dementia care. Given the nature of their caring tasks, which focus on enabling the care recipient to engage in meaningful activities, informal dementia carers are affected in their everyday mobility. Expectations manifested by society, loved ones and the carers themselves play a critical role in how carers perform their caring role and how they perceive their opportunity, or capability, to be mobile. This article uses Butler's concept of performativity to understand informal dementia carers' capability to be mobile. In the spring and summer of 2021, we combined remote graphic elicitation with telephone interviews to gather the views of 17 informal dementia carers (aged 50+) living in England. Three key themes emerged from our analysis of the data. Firstly, participants perceived that becoming a carer changed their capability to be mobile. Secondly, the caring role in relation to the capability to be mobile resulted in an emotional toll and perceived loss of autonomy. Thirdly, the performativity of the caring role created feelings of guilt, selfishness and resentment due to the impact caring had on participants' capability to be mobile. Our study enriches the literature on informal dementia carers' mobility, as we suggest that performativity is a key factor in how this population experiences their everyday mobility. The findings suggest that existing ageing-in-place policies should take a more holistic approach by better including those ageing adults who provide the most support: informal dementia carers.

Multidimensional Food Poverty: Evidence from Low-Income Single Mothers in Contemporary Japan

The objective of this article is to gain an in-depth understanding of the eating lives of low-income single mothers in Japan. Semi-structured interviews were conducted with nine low-income single mothers living in the three largest urban areas (Tokyo, Hanshin [Osaka and Kobe] and Nagoya) in Japan. Framed by the capability approach and sociology of food, their dietary norms and practices, as well as underlying factors that impact the norm-practice gap were analysed across nine dimensions: meal frequency, place of eating, meal timing, duration, persons to eat with, procurement method, food quality, meal content and pleasure of eating. These mothers were deprived of various types of capabilities, extending not only from the quantity and nutritional aspects of food, but also to spatial, temporal, qualitative and affective aspects. Aside from financial constraints, eight other factors (time, maternal health, parenting difficulties, children's tastes, gendered norms, cooking abilities, food aid and local food environment) were identified as influencing their capabilities to eat well. The findings challenge the view that food poverty is the deprivation of economic resources required to ensure a sufficient amount of food. Social interventions that go beyond monetary aid and food provision need to be proposed.

Estimating loss in capability wellbeing in the first year of the COVID-19 pandemic: a cross-sectional study of the general adult population in the UK, Australia and the Netherlands

OBJECTIVES

To estimate capability wellbeing lost from the general adult populations in the UK, Australia and the Netherlands in the first year of the COVID-19 pandemic and the associated social restrictions, including lockdowns.

DESIGN

Cross-sectional with recalled timepoints.

SETTING

Online panels in the UK, Australia and the Netherlands conducted in February 2021 (data collected 26 January-2 March 2021).

PARTICIPANTS

Representative general adult (≥ 18 years old) population samples in the UK (n = 1,017), Australia (n = 1,011) and the Netherlands (n = 1,017) MAIN OUTCOME MEASURE: Participants completed the ICECAP-A capability wellbeing measure in February 2021, and for two recalled timepoints during the initial lockdowns in April 2020 and in February 2020 (prior to COVID-19 restrictions in all three countries). ICECAP-A scores on a 0-1 no capability-full capability scale were calculated for each timepoint. Societal willingness to pay estimates for a year of full capability (YFC) was used to place a monetary value associated with change in capability per person and per country. Paired t tests were used to compare changes in ICECAP-A and YFC from pre- to post-COVID-19-related restrictions in each country.

RESULTS

Mean (standard deviation) loss of capability wellbeing during the initial lockdown was 0.100 (0.17) in the UK, 0.074 (0.17) in Australia and 0.049 (0.12) in the Netherlands. In February 2021, losses compared to pre-lockdown were 0.043 (0.14) in the UK, 0.022 (0.13) in Australia and 0.006 (0.11) in the Netherlands. In monetary terms, these losses were equivalent to £14.8 billion, AUD$8.6 billion and €2.1 billion lost per month in April 2020 and £6.4 billion, A$2.6 billion and €260 million per month in February 2021 for the UK, Australia and the Netherlands, respectively.

CONCLUSIONS

There were substantial losses in capability wellbeing in the first year of the COVID-19 pandemic. Future research is required to understand the specific impact of particular COVID-19 restrictions on people's capabilities.

Moderate Multidimensional Poverty Index: Paving the Way Out of Poverty

Eradicating poverty in all its forms, everywhere, requires indicators that measure sustainable pathways out of poverty, and not only the absence of acute poverty. This paper introduces a trial Moderate Multidimensional Poverty Index (MMPI) that reflects moderate rather than acute levels of multidimensional poverty. The MMPI adjusts nine of the 10 indicators of the global Multidimensional Poverty Index (global MPI) to reflect moderate poverty and create a meaningful superset of the acutely poor population. Although data-constrained, the trial MMPI outlines a methodology and potential indicators for a measure that would: (i) be meaningful and comparable across populations at higher levels of development; (ii) align with higher standards defined in Agenda 2030; and (iii) provide insight into aspects of intrahousehold deprivation. The MMPI is illustrated empirically using nationally representative household surveys from Bangladesh, Guatemala, Iraq, Serbia, Tanzania and Thailand. The results confirm the added value of having three nested measures of destitution, acute, and moderate multidimensional poverty. The MMPI also complements monetary measures with informative differences in poverty levels observed. The results demonstrate that a Moderate MPI is a desirable global poverty index, which is likely to illuminate thus far hidden aspects in of multidimensional poverty, such as intrahousehold deprivations in education. Challenges remain regarding data availability, and further study across additional countries is required before the MMPI structure can be finalised.

A longitudinal study of capability-based quality of life and mental health in the first 5-months of lockdown restrictions in the UK

BACKGROUND

COVID19, and associated lockdown restrictions, have impacted on people's daily lives. Understanding the mental health and wellbeing implications of these impacts has been identified as a public health research priority.

AIMS

Building on an earlier cross-sectional study, the current study sought to investigate whether capability-based quality of life changed during the first 5-months of lock-down restrictions in the UK, and whether capability-based quality of life was predictive of future levels of depression and anxiety.

METHODS

An initial convenience sample of 594 participants were followed up at three different timepoints spanning a 20-week time-period between March 2020 and August 2020. Participants provided demographic information and completed the Oxford Capabilities Questionnaire - Mental Health (OxCAP-MH), and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

The mean scores indicated that levels of both depression and anxiety decreased across the three timepoints, whereas capability-based QoL (as assessed by the OxCAP-MH) decreased over time. Capability-based QoL predicted additional levels of variance in both depression and anxiety levels when time and sociodemographic factors were controlled for. Cross-lagged panel model analyses indicated that capability-based QoL over a month into lockdown restrictions predicted levels of depression and anxiety 5 months into the restrictions.

CONCLUSIONS

The study findings suggest that the capability-limiting impact of public health emergencies and related lockdown restrictions are important for understanding peoples' levels of depression and anxiety. The implications that the findings have for the provision of support in the context of public health emergencies and associated restrictions are discussed.

