Subjective Experience Of Health Research Articles

Disease acceptance, but not perceived control, is uniquely associated with inflammatory bowel disease-related disability.

Disability, an important aspect of disease burden in patients with inflammatory bowel disease (IBD), has been suggested as a valuable clinical endpoint. We aimed to investigate how disease acceptance and perceived control, two psychological predictors of subjective health, are associated with IBD-related disability. In this cross-sectional study, adult IBD patients from the University Hospitals Leuven received a survey with questions about clinical and demographic characteristics, disease acceptance and perceived control (Subjective Health Experience model questionnaire), and IBD-related disability (IBD Disk). Multiple linear regressions assessed predictors of IBD-related disability in the total sample and in the subgroups of patients in clinical remission or with active disease. In the total sample (N = 1250, 54.2% female, median [IQR] age 51 [39-61] years, 61.3% Crohn's disease, 34.9% active disease), adding the psychological predictors to the model resulted in an increased explained variance in IBD-related disability of 19% compared to a model with only demographic and clinical characteristics (R2adj 38% vs. 19%, p<.001). The increase in explained variance was higher for patients in clinical remission (ΔR2adj 20%, p<.001) compared to patients with active disease (ΔR2adj 10%, p<.001). Of these predictors, disease acceptance was most strongly associated with disability in the total sample (β=-0.44, p<.001), as well as in both subgroups (β=-0.47, p<.001 and β=-0.31, p<.001 respectively). Perceived control was not significantly associated with disability when accounting for all other predictors. Disease acceptance is strongly associated with IBD-related disability, supporting further research into disease acceptance as a treatment target.

A Core Outcome Set for inflammatory bowel diseases: development and recommendations for implementation in clinical practice through an international multi-stakeholder consensus process.

Standardising health outcome measurements supports delivery of care, enables data-driven learning systems, and secondary data use for research. As part of the Health Outcomes Observatory initiative and building on existing knowledge, a core outcome set (COS) for inflammatory bowel diseases (IBD) was defined through an international modified Delphi method. Stakeholders rated 90 variables on a 9-point importance scale twice, allowing score modification based on feedback displayed per stakeholder group. Two consecutive consensus meetings were held to discuss results and formulate recommendations for measurement in clinical practice. Variables scoring 7 or higher by ≥80% of the participants, or based on consensus meeting agreement, were included in the final set. In total, 136 stakeholders (45 IBD patients (advocates), 74 healthcare professionals/researchers, 13 industry representatives and 4 regulators), from 20 different countries participated. The final set includes 18 case-mix variables, 3 biomarkers (haemoglobin to detect anaemia, C-reactive protein and faecal calprotectin to detect inflammation) for completeness and 28 outcomes (including 16 patient-reported outcomes (PROs) and 1 patient-reported experience). The PRO-2 and IBD-Control questionnaires were recommended to collect disease-specific PROs at every contact with an IBD practitioner, and the Subjective Health Experience model questionnaire, PROMIS Global Health and Self-Efficacy short form to collect generic PROs annually. A COS for IBD, including a recommendation for use in clinical practice, was defined. Implementation of this set will start in Vienna, Berlin, Barcelona, Leuven and Rotterdam, empowering patients to better manage their care. Additional centres will follow worldwide.

Determining the Appropriate Support for Older Adults with Different Levels of Vitality and Health-Related Quality of Life: An Explanatory Study.

Vitality and health-related quality of life are often assessed in older adults. However, these assessments do not provide guidance on support for older adults with different levels of vitality and health-related quality of life. This guidance can be established through segmentation. The Subjective Health Experience model segments individuals and indicates support for each segment. By examining how older adults with different levels of vitality and health-related quality of life correspond with each segment and by specifying the indicated support to older adults, guidance can be established. This was examined by administering a questionnaire to 904 older adults and interviewing 8. Analysis was performed using one-way ANOVA and the matrix method. In segment 1, older adults sustained higher levels of vitality and health-related quality of life relative to other segments. They need information and certainty. In segment 2, older adults sustained lower levels of vitality and health-related quality of life relative to segment 1, and higher levels relative to segment 3 or 4. They need planning and structure. In segment 3, older adults sustained lower levels of vitality and health-related quality of life relative to segment 1 or 2, and higher levels relative to segment 4. They need emotive assistance. In segment 4, older adults sustained lower levels of vitality and health-related quality of life relative to other segments. They need personal coaching. As levels of vitality and health-related quality of life correspond with the segments, deploying vitality and health-related quality of life measures together with the model might be beneficial.

