Dimensions Of Positive Health Research Articles

Work and disability benefit unraveled in chronic gastrointestinal patients

Abstract Background Persons with a chronic disease, such as chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disease, have a lower work participation (WP) than the healthy population. Instead, they might receive a disability benefit (DB). Positive Health (PH) is a newly developed, holistic view of health and comprises six dimensions: bodily functions, mental well-being, meaningfulness, quality of life, participation, and daily functioning. In this study we aim to determine whether the dimensions of PH relate to WP and DB in persons with GI-HPB. Methods GI-HPB patients attending the outpatient clinic of the Maastricht University Medical Center between 2019-2021 received validated questionnaires (Gastrointestinal Symptom Rating Scale, Short Nutritional Assessment Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Short Form-36, Disease Experience Questionnaire, EuroQol-5D-5L) and items regarding WP and DB. The relation between the six dimensions of PH, and WP and DB, were tested with univariate and multivariate statistics. Results 448 patients (Mage = 45 years; 69% female) were included. Univariate analysis revealed that, except for meaningfulness, all dimensions were significantly associated with WP (p≤.02) and DB (p≤.005). In multivariate analyses, lower age (p=.010), better general health (p=.044) and better physical functioning (p<.001) related to WP. Higher age (p=.002) and lower physical functioning (p=.011) related to DB. Conclusions Among GI-HPB patients, physical functioning related to both WP and DB. The chance of working was higher among younger patients and those with better general health while those with a higher age received DB more often. The PH concept was only partially relevant to work status and DB. Key messages • Within the dimensions of Positive health, work participation was associated with a lower age, a better general health and a better physical functioning. • Within the dimensions of Positive health, disability benefit was associated with higher age and lower physical functioning.

Children eight to twelve years of age have clear opinions about Positive Health

Abstract Introduction Positive Health (PH) focuses on the ability to maintain control over one’s own health, also for children. This study explores how primary school children eight to twelve years of age think about the concept of PH and the dimensions of PH as described in the child tool. Methods A qualitative research method was applied, in which 25 semi-structured interviews consisting of eight questions were conducted. Results Children mainly think of nutrition, exercise and ‘feeling good’ when asked what PG means. More specifically on the different dimensions, for ‘My body’ they mainly think about sleeping, healthy eating and exercise. For ‘My feelings and thoughts’, they mainly mention being happy, sad or angry and also for ‘feeling good about yourself’ they mainly talk about emotions and feeling good where appearance is important. The dimension ‘Now and later’ is mainly about occupation later, according to the children. Friends and bullying are terms mentioned in the dimension ‘Participation’ and being able to do what they feel like is most important in the dimension ‘Daily life’. For children, the dimensions ‘Feeling good about yourself’ and ‘My feelings and thoughts’ are most important. In addition, ‘Participating’ is important where having fun with friends is particularly mentioned by all children. Conclusions Children aged eight to twelve years of age perceive PH more than just the physical component and recognise all the dimensions of PH be it in their own words. Where children of all ages value the dimensions ‘Feeling good about yourself’, ‘My feelings and thoughts’ and ‘Participating’ most, these dimensions become even more important with increasing age. For teachers, youth health professionals and parents/carers this might imply, first, that the concept of Positive Health could be used as a tool when talking about being and staying healthy. Second, interventions might be more effective when aligned to children’s perceptions and language. Key messages • The concept of Positive Health could be used as a tool when talking about being and staying healthy. • Interventions might be more effective when aligned to children’s perceptions and language.

Positive health: An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders.

The concept of positive health (PH) supports an integrated approach for patients by taking into account six dimensions of health. This approach is especially relevant for patients with chronic disorders. Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disorders are among the top-6 of the most prevalent chronically affected organ systems. The impact of chronic GI-HPB disorders on individuals may be disproportionally high because: (1) The affected organ system frequently contributes to a malnourished state; and (2) persons with chronic GI-HPB disorders are often younger than persons with chronic diseases in other organ systems. To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders. Prospective, observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GI-HPB disorder attending the Outpatient Department of the Maastricht University Medical Center. Validated questionnaires and data from patient files were used to quantify the six dimensions of PH. Internal consistency was tested with McDonald's Omega. Zero-order Pearson correlations and t-tests were used to assess associations and differences. A P value < 0.05 was considered significant. The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population. Regarding quality of life, participation and daily functioning, GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems, but depressive symptoms (in 35%) and malnutrition (in 45%) were more frequent in patients with chronic GI-HPB disorders. Intercorrelation scores between the six dimensions were only very weak to weak, forcing us to quantify each domain separately. All six dimensions of PH are impaired in the GI-HPB patients. Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.

Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home.

Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.

Association between freedom of movement and health of nursing home residents with dementia: an exploratory longitudinal study

BackgroundLocked doors remain a common feature of dementia units in nursing homes (NHs) worldwide, despite the growing body of knowledge on the negative effects of restricted freedom on residents. To date, no previous studies have explored the health effects of opening locked NH units, which would allow residents to move freely within the building and enclosed garden. This study examines the association between increased freedom of movement and the health of NH residents with dementia.MethodsThis longitudinal, pre-post study involved a natural experiment in which NH residents with dementia (N = 46) moved from a closed to a semi-open location. Data on dimensions of positive health were collected at baseline (T0; one month before the relocation), at one (T1), four (T2) and nine (T3) months after the relocation. Linear mixed models were used to examine changes in positive health over time.ResultsCognition, quality of life and agitation scores improved significantly at T1 and T2 compared to the baseline, while mobility scores decreased. At T3, improvements in agitation and quality of life remained significant compared to the baseline. Activities of daily living (ADL) and depression scores were stable over time.ConclusionsIncreasing freedom of movement for NH residents with dementia is associated with improved health outcomes, both immediately and over time. These findings add to the growing evidence supporting the benefits of freedom of movement for the overall health of NH residents with dementia.

The impact of the COVID-19 pandemic on Positive Health among older adults in relation to the complexity of health problems.

The broad concept of health as "the ability to adapt and self-manage in the face of social, physical and emotional challenges" has been operationalized by "Positive Health," a framework increasingly used in the Netherlands. We explored to what degree the impact of the COVID-19 pandemic and preventive measures on Positive Health differed between community-dwelling older adults without, with mild and with complex health problems, as well as differences flowing from their use of preventive measures. During the second wave in the Netherlands (November 2020-February 2021), a convenience sample of adults aged ≥65 years completed an online questionnaire. Positive Health impact was measured based on self-reported change of current health status, across six dimensions, compared to before the pandemic (decreased/unchanged/increased). The complexity of health problems (past month) was assessed using the validated ISCOPE tool, comparing subgroups without, with mild or with complex health problems. High use of preventive measures was defined as ≥9 of 13 measures and compared to low use (<9 measures). Of the 2397 participants (median age 71 years, 60% female, and 4% previous COVID-19 infection), 31% experienced no health problems, 55% mild health problems, and 15% complex health problems. Overall, participants reported a median decrease in one Positive Health dimension (IQR 1-3), most commonly in social participation (68%). With an increasing complexity of health problems, subjective Positive Health declined more often across all six dimensions, ranging from 3.3% to 57% in those without, from 22% to 72% in those with mild, and from 47% to 75% in those with complex health problems (p-values for trend <0.001; independent of age and sex). High users of preventive measures more often experienced declined social participation (72% vs. 62%, p < 0.001) and a declined quality of life (36% vs. 30%, p = 0.007) than low users, especially those with complex health problems. As the complexity of health problems increased, the adverse impact of the COVID-19 pandemic and related preventive measures was experienced more frequently across all dimensions of Positive Health. Acknowledging this heterogeneity is pivotal to the effective targeting of prevention and healthcare to those most in need.

Letting people flourish: defining and suggesting skills for maintaining and improving positive health.

The concept of "positive health" emerged from the need for a holistic and more dynamic perspective on health, emphasising the ability of individuals to adapt and self-manage. The positive health conversation tool helps understand how people score on six positive health dimensions. However, skills within these dimensions to maintain or improve health have not yet been described. This is important for enabling individuals to put health advice into practise. Therefore, this paper aims to define and suggest skills for maintaining and improving positive health. Suggestions for definitions of skills within the positive health dimensions are described using the functional, interactive, and critical health literacy framework. Additionally, executive functions and life skills were incorporated. Moreover, the environment's role in these individual skills was noted, mentioning organisational health literacy that emphasises organisations' responsibility to provide comprehensible health information to all individuals. We propose that health promotion interventions can incorporate the proposed skills in practical exercises while aligning intervention materials and implementation tools with end-users and implementers. The suggested skills for maintaining and improving positive health are a first step towards a more comprehensive understanding and open to discussion. These skills may also be applied to other practical conversation tools for maintaining or improving health. Increasing positive health through the defined skills may be especially relevant to those with a lower socioeconomic position who also have limited health literacy and thereby may contribute to reducing health inequalities. Taken together, strengthening the defined skills may hopefully contribute to allowing people to flourish in life.

