Which personal quality of life domains affect the happiness of older South Africans?

Objective To ascertain which quality of life domains affect the happiness of older South Africans. Method Seven hundred and ten respondents, aged between 50 years and 93 years, participated in the study. Seven single items assessed satisfaction with: oneself, family life, friendship, one’s time to do things, neighbours, social life and health. Responses were summed for overall quality of life. A 31-item scale measured satisfaction with activities (16 items), financial situation (7 items) and people (8 items). One item measured global happiness. Results Coefficient alpha was 0.90 (7-item quality of life scale), 0.95 (activities scale) and 0.87 (finances and people scales). Although there some racial differences on the 10 quality of life domains and happiness, Black respondents, who acted as caregivers, had a poorer quality of life and were less happy (P < 0.05) than those without these responsibilities. Stepwise multiple regression revealed that satisfaction with social life was the most important predictor of happiness for Blacks and Indians; satisfaction with oneself for Whites, and time to do things for Coloureds. Overall findings suggested that three out of the ten domains adequately represented perceived quality of life, care-giving responsibilities negatively affect quality of life and happiness and race plays a role in predicting happiness.     

Perceived change in quality of life during the menopause

The directly attributable effect of menopausal transition on women's quality of life (QoL) remains unclear. This study investigates the relationship between perceived change in QoL and menopausal transition status, socio-economic circumstances, lifestyle factors, and life stress. Prospective data were collected from a cohort of 1525 British women followed up since their birth in 1946 and annually from 47 to 54 years. Following factor analysis, the 10 survey items for perceived change were combined into three QoL domains: physical health (physical health, energy level, and body weight), psychosomatic status (nervous and emotional state, self-confidence, work life, ability to make decisions, and ability to concentrate), and personal life (family life and time for self, hobbies, and interests). In the fully adjusted model, the most important risk factor for decline in all three domains was work or family related stress (p<0.001). Menopausal transition status was significantly associated with change in physical health (p<0.001) and psychosomatic (p<0.001) domains, but not personal life. Women who were perimenopausal for at least a year perceived decline in physical (p=0.009) and psychosomatic (p=0.05) domains compared with premenopausal women, while those on hormone replacement therapy (HRT) for at least a year reported relative improvement (physical p=0.02, psychosomatic p=0.06). Apart from work and family-related stress, physical inactivity was associated with a relative decline (p=0.03) in the physical health domain, and nulliparity with a relative decline in the personal life domain (p=0.006). Both psychosomatic and personal life domains declined significantly with age (p<0.0001 and p=0.003, respectively). Women with four or more children reported a relative improvement in the psychosomatic (p=0.05) domain. In terms of the three QoL domains, women's experience of the menopausal transition appears complex, potentially involving a range of other factors and influences in their lives, and is by no means overwhelmingly negative.     

Healthy upbringing of children through the empowerment of women in a disadvantaged neighbourhood: evaluation of a peer group project

Aim  

The study evaluates a community-based intervention programme, using a peer approach. The programme’s objective is to improve life opportunities for children from disadvantaged families in a poor district of Berlin by empowering their mothers. Women of varying cultural backgrounds—most of them from immigrant families—are educated in subjects like child development, early education and health in order to work as community mothers (CMs). Their major task is to obtain access to the families, strengthen the mothers’ parenting and personal skills, and promote early nursery school attendance and access to social support systems. Community settings are integrated in the programme through the establishment of family cafés in nursery and primary schools.     