State-of-the-art Applications of Patient-Reported Outcome Measures in Spinal Care.

Patient-reported outcome measures (PROMs) assign objective measures to patient's subjective experiences of health, pain, disability, function, and quality of life. PROMs can be useful for providers in shared decision making, outcome assessment, and indicating patients for surgery. In this article, we provide an overview of the legacy PROMs used in spinal care, recent advancements in patient-reported outcomes, and future directions in PROMs. Recent advances in patient-reported outcome assessments have included standardization of measurement tools, integration of data collection into workflow, and applications of outcome measures in predictive models and decision-making tools. Continual appraisal of instruments and incorporation into artificial intelligence and machine learning analytics will continue to augment the delivery of high-value spinal care.

How to Provide Tailored Medication Counselling to Hematology Patients? A Pilot Project

Hematological diseases are characterized by ample variance in disease trajectories requiring the delivery of tailored medication counselling. However, the one size fits all approach to providing medication counselling still seems pervasive in hospitals. Therefore, the outpatient pharmacy of the Albert Schweitzer hospital in the Netherlands implemented a pilot project concerning tailored allocation of medication counselling among hematology patients through structural assessment of their needs. The 124 included hematology patients were provided with tailored medication counselling by trained pharmacy assistants for 12 months. The tailored medication counselling provided to the hematology patients was based on the assessments of their needs using the Bloem &amp; Stalpers segmentation model. This model constitutes four segments each describing a medication counselling profile based on the perceived acceptance and control of patients. The evaluation of this pilot project shows that subjective health experience, satisfaction with medication information and medication compliance among included patients improved

Differences between expert reported and patient reported burden of disease rankings

Many attempted to develop burden of disease rankings for the purpose of resource allocation, priority setting, cost-effectiveness evaluation, and service development in healthcare. As this proved difficult the World Health Organization commissioned expert panels to develop internally consistent burden of disease rankings. Although these rankings provide valuable insight in the biomedical burden of different diseases, they do not yet provide insight in the psychological burden of different diseases experienced and reported by patients on a daily basis. Since expert reported and patient reported burden of disease could differ, deviations between expert reported and patient reported burden of disease rankings are likely. To explore how these rankings differ, it is important to develop patient reported burden of disease rankings and compare these to expert reported burden of disease rankings. In this study patient reported burden of disease rankings were developed by ranking the subjective health experience of patients. To measure subjective health experience an online questionnaire was administered to a large panel of Dutch citizens. The final sample consisted of 58,490 panel members. This final sample contained 36 diseases and was largely representative of the Dutch population. The data were analysed by using reliability tests, descriptive statistics and Spearman rank-order correlation coefficients. This study shows that expert reported and patient reported burden of disease rankings could differ. Burden of cardiovascular diseases ranks low on patient reported burden of disease rankings, while it ranks higher on expert reported burden of disease rankings. Burden of psychiatric diseases and gastrointestinal diseases ranks high on patient reported burden of disease rankings, while it ranks lower on expert reported burden of disease rankings. Burden of pain diseases ranks high on patient reported burden of disease rankings, while it is still overlooked in expert reported burden of disease rankings. This study suggests that it can be beneficial to develop and utilize patient reported burden of disease rankings in addition to the already existing expert reported burden of disease rankings in order to establish a more comprehensive perspective on burden of disease. This could improve decision-making on resource allocation, priority setting, cost-effectiveness evaluation, and service development in healthcare.