Positive health during the COVID-19 pandemic: a survey among community-dwelling older individuals in the Netherlands

BackgroundCoronavirus Disease 2019 (COVID-19) reached the Netherlands in February 2020. To minimize the spread of the virus, the Dutch government announced an “intelligent lockdown”. Older individuals were urged to socially isolate completely, because they are at risk of a severe disease course. Although isolation reduces the medical impact of the virus, the non-medical impact should also be considered.AimTo investigate the impact of COVID-19 pandemic and associated restrictive measures on the six dimensions of Positive Health in community-dwelling older individuals living in the Netherlands, and to identify differences within subgroups.MethodsIn May/June 2020, community-dwelling older individuals aged ≥ 65 years completed an online survey based on Huber’s model of Positive Health. Positive Health was measured regarding the appreciation of the six dimensions (categorized as poor/satisfactory/excellent) and a comparison with a year before (categorized as decreased/unchanged/increased) using frequencies (%) and a chi-square test.Results834 older individuals participated (51% women, 38% aged ≥ 76 years, 35% living alone, 16% self-rated poor health). Most respondents assessed their bodily functions, mental well-being and daily functioning as satisfactory, their meaningfulness and quality of life (QoL) as excellent, and their social participation as poor. 12% of the respondents reported a deterioration of 4–6 dimensions and 73% in 1–3 dimensions, compared to the past year. Deterioration was most frequently experienced in the dimension social participation (73%), the dimension mental well-being was most frequently improved (37%) and quality of life was in 71% rated as unchanged. Women more often observed a deterioration of 4–6 dimensions than men (15% vs. 8%, p = 0.001), and individuals with self-rated poor health more often than individuals with self-rated good health (22% vs. 10%, p < 0.001). Older individuals living alone experienced more frequently a decrease in meaningfulness compared to older individuals living together.ConclusionThe COVID-19 pandemic and associated restrictive measures had a substantial impact on all six dimensions of Positive Health in community-dwelling older individuals, especially in women, respondents living alone and respondents with self-rated poor general health.

Development and psychometric evaluation of a Positive Health measurement scale: a factor analysis study based on a Dutch population

ObjectivesThe My Positive Health (MPH) dialogue tool is increasingly adopted by healthcare professionals in the Netherlands as well as abroad to support people in their health. Given this trend, the...

Refining insights in SES and other determinants on perceived health; a Positive Health Perspective

Abstract Background Many studies use dichotomous distinction between high and low SES and overall 'general total health' as outcome variable in studying Socio-Economic Status (SES) as determinant of health. In light of recent views on health and society, this study challenges this approach by proposing a more multidimensional view on both SES as well as health by analyzing four groups of SES and including six dimensions of positive health (PG) next to total general health. This study therefore addresses the impact of SES on the perception of total general health and the six domains distinguishing four instead two SES groups. Methods An online questionnaire on health perceptions was performed amongst 1000 respondents age 18 years and older in the Netherlands. Spearman correlations and regression analysis have been performed determining relationships and relative contributions of effects to the main outcome of perceived total general health using IBM SPSS Statistics 24. Results It appears that on average total general health is higher with increasing SES scores. Furthermore, distinguishing between four levels of SES instead of two revealed that low and mid low SES group evaluated total general health and all six health domains equal. However, mid low SES group evaluate their general health and 5 out of 6 domains lower than mid high SES group and mid high SES group scored lower on general health and all 6 domains than very high SES group. Variance in people's evaluation of their perceived health was explained for 10% of the impact of SES on total general health using simple regression analysis which remarkably disappeared using multiple regression including other socioeconomic and demographic variables. Discussion Results show that a more refined SES score and using the six health domains of positive health seems to give more insight into peoples' perceptions of their health. These findings suggest that health promoting interventions should be tailored to different SES-groups. Key messages Using more SES-groups and positive health domains gives more insight in peoples' perception on experienced health. Tailoring health promoting interventions to peoples' perspectives on health and SES might decrease health disparities.

