1 / 16

Conceptual Foundations for Health Measurements

Conceptual Foundations for Health Measurements. Disability and Handicap. Examples of Conceptual Foundations for Measurement Scales. Three Perspectives: Disease, Sickness & Illness. Disease (Underlying pathology; biologically defined: the practitioner’s perspective.

donald
Download Presentation

Conceptual Foundations for Health Measurements

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Conceptual Foundations for Health Measurements

  2. Disability and Handicap Examples of Conceptual Foundationsfor Measurement Scales

  3. Three Perspectives:Disease, Sickness & Illness Disease (Underlying pathology; biologically defined: the practitioner’s perspective. The illness seen in terms of a biological theory of disorder) Illness (Theperson’s subjective experience of their symptoms. What the patient brings to the doctor) Sickness (Social & cultural conceptions of the condition: cultural beliefs and reactions such as fear or stigma. These affect how the patient reacts, and also what is considered a disorder suitable for medical treatment)

  4. WHO Classifications • International Classification of Diseases (ICD) • Etiological framework • Diagnosis of health condition • Disease process, signs & symptoms • International Classification of Impairments, Disabilities & Handicaps (ICIDH) • How people live; body functions • Framework to describe activities & participation • Covers non fatal outcomes

  5. Conceptions of Disability “a disability is any restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being” (WHO International Classification of Impairments, Disabilities, and Handicaps, 1980.)

  6. ICIDH* - 1 Disability Handicap Impairment Internal,body Applied Societal (N.b. dotted arrows indicate that one stage may, but need not, influence the next) * International Classification of Impairment, Disability & Handicap

  7. Issues in the Definition • Defining disability in terms of activity limitations is neat, but what activities? • What level of limitation should be used? • Same expectations for everyone, or relative to age, sex, etc.? • Threshold: does not perform an activity, versus cannot perform it? Maybe doesn’t, but could?

  8. ICIDH - 2 • Appeared March, 2001 • Conceptual changes: • From consequences of disease (1980) to components of health (2000) • Uses more positive language (‘activity’ & ‘participation’ instead of ‘disability’ & ‘handicap’) • Broadens concept of disability • More on environmental factors in which the person lives

  9. ICIDH - 2 Health Condition (disorder / disease) Body Functions & structures Activities Participation PERSON Activities SOCIETY Participation BODY Structure & Function impairment limitation restriction

  10. Body Functions • Mental functions • Sensory • Voice & speech • CVD, hematological, etc. • Digestive, metabolic & endocrine • Genitourinary • Neuro-musculoskeletal • Skin

  11. Learning Communication Movement Self-care Domestic activities Interpersonal Major life activities Community Exchanging information Communicating Mobility Personal maintenance Home life Social relationships Work & employment Social & civic life Activities & Participation

  12. A ‘Circumplex’ Model High positive affect active,elated,excited Strong engagement Pleasantness content,happy,satisfied aroused,astonished,concerned High negative affect Low negative affect relaxed,calm, placid distressed, fearful, hostile sad, lonely, withdrawn inactive,still,quiet sluggish,dull,drowsy Disengagement Unpleasantness Low positive affect

  13. Health-Related Quality of Life • QoL is deliberately subjective & value-specific • Invented in the USA • How universally applicable is it? • Definition will surely vary across cultures (naïve early enthusiasm for QoL as final outcome) • Handicap reflects impairment + environment, so measures may perform differently in different environments

  14. Quality of life is… “Having the important people in your life see your strengths and talents” “A good night’s sleep” “Validation of worth and affirmation of experience” “Having control of your own life” “Taking control of your health condition” “Life free from stigma” “Having a ‘real’ job” “Having a purpose” “Being free to come and go” Quality of Life (from a consumer’s perspective) Carne, B. A consumer perspective. Can J Community Mental Health 1998, Suppl 3: 21.

  15. The Deceptive Simplicity of HRQOL… Health-Related Quality of Life Or Quantity? (How would we we measure quality?) Definition? What model? (Caused by Associated with? or ?) Of life or Living?

  16. Mapping Physical Measures onto Quality of Life Clinical / Physical Markers (the clinician’s concern) cover part of Disease-Specific Dysfunction cover part of Health-Related Quality of Life cover part of Overall Quality of Life (the patient’s concern) Source: SH Kaplan et al. Medical Care, 2000

More Related