Abstract
As responsibility for health funding shifts from central to local governments, providers find themselves in decision-making roles or asked to give guidance in allocation of resources. To develop a picture of a population’s health, data are needed about the effects that illness and disability have on a person’s ability to function and thus on quality of life. This study assessed the validity in a Canadian city, of a Health-related Quality of Life (HRQoL) instrument developed by the US Centers for Disease Control and used in the US Behavioral Risk Factor Surveillance System. The HRQoL was administered to a random sample of 1,042 adults. The patterns of association among the HRQoL questions, and the direction of the relationships among independent variables and HRQoL were consistent with those hypothesized. The accumulating evidence for validity of the HRQoL support its use in monitoring the performance of local health initiatives in Canada.
Résumé
La responsabilité du financement des soins de santé passant des gouvernements centraux aux gouvernements locaux, les prestateurs de soins se retrouvent dans la situation où il leur incombe de décider ou d’offrir des conseils quant à la façon d’allouer les ressources. Pour dresser un tableau de la santé de la population, il faut disposer de données sur les effets qu’une maladie et une incapacité ont sur l’aptitude à fonctionner d’une personne et, par voie de conséquence, sur sa qualité de vie. Cette étude a cherché à évaluer l’utilité dans une ville canadienne de recourir à un instrument mis au point par les US Centers for Disease Control, à savoir le HRQoL (mesure de la qualité de la vie en fonction de la santé), qui est utilisé par le système américain de surveillance des facteurs de risques comportementaux. Le HRQoL a été administré à un échantillon aléatoire de 1 042 adultes. Les schémas d’association entre les questions et l’orientation des relations entre les variables indépendantes et le HRQoL sont apparus conformes aux hypothèses. L’accumulation de preuves de la validité du HRQoL justifie son utilisation pour surveiller les résultats des initiatives locales en matière de santé au Canada.
Footnotes
Study funded in part by the Public Health Research and Development Program of the Ontario Ministry of Health.
References
- 1.Chambers LW, Woodward CA, Dok CM. Guide to Health Needs Assessment: A Critique of Available Sources of Health and Health Care Information. Ottawa: Canadian Public Health Association; 1983. [Google Scholar]
- 2.Birch S, Eyles J, Newbold KB. Proxies for healthcare need among populations: Validation of alternatives–a study in Quebec. J Epidemiol Commun Health. 1996;50:564–69. doi: 10.1136/jech.50.5.564. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Mays N, Chinn S, Ho KM. Interregional variations in measures of health from the health and lifestyle survey and their relation with indicators of health care need in England. J Epidemiol Commun Health. 1992;46:38–47. doi: 10.1136/jech.46.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Durch J, Bailey LA, Stoto MA, editors. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: National Academy Press; 1997. [PubMed] [Google Scholar]
- 5.Statistics Canada. National Population Health Survey Overview, 1996/97 (Catalogue 82-567) Ottawa: Minister of Industry; 1998. [Google Scholar]
- 6.LaRue A, Bank L, Jarvik L, Hetland M. Health in old age: How do physicians’ ratings and self-ratings compare? J Gerontology. 1979;34(5):687–91. doi: 10.1093/geronj/34.5.687. [DOI] [PubMed] [Google Scholar]
- 7.Linn BS, Linn MW. Objective and self-assessed health in the old and very old. Soc Sci Med. 1980;14A:311–15. doi: 10.1016/0160-7979(80)90112-5. [DOI] [PubMed] [Google Scholar]
- 8.Fillenbaum GG. Social context and self-assessments of health among the elderly. J Health Soc Behav. 1979;20:45–51. doi: 10.2307/2136478. [DOI] [PubMed] [Google Scholar]
- 9.Segovia J, Bartlett RF, Edwards AC. The association between self-assessed health status and individual health practices. Can J Public Health. 1989;80:32–37. [PubMed] [Google Scholar]
- 10.Idler EL, Anger RJ. Self-rated health and mortality in the NHANES-1 Epidemiologic follow-up study. Am J Public Health. 1990;80(4):446–52. doi: 10.2105/AJPH.80.4.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.World Health Organization. Health Promotion: A discussion document on the concept and principles. Copenhagen: World Health Organization Regional Office for Europe; 1984. [Google Scholar]
- 12.Hennessy CH, Moriarity DG, Zack MM, et al. Measuring health-related quality of life for public health surveillance. Public Health Rep. 1994;109(5):665–72. [PMC free article] [PubMed] [Google Scholar]
- 13.Beatty P, Schechter S, Whitaker K. Evaluating subjective health questions: Cognitive and methodological investigations. Proceedings of the American Statistical Association, Section on Survey Research Methods, In press.
- 14.Newschaffer CJ. Validation of BRFSS HRQoL measures in a statewide sample. Atlanta: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion; 1998. [Google Scholar]
- 15.Centers for Disease ControlPrevention. Quality of life as a new public health measure–Behavioural Risk Factor Surveillance System, 1993. MMWR. 1993;43(20):75–80. [PubMed] [Google Scholar]
- 16.Norusis MJ. SPSS 6.1: Guide to Data Analysis. New Jersey: Prentice Hall; 1995. [Google Scholar]
- 17.Statistics Canada. Profiles, Statistics Canada (Catalogue No. 95-337) 1991. [Google Scholar]
- 18.Siegel PZ. Self-reported health status: Public health surveillance and small-area analysis. In: Schechter S, editor. Proceedings of the 1993 NCHS Conference on the Cognitive Aspects of Self-Reported Health Status. Working paper series. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, National Center for Health Statistics; 1994. [Google Scholar]
- 19.Centers for Disease ControlPrevention. Health-related quality of life and activity limitation–eight states, 1995. MMWR. 1998;47(7):134–40. [PubMed] [Google Scholar]
- 20.Centers for Disease ControlPrevention. Self-reported mental distress among adults - United States, 1993–1996. MMWR. 1998;47(16):325–31. [Google Scholar]
- 21.Centers for Disease ControlPrevention. State differences in reported health days among adults–United States, 1993–1996. MMWR. 1998;47(12):239–43. [PubMed] [Google Scholar]