Graphic Medicine's Possible Futures: Reconsidering Poetics and Reading

Graphic Medicine's Possible FuturesReconsidering Poetics and Reading Erin La Cour (bio) and Anna Poletti (bio) Since its coinage in 2007 by medical practitioner and comics artist Ian Williams, graphic medicine has steadily gained traction as an umbrella term for comics that explore healthcare issues, the theoretical discourse these comics engender, and the study of comics as expressive communicative tools. Embedded within comics studies, graphic medicine interacts with the interdisciplinary medical humanities, which applies insights from the humanities, the social sciences, and the arts to the study and practice of medicine. Primarily promoted as a means of engendering compassion in practitioners in training, the goal of the medical humanities is: to reconceptualize health care, through influencing students and practitioners to query their own attitudes and behaviors, while offering a nuanced and integrated perspective on the fundamental aspects of illness, suffering, and healing. In Aristotelian terms, medical humanities aim to improve health care (praxis) by influencing its practitioners to refine and complexify their judgments (phronesis) in clinical situations, based on a deep and complex understanding (sophia) of illness, suffering, personhood, and related issues. In this respect, medical humanities have a more applied function than the humanities as they are traditionally defined in the academy. (Shapiro et al. 192–93) Moving on from the use of comics in medical institutions, which predominately take the form of simple, top-down didactic infographics on posters and in patient brochures, graphic medicine aims to expand the benefits of using comics in both healthcare training and information dissemination. While the visual shorthand of infographics is easy to comprehend and can be helpful in providing patients with important information that orients them in relation to a specific illness or disability and its treatment, what they lack is an in-depth exploration of how illness and disability, as well as healthcare systems and statistics, can make one feel. Graphic medicine aims to redress this lack by focusing on how the complex affordances of the comics medium can provide subjective insights into experiences of various forms of illness and disability (Williams, "Autography" and "Graphic Medicine"; McNicol; Squier and Marks; Green and Myers). Emphasizing and examining the communicative potential of the juxtaposition of incongruent texts and images, verbal and visual metaphor, color, line, and pacing through page layout, paneling, and guttering, the study and production of graphic medicine aims to explore and expose the subjective experiences of health and healthcare systems that may be difficult for both practitioners and patients to understand or explain in either verbal or visual language alone. [End Page 1] The past decade has seen a proliferation of graphic medicine comics, produced in large part by individuals aiming to relay their personal experience living with a particular illness or disability. These works, along with those from the perspectives of doctors, nurses, social workers, carers, and family members, echo calls in the medical humanities for the urgent need for different understandings and expressions of illness and disability than those found in conventional medical discourse. Whereas medical institutions largely focus on diagnosis, prognosis, and treatment, graphic medicine takes a bottom-up approach that reveals how communication is not always easy or straightforward. With its focus on the patient as an identity that is constituted by pathology and the body, medical discourse often ignores the encounter between healthcare professionals and patients as a culturally bounded and interpersonal one, influenced by factors such as cultural context, language, gender, class, and ethnicity. To counter this tendency, graphic medicine discourse promotes comics as an important medium to depict interactions between individuals, their loved ones, a wide array of healthcare workers, and the healthcare system as scenes of intercultural, interdiscursive, and intergenerational encounter. Graphic medicine focuses on "taking back the experience of somatic dysfunction from medical authority and talking back to medical discourse" (Couser 348). Taking cues from narrative medicine, which has long advocated for the use of reading literature and writing reflectively as part of medical training and treatment (Milota et al.; Charon; and Williams, "Graphic Medicine"), a handful of medical schools have begun encouraging their students to read comics to gain insights into what their (future) patients may be experiencing. Comics about various forms of illness and disability now often...

Health and suffering are associated with social support: a cross-sectional study of women and mothers with exhaustion and pain

BackgroundDespite women are generally overrepresented in behavioral, mental, and musculoskeletal disorders, motherhood as a central part of women’s life is poorly understood in relation to exhaustion and long-lasting pain. Mothers’ health impairments imply suffering both for herself and her family. A profound understanding of health is needed taking mothers’ subjective health experience, their suffering and life situation into account to give women, their families and society better prerequisites to alleviate exhaustion and long-lasting pain. The aim of the study was to describe health and suffering of women and mothers undergoing rehabilitation for long-lasting pain and exhaustion and its correlation with perceived social support.MethodsThe study had a cross-sectional design with an exploratory approach. A main sample consisted of 166 women undergoing rehabilitation for exhaustion and long-lasting pain and a reference sample included 129 women working and studying within health care professions. Both samples included women with and without children. Women’s subjective health and suffering was assessed from a caring science perspective using the recently developed and validated Health and Suffering Scale. Two additional scales measuring exhaustion and social support were distributed among the two samples. Descriptive statistics and multiple linear regression models, including health and suffering and perceived social support, were analyzed.ResultsMothers undergoing rehabilitation for pain and exhaustion reported significantly poorer health and more suffering compared to healthy mothers, but similar health and suffering when compared with childless women in rehabilitation. Health and suffering were correlated with perceived social support among both healthy and exhausted mothers. In both samples, the correlation between health and suffering and social support was stronger among mothers than among women without children.ConclusionsWomen and mothers living with exhaustion and long-lasting pain show signs of unbearable suffering and perceived insufficient social support. Social support from various sources particularly helps mothers to create meaning in life and make their suffering bearable. Hence, health care must address the fact that mothers are dependent on their immediate social environment and that this dependency interacts with their health and suffering on an existential level.