Capability Approach and Inclusion: Developing a Context Sensitive Design for Biobased Value Chains

Biomass such as crops and agricultural waste is increasingly used as the primary resource for products like bioplastics and biofuels. Incorporating the needs, knowledge, skills and values of biomass producers in the design of global value chains - the steps involved in creating any finished product from design to delivery - can contribute to sustainability, reliability and fairness. However, how to involve biomass producers, especially if they are resource poor, remains a challenge. To make sure that inclusion in global biobased value chains is both fair and effective, the capabilities of relevant actors need to be taken into account, especially of those producing biomass. Access to resources determines to what extent a specific actor can participate in a global value chain. Therefore, differences in capabilities should be a central consideration when new (biobased) value chains are designed. Using the capability approach as an ethical framework to realize inclusion, we discern three complementary strategies for setting up inclusive value chains. Firstly, designing for local conversion factors second, providing adaptive design for new capabilities, and third, investing in local conversion factors. Applying these strategies can lead to context-sensitive design of biorefineries that allow for true inclusion of local stakeholders. We support these claims with reference to case-studies of sugarcane production in Jamaica, modified tobacco in South Africa and the non-edible parts of corn (stover) in the US.

An Innovative Approach to the Dismantlement of a Forensic Psychiatric Hospital in Italy: A Ten-year Impact Evaluation

Aims

This study aimed to evaluate the impacts of a pilot project concerning the closure of a Forensic Psychiatric Hospital (FPH) inspired by Human Development Theory and the Capability Approach.

Background

The dismantlement of the FPH of Barcellona Pozzo di Gotto (Sicily Region in Italy) began in 2010 with the pilot project Luce é Libertà and ended in 2017. With the closure of six FPHs, Italy officially became the first country worldwide to close such institutions. After the closure of FPHs, some critical issues emerged, and the debate shifted to developing small-scale facilities and residences for the execution of security measures (RESM). However, few studies have provided results on the cohort of patients discharged from FPHs.

Objective

Following are the objectives of this study: a) Assessing the effectiveness of the pilot project in terms of better functioning accordingly to the Classification of Functioning of Disability and Health (ICF) framework, social and labour insertion, health conditions, level of dangerousness to other, rate of readmission in forensic services, b) cost analysis, and c) describing how the CA has been applied and translated into methodological and administrative devices and concrete intervention strategies.

Methods

A pre-post evaluation design was performed with a comparison between the intervention and the control group for the healthcare cost analysis. Data were collected from 2010 to 2019 at three points: T0) as a baseline, T1 and T2) for the follow-up. The instruments are a structured questionnaire, the Scale HoNOS Secure, 4 sub-scales of ICF (Activity and participation dimensions: sociality, culture, and knowledge, daily life, income, and work) (Cronbach's Alpha from 0.76 to 0.94), and n.20 interviews with key stakeholders and beneficiaries.

Results

Main results include a) the discharge of 55 patients through the use of a person-centered approach and the Personal Capability Budget (PCB), b) the expansion of substantial freedom of choice and the improvement of ICF score (t-test Sig. <, 02), c) the reduction of the risk for others and themselves (Mean Diff. -2,15 Sig. .000), d) at T2 42% of beneficiaries achieved a job placement and 36% were living in one's own home, e) at T2 the need of security measures has reduced from the initial 70% to 6.8%, and f) reduction of the healthcare costs from the fourth year onwards.

Conclusion

Indications emerge to support processes of deinstitutionalisation and capabilities expansion through innovative models, a person-centered approach supported by PCBs, social finance, and social impact investments.

Relative acquisition evaluation of health poverty alleviation project: a quantitative study of data from different regions of China

BACKGROUND

Poverty is the greatest obstacle to the realization of human rights, among which illness is the leading cause in China. In 2015, China began to implement the health poverty alleviation project (HPAP). By 2020, all rural households living below the current poverty level (2300 yuan per person per year) have been lifted out of poverty.

METHODS

This study introduces the concept of relative acquisition and constructs a scale based on the capability approach to measure the relative acquisition and compares its fairness of HPAP.

RESULTS

The findings show that the values of the relative acquisition of HPAP in survey areas are all reached middle level (0.4-0.6), with 0 indicating the worst level and 1 indicating the best level. Specifically, the values of the functional activities of "health care", "health ability", "equal treatment opportunities" and "social support" are all above 0.4, while the values of "economic conditions" and "health education" are below 0.4.

CONCLUSIONS

The HPAP plays a significant role in reducing the economic burden of disease on patients. However, due to insufficient social support and health education, the HPAP objects lack endogenous motivation to fight against poverty, and the fairness also needs to be improved.

Capability Index: Applying a Fuzzy-Based Decision-Making Method to Evaluate Social Inclusion in Urban Areas Using the Capability Approach

There is rising interest in re-evaluating transport policy, moving away from analysing concrete economic indicators and towards examining the number of persons participating in activities as 'social justice.' So, using the Capacity Approach, this study presents an aggregated model to calculate the level of capability in two neighbourhoods in Tehran, Iran, involving variables from the 'Individuals' and 'Environment' dimensions. The computed factors were then weighted by the Fuzzy AHP technique based on the opinion of Iranian and international experts and combined to produce the final Capability Index (CI). CI results show that residents of the central business district, with an average of 0.628, had a 20% higher CI than residents of the city's outskirts, with 0.483. Furthermore, CI values corroborate prior research results that individuals with higher income, education level, and work position, in addition to higher individual capacity, benefit from a better neighbourhood environment. Also, calculations show that the neighbourhoods are not environmentally accessible for people with disabilities, and this group is suffering from low external capability. Additionally, the model estimates different levels of CI to evaluate the current status and prioritize future urban projects, so the model can be helpful for policy-makers to investigate the capability dimensions separately and decide about future plans.

Ethics at the Centre of Global and Local Challenges: Thoughts on the Future of Business Ethics

To commemorate 40 years since the founding of the Journal of Business Ethics, the editors in chief of the journal have invited the editors to provide commentaries on the future of business ethics. This essay comprises a selection of commentaries aimed at creating dialogue around the theme Ethics at the centre of global and local challenges. For much of the history of the Journal of Business Ethics, ethics was seen within the academy as a peripheral aspect of business. However, in recent years, the stakes have risen dramatically, with global and local worlds destabilized by financial crisis, climate change, internet technologies and artificial intelligence, and global health crises. The authors of these commentaries address these grand challenges by placing business ethics at their centre. What if all grand challenges were framed as grand ethical challenges? Tanusree Jain, Arno Kourula and Suhaib Riaz posit that an ethical lens allows for a humble response, in which those with greater capacity take greater responsibility but remain inclusive and cognizant of different voices and experiences. Focussing on business ethics in connection to the grand(est) challenge of environmental emergencies, Steffen Böhm introduces the deceptively simple yet radical position that business is nature, and nature is business. His quick but profound side-step from arguments against human-nature dualism to an ontological undoing of the business-nature dichotomy should have all business ethics scholars rethinking their "business and society" assumptions. Also, singularly concerned with the climate emergency, Boudewijn de Bruin posits a scenario where, 40 years from now, our field will be evaluated by its ability to have helped humanity emerge from this emergency. He contends that Milieudefensie (Friends of the Earth) v. Royal Dutch Shell illustrates how human rights take centre stage in climate change litigation, and how business ethics enters the courtroom. From a consumer ethics perspective, Deirdre Shaw, Michal Carrington and Louise Hassan argue that ecologically sustainable and socially just marketplace systems demand cultural change, a reconsideration of future interpretations of "consumer society", a challenge to the dominant "growth logic" and stimulation of alternative ways to address our consumption needs. Still concerned with global issues, but turning attention to social inequalities, Nelarine Cornelius links the capability approach (CA) to global and corporate governance, arguing that CA will continue to lie at the foundation of human development policy, and, increasingly, CSR and corporate governance. Continuing debate on the grand challenges associated with justice and equality, Laurence Romani identifies a significant shift in the centrality of business ethics in debates on managing (cultural) differences, positing that dialogue between diversity management and international management can ground future debate in business ethics. Finally, the essay concludes with a commentary by Charlotte Karam and Michelle Greenwood on the possibilities of feminist-inspired theories, methods, and positionality for many spheres of business ethics, not least stakeholder theory, to broaden and deepen its capacity for nuance, responsiveness, and transformation. In the words of our commentators, grand challenges must be addressed urgently, and the Journal of Business Ethics should be at the forefront of tackling them.

