Week 5 - HRQL and Social support Flashcards
defining quality of life
Subjective AND objective evaluations of:
Subjective Evaluations:
Objective Evaluations:
- Overall goodness of one’s life
- Includes a number of domains
- Reflect people’s perceptions of “goodness” or quality of their own lives
- Measures of various aspects of one’s life made by someone other than individual
Defining Health-Related Quality of Life (HRQL)
Subcomponent of QOL**:
General consensus on dimensions of HRQL:
- Reflects “goodness” of dimensions of life affected by health and health interventions
- physical function
Aerobic fitness, strength, ability to perform ADLs - cognitive function
Memory, attention, concentration, decision making - emotional function
Depression, anxiety, happiness, hope - socail function
Ability to fulfill roles such as spouse, parent, etc., involvement in community - health status
Physical health, symptoms
Why is HRQL Important to Health Psychologists?
Biomedical definition of health:
Biopsychosocial definition:
- Health not simply absence of disability and disease
- Focus on physical health
-Health is conceptualized as positive state of physical, mental, and social well-being
-unity of all three components
HRQL is important for 3 reasons
- Improvements in HRQL are an important benefit of ????
- Knowledge of a patient’s HRQL is important for prescribing exercise
- Important index of treatment effectiveness
- Improvements in HRQL = Important Benefit of exercise
- Knowledge of a Patient’s HRQL = Important for Exercise Rx
- Important Index of Treatment Effectiveness
-PA used as therapeutic modality for chronic disease treatment and prevention
- Increase in health practitioners promoting PA to improve HRQL
Image Source: Exercise is Medicine Canada
By asking patients about the effects of exercise on HRQL, we can make better decisions about exercise prescription
* Do they enjoy exercise? Do they feel better?
HRQL = ???? for determining the
effectiveness of an exercise intervention
* Must also demonstrate intervention
does not have negative effect on HRQL
HRQL measurement
Objective measures
- Quality-Adjusted Life Years (QALY)
subjective measure
Two general approaches exist for measuring HRQL:
1. objective
2. subjective
Objective:
1. Made by someone other than patient
2. Quantitative (numeric) in nature
ex: days in bed, number of pills taken
QALY: Assumes people with similar health problems and symptoms have same HRQL
Subjective:
Assess individual perceptions of “goodness” of various domains that constitute HRQL
- Rate their level of functioning in one or more HRQL domains
A) Emotional functioning “Over the past week, how happy have you felt?” - Rate their satisfaction with their functioning in one or more HRQL domains
A) Emotional satisfaction “Over the past week, how satisfied have you been
with the amount of happiness that you have felt?”
Measuring HRQL - SF 36. What is
With regard to HRQL:
- Most widely used measure of HRQL is 36-item Short Form Health Survey (SF-36). Is also a shorter version, SF-12
-Assesses patients’ perceptions of symptoms and the extent to which symptoms impact daily
functioning
With regard to the following dimensions of HRQL:
* General health
* Physical functioning
* Social functioning
* Mental health
* Bodily pain
* Vitality
SF-36
SF- 36 and exercise
SF-36 generic measure of HRQL
- Designed to assess multiple aspects of HRQL across wide range of patient
populations
- Two components – Physical Component Scale (PCS) and Mental
Component Scale (MCS) - exercise has postive impact on overall SF36 scores
Overall: exercise and HRQL
- Exercise = improvements in HRQL in general populations, as well as
those who have “more to gain”: Older adults, those with chronic health conditions, mental illness - Effects of exercise are less dramatic among people who already have high HRQL scores
- Difficult to increase HRQL further among these people
For many people with chronic disease and disability, goal of exercise is to help
them regain or maintain functional capacity to perform activities of daily living (ADL)
Physical functioning
Cognitive functioning:
- Exercise results in significant improvements in perception of physical functioning
- Physical self-concept: How individual feels about physical abilities and appearance
Exercise has been shown to improve objective indices of cognitive performance:
-Processing and sorting information, planning and initiating behaviours
Emotional well- being
Social functioning
Health status:
Exercise associated with improvements in numerous aspects of emotional well being among general population and special populations
- Decreased depression & anxiety among the elderly, MI patients, cancer patients, others
-Evidence suggests exercise can positively affect patient
perceptions of their social lives
* This is NOT necessarily a “group” thing
-Exercise may enhance social confidence of people with disease
and disability by reducing concerns about being perceived by
others as “disabled”
Exercise shown to improve perceptions
of physical health and symptom severity across wide range of populations
* Exercise can help alleviate disease-related symptoms and might provide patients with a strategy for managing or controlling symptoms
* ENHANCED SENSE OF CONTROL – SELF-EFFICACY
Exercise and HRQL - factors to consider
Purpose of an intervention
HRQL dimensions
Other interventions
People who exercise for health promotion or disease prevention, vs.
