Do capability and functioning differ?:A study of U.K. survey responses

Faculty Senate Resolution on undergraduate admissions requirements, adopted on May 3, 1989

Choice and wellbeing in informal care

‘Choice’ is increasingly pursued as a goal of social policy. However the degree to which choice is exercised when entering an informal care role is open to debate. In this study of UK carers, we examined whether caring was perceived as a free choice, and what the consequence of choice was for carers’ wellbeing. Our data were derived from responses to a postal survey conducted in a large British city. One thousand one hundred respondents reported providing care to a close person and of these, 72% answered a further set of questions about caregiving and about their own well-being. We found that informal care was generally perceived to be a free choice, albeit in most cases, a choice that was constrained by duty, financial or social resources. Having a sense of free choice in entering care was strongly and positively associated with wellbeing. The positive impact on wellbeing persisted across different measures of wellbeing and when controlling for socio-demographic characteristics and the nature of the caring role. Further work is needed to better understand the modifiable aspects of choice for carers. Nonetheless, this study suggests that enabling individuals to have more choice in their caring roles may improve their lives

Predicting carer health effects using patient data

Illnesses and interventions can affect the health status of family carers in addition to patients. However economic evaluation studies rarely incorporate data on health status of carers.We investigated whether changes in carer health status could be 'predicted' from the health data of those they provide care to (patients), as a means of incorporating carer outcomes in economic evaluation.We used a case study of the family impact of meningitis, with 497 carer-patient dyads surveyed at two points. We used regression models to analyse changes in carers' health status, to derive predictive algorithms based on variables relating to the patient. We evaluated the predictive accuracy of different models using standard model fit criteria.It was feasible to estimate models to predict changes in carers' health status. However, the predictions generated in an external testing sample were poorly correlated with the observed changes in individual carers' health status. When aggregated, predictions provided some indication of the observed health changes for groups of carers.At present, a 'one-size-fits-all' predictive model of carer outcomes does not appear possible and further research aimed to identify predictors of carer's health status from (readily available) patient data is recommended. In the meanwhile, it may be better to encourage the targeted collection of carer data in primary research to enable carer outcomes to be better reflected in economic evaluation

Is the NHS underfunded?:Three approaches to answering the question

The adequacy of funding for the National Health Service (NHS) is a perennial issue1,2 and one that has become particularly prominent in recent years.3 The way ‘underfunding’ is understood influences perceptions about how much resource is needed and where it ought to be channelled. This in turn has profound implications for patients, citizens and staff. In this article, we examine what it means to claim that health systems are underfunded and whether this applies to the contemporary NHS. We identify three main approaches to studying the issue and uncover the value judgements inherent in each approach. We argue that there is evidence to support the current claim of underfunding and conclude by suggesting future avenues for addressing this critical issue, both in the UK and elsewhere

A framework for including family health spillovers in economic evaluation

Health care interventions may affect the health of patients' family networks. It has been suggested that these health spillovers? should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the health care perspective?). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effect

The validity and responsiveness of the ICECAP-A capability-wellbeing measure in women with irritative lower urinary tract symptoms

PURPOSE: A desire to incorporate broader aspects of well-being in health economic evaluations has led to the development of the ICEpop CAPability measure for Adults (ICECAP-A). The ICECAP-A draws upon Amartya Sen's capability approach and conceptualises well-being as the capability to achieve Stability, Attachment, Autonomy, Achievement, and Enjoyment. The aim of this study was to assess the psychometric performance of the ICECAP-A in a context where patient outcomes can extend beyond health-related quality of life. METHODS: Longitudinal data were collected for 478 women with symptoms of urinary frequency and urgency, with or without incontinence. Women were recruited across 22 hospitals in the UK and had a mean age of 55 (SD 14). The psychometric performance of the measure was evaluated in relation to the EuroQol Five-Dimension Questionnaire (EQ-5D-3L) and the International Consultation on Incontinence Questionnaire for Overactive Bladder (ICIQ-OAB) and involved an assessment of acceptability, construct validity, and responsiveness using parametric and nonparametric methods. RESULTS: ICECAP-A showed good convergence with the ICIQ-OAB with 20 out of 22 expected patterns of relationship confirmed. Findings suggested that the ICECAP-A has better discriminative properties than EQ-5D-3L and as good as those of the ICIQ-OAB, confirming expected associations with clinical and demographic factors. The ICECAP-A was more responsive than EQ-5D-3L and ICIQ-OAB to deteriorations of clinical symptoms. Improvements in symptoms were not valued as highly as deteriorations by either ICECAP-A or EQ-5D-3L. CONCLUSIONS: The ICECAP-A is a valid and responsive measure capturing broad emotional and practical impacts of urinary symptoms on women's well-being and could be considered for use in economic evaluations in this context

Financial stress and depression in adults:A systematic review

Financial stress has been proposed as an economic determinant of depression. However, there is little systematic analysis of different dimensions of financial stress and their association with depression. This paper reports a systematic review of 40 observational studies quantifying the relationship between various measures of financial stress and depression outcomes in adults. Most of the reviewed studies show that financial stress is positively associated with depression. A positive association between financial stress and depression is found in both high-income and low-and middle-income countries, but is generally stronger among populations with low income or wealth. In addition to the “social causation” pathway, other pathways such as “psychological stress” and “social selection” can also explain the effects of financial stress on depression. More longitudinal research would be useful to investigate the causal relationship and mechanisms linking different dimensions of financial stress and depression. Furthermore, exploration of effects in subgroups could help target interventions to break the cycle of financial stress and depression

Understanding the role of peace of mind in childhood vaccination: A qualitative study with members of the general public.

BACKGROUND: Recent debates on the introduction of new childhood vaccines in the UK have suggested that 'peace of mind' (PoM) might influence decision making. The aim of this study is to ascertain the importance of 'PoM' in individuals' decision making. METHODS: Four focus groups were conducted in the UK. Participants were 22 females and 2 males, aged 18-74 years, with a selection of non-parents, parents, guardians and foster carers. Data were analysed using an inductive thematic framework approach and conceptualised using the Health Belief Model, which provided an overview of participants' perceptions and behaviours about childhood vaccinations. RESULTS: Vaccine associated PoM was associated with individuals' perceptions of disease severity, with individuals feeling more reassurance after obtaining vaccinations against diseases that they considered to be severe compared to relatively mild diseases. Conversely, concerns about vaccination side-effects reduced participants PoM, but the duration of this effect varied between individuals. Other factors, such as social pressure and the emotional anxiety related to children's feelings, or physical reactions, to vaccinations also negatively impacted on participants' vaccine associated PoM. CONCLUSION: Vaccine associated PoM was a consideration for some participants seeking vaccinations but was only a minor motivating factor for these individuals. These differences stemmed from whether participants received PoM from the uptake of a vaccination because they perceived some intrinsic benefit from it or, conversely, they considered vaccinations as a routine health intervention. Overall, vaccine related PoM varied between participants in magnitude and fluctuated over time, even in the same individuals