Ancillary Benefits for Caregivers of Children with Asthma Participating in an Environmental Intervention Study to Alleviate Asthma Symptoms

Providing care for children with asthma can be demanding and time-intensive with far-reaching effects on caregivers’ lives. Studies have documented childhood asthma symptom reductions and improved asthma-related quality of life (AQOL) with indoor allergen-reducing environmental interventions. Few such studies, however, have considered ancillary benefits to caregivers or other family members. Ancillary benefits could be derived from child health improvements and reduced caregiving burden or from factors such as improved living environments or social support that often accompanies intensive residential intervention efforts. As part of the Boston Healthy Public Housing Initiative (HPHI), a longitudinal single-cohort intervention study of asthmatic children, we examined trends in caregivers’ quality of life related to their child’s asthma (caregiver AQOL) using monthly Juniper Caregiver Asthma Quality of Life Questionnaires (AQLQ) for 32 primary caregivers to 42 asthmatic children aged 4 to 17 years. Longitudinal analyses were used to examine caregiver AQOL trends and their relationship to the child’s AQOL, then to consider additional predictors of caregiver AQOL. Caregiver AQLQ improved significantly over the course of the study with overall improvements significantly correlated with child AQOL (p = 0.005). However, caregiver AQOL improved most in the months before environmental interventions, while children’s AQOL improved most in the months following. Time trends in caregiver AQOL, controlling for child AQOL, were not explained by available social support or caregiver stress measures. Our findings suggest potential participation effects not adequately captured by standard measures. Future environmental intervention studies should more formally consider social support and participation effects for both children and caregivers     

Health-related quality of life (HRQoL) domains most valued by urban isiXhosa-speaking people

Purpose The aim of the study was to investigate and identify aspects of health-related quality of life (HRQoL) that are most valued by isiXhosa-speaking people resident in under-resourced areas of Cape Town. Methodology Fifty-seven domains of HRQoL were identified as important through group discussions with isiXhosa-speaking people. Participants randomly selected from the community (n = 601) and from individuals seeking medical attention at a local clinic (n = 102) graded the domains on a visual analogue scale (VAS) ranging from 0 as “not at all important” to 10 as “ very important”. The domains were then mapped to the categories of the International Classification of Functioning, Disability, and Health. Results The domains regarded as being most important were food availability (9.5, SD = 1.52), owning a brick house (9.4, SD = 1.57), access to medical services (9.4, SD = 1.55), and family safety (9.4, SD = 1.7). Having no bodily pain was ranked 40th. Environmental factors were valued significantly more than the other two categories and those related to body functions were valued more highly than domains in the category of activity/participation. Discussion and conclusion Despite being asked specifically to answer the questions in relation to their health status, the participants apparently did not differentiate between general quality of life (QoL) and specific HRQoL. It appears that members of an under-resourced community regard socioeconomic and service delivery aspects of their lives as integral to their perceived state of health. It may be that it is not possible to separate factors relating to general quality of life from those specifically related to HRQoL in an under-resourced population and such populations might not be suitable for inclusion in certain clinical trials where improvement in HRQoL is the required outcome. Alternatively, if a HRQoL instrument is to be used to monitor the impact of medical intervention, the inclusion of environmental factors should be considered.     

India Moves Towards Menstrual Hygiene: Subsidized Sanitary Napkins for Rural Adolescent Girls—Issues and Challenges

The onset of menstruation is one of the most important physiological changes occurring among girls during the adolescent years. Menstruation heralds the onset of physiological maturity in girls. It becomes the part and parcel of their lives until menopause. Apart from personal importance, this phenomenon also has social significance. In India, menstruation is surrounded by myths and misconceptions with a long list of “do’s” and “don’ts” for women. Hygiene-related practices of women during menstruation are of considerable importance, as it may increase vulnerability to Reproductive Tract Infections (RTI’s). Poor menstrual hygiene is one of the major reasons for the high prevalence of RTIs in the country and contributes significantly to female morbidity. Most of the adolescent girls in villages use rags and old clothes during menstruation, increasing susceptibility to RTI’s. Adolescents constitute one-fifths of India’s population and yet their sexual health needs remain largely unaddressed in the national welfare programs. Poor menstrual hygiene in developing countries has been an insufficiently acknowledged problem. In June 2010, the Government of India proposed a new scheme towards menstrual hygiene by a provision of subsidized sanitary napkins to rural adolescent girls. But there are various other issues like awareness, availability and quality of napkins, regular supply, privacy, water supply, disposal of napkins, reproductive health education and family support which needs simultaneous attention for promotion of menstrual hygiene. The current article looks at the issue of menstrual hygiene not only from the health point of view, but also considers social and human rights values attached to it.     