The norms and practices of eating well: In conflict with contemporary food discourses in Japan

In contemporary society, numerous food discourses are being constructed and promoted regarding how and what people should eat. However, such expositions are often too nutrition-centred and contradict each other, leaving contemporary eaters at a loss rather than rescuing them from their gastro-anomic situations. It is therefore necessary to seek an understanding of what 'eating well' means to contemporary people and to navigate current food discourses based on such a social consensus. Using a combined method of ethics (capability approach) and the sociology of food, the aim of this study was to arrive at an understanding of the total - spatial to temporal, quality, structural and aesthetic - dimensions of eating well through a web-based questionnaire survey conducted in Japan (n = 973). The norms and practices across all the dimensions were identified, facilitating the creation of a social standard that indicates the parameters of their capability to eat well. Some findings are in conflict with current discourses, in which particular meal structures have been idealised and solo eating has been stigmatised. The analysis also highlights the absence of socio-cultural values in people's dietary mindsets as a consequence of the nutrition-centred food discourses.

Agency as conversion process

Its importance for understanding social dynamics notwithstanding, the concept of agency is one of sociology's more controversial ideas. The debate around this concept has mostly been developed at a theoretical level and the empirical studies tend to rely on socio-psychological interpretations of agency as a stable, inner force capable of influencing prospects, decisions, and behavior with little room for change in agency capacity. Social sciences, though, should take a more dynamic stance on agency and highlight the role of the different elements of the social context that can enable or hinder individual agency capacity. Prompted by recent developments of the Capability Approach, this article proposes a framework for the study of agency that defines individual agency as the result of a conversion process of personal resources shaped by conversion factors. Conversion factors operate at micro, meso, and macro levels of analysis, each of which can be oriented toward past experiences, present conditions, and future prospects. This article also seeks to analytically distinguish three types of agency outcome: adaptation, autonomy, and influence. Such a framework will facilitate the transformation of the slippery notion of agency into more tractable empirical phenomena which increase its analytical and critical capacity.

Comparison of capability and health-related quality of life instruments in capturing aspects of mental well-being in people with schizophrenia and depression

BACKGROUND

There is increasing evidence that assessing outcomes in terms of capability provides information beyond that of health-related quality of life (HRQoL) for outcome evaluation in mental health research and clinical practice.

AIMS

To assess similarities and differences in the measurement properties of the ICECAP-A capability measure and Oxford Capabilities Questionnaire for Mental Health (OxCAP-MH) in people with schizophrenia experiencing depression, and compare these measurement properties with those of (a) the EuroQol EQ-5D-5L and EuroQol Visual Analogue Scale (EQ-VAS) and (b) mental health-specific (disease-specific) measures.

METHOD

Using data for 100 patients from the UK, measurement properties were compared using correlation analyses, Bland-Altman plots and exploratory factor analysis. Responsiveness was assessed by defining groups who worsened, improved or remained unchanged, based on whether there was a clinically meaningful change in the instrument scores between baseline and 9-month follow-up assessments.

RESULTS

The two capability instruments had stronger convergent validity with each other (Spearman's rho = 0.677) than with the HRQoL (rho = 0.354-0.431) or the mental health-specific (rho = 0.481-0.718) instruments. The OxCAP-MH tended to have stronger correlations with mental health-specific instruments than the ICECAP-A, whereas the ICECAP-A had slightly stronger correlation with the EQ-VAS. Change scores on the capability instruments correlated weakly with change scores on the HRQoL scales (rho = 0.131-0.269), but moderately with those on mental health-specific instruments for the ICECAP-A (rho = 0.355-0.451) and moderately/strongly on the OxCAP-MH (rho = 0.437-0.557).

CONCLUSIONS

Assessing outcomes in terms of capabilities for people with schizophrenia and depression provided more relevant, mental health-specific information than the EQ-5D-5L or the EQ-VAS. The ICECAP-A and the OxCAP-MH demonstrated similar psychometric properties, but the OxCAP-MH was more correlated with disease-specific instruments.

Toward a paradigm shift in healthcare: using the International Classification of Functioning, Disability and Health (ICF) and the capability approach (CA) jointly in theory and practice

PURPOSE

Over the past two decades, healthcare systems have shifted to adopt a more holistic, patient-centered care system. However, operationalization in practice remains challenging. Two frameworks have contributed substantially to the transformation toward more holistic and patient-centered care: the International Classification of Functioning, Disability and Health (ICF) and the capability approach (CA). Using these frameworks jointly can contribute to improved patient-centered care in clinical practice.

METHODS

This article explores the strengths and weaknesses of the use of the two frameworks in care and investigates whether using them jointly might contribute to more appropriate and patient-centered care. We will present a practical example of this integration in the form of a novel e-health application.

RESULTS

The exploration indicated that if the frameworks are used jointly, the individual weaknesses can be overcome. The application, used to exemplify the joint use of the frameworks, contains all categories of the ICF. It offers a unique tool that allows a person to self-assess, record, and evaluate their functioning and capabilities and formulate related goals.

CONCLUSIONS

Using the ICF jointly with the CA can foster holistic, patient-centered care. The e-health application provides a concrete example of how the frameworks can be used jointly. Implications for rehabilitationUsing the International Classification of Functioning, Disability and Health jointly with the capability approach can foster holistic, patient-centered care.The joint use of the frameworks is demonstrated by an e-health application which enables users to evaluate their functioning in relation to their own goals, provides them with the opportunity to increase control over their health and have a more active role in their care.Tools to record both functioning and goals from a patient's perspective can support professionals in offering patient-centered care in daily practice.Individual recording, monitoring and evaluation of functioning, capabilities and goals regarding functioning can provide a basis for research and quality improvement.

Understanding feedback relationships between resources, functionings and well-being: A case study of seaweed farming and artisanal processing in Indonesia

Sen's Capability Approach is one of the most significant theoretical contributions to welfare analysis across a range of disciplines. A part of the literature argues that its conceptual linear flow-from resources to 'functionings', which result in well-being-potentially ignores more complex relations with the feedback loops where a single item could be viewed as having a different role by different people, in different contexts. We explore perceptions of existing feedback relationships in interviews with 74 women from nine seaweed farming villages in Indonesia, engaged in two distinct activities: seaweed farming and artisanal seaweed processing. We find that capability sets required for farming and for processing are distinct and in both cases we observe feedback loops. Several factors, notably social networks and transportation (motorbikes), were mentioned in almost all contexts indicating that not all resources are of equal 'value' and might yield different levels of well-being.