Implementing human health as a landscape service in collaborative landscape approaches

Landscape services have been found to foster collaboration among actors in social-ecological transitions towards a more sustainable landscape. In this essay I propose that the contribution of landscape to human health could be particularly effective to play such a role. Health is important to most people in society, to business and government, and of economic and social value. Urban green space is widely known to have a positive impact on human health, but outside the urban landscape this effect is much less known. However, human health is underrepresented in frameworks of ecosystems services and applications of landscape services.I explore how health could be incorporated into landscape approaches beyond the urban fringe. For the application in landscape approaches, it is vital that the relationship between landscape and human health is expressed in parameters that are recognized as meaningful by the various actor groups. As a health specification, I propose the concept of positive health, because it is based on well-being and subjective perceptions of health. To characterize the physical assets of landscape that associate with health, perceived landscape naturalness seems a promising concept to explore further. I offer examples of studies illustrating the relationship between landscape naturalness and 5 dimensions of positive health. I conclude with suggesting research priorities to develop a knowledge base for integrating human health in collaborative landscape adaptation.

Measuring Population Health from a Broader Perspective: Assessing the My Quality of Life Questionnaire

Introduction:Population health perspectives increasingly focus on people’s perception of resilience, ability to adapt and self-manage. The goal of this study is to determine whether the MijnKwaliteitVanLeven.nl (“MyQualityOfLife.nl”) survey is a valid and reliable instrument for assessing the broader health perspectives at population level.Methods:19,809 entries of the MyQualityOfLife.nl survey were used. To assess face validity, Huber’s six dimensions of positive health were used as a framework for expert feedback. A confirmative factor analyses was done using the expert’s item clustering, followed by data-driven explorative factor analyses and reliability tests.Results:Experts distributed 74 of the 118 items over all six dimensions of positive health. The confirmatory factor analysis model based on expert classification was not confirmed. The subsequent exploratory factor analysis excluded most items based on factor loading and suggested two factors; ‘quality of life’ and ‘daily functioning’, both showing excellent reliability.Conclusion:The MyQualityOfLife.nl survey can assess the broader concept of health in a population as well as ‘quality of life’ and ‘daily functioning’. However, the survey can currently not evaluate several of the positive health dimensions separately. Further research is needed to determine whether this is due to the instrument or the positive health dimensions.

Measuring Population Health in a Positive Way: The “My Quality Of Life” Questionnaire

Introduction : Changes in the concept of population health require new instruments. Population health is not an easy concept to measure, as the concept and its considered constructs have shown little consensus over the years. Recently, the definition of health has been broadened and focuses more on the individual’s ‘ability to adapt’. “Classic” dimensions, such as physical, mental and social health, are still included, but additional emphasis is put on a person’s daily functioning, sense of purpose and quality of life. Insight is needed into this so-called ‘positive health’ at population level, as many healthcare reform efforts shift toward population-based policies. However, despite the need by population focused healthcare initiatives, not many instruments exist to measure the new dimensions of positive health. A potential instrument that could fill this gap is the MijnKwaliteitVanLeven.nl (“MyQualityOfLife.nl”, MKVL) survey. This study aims whether the MKVL survey can be used to measure population health. Method : Although the MKVL was not developed for positive health, it includes the participants’ views regarding their own life, quality of life and their experiences regarding the care and support they receive. Participants go to www.mijnkwaliteitvanleven.nl, which is available to everyone, and fill out the application form. Once participants apply, they receive an email with an invitation to fill out either the long or the short version of the survey. If they have applied and filled out survey at least once, then they receive two additional email invitations per year. First, the face validity of the survey will be assessed using a group of five experts. Input provided by experts will be used to exclude irrelevant questions. Second, relevant questions will be entered into a factor analysis to determine underlying constructs. Third, reliability will be assessed by internal consistency as calculated by Cronbach’s alpha per factor as identified by the above factor analysis. Additionally, corrected item-total correlations will be used to assess convergent validity and distributions of each item will be used to check for floor and/or ceiling effects. Results : The study population consisted out of 13,911 participants, consisting out of mostly women, with a chronic condition and born in the Netherlands. During the conference the background, objectives, design and methods, and results of the study will be discussed in further detail. Discussion and conclusion : It is of interest to identify whether and how the MKVL survey relates to other (positive) health surveys and if the MKVL shows gaps that can potentially be addressed by these.