Using WHOQOL-BREF to evaluate quality of life among Turkish elders in different residential environments

Objective  This study used the Brief Version of The World Health Organization’s Quality of Life Questionnaire (WHOQOL-BREF) to assess and compare the quality of life in older people who live at home and older people who live in public assisted-living facilities for the elderly. Design  Cross-sectional. Setting  Data were collected by a research nurse in each home and in the assisted living facility. Participants  Participants were 60 years old and older. The sample included 37 people who were living in a public assisted-living facility and 37 elderly people living in their own homes. Measurement  The WHOQOL-BREF was used to measure participants’ quality of life. Results  The groups were similar according to gender, literacy, existence of chronic diseases, and general perceived health. However, quality of life scores for social relationships and environment domains were lower in those living in an assisted living facility than those living in their own homes. The scores for elderly females staying in the assisted living facility were lower compared to the scores of males in the facility. Conclusion  The results suggest that social and environmental domains of life quality are low in elderly assisted living facilities. Social activities should be diversified for elderly people staying in assisted living facilities to improve social relationships. Physical and psychological health of females in assisted living facilities should be comprehensively supported by professionals. Alternatively, elderly people may be professionally supported to live in their own homes.     

Measurement accuracy in assessing patient’s quality of life: to weight or not to weight domains of quality of life

Purpose  Health-related quality of life (HRQOL) measures typically do not incorporate patients’ preferences for domains such as physical, emotional, functional and social/family well-being, which may compromise precision. Method  A forced-choice domain-preference measure was developed to assess the importance of HRQOL domains. About 194 cancer patients completed the domain-preference measure, along with measures of HRQOL, coping, adjustment, and life satisfaction. Results  Patients ranked emotional well-being as most important and the loss of social-family well-being as the most difficult to do without. A weighting algorithm revealed no advantage to incorporating individuals’ domain preferences in HRQOL assessment; however, preliminary evidence suggested that HRQOL measurement may be more accurate in predicting outcomes for individuals with no distinct domain preferences than those with distinct preference profiles. Conclusion  This study provides preliminary evidence for the validity of current measures of HRQOL, which may inherently take into account patients’ domain preferences.     

West African Immigrant Families from Mauritania and Senegal in Cincinnati: A Cultural Primer on Children’s Health

Similar to many cities in the US, the Greater Cincinnati area has recently had an increase in immigrants from other countries. In particular, there is a small but growing population of West African immigrants especially from Senegal and Mauritania. In order to better understand children’s health of West African families in the Cincinnati area, in-depth, in-home narrative interviews were conducted with ten West African immigrant parents from Senegal and Mauritania. Four salient themes about cultural information related to children’s health were derived from the qualitative analysis: (1) health care practice and expectations including barriers; (2) cultural values and identity; (3) health beliefs and traditions/customs; and (4) quality of life. It is essential that health care providers understand the nuances of working with West African immigrants including cultural differences, strengths, challenges and perceptions in order to provide these individuals with the most effective health care services.     

Association of thoracic kyphosis with subjective poor health, functional activity and blood pressure in the community-dwelling elderly