Enhancing the career capabilities of NEET youth in Hong Kong: an experience-driven framework

Inspired by Amartya Sen's conceptualization of capability, this article examined how the introduction of an experience-driven (ED) framework into the capability approach helps inform the delivery of a career support service project targeted at youth aged 15-21, who are not in education, employment or training (NEET youth) with difficulties to develop their career capabilities. Based on a thematic analysis of ten individual interview transcripts collected from five career practitioners and five ex-users, the study discussed four interlocking domains of experiences and experience-driven career interventions for enhancing youth's capabilities to aspire and realize aspirations with a transition from the zone of proximal development to the zone of aspired development, namely, recognition, exposures, self-growth and transferability. We recommended further research studies on evaluating the effectiveness of using the ED framework for applying the capability approach to strengthening the career capabilities of service users characterized by diversity and vulnerability in different service settings.

What is eating well? Capability approach and empirical exploration with the population in Japan

'Eating well' or 'food-related well-being' have attracted scientific attention since the 1990s in the public health, psychology, sociology and, to a lesser degree, economics fields. A large number of empirical studies have been conducted on the content, determinants and measurements of eating well. However, what is missing is a theoretical framework that delineates the structure of well-being and highlights both the problem of one's mental 'adaptation' to straitened circumstances and the importance of one's agency and democratic practices. In this regard, Amartya Sen's capability approach shows promise. The objective of this study was to apply the capability approach to understanding what eating well means to the population in Japan and to articulate its theoretical implications. The perspective of Japanese participants was elicited by conducting a web-based questionnaire survey (n = 973). The seven categories of eating well that were identified in Japan included two objectives (health and pleasure) and five strategies (regularity, required intake, moderation, balance and quality) to achieve them. Through additional analysis of their 'actual' eating practices, it was elucidated that their satisfaction was relatively high despite their actual failure to achieve such eating well, which implies the critical importance of plural (both subjective and objective) perspectives for ethically evaluating the level of eating well.

Internal and external aspects of freedom of choice in mental health: cultural and linguistic adaptation of the Hungarian version of the Oxford CAPabilities questionnaire-Mental Health (OxCAP-MH)

Background

A link between mental health and freedom of choice has long been established, in fact, the loss of freedom of choice is one of the possible defining features of mental disorders. Freedom of choice has internal and external aspects explicitly identified within the capability approach, but received little explicit attention in capability instruments. This study aimed to develop a feasible and linguistically and culturally appropriate Hungarian version of the Oxford CAPabilities questionnaire—Mental Health (OxCAP-MH) for mental health outcome measurement.

Methods

Following forward and back translations, a reconciled Hungarian version of the OxCAP-MH was developed following professional consensus guidelines of the International Society for Pharmacoeconomics and Outcomes Research and the WHO. The wording of the questionnaire underwent cultural and linguistic validation through content analysis of cognitive debriefing interviews with 11 Hungarian speaking mental health patients in 2019. Results were compared with those from the development of the German version and the original English version with special focus on linguistic aspects.

Results

Twenty-nine phrases were translated. There were linguistic differences in each question and answer options due to the high number of inflected, affixed words and word fragments that characterize the Hungarian language in general. Major linguistic differences were also revealed between the internal and external aspects of capability freedom of choices which appear much more explicit in the Hungarian than in the English or German languages. A re-analysis of the capability freedom of choice concepts in the existing language versions exposed the need for minor amendments also in the English version in order to allow the development of future culturally, linguistically and conceptually valid translations.

Conclusion

The internal and external freedom of choice impacts of mental health conditions require different care/policy measures. Their explicit consideration is necessary for the conceptually harmonised operationalisation of the capability approach for (mental) health outcome measurement in diverse cultural and linguistic contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00660-0.

Doctor, please make me freer: Capabilities enhancement as a goal of medicine

Biomedical innovations are making possible the enhancement of human capabilities. There are two philosophical stances on the role that medicine should play in this respect. On the one hand, naturalism rejects every medical intervention that goes beyond preventing and treating disease. On the other hand, welfarism advocates enhancements that foster subjective well-being. We will show that both positions have considerable shortcomings. Consequently, we will introduce a third characterization in which therapies and enhancements can be reconciled with the legitimate objectives of medicine inasmuch as they improve the capabilities that enable the freedom to pursue personal well-being.

Individual quality of life and the environment - towards a concept of livable areas for persons with disabilities in Poland

Background

The United Nations Convention on the Rights of Persons with Disabilities [1] highlights the need to create proper socioeconomic and political conditions for persons with disabilities, with a special focus on their immediate living conditions. According to the Convention, these conditions should be built to ensure that persons with disabilities have the potential to enjoy a high quality of life (QoL), and this principle is reflected in the notion of livable areas. The crucial aspect of this framework is the relationship between the individual QoL and the environment, broadly understood as the socioeconomic as well as the technical conditions in which persons with disabilities function.

Methods

The basic research problem was to assess the relationship between individual QoL for the population with disabilities as a dependent variable and livability indicators as independent variables, controlling for individual characteristics. The study used a dataset from the EU-SILC (European Union Statistics on Income and Living Conditions) survey carried out in 2015 in Poland. The research concept involved several steps. First, we created a variable measuring the QoL for the entire population with disabilities. To measure the multidimensional QoL, we used Sen’s capability approach as a general concept, which was operationalized by the MIMIC (multiple indicators multiple causes) model. In the second step, we identified the livability indicators available in the official statistics, and merged them with survey data. Finally, in the last step, we ran the regression analysis. We also checked the data for the nested structure.

Results

We confirmed that the general environmental conditions, focused on creating livable areas, played a significant role in shaping the QoL of persons with disabilities; i.e., we found that the higher the level of the local Human Development Index, the higher the quality of life of the individuals living in this area. This relationship held even after controlling for the demographic characteristics of the respondents. Moreover, we found that in addition to the general environmental conditions, the conditions created especially for persons with disabilities (i.e., services for this group and support for their living conditions) affected the QoL of these individuals.

Conclusions

The results illustrate the need to strengthen policies aimed at promoting the QoL of persons with disabilities by creating access to community assets and services that can contribute to improving the life chances of this population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10797-7.

Cultural and linguistic adaptation of the multi-dimensional OXCAP-MH for outcome measurement of mental health among people living with HIV/AIDS in Uganda: the Luganda version

BACKGROUND

It is rare to find HIV/AIDS care providers in sub-Saharan Africa routinely providing mental health services, yet 8-30% of the people living with HIV have depression. In an ongoing trial to assess integration of collaborative care of depression into routine HIV services in Uganda, we will assess quality of life using the standard EQ-5D-5L, and the capability-based OxCAP-MH which has never been adapted nor used in a low-income setting. We present the results of the translation and validation process for cultural and linguistic appropriateness of the OxCAP-MH tool for people living with HIV/AIDS and depression in Uganda.

METHODS

The translation process used the Concept Elaboration document, the source English version of OxCAP-MH, and the Back-Translation Review template as provided during the user registration process of the OxCAP-MH, and adhered to the Translation and Linguistic Validation process of the OxCAP-MH, which was developed following the international principles of good practice for translation as per the International Society for Pharmacoeconomics and Outcomes Research's standards.

RESULTS

The final official Luganda version of the OxCAP-MH was obtained following a systematic iterative process, and is equivalent to the English version in content, but key concepts were translated to ensure cultural acceptability, feasibility and comprehension by Luganda-speaking people.