rehabilitation / disease management, show largest gains in HRQL
Some HRQL dimensions may show greater improvements than others
* Improvements in fitness = improved physical functioning
* Aspects people value the most – people tend to focus on whether exercise impacted these
-Exercise most effective when combined with standard treatments for certain populations
* EXERCISE AS ADJUNCT TO OTHER THERAPIES
Mechanisms of change - behaviour of change
objective changes in health and fitness
changes in self efficacy
-Person does NOT need to experience significant changes in (BP, fitness, body
composition) to derive HRQL benefits
- HRQL reflects that PERCEPTIONS about health are subjective responses are more critical
- Low HRQL is reported in those who believe they have little control over illness and their lives
Exercise can improve HRQL by enhancing self-efficacy to
control their health
Social support
defined as
two approaches
Defined as: perceived support , and information person receives from others
- Two approaches have been used to define and measure social support among exercisers:
1. Size of social network
2. amount and type of support provided
- Size of social network
The number of social relationships one has
Relationship to PA participation:
- Measured as number of groups or individuals an exerciser can turn to for support
- More available support sources report greater levels of physical exertion during PA
- People who have many significant others to exercise with are more likely to exercise at recommended levels
- Amount of Type of Social support
A) Tangible
B) Emotional
C) Informational
D) Companionship
E) Validity/esteem
- Provide tangible, practical assistance
- Express encouragement, caring, empathy, and concern
- Give direction, advice, or suggestions about exercise
- People with whom one can exercise
- Comparing oneself with others to gauge progress
Social support and physical activity
As exercisers’ needs fluctuate so do there social support requirements
- Most effective type of support depends on exercisers’ needs at any given point in time
- Needs may vary as function of changes in the exerciser’s psychology, physiology, or stage of development
Individual and group influences
- Family
- Important others
- Exercise professionals
- Other exercise participants
Family
Spousal or partner support
Family
Parental support
- Positive effects of supportive partner
-People who exercise with spouses have greater emotional support, higher attendance and lower drop-out rates
-Parents provide full range of social support and serve as role models and establish PA norms
* Family support also plays important role for children prescribed exercise for medical conditions
* Children’s compliance is best when parents take part in exercise interventions with them
Family: limitations
When family members pressure loved ones to exercise, the person may exercise less
- Behavioral Reactance
- Response in direction opposite to direction being advocated
- Over- protectivness, feels controlled
- Going to extremes in trying to protect another person from harm
- Intrusive, controlling, and undermines self-efficacy
Important others: Health professionals
Health professionals are an important source of support for people wishing to become active
Important others: the physician
Source of information for those starting out but….
- Increasing number of health professionals who discuss PA
- PA counseling from health professional leads to increased PA
- Health professionals also serve as exercise role models
-activity counseling occurs during less then half of all patient visits
-study showed: More than half of the physicians trained in the US received no formal education in PA
Exercise professionals
Exercise professionals are cited as the single most important determinant of an exerciser’s continued participation in exercise program
Exercise professionals are able to provide multiple types of social support
Leadership style makes a difference
Supportive leadership style
Bland leadership style
People who experience socially supportive leadership:
- Encouragement, verbal reinforcement, interactive
-Un-encouraging, critical, non-interactive
- Greater self-efficacy
- More energy & enthusiasm
- Less post-exercise fatigue
- Less self-conscious
- More class enjoyment
- Stronger intentions to exercise