Patient-reported Outcome Measures in Pediatric Non-Malignant Hematology: A Systematic Review.

Patient-reported outcome measures (PROMs) are questionnaires completed by patients or caregivers without influence by health care professionals. As such, PROMs show subjective health experiences, enhance the clinical information available to providers, and inform clinical action. The objective of this systematic review is to identify and list which validated PROMs have been used to monitor health-related quality of life in pediatric patients with nonmalignant hematology (hemophilia, immune thrombocytopenia, sickle cell disease, and thalassemia). Databases (MEDLINE, Embase, HaPI, CINAHL, and PsycTESTS) were searched to identify publications that validated or used PROMs as an outcome measure in the 4 disease groups. Overall, 209 articles met the inclusion criteria, identifying 113 PROMs. Of the 113 identified PROMs, 95 are generic and can be used in multiple disease groups. The Pediatric Quality of Life Generic Core Scales was the most frequently used generic PROM (68 studies). The 18 remaining PROMs were disease specific. The results of this review, together with the COSMIN tool for selecting outcome measures, will allow clinicians to evaluate the PROMs that are best suited to their patient population. In addition, the focus groups are currently being conducted with patients, parents, and clinicians to determine the optimal use of PROMs in the clinical environment.

Subjective experience of health, personal health resources and beliefs: supporting a lifeworld approach to social work in youth health

ABSTRACT The Salutogenesis model proposes that life experiences shape our Sense of Coherence (SOC), supporting the application of resources to help us cope with stressors. Along with our beliefs, these factors determine our health experience. Young people face rapid development in relation to personal resources. However, to date, there has been little exploration of the subjective health experience or availability of resources of young people within the German context. This research employed a 2 phase, mixed-methods study using a questionnaire (n = 482) and focus groups (n = 12) to examine: subjective health experience, personal health resources (SOC), self-efficacy (SE) and health locus of control (HLoC) and health beliefs. Results identified three participant typologies. Type 1 reported the highest levels of subjective health and resources and defined health as relating to functional performance. Type 2 reported moderate health and resources and prioritised both physical and social health. Type 3 reported the poorest health and resources and low health priority. This study demonstrates the important relationship between subjective health assessment and personal resources for young people. It illustrates the importance of developmentally-tailored approaches to social work practice, founded in a lifeworld-oriented approach, to enable understanding of subjective health experience and foster agency to maximise health outcomes.

Health and Disease-Emergent States Resulting From Adaptive Social and Biological Network Interactions.

Health is an adaptive state unique to each person. This subjective state must be distinguished from the objective state of disease. The experience of health and illness (or poor health) can occur both in the absence and presence of objective disease. Given that the subjective experience of health, as well as the finding of objective disease in the community, follow a Pareto distribution, the following questions arise: What are the processes that allow the emergence of four observable states—(1) subjective health in the absence of objective disease, (2) subjective health in the presence of objective disease, (3) illness in the absence of objective disease, and (4) illness in the presence of objective disease? If we consider each individual as a unique biological system, these four health states must emerge from physiological network structures and personal behaviors. The underlying physiological mechanisms primarily arise from the dynamics of external environmental and internal patho/physiological stimuli, which activate regulatory systems including the hypothalamic-pituitary-adrenal axis and autonomic nervous system. Together with other systems, they enable feedback interactions between all of the person's system domains and impact on his system's entropy. These interactions affect individual behaviors, emotional, and cognitive responses, as well as molecular, cellular, and organ system level functions. This paper explores the hypothesis that health is an emergent state that arises from hierarchical network interactions between a person's external environment and internal physiology. As a result, the concept of health synthesizes available qualitative and quantitative evidence of interdependencies and constraints that indicate its top-down and bottom-up causative mechanisms. Thus, to provide effective care, we must use strategies that combine person-centeredness with the scientific approaches that address the molecular network physiology, which together underpin health and disease. Moreover, we propose that good health can also be promoted by strengthening resilience and self-efficacy at the personal and social level, and via cohesion at the population level. Understanding health as a state that is both individualized and that emerges from multi-scale interdependencies between microlevel physiological mechanisms of health and disease and macrolevel societal domains may provide the basis for a new public discourse for health service and health system redesign.

Art-making to deepen our understanding of illness.