CONCLUSION

The newly developed Luganda version of the OxCAP-MH can be used both as an alternative or as an addition to health-related quality of life patient-reported outcome measures in research about people living with HIV with comorbid depression, as well as more broadly for mental health research.

How does sanitation influence people's quality of life? Qualitative research in low-income areas of Maputo, Mozambique

Preventing infectious disease has often been the primary rationale for public investment in sanitation. However, broader aspects of sanitation such as privacy and safety are important to users across settings, and have been linked to mental wellbeing. The aim of this study is to investigate what people most value about sanitation in low-income areas of Maputo, Mozambique, to inform a definition and conceptual model of sanitation-related quality of life. Our approach to qualitative research was rooted in economics and applied the capability approach, bringing a focus on what people had reason to value. We undertook 19 in-depth interviews and 8 focus group discussions. After eliciting attributes of "a good life" in general, we used them to structure discussion of what was valuable about sanitation. We applied framework analysis to identify core attributes of sanitation-related quality of life, and used pile-sorting and triad exercises to triangulate findings on attributes' relative importance. The five core attributes identified were health, disgust, shame, safety, and privacy. We present a conceptual model illustrating how sanitation interventions might improve quality of life via changes in these attributes, and how changes are likely to be moderated by conversion factors (e.g. individual and environmental characteristics). The five capability-based attributes are consistent with those identified in studies of sanitation-related insecurity, stress and motives in both rural and urban areas, which is supportive of theoretical generalisability. Since two people might experience the same toilet or level of sanitation service differently, quality of life effects of interventions may be heterogeneous. Future evaluations of sanitation interventions should consider how changes in quality of life might be captured.

How can wellbeing at work and sustainable employability of gifted workers be enhanced? A qualitative study from a capability approach perspective

Background

Being gifted with a very high IQ (> 98 percentile) can provide an advantage in the occupational context but can also come with its` own specific challenges. Where some studies found higher than average levels of wellbeing at work and successful careers amongst the gifted, other studies report boredom and less job satisfaction. This poses the question what gifted people value in work, and which factors are associated with the achievement of valued work related outcomes, wellbeing and sustainable employability. In this study these questions were explored using the value driven capability approach as a theoretical framework.

Method

A qualitative approach was chosen and 16 in-depth semi-structured interviews with gifted workers (IQ > 130) were conducted. The transcripts were analysed using a reflexive thematic analysis aimed at identifying the work related outcomes participants aspired to achieve and the contextual and personal factors that affected the actualisation of these outcomes.

Results

Participants placed great value on the opportunity to learn, to use their knowledge and skills, and tended to have high ethical standards. If realized, these values contributed to wellbeing whereas if not fulfilled, this often resulted in frustration and sadness. The most important personal factors associated with wellbeing at work and sustainable employability were the level of organizational awareness, self-knowledge, a willingness to compromise, and fear of stigmatisation. Contextually a facilitating leadership style of managers was important, allowing the worker autonomy and decision latitude. Socially, participants enjoyed others as sparring partners but often had an aversion to small talk which could lead to social avoidance and loneliness.

Conclusions

If gifted workers managed (to get) what they valued in work, this was associated with wellbeing and sustainable employment Coaching aimed at improving organizational awareness, specific social skills (e.g. small talk, adaptability) and understanding their own cognitive processes could be valuable. The application of an autonomy supporting facilitative leadership style by supervisors would be beneficial. Further research should try to confirm the findings using quantitative methods and needs to examine more closely the impact of stigmatisation and leadership styles.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10413-8.

Measuring capabilities in health and physical activity promotion: a systematic review

BACKGROUND

The capability approach by Amartya Sen and Martha Nussbaum has gained increasing attention in the field of public health. As it combines individual, social and structural factors and shifts the focus of attention from the actual behavior towards available options for health behaviors that people can actually choose from, it may help advance our understanding of complex health issues.

OBJECTIVES

The aim of this article is to identify and describe tools available to measure capabilities within the context of health, with a specific focus on capabilities for health-enhancing physical activity.

METHOD

We conducted a systematic literature review using 11 databases covering scientific journal articles published in English or German between the years 2000 and 2020 with a focus on capabilities for health or physical activity.

RESULTS

We found a total of 51 articles meeting our inclusion criteria. Four articles measured capabilities using qualitative methods, one combined qualitative and quantitative methods, while the rest used quantitative methods. We identified a total 11 different capability questionnaires, all showing moderate to good validity/reliability. Only one questionnaire and one interview-based tool specifically dealt with capabilities for health enhancing physical activity.

CONCLUSION

Although we were able to identify measurement tools for capabilities in health, this review has shown that there is no generic tool available for the measurement across all population- and age-groups, and tools focusing on physical activity are scarce. However, our results can be used as guide for future projects that aim at measuring capabilities.

Ageing in place processes in the neighbourhood environment: a proposed conceptual framework from a capability approach

The concept of "ageing in place" has become increasingly significant in the environmental gerontology literature. Despite its predominance, there have been limited efforts to offer a more comprehensive and nuanced conceptualization of this topic. Definitions found in the literature are often too simplistic and only partially capture the various aspects of older adults' experience while ageing in place. This paper presents a conceptual framework on ageing in place in the context of neighbourhood environment which aims to address this gap by proposing a multi-faceted understanding of ageing in place processes through the lenses of a capability approach, a more comprehensive definition of the concept, and related overarching principles. Building on predominant theories in environmental gerontology, this conceptual framework offers new insights into the interactions between "place" and the "ageing individual". It is meant to offer opportunities for discussion, to suggest new paths of inquiry, and to explore implications for policy and practice.

[Cooperative planning of measures to promote physical activity : New paths for expanding capabilities-results from the Capital4Health research consortium]

BACKGROUND

Despite various national and international political initiatives for promoting physical activity at the population level, the development of effective interventions for physical activity promotion remains a challenge. In this context, there is a growing interest in participatory approaches that actively involve central setting actors in the development of specific measures.

AIM OF THE ARTICLE

This article reports on the experience made by the Capital4Health research consortium while using a participatory approach called "cooperative planning" to increase capabilities for physical activity across different age groups.

RESULTS

Capital4Health employed the cooperative planning approach in the childcare, school, vocational training (car mechatronics and nursing), and community setting (with a focus on men 50+). While the central elements of the approach were implemented in all settings, planning processes varied significantly with respect to the spectrum of involved actors, the number of participants and sessions, the specific measures developed, the evaluation methods, and the effects achieved at an individual and systems level.

CONCLUSION

From the perspective of the Capital4Health principal investigators, the preliminary empirical results from the different settings allow for the overall conclusion that the cooperative planning approach can work and generate health promotion impact in very different settings. However, it must (and can) be adapted to the respective setting, especially in relation to involving population groups. Actors' readiness for change is crucial, as physical activity does not always have top priority in settings. In this context, key individuals can make a decisive contribution to a project's success.

