HRQOL Models Flashcards
Wilson & Cleary’s Model
- biomedical and social science
- linear relationship between constructs
- impacted by environmental and individual factors
- founded on biological and psychological aspects of health outcomes
Wilson & Cleary’s 5 Domains
- bio-physiological status
- symptoms
- functional status
- general health perception
- quality of life
Wilson & Cleary: Bio-physiological Status
- Commonly conceptualized, measured and applied in clinical practice
- Focuses on function of cells, organs and systems
Wilson & Cleary: Symptoms
- Focus shifts from cells/organs to organism as a whole
- Physical symptoms – a perceptions, feeling or belief about the state of the body
- Psychophysical – associated with mental health; symptoms not clearly physical or psychological
- Emotional
Wilson & Cleary: Functional Status
Asses the ability of the individual to perform defined tasks
Wilson & Cleary: General Health Perception
Integration of all health concepts
Wilson & Cleary: Quality of Life
Subjective assessment of well-being, happiness and satisfaction
Ferrans et al. Model & how it built upon Wilson & Cleary’s model?
- HRQOL= desired end product
- environment and individual effects are linear
- explained individual and environmental characteristics
- removed non-medical factors
- simplified the interrelation of domains
- dominant causal relationships
- retains reciprocal relationships
WHOICF Model
- unifying
- covers many demographics
- examines disease and how it affects HRQOL?
- ICF= similar to DSM
- Part 1= functioning/disability
- Part 2= context (individual and environmental)
What is unique about the WHOICF?
- stresses health and functioning
- every person can experience disability (universal human experience)
- shifts from cause of health conditions to their impact
WHOICF: Universality
- classification of functioning and disability should be applicable to all people irrespective of their health condition
WHOICF: Parity
- disability should not be differentiated by etiology (i.e. “mental” vs “physical”)
WHOICF: Neutrality
- domains should be worded in neutral language
WHOICF: Environmental
- SM of disability
- factors range from physical factors such as climate and terrain, to social attitudes, institutions, and laws
Applications of WHOICF at the Individual Level
- assessment of individuals
- individual treatment planning
- evaluation of treatment and other interventions
- communication amongst health care teams
- self-evaluation by consumers
Applications of WHOICF at Institutional Level
- educational and training purposes
- resource planning and development
- quality improvement
- management and outcome evaluation
- managed care models of health care delivery
Applications of WHOICF at Social Level
- eligibility criteria for state entitlements
- social policy development
- needs assessments
- environmental assessment for universal design
WHOICF: Contextual Factors
- external environmental factors (social attitudes, architectural characteristics, legal and social structures, as well as climate, terrain…)
- internal personal factors, which include gender, age, coping styles, social background, education, profession, past and current experience, overall behavior pattern, character and other factors that influence how disability is experienced by the individual
3 Levels of Human Functioning Classified by the ICF…
- functioning at the level of body or body part
- the whole person
- the whole person in a social context
Hierarchy Order of WHOICF
Chapter (sensory functions and pain)-> Second level (seeing functions)-> Third level (quality of vision)-> Forth level (colour vision)
Mishels Uncertainty of Illness Theory
- how people cope with a disease when given a diagnosis?
- antecedents of uncertainty
- appraisal of uncertainty
- coping with uncertainty
- useless as it cannot measure uncertainty
OHRQOL
Reflects people’s comfort when eating, sleeping and engaging in social interaction; their self-esteem; and their satisfaction with respect to their oral health
OHRQOL Core Concepts
- multidimensional: well being, emotional well being, expectations, satisfaction, sense of self
- Subjective
- balance: both positive and negative aspects
- unclear on how to achieve adequate oral health (doesn’t connect to HRQOL and QOL)
OHRQOL Dimensions
- oral health
- social/emotional
- environment
- treatment expectations
- function
Integrative Approach to QOL Defined
- extent to which objective human needs are fulfilled in relation to personal or group perceptions of subjective well-being
- relation between specific human needs and perceived satisfaction with each of them can be affected by mental capacity, cultural context, information, education, temperament, and the like, often in quite complex ways
Integrative Approach to QOL Components
- opportunities
- human needs
- subjective well being
Stewart’s Conceptual Model of Factors Affecting Quality and Length of Life of Dying patients and their Families: Categories
- patient and family factors affecting health care and its outcomes
- structure and process of care
- patient and family outcomes of care including satisfaction with care and quality and length of life
Stewart’s Conceptual Model of Factors Affecting Quality and Length of Life of Dying patients and their Families: Critiques
- no definition or measure of QOL
- does not explain a direct relationship between the concepts and QOL, no causal pathways
- emphasis on structure of health care system (not generalizable)
- scope is too narrow
Theory of Health-related Family Quality of Life
- when a family member is diagnosed with an illness/disease the entire family is affected
- families are governed by their own rules
- QOL is subjective and situation dependent
- no explicit framework
- not generalizable beyond western context as family dynamic is culturally dependent
- no focus on self-management only on family as a unit
Maslow’s Hierarchy of Needs
- self-actualization, esteem needs, belongingness and love needs, safety needs, and physiological needs
- step by step and does not look at interactions between concepts
Advantages of the WHOICF
- Accepts notion of interaction among multiple factors and the influence on the person
- Clearly has merit and application in health care (primary, secondary, rehabilitative)
Applications of the ICF
- Statistical tool (e.g., surveys)
- Research tool (e.g., outcomes)
- Clinical tool (e.g., rehabilitation effectiveness)
- Social policy tool (e.g., determination of disability benefits)
- Educational tool (e.g., framework to understand disablement)
Application of the WHOICF and QOL
- Need for a multipurpose health classification system
- One that meets individual needs and expectations
- Offers clinical providers a conceptual basis for care programs