Development and Validation of a Novel Generic Health-related Quality of Life Instrument With 20 Items (HINT-20).

ObjectivesFew attempts have been made to develop a generic health-related quality of life (HRQoL) instrument and to examine its validity and reliability in Korea. We aimed to do this in our present study.MethodsAfter a literature review of existing generic HRQoL instruments, a focus group discussion, in-depth interviews, and expert consultations, we selected 30 tentative items for a new HRQoL measure. These items were evaluated by assessing their ceiling effects, difficulty, and redundancy in the first survey. To validate the HRQoL instrument that was developed, known-groups validity and convergent/discriminant validity were evaluated and its test-retest reliability was examined in the second survey.ResultsOf the 30 items originally assessed for the HRQoL instrument, four were excluded due to high ceiling effects and six were removed due to redundancy. We ultimately developed a HRQoL instrument with a reduced number of 20 items, known as the Health-related Quality of Life Instrument with 20 items (HINT-20), incorporating physical, mental, social, and positive health dimensions. The results of the HINT-20 for known-groups validity were poorer in women, the elderly, and those with a low income. For convergent/discriminant validity, the correlation coefficients of items (except vitality) in the physical health dimension with the physical component summary of the Short Form 36 version 2 (SF-36v2) were generally higher than the correlations of those items with the mental component summary of the SF-36v2, and vice versa. Regarding test-retest reliability, the intraclass correlation coefficient of the total HINT-20 score was 0.813 (p<0.001).ConclusionsA novel generic HRQoL instrument, the HINT-20, was developed for the Korean general population and showed acceptable validity and reliability.

Differences in Self-Reported Importance of Elements of Health and Subjectively Experienced Health Among Outpatients in Community Mental Health Services

Positive dimensions of mental health are strong protective factors against physical and mental illness in general population. A cross-sectional study including a randomly selected sample of 141 outpatients was performed to explore differences in patients' self-reported importance of elements of health and subjective experiences of health related to sociodemographic background variables. The examination of differences in self-reported importance of elements of health showed differences regarding gender, and the analyses of subjectively experienced health showed differences regarding age and diagnosis. Clinical interventions aiming at strengthening positive dimensions of health are required in community mental health services to meet the patients' individual needs of enhanced health.

Direction of wording and responses to items in oral health‐related quality of life questionnaires for children and their parents

In order to minimize acquiescence response set bias, it is often recommended that questionnaires measuring attitudes, behaviours or health states contain items worded positively and negatively. It has also been suggested that when measuring health status this approach means that both the negative and positive dimensions of health can be assessed. This study aimed at assessing the performance of negatively and positively worded items in questionnaires to measure child and parent perceptions of child oral health-related quality of life. Both the child and parent questionnaire included four pairs of items, one negatively worded and one positively worded, that assessed eating, appearance, oral self-care and self-confidence. The response format was a five-point Likert frequency scale with a 'Don't know' option. Prior to analysis, the positive items were reverse coded. The relative performance of the two sets of items was assessed by means of comparisons of the proportions with 'Don't know' responses or missing values, mean item scores and proportions with the two highest frequency codes. Kappa statistics and intraclass correlation coefficients were used to assess the agreement between the negative and reverse-coded positive items and scores and the agreement between child and parent pairs. Factor analysis was used to determine if the two sets of items were measuring the same underlying construct. The study was completed by 91 Canadian children and 100 parents (91 child-parent pairs) recruited from clinics treating paediatric, orthodontic and oro-facial conditions. The positively worded items elicited substantially more 'Don't know' responses or missing values than the negatively worded items and failed to discriminate between groups. In addition, mean item scores and proportions with the highest frequency codes were substantially larger for reverse-coded positive than negative items. Agreement between pairs of items was slight. Child-parent agreement was substantial for a scale constructed from the negative items but only moderate for the positive items. Factor analysis revealed that the two sets of items loaded onto different factors. The performance of the positively worded items was unsatisfactory and their use in oral health-related quality of life indexes, either to reduce response set or assess positive oral health, is at best questionable.