Fulfilling food practices: Applying the capability approach to ethnographic research in the Northern Netherlands

Often, food practices are evaluated in terms of their healthiness or lack thereof, but fulfilling food practices based on other values and influenced by family members' capabilities are overlooked. This study analyses food practices in families with low socio-economic status, and aims to explain how family households come to prioritise one food practice over another. We conducted an ethnographic study using the capability approach as an analytical framework. In-depth interviews and observations concerning food patterns and health-related choices with family members from three generations were analysed. Two dimensions of fulfilling food practices which emerged from our study are having a healthy as well as harmonious meal. The families under study tended to prioritise having harmonious meals over having healthy meals, despite the attempts by mothers to serve healthy meals. This choice can be understood from the perspective of capabilities, such as being able to enjoy meals, eating what everybody else eats in the region, avoiding conflicts, creating good relationships with children and serving and organising meals with ease. Within the cultural environment, there prevailed a tendency not to care too much about nutritional outcomes, which also supported the preference for harmonious over healthy meals. In the decision about whether to have a healthy or a harmonious meal, children's agency often outweighed the voices of parents and grandparents. The capability approach helped unravel the complexity of family food practices and the role of intergenerational family dynamics in a setting of low socio-economic status. Acknowledging the multi-dimensional nature of food practices, and including dimensions beyond the food domain, such as harmony at the dinner table, contribute to a better understanding of this complexity. It also helps to shed new light on opportunity deprivation in households, for example in relation to agency, which should be accounted for in health interventions.

An introduction to the special section on the Capability Approach to career guidance

This editorial introduces readers to the Capability Approach to career guidance. It outlines the origins of the approach in the work of economist Amartya Sen, and explains some of its key concepts. The Capability Approach offers a way to think about freedom, justice and well-being that has great relevance to the concerns of career guidance. A brief summary is provided of scholarship adapting the Capability Approach for application to career research, policy and practice. Finally, the four papers in the special section (Egdell & Robertson; Joncas & Pilote; Skovhus; Fuertes et al.) are introduced.

An introduction to the special section on the Capability Approach to career guidance

This editorial introduces readers to the Capability Approach to career guidance. It outlines the origins of the approach in the work of economist Amartya Sen, and explains some of its key concepts. The Capability Approach offers a way to think about freedom, justice and well-being that has great relevance to the concerns of career guidance. A brief summary is provided of scholarship adapting the Capability Approach for application to career research, policy and practice. Finally, the four papers in the special section (Egdell & Robertson; Joncas & Pilote; Skovhus; Fuertes et al.) are introduced.

Capability Sensitive Design for Health and Wellbeing Technologies

This article presents the framework Capability Sensitive Design (CSD), which consists of merging the design methodology Value Sensitive Design (VSD) with Martha Nussbaum's capability theory. CSD aims to normatively assess technology design in general, and technology design for health and wellbeing in particular. Unique to CSD is its ability to account for human diversity and to counter (structural) injustices that manifest in technology design. The basic framework of CSD is demonstrated by applying it to the hypothetical design case of a therapy chatbot for mental health. By applying CSD to a design case, the merits of this new framework over the standard VSD approach become apparent. Also, the application demonstrates what a technology design would look like when attention is paid to capabilities right from the start of the design process.

Beyond empathy: a qualitative exploration of arts and humanities in pre-professional (baccalaureate) health education

For nearly four decades, researchers have explored the integration of arts and humanities content into health professions education (HPE). However, enduring controversies regarding the purpose, efficacy, and implementation of humanities initiatives suggest that the timing and context of trainees' exposure to such content is a key, but seldom considered, factor. To better understand the affordances of introducing humanities-based health curriculum prior to the HPE admissions gateway, we conducted a qualitative instrumental case study with participants from Canada's first Health Humanities baccalaureate program. Fully anonymized transcripts from semi-structured interviews (n = 11) and focus groups (n = 14) underwent an open-coding procedure for thematic narrative analysis to reveal three major temporal domains of described experience (i.e., prior to, during, and following their participation in a 12-week semester-long "Introduction to Health Humanities" course). Our findings demonstrate that perceptions of arts- and humanities content in health education are generated well in advance of HPE admission. Among other findings, we define a new concept-epistemological multicompetence-to describe participants' emergent capability to toggle between (and advocate for the role of) multiple disciplines, arts and humanities particularly, in health-related teaching and learning at the pre-professional level. Improved coordination of baccalaureate and HPE curricula may therefore enhance the development of capabilities associated with arts and humanities, including: epistemological multicompetence, aesthetic sensibility, and other sought-after qualities in HPE candidates. In conclusion, attending to the pre-professional admissions gateway presents a new, capabilities-driven approach to enhancing both the implementation and critical understanding of arts and humanities' purpose, role, and effects across the "life course" of health professions education.

Ageing as well as you can in place: Applying a geographical lens to the capability approach

Despite policy commitments to support ageing in place, we know very little about the everyday realities and experiences of older people living in different environmental circumstances, with varying personal capabilities. This paper: 1) examines the valued place-based functionings of older people through the use of geo-spatial and in-situ methods, where functionings are defined as states of being and doing, and place-based functionings are defined as places, activities, interactions, routes, and routines that support these beings and doings; and 2) demonstrates the utility of a capability approach by amalgamating the interconnected concepts 'ageing in place' and 'ageing well'. Three in-depth individual experiences of ageing at home in a Dublin (Ireland) suburb show how differing health and mobility challenges are managed, and illustrate how conceptions of ageing well in place can be identified from geographically-grounded lifeworlds. Participants' place-based functionings are identified by combining qualitative and geo-spatial approaches through the use of annotated maps, using data obtained from traditional interviews, go-along interviews, and mapping exercises. Results demonstrate the diversity of place-based functionings valued by each individual, and how functionings are negotiated depending on different needs, wishes, and health or mobility challenges. Results also highlight the importance of supportive environments and social supports in enabling older people to realise their most valued functionings over time, which include being able to get out and about, engage and connect with others, carry out daily tasks and errands confidently, and remain independent. By paying attention to subjectively valued place-based functionings, as well as the specific supports required to sustain them, we can facilitate older people to not just age in place, or age well, but to age - as well as they can - in place.

Estimating the monetary value of health and capability well-being applying the well-being valuation approach

BACKGROUND

Quality of life measures going beyond health, like the ICECAP-A, are gaining importance in health technology assessment. The assessment of the monetary value of gains in this broader quality of life is needed to use these measurements in a cost-effectiveness framework.

METHODS

We applied the well-being valuation approach to calculate a first monetary value for capability well-being in comparison to health, derived by ICECAP-A and EQ-5D-5L, respectively. Data from an online survey administered in February 2018 to a representative sample of UK citizens aged 18-65 was used (N = 1512). To overcome the endogeneity of income, we applied an instrumental variable regression. Several alternative model specifications were calculated to test the robustness of the results.

RESULTS

The base case empirical estimate for the implied monetary value of a year in full capability well-being was £66,597. The estimate of the monetary value of a QALY, obtained from the same sample and using the same methodology amounted to £30,786, which compares well to previous estimates from the willingness to pay literature. Throughout the conducted robustness checks, the value of capability well-being was found to be between 1.7 and 2.6 times larger than the value of health.

CONCLUSION

While the applied approach is not without limitations, the generated insights, especially concerning the relative magnitude of valuations, may be useful for decision-makers having to decide based on economic evaluations using the ICECAP-A measure or, to a lesser extent, other (capability) well-being outcome measures.

Policies to reduce food insecurity: An ethical imperative

A quarter of U.S. households receive food assistance, yet more than 11% still experience food insecurity annually. We argue that an expansion-oriented approach to food and nutrition assistance policy is an ethical imperative. Drawing on values from the Capability Approach and Social Empathy Model and supported by empirical evidence, we propose an ethical framework characterized by four principles that can be used to assess and inform the development of just food policies. We argue that policies should (1) embrace compassion, (2) create opportunity, (3) consider essential needs, and (4) promote knowledge and empathy. In an applied case, we evaluate current SNAP policy in terms of those principles and offer recommendations to promote justice in the design and implementation of SNAP and other food policies.