Although much of our current medical education is focused on disease (which is concerned with pathology), we end up spending less time learning about illness — the subjective experience of health and disease. I was interested in deepening my understanding of illness and began a project to explore

Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model

BackgroundHealth behaviours during pregnancy and the early years of life have been proven to affect long term health, resulting in investment in interventions. However, interventions often have low levels of completion and limited effectiveness. Consequently, it is increasingly important for interventions to be based on both behaviour change theories and techniques, and the accounts of pregnant women. This study engaged with pregnant women from deprived communities, to understand their subjective experiences of health in pregnancy.MethodsThe study adopted a women-centred ethos and recruited a purposive sample of ten pregnant women, who lived in deprived areas and were on low incomes. Participants engaged with three creative techniques of visual data production (timelines, collaging and dyad sandboxing), followed by elicitation interviews. One participant only engaged in the initial activity and interview, resulting in a total of 28 elicitation interviews. This in-depth qualitative approach was designed to enable a nuanced account of the participants’ thoughts, everyday experiences and social relationships. Data were deductively coded for alcohol, smoking and infant feeding and then mapped to the COM-B model (Capability, Opportunity, Motivation – Behaviour).ResultsFive participants had experience of smoking during pregnancy, four had consumed alcohol during pregnancy, and all participants, except one who had exclusively formula fed her child, disclosed a range of infant feeding experiences and intentions for their current pregnancies. Considerable variation was identified between the drivers of behaviour around infant feeding and that related to abstinence from tobacco and alcohol during pregnancy. Overall, knowledge and confidence (psychological capability), the role of partners (social opportunity) and support from services to overcome physical challenges (environmental opportunity) were reported to impact on (reflective) motivation, and thus women’s behaviour. The role of the public in creating and reinforcing stigma (social opportunity) was also noted in relation to all three behaviours.ConclusionsWhen designing new interventions to improve maternal health behaviours it is important to consider the accounts of pregnant women. Acknowledging pregnant women’s subjective experiences and the challenges they face in negotiating acceptable forms of motherhood, can contribute to informed policy and practice, which can engage rather than isolate potential user groups.

Medicalización, prevención y cuerpos sanos: la actualidad de los aportes de Illich y Foucault

A partir de los análisis de Illich y Foucault se sostiene que el desarrollo de la medicina moderna ocurre paralelo a una cada vez más profunda medicalización que conlleva a importantes cambios en lo que respecta al significado del cuerpo y de la salud. Una de las expresiones actuales más paradigmáticas de estas transformaciones se observa en la medicina preventiva de alta tecnología, en cuanto ella contribuye no sólo a diluir la experiencia subjetiva de enfermedad y sanidad, sino que también dispone al cuerpo para formas sofisticadas de control y poder. El objetivo de este estudio, sin embargo, no es demonizar toda práctica preventiva, sino más bien, denunciar la medicalización como problema creciente y ofrecer elementos teóricos y filosóficos que permitan comprender mejor este fenómeno y develar algunos de sus fundamentos normativos ocultos.

Perceptions of self-rated health among stroke survivors: a qualitative study in the United Kingdom

BackgroundSelf-rated health predicts health outcomes independently of levels of disability or mood. Little is known about what influences the subjective health experience of stroke survivors. Our aim was to investigate stroke survivors’ perceptions of self-rated health, with the intention of informing the design of interventions that may improve their subjective health experience.MethodsWe conducted semi-structured interviews with a purposive sample of 28 stroke survivors recruited from a stroke unit and follow-up outpatient clinic, 4–6 months after stroke, to explore what factors are perceived to be part of self-rated health in the early stages of recovery. Qualitative data were analysed using a thematic analysis approach to identify underlying themes.ResultsParticipants’ accounts show that stroke survivors’ perceptions of self-rated health are multifactorial, comprising physical, psychological and social components. Views on future recovery after stroke play a role in present health experience and are shaped by psychosocial resources that are influenced by past experiences of ill-health, dispositional outlook such as degree of optimism, a sense of control and views on ageing.ConclusionsSeverity of physical limitations alone does not influence perceptions of self-rated health among stroke survivors. Self-rated health in stroke survivors is a multidimensional construct shaped by changes in health status occurring after the stroke, individual characteristics and social context. Understanding the factors stroke survivors themselves associate with better health will inform the development of effective approaches to improve rehabilitation and recovery after stroke.

Subjective health among LGBT persons living with disabilities: A qualitative content analysis.

