Well-being Outcome Measures Research Articles

Economic evaluations of community-based care: lessons from twelve studies in Ontario.

A series of 12 studies (five historic cohort and seven randomized trials) examined clients in community settings in Southern Ontario suffering from a variety of chronic physical and mental health conditions. These studies are appraised using a framework for evaluating possible outcomes of economic evaluation. In the 12 studies, sample composition and size varied. Each study was designed to quantify the well-being outcomes and expenditures associated with different community-based approaches to care provided in the context of a system of national health insurance. As a collective, these studies represent increasing methodological rigour. Multiple-perspective client well-being outcome measures were used. In two studies, caregiver burden also was analysed. A common approach to quantification and evaluation of expenditures for service consumption was used in all 12 studies. The nature of community-based health services (health vs. disease care orientation) was found to have direct and measurable impact on total expenditures for health service utilization and client well-being outcomes. In most cases, a recurring pattern of equal or better client outcomes, yet lower expenditures for use of community based health services, was associated with well-integrated health oriented services. Integrated services aimed at factors which determine health are superior when compared to individual, fragmented, disease oriented, and focused approaches to care. The main lessons from the 12 studies are that it is as or more effective and as or less expensive to offer complete, proactive, community health services to persons living with chronic circumstance than to provide focused, on-demand, piecemeal services. Complete services would have a psychosocial and mental health focus included with the physical care approach. Furthermore, people with coexisting risk factors (age, living arrangements, mental distress and problem-solving ability) are the ones who most benefit at lower expense from health oriented, proactive interventions.

More effective and less expensive: lessons from five studies examining community approaches to care

Does the nature of community health services used by chronically ill clients and their caregivers have an impact on utilization of services, expenditure and well-being outcomes? A series of five studies, (four historic cohort and one randomized trial) examined clients suffering from a variety of chronic conditions in a number of community settings in different regions of Southern Ontario. Study sample composition and size varied. Each study was designed to quantify the well-being outcomes, and expenditure associated with different community approaches is covered under a nation-wide system of health insurance plans. As a collective, these studies represent increasing methodological rigor. Multiple-perspective client well-being outcome measures were used. Caregiver burden was also analyzed. A common approach to quantification and evaluation of expenditure for service consumption was applied across all five studies. The nature of community health services (proactive versus reactive approaches to care) was found to have direct and measurable impact on total expenditure for health service utilization and client well-being outcomes. A recurring pattern of lower expenditure for community health service utilization and equal or better client outcomes was associated with well-integrated proactive services when compared with individual fragmented, reactive approaches to care. The main lesson emerging from examining the five studies on approaches to community care is that it is as, or more, effective and less expensive to offer complete proactive health care services to chronically ill people in the early stages of their illness than to provide services on demand in a piecemeal manner.

Dysfunctional Attitudes, Roles Stress Evaluations, and Psychological Well-Being

Recent work suggests that role evaluation variables, such as ratings of role stress, may be better predictors of psychological well-being than the number of roles an individual occupies. Little is yet known, however, about the possible influence of personality factors on these role judgments. Accordingly, the present research examined this issue by assessing the relationship between dysfunctional attitudes (i.e., extremely rigid and negative self-evaluative standards) and ratings of role stress. Initial findings indicated that those individuals endorsing a larger number of dysfunctional attitudes also rated their personal role experiences as more stressful. As a further major goal, the present studies also assessed the relative contributions of both dysfunctional attitudes and role stress ratings to predictions of various outcome measures of well-being. Study 1 found that higher levels of dysfunctional attitude endorsement and greater role stress ratings were both associated with increased depression and lower self-esteem. The second study, however, indicated that only dysfunctional attitudes were able to predict depression, self-esteem, and positive and negative affect in a longitudinal manner. This pattern for dysfunctional attitudes was especially robust, as these longitudinal predictions remained significant even after accounting for initial levels of well-being. Discussion then focused on the importance of including relevant personality variables in research that attempts to elucidate the relationship between various role assessments and psychological well-being.

Antecedents and Outcomes of Work-Family Conflict Among Married Professional Women: Evidence from Singapore

The study reported here examined the impact ol fivc antecedent sets of work and family domain variables on three types of work-lamily conflict (job-spouse, job-parent, and job-homemakcr) and the impact of these types of work-family conflict on well-being and work outcome measures. Data were obtained from 354 married professional women from duil-career families in Singapore. Results indicate that married professional women in this study experienced moderate amounts of each type of work-lamily conflict. Role stressors explained the most variance in job-spouse and job-homemaker conflicts while task characteristics explained the most variance in job-parent conflict. The three types of work-family conflict explained only modest amounts of the variance in the well-being and work outcome measures. The findings are discussed within a feminist framework and an option for combining work and family lives is suggested.

Academic Environments in Preschool: Do They Pressure or Challenge Young Children

The question of whether early environments provide a challenge or a pressure for young children is being hotly debated, yet there is little empirical research on this topic. This paper presents a subset of data from a two-year comprehensive project designed to examine this question. Parental attitudes and behaviors along with school philosophy and practices comprised the predictor variables used to define academic environments. This study then focused on how these family and school variables related to child outcome measures of competence, creativity, and emotional well-being for 90 prekindergarten children, and a follow-up sample of 56 kindergarten children. The results suggest no advantages for children from highly environments, and potential disadvantages in creative expression (measured as originality) and emotional well-being (measured as test anxiety and attitudes toward school). Possible interpretations and ramifications of these results are discussed.

Measures of Psychological Well‐being and Treatment Satisfaction Developed from the Responses of People with Tablet‐treated Diabetes

Psychological outcome measures of Well-being and Treatment Satisfaction have been designed and developed for people with tablet-treated Type 2 diabetes. The Well-being scale includes three six-item sub-scales to measure Depression, Anxiety, and Positive Well-being. A prime consideration when selecting items for the psychological well-being measures was to minimize the confounding of diabetic symptomatology with the somatic symptoms of depression and anxiety. Cronbach's alpha indicated that each of the Well-being sub-scales and the Treatment Satisfaction scale was internally reliable (alphas ranged from 0.70 to 0.88) and evidence for construct validity was provided by predicted associations with other variables collected at the time of the study. For example, lower Well-being scores were associated with being overweight (Depression: p less than 0.05; Anxiety: p less than 0.001) while greater Satisfaction with Treatment was associated with lower HbA1 levels (p less than 0.001) and lower percent ideal body weight (p less than 0.01). These scales should prove particularly useful where measures of quality of life are required to complement metabolic variables when evaluating new treatments, education programmes, and other interventions, or in the routine auditing of established methods of treatment.