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature

PURPOSE

Given increasing interest in using the capability approach for health economic evaluations and a growing literature, this paper aims to synthesise current information about the characteristics of capability instruments and their application in health economic evaluations.

METHODS

A systematic literature review was conducted to assess studies that contained information on the development, psychometric properties and valuation of capability instruments, or their application in economic evaluations.

RESULTS

The review identified 98 studies and 14 instruments for inclusion. There is some evidence on the psychometric properties of most instruments. Most papers found moderate-to-high correlation between health and capability measures, ranging between 0.41 and 0.64. ASCOT, ICECAP-A, -O and -SCM instruments have published valuation sets, most frequently developed using best-worst scaling. Thirteen instruments were originally developed in English and one in Portuguese; however, some translations to other languages are available. Ten economic evaluations using capability instruments were identified. The presentation of results show a lack of consensus regarding the most appropriate way to use capability instruments in economic evaluations with discussion about capability-adjusted life years (CALYs), years of capability equivalence and the trade-off between maximisation of capability versus sufficient capability.

CONCLUSION

There has been increasing interest in applying the capability-based approach in health economic evaluations, but methodological and conceptual issues remain. There is still a need for direct comparison of the different capability instruments and for clear guidance on when and how they should be used in economic evaluations.

Wellbeing at older ages: Towards an inclusive and multidimensional measure

BACKGROUND

With population aging, there is a growing need to measure and monitor the wellbeing of older people, including older people with disabilities.

OBJECTIVE

To estimate the extent of wellbeing for individuals age 60+ in the U.S. overall and across disability status, this paper develops a measure of wellbeing at older ages that is multidimensional and disability inclusive.

METHODS

Rates of multidimensional wellbeing among American older adults overall and among older adults with disabilities were estimated using multivariate regression analysis and data from the Panel Study of Income Dynamics matched with the 2013 Disability and Use of Time Supplement. Multidimensional wellbeing was defined as the simultaneous achievement of outcomes in five dimensions: material wellbeing, health status, personal activities, social connections/relationships, and economic security.

RESULTS

Among all older adults, 33% experience multidimensional wellbeing. However, only 4-18% of older adults with disabilities experience wellbeing. Wellbeing varies across the dimensions of wellbeing for this subpopulation. Persons with disabilities experience as much wellbeing as persons without disabilities in terms of health insurance status and social connections/relationships. In contrast, for material wellbeing, health status and personal activities, older persons with disabilities less often experience wellbeing.

DISCUSSION

This paper brings to light a disability gap in the experience of wellbeing among older adults in the U.S. There is a need for research which can inform the development of policies and practices that will enhance wellbeing for older people with disabilities, including material wellbeing, health and personal activities.

"We struggle with the earth everyday": parents' perspectives on the capabilities for healthy child growth in haor region of Bangladesh

BACKGROUND

Childhood stunting is an important public health problem in the haor region of Bangladesh. Haor areas are located in the north-eastern part of the country and are vulnerable to seasonal flooding. The key objective of this study is to identify the capabilities of the parents and their children that shape multidimensional child growth outcomes in the haor region in the first thousand days of life.

METHODS

A qualitative study was conducted in two sub-districts of the haor region, including in Derai in the Sunamganj district and Baniachang in the Habiganj district. We facilitated eight focus group discussions with the parents of children under age two. To allow us to explore individual stories, we conducted in-depth interviews with four fathers and four mothers. A capability framework to child growth was used in shaping the interview guides and analysing the data.

RESULTS

The findings were categorised at four levels: a) capabilities for the child, b) capabilities for the mother, c) capabilities for the father, and d) capabilities at the household level. At the child's level, the parents discussed the capability to stay away from disease and to eat well, the capability to stay happy and playful, and the capability to be born with God's blessings and the hereditary traits needed to grow in size. The mothers frequently mentioned the capability to stay healthy and nourished, to stay away from violence, and to practice autonomy in allocating time for child care. The fathers stressed the earning opportunities that are affected by long-term flooding and the loss of agricultural productivity. At the household level, they discussed the capability to live in a safe shelter, to be mobile, to overcome their struggles with the earth, and to have a source of safe drinking water.

CONCLUSIONS

The capability framework for child growth helped identify relevant capabilities in the haor region. These findings can guide discussions with communities and policy makers about developing programmes and interventions aimed at enhancing the identified capabilities for child growth in this vulnerable region.

Is accessibility in the eye of the beholder? Social inequalities in spatial accessibility to health-related resources in Montréal, Canada

Neighbourhood resources are often considered to be spatially accessible to people when they are located close to their place of residence, a perspective which overlooks individuals' unique lived experience of their neighbourhood and how they define it. Drawing on the relational approach to place and on Sen's capability approach, we explore spatial accessibility to health-related resources, and the social gradient therein, in light of people's place experiences. Using data from 1101 young adults from Montreal (Canada) who participated in the Interdisciplinary Study of Inequalities in Smoking (ISIS), we compare the social gradients in the presence of health-related resources located (i) within uniform areas (defined as circular buffers and road-network buffers) around participants' place of residence; and (ii) within participants' self-defined neighbourhoods. Social inequalities in accessibility to a diversity of health-related resources (grocery stores, fruit and vegetable stores, eating and drinking places, recreational sports centres, civic, social, and fraternal organizations, bike paths, parks, social services, libraries, dental offices, physician offices) were more pronounced in self-defined neighbourhoods than in uniform buffer areas. Neglecting the variability in people's place experiences may distort the assessment of social inequalities in accessibility, and ultimately, of neighbourhood effects on health inequalities.

Towards a Multi-Dimensional Index of Child Growth to Combat the Double Burden of Malnutrition

BACKGROUND

There is growing awareness in the field of public health that combatting the double burden of malnutrition requires approaches that address its multi-dimensional origin, rather than focusing primarily on the biomedical domain. Current frameworks of malnutrition like the UNICEF conceptual framework, and the Lancet Series 2013 framework have been instrumental in understanding the determinants of malnutrition and developing appropriate interventions. However, these frameworks fail to explicitly address issues of agency, that is, about being able to pursue one's goal. The capability approach as originally developed by Amartya Sen includes agency in the causal chain. Summary and key Messages: In the past 5 years, the International Union of Nutritional Sciences Task Force "Towards a multi-dimensional index for child growth and development" has developed a capability framework for child growth, and conducted empirical research applying this framework. The working group discussed what would be needed to further develop the approach and explained the added value to international organisations and policy makers. We suggest developing an index of advantage that will be a proxy for a child's agency. We hypothesise that such an index will explain much of the variance in studying inequalities in child nutrition and thus call for action to improve this focal point.

Investigating the impact of the economic crisis on children's wellbeing in four European countries

This paper analyses the impact of the economic crisis on children's wellbeing from a comparative European perspective using a multidimensional and fuzzy methodology. Comparisons of children's wellbeing based solely on monetary resources are likely to give a partial picture, because wellbeing can be related to different capabilities and the economic crisis impacted them differently. The use of several indicators captures the multidimensional and interrelated nature of wellbeing as experienced by children and can give a comprehensive view of the threats of future generations. A propensity score method is used to compare children's capabilities distributions and to assess the impact of the economic crisis on the net change between 2009 and 2014 using EU-SILC data for four European countries. Results show that the economic crisis had a wide range of consequences for children's wellbeing: a disparity is observed across the four countries in preserving the same level of wellbeing after the economic crisis.