There exist significant health disparities among both lesbian, gay, bisexual, transexual (LGBT) and disability persons; however, there is a dearth of information regarding the subjective health experiences of LGBT persons living with disabilities (LGBTPWD). As such, the purpose of this study was to understand how LGBTPWD subjectively defined and characterized the meaning of health in their lives. Using qualitative content analyses procedures outlined by Elo and Kyngäs (2008), we conducted a secondary data analysis using a larger questionnaire study that was administered via the Internet. Participants were originally asked to answer the following prompt, "Describe what it personally means to you to be healthy?" Open-ended responses from 79 participants were thematically analyzed over several inductive and comparative coding iterations by a 3-person research team. Trustworthiness of data analysis was ensured via researcher triangulation, negative case analyses, and researcher reflexivity. Four dimensions of subjective health emerged during the qualitative analytic process: physical wellness, emotional vitality, functionality, and social engagement. There are contextually nuanced characteristics that constitute subjective health for LGBTPWD. These findings could help rehabilitation professionals provide culturally competent interventions. Implications for future research and limitations are provided in the discussion section. (PsycINFO Database Record

Subjective Health-Related Quality of Life in Homeless and Vulnerably Housed Individuals and Its Relationship with Self-Reported Physical and Mental Health Status

Although the association between homelessness and objective indicators of poor health is well-established, little research has focused on the subjective health-related quality of life of homeless and vulnerably housed (HVH) individuals. This study examined the subjective health-related quality of life of HVH individuals, using the Multiple Discrepancies Theory (MDT) Scale for Health of the Quality of Life for Homeless and Hard-to-House Individuals (QoLHHI) Inventory, and its association with self-reported functional health status, as measured by the SF-12, and self-reported physical and mental health conditions in a sample of 100 HVH individuals recruited in Vancouver, Toronto and Ottawa. Our findings indicate that physical and mental health conditions are highly prevalent among HVH individuals and that the SF-12 Physical and Mental Component Summary scores are substantially lower compared to US population norms. The MDT Health items were not statistically significantly associated with physical or mental health conditions and only showed correlations of small to moderate magnitude with the SF-12 Component Summary Scales. These findings suggest that the QoLHHI MDT Scale for Health can provide information about HVH individuals’ subjective health experiences that is different from, and can serve as a valuable complement to, health status information for use in research and evaluation studies, as well as for policy purposes to make informed decisions based on subjective health-related quality of life data from HVH individuals.

171. Self-rated health in response to experimental manipulations of inflammation

Self-rated health is often viewed as a relatively stable construct and few studies have investigated short-term variations or used experimental approaches to manipulate subjective health perception. We have previously showed that higher levels of inflammatory cytokines are generally connected with less favorable self-rated health. Therefore, we explored the subjective health experience in response to a canonical activation of an inflammatory response with endotoxin in healthy subjects. In a first study, eight healthy participants were injected at two occasions: once with 0.8 ng/kg lipopolysaccharide (LPS) and once with placebo. In a second study, a between-subject design was used where 51 healthy subjects were injected with either LPS (now reduced to 0.6 ng/kg) or placebo. Stimulation resulted in a peak response in pro-inflammatory cytokines after 90–120 min. Ninety minutes after injection, perceived health framed to represent the present day (“How is your health right now?”), was significantly lowered in the endotoxin condition in both studies ( p ’s p ’s

Subjective Experienced Health as a Driver of Health Care Behavior

This paper describes the key role of the subjective experience of health as the driver of health related behavior. Individuals vary greatly in terms of behaviors related to health. Insights into these interindividual differences are of great importance for all parties involved in health care, including patients and consumers themselves. Such insights allow for better tuning of health care offerings to patient and consumer needs. Subjective experienced health is identified as the key driver of health care behavior. Consequently, insights into the subjective health experience and its antecedents are essential to describe, explain, predict, and control health-related behaviors. Implications of these insights are discussed for a number of topical issues in health care: services-diversification, therapy non-adherence, patient self-management, and outcome measurement.

Health Subjectivities and Labor Market Participation

Decisions around retirement and continued labor market participation are of great significance for those who make them, as well as policy makers, researchers, welfare states, and pension programs. The literature acknowledges the multifaceted nature of these choices and particularly the interaction of key variables—job satisfaction, financial status, caring responsibilities, spouse’s plans, and health. This article explores this latter factor, challenging assumptions that it can be treated as an unproblematic independent variable. Analyzing qualitative data from interviews with 96 people approaching or in the midst of retirement, the subjective experience of health and its effect on decisions was strongly evident. The socialized context—as shaped at societal, organizational, household, and individual-life-historical levels—was crucial in understanding how similar symptoms of morbidity resulted in widely varying decisions/outcomes. Direct interpersonal experiences, shaped by social structures, were useful in explaining the prevalence of health pessimism, despite general increases in life expectancy.