Abstract
PurposeThe global activity limitation indicator (GALI) is the only internationally agreed and harmonised participation restriction measure. We examine if GALI, as intended, is a reflective measure of the domains of participation; furthermore, we determine the relative importance of these domains. Also, we investigated the consistency of response to GALI by age and gender and compared the performance of GALI with that of self-rated health (SRH).MethodsWe used Spanish data from the European Health and Social Integration Survey and selected adults aged 18 and over (N = 13,568). Data analysis, based on logistic regression models and Shapley value decomposition, were also stratified by age. The predictors of the models were demographic variables and restrictions in participation domains: studies, work, mobility, leisure and social activities, domestic life, and self-care. The GALI and SRH were the response variables.ResultsGALI was strongly associated with all participation domains (e.g. for domestic life, adjusted OR 24.34 (95% CI 18.53–31.97) in adult under 65) and performed differentially with age (e.g. for domestic life, adjusted OR 13.33 (95% CI 10.42–17.03) in adults over 64), but not with gender. The relative importance of domains varied with age (e.g. work was the most important domain for younger and domestic life for older adults). The results with SRH were parallel to those of GALI, but the association of SRH with participation domains was lowest.ConclusionsGALI reflects well restrictions in multiple participation domains and performs differently with age, probably because older people lower their standard of good functioning.
Highlights
Summary measures of population health that combine life expectancy and global health measures in a single indicator, i.e. healthy life expectancy, are essential for assessing the performance of public health, clinical medicine, and that of other sectors, such as education and employment, which influence health [1, 2]
Madans and Weeks [1] have proposed a hierarchical framework for these measures that places healthy life expectancy based on activity limitations/participation restrictions (PR) at the top, followed by those based on functional limitations and perceived health
The main objective of this study was (i) to examine whether global activity limitation indicator (GALI) has a broad coverage of participation domains: education and training, work, mobility, community life and leisure activities, domestic life, and self-care; in addition, we estimated the relative importance of these domains
Summary
Summary measures of population health that combine life expectancy and global health measures in a single indicator, i.e. healthy life expectancy, are essential for assessing the performance of public health, clinical medicine, and that of other sectors, such as education and employment, which influence health [1, 2]. Madans and Weeks [1] have proposed a hierarchical framework for these measures that places healthy life expectancy based on activity limitations/participation restrictions (PR) at the top, followed by those based on functional limitations and perceived health. For global measures of functional limitations and perceived health, there are “definitive” candidates: the six items of the Washington Group on Disability Statistics and Self-Rated Health (SRH); for PR, there is not [1, 3]. It consists of a single item that asks: “For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do?”. The experience gathered with GALI is doubly relevant: per se, and as a reference for developing a new, more internationally agreed global PR measure [3]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have