Test-retest reliability of ICECAP-A in the adult Danish population

PURPOSE

To investigate the test-retest reliability of Investigating Choice Experiments Capability measure for Adults (ICECAP-A) in the adult Danish population.

METHODS

The original English ICECAP-A was translated into Danish by forward-backwards translation using the guidelines by Beaton et al. Three hundred and-thirty-two participants with mean age of 57 years participated in a Web-based study. Data concerning relative and absolute agreement were analysed by the intra-class correlation coefficient and Bland-Altman plot with limits of agreement. The overall and item consistency was investigated by weighted kappa statistics from baseline to 2-week follow-up. Logistic regression was used to study the effect of the sociodemographic characteristics with inconsistent responses as the dependent binary variable. The independent variables were age, sex, education, income, and region of residence at baseline.

RESULTS

The baseline ICECAP-A preference-based index score was 0.84, and at follow-up, 0.83. The ICC was 0.86 (95% CI 0.826-0.884), and limits of agreement were 0.164 and - 0.151. The kappa coefficient ranges from 45 to 65%, between random and perfect agreement. The logistic regression to analyse inconsistent responses showed no significant association between the overall index score and sociodemographic characteristics, and no clear pattern was found concerning the individual item inconsistency.

CONCLUSIONS

Evidence regarding the reliability of the Danish version of ICECAP-A is satisfactory for both the index score agreement and the individual item consistency and is a reliable measure to be used in a Danish context and future health economic evaluations.

Do Fair and Just Systems Require Compensation for the Disadvantages of the Natural Lottery? A Discussion on Society's Duties on the Provision of Gene Therapy

Genetic diseases have been thought to be acquired as a result of sheer bad luck. However, recent advances in medical science have demonstrated the mechanisms of genetic disorders, which enable us to intervene with their occurrence and treatment. Today, gene therapy, once considered too risky, has become safer and can save the lives of patients with previously untreatable and lethal genetic diseases. However, the positive expectations from gene therapy are overshadowed by their extremely high prices. Thus, the duty of society in the provision of gene therapies has been frequently discussed. The discussions mainly focus on how to meet the genetic treatment needs of patients without violating the notion of justice and fairness in society. This study discusses the theoretical grounds for society's duty to compensate for genetic disease patients' disadvantages by providing them with appropriate genetic treatment. The main question is whether a fair and just system requires society to provide available lifesaving gene therapy to patients in need. The discussion is constructed on the crucial notion of the fair equal opportunity principle in a just system and the plausibility of including disadvantages emerging from bad luck in the natural lottery in the domain of justice.

Using deliberative methods to establish a sufficient state of capability well-being for use in decision-making in the contexts of public health and social care

BACKGROUND

Health maximisation is unlikely to be a relevant objective for social care, where service users and the workforce have distinct priorities and needs. NICE permit use of a small number of capability-based measures for the evaluation of social care, including ICECAP-A, a measure with five attributes, each with four levels.

AIM

To establish a sufficient state of capability well-being, as defined by ICECAP-A, through public deliberation, and evaluate and critically reflect on the deliberative process.

METHODS

A series of one-day/6.5 h citizens' workshops were conducted, with recruitment from within purposively selected local authority areas. Workshops consisted of a mixture of background information, individual tasks, group discussion and voting. Representatives from each workshop were then invited to attend a 'consensus workshop'. Follow-up interviews facilitated evaluation of the deliberative process.

RESULTS

62 participants took part in deliberative work, across eight workshops. Participants actively engaged and provided positive feedback about their experience. Key considerations for participants included: the realistic ability of public services to enhance some areas of well-being; not removing incentives for self-help and avoiding state intrusion; building resilience and enabling people to 'give back to society'; ensuring that people are not left with a standard of well-being that is morally indefensible. The resulting sufficient state of capability well-being (defined by ICECAP-A) was 3,3,3,3,3 (where the best possible state is 4,4,4,4,4).

CONCLUSION

Through a deliberative approach, representatives of the public were able to debate a complex social issue and reach a consensus decision on a sufficient state of capability well-being.

ICECAP-O, the current state of play: a systematic review of studies reporting the psychometric properties and use of the instrument over the decade since its publication

PURPOSE

A paper reporting the development of the ICECAP-O was published in 2006. Since then, there has been increasing interest in the use of capability-based measures within health economics and the ICECAP-O has been suggested for use in economic evaluation by decision-making bodies in the Netherlands and UK.

METHODS

A systematic review of studies published between January 2006 and October 2018 which have assessed the psychometric properties of ICECAP-O or utilised the measure within economic evaluation.

RESULTS

Twenty-four studies explored the psychometric properties of ICECAP-O and 21 have utilised the measure within economic evaluation; one study reported psychometric properties as well as utilising the measure within economic evaluation. The ICECAP-O has good construct validity and responsiveness, but there is evidence of some issues relating to content validity. In the context of economic evaluation, the ICECAP-O has, to date, mainly been included as a secondary economic measure and the reporting of results is brief with minimal detail and often no discussion. Five of the economic evaluation studies combined scores from ICECAP-O with time, but each used different terminology to describe this result.

CONCLUSION

Focus, in terms of publications, appears to have shifted now from assessment of psychometric properties to the utilisation of the ICECAP-O within economic evaluation. Further research is needed with respect to a decision-rule for the ICECAP measures. This additional research should also guide users in terms of appropriate analysis, terminology and presentation of results, which are in-keeping with the conceptual framework underpinning the ICECAP-O.

"Change-makers in midwifery care": Exploring the differences between expectations and outcomes-A qualitative study of a midwifery net-based education programme in the Somali region

OBJECTIVE

The aim of this study is to explore midwifery educators' expected outcomes in the net-based master's programme, the programmes' realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.

DESIGN

In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.

SETTING AND PARTICIPANTS

Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.

FINDINGS

Findings show that many of the graduates' expectations were met, while some were more difficult to fulfil. While the midwives' choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.

CONCLUSION

The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.

Experiences of carriers of multidrug-resistant organisms: a systematic review

OBJECTIVES

A comprehensive overview of the ways control measures directed at carriers of multidrug-resistant organisms (MDRO) affect daily life of carriers is lacking. In this systematic literature review, we sought to explore how carriers experience being a carrier and how they experience being subjected to control measures by looking at the impact on basic capabilities.

METHODS

We searched Medline, Embase and PsychINFO until 26 May 2016 for studies addressing experiences of MDRO carriers. Twenty-seven studies were included, addressing experiences with methicillin-resistant Staphylococcus aureus (n = 21), ESBL (n = 1), multiple MDRO (n = 4) and other (n = 1, not specified). We categorized reported experiences according to Nussbaum's capability approach.

RESULTS

Carriage and control measures were found to interfere with quality of care, cause negative emotions, limit interactions with loved ones, cause stigmatization, limit recreational activities and create financial and professional insecurity. Further, carriers have difficulties with full comprehension of the problem of antimicrobial resistance, thus affecting six out of ten basic capabilities.

CONCLUSIONS

Applying Nussbaum's capability approach visualizes an array of unintended consequences of control measures. Carriers experience stigmatization, especially in healthcare settings, and have limited understanding of their situation and the complexities of antimicrobial resistance.