Objectives The prevalence of thoracic kyphosis is considered to increase as the population is ageing in Japan. However, little is known about the clinical and preventive significance of kyphosis. The purpose of the study is to assess the association of kyphosis with subjective poor health and functional activity in the community-dwelling Japanese elderly. The relation of kyphosis with blood pressure, as a subclinical indicator of arteriosclerosis, is also examined. Methods The subjects consisted of 536 (male 241, female 295) elderly persons aged 65 years old and older. Trained examiners measured thoracic kyphosis using a flexicurve, and kyphosis index was calculated. Information on the subjects’ subjective poor health and functional activity were collected through a face-to-face interview, and blood pressure was measured by a conventional method. Results In females, their kyphosis index increased with age increased, whereas in males, there was no clear age-related change. An increased kyphosis index was associated with subjective poor health only among females. Compared with the lowest kyphosis index tertile, adjusted odds ratios for being in poor health were 5.4 (95% confidence interval: 1.1–27.4) in the middle tertile, and 6.4 (95% confidence interval: 1.3–32.1) in the highest tertile. Kyphosis index did not seem to be associated with functional activity score and blood pressure both in males and females even after adjustment. Conclusions Kyphosis is associated with subjective poor health in the community-dwelling female elderly in this study population, but not with functional activity and blood pressure both in males and females.     

Life mapping: a ‘Therapeutic Document’ approach to needs assessment

This study tested the effectiveness of The Life Map designed by the authors for holistic needs assessment for the promotion of mental health based on the World Health Organisation’s six Quality of Life domains (1985). Tests were conducted of test–retest reliability and validity (criterion, discriminant, construct and concurrent) compared with an existing validated needs assessment, the Camberwell Assessment of Needs Inventory CAN-R. For main analyses, 43 mental health service users (SUs) were age–sex matched with 43 of non-service users (non-SUs). The Life Map significantly discriminated between these two study groups. Non-parametric correlations in each group showed significant relationship between a general quality of life question and the ‚well-being’ and the ‚influence over’ scores in each of the six domains. Consistent significant agreement was found in test–retests conducted 2 weeks apart. Qualitative data in the Life Map was able to conceptualise the quantitative Life Map scores. This makes the Life Map a tool to improve communication between user and care-provider using a reliable felt and expressed needs assessment that empowers the service user with a ‚voice’ and empowers the care-provider with the capacity to compare aggregated needs between localities and for change over time. The limitations of this study, the Life Map’s utility to facilitate meeting Standards 1 and 2 of the UK’s National Service Framework for adult mental health and future directions are discussed.     

The effect of the will of the bedridden elderly to be self-reliant on their life prognoses in Japan

The purpose of this study was to establish the relationship between the will of bedridden elderly people to be self-reliant and their life prognosis, and to clarify the factors related to the will to be self-reliant of such persons. The cohort consisted of 274 bedridden elderly persons aged 65 years and over who lived at home and were observed continually over ten years. Data were obtained from observation records done by four public health nurses who visited the subjects at least once a year and assessed their state of health. The variables studied were demographic variables, activities of daily living, the cause of being bedridden, the strength of the will to be self-reliant and the date of having become bedridden. Cox’s proportional hazard model, the Kaplan-Meier method and discriminant analysis were used for statistical analysis. Of the 274 subjects, 107 subjects (39.1%) were male and 167 (60.9%) female, with a mean age of 82 years. The subjects who lived with their families accounted for 96.7%. The mortality hazard ratio for subjects with a weak will to be self-reliant to those with a strong will was 1.64, which was statistically significant. Discriminant analysis demonstrated that the will to be self-reliant showed a significant relationship with age, level of activities of daily living and refraining from expressing one’s own feelings in consideration of the family’s feelings. Bedridden elderly persons with a strong will to be self-reliant had a significandy better life prognosis than those with a weak one. A strong will to be self-reliant among the elderly is related to age, level of activities of daily living, and refraining from expressing one’s own feelings in consideration of the family’s feelings. This study clearly points out the need for home care service personnel to work in cooperation with families to emphasize encouragement to build the will to be self-reliant for the elderly in Japan.     

Benefits of Family and Social Relationships for Thai Parents Living with HIV

Family and social relationships are important structural supports in Thailand that are likely to influence the health and mental health of persons living with HIV (PLH). Structural equation modeling examined these relationships among 409 PLH in two communities in Thailand. Latent variables were constructed for most outcomes and mediators, with adherence to antiretroviral (ARV) therapy, depression, and disclosure represented by single-item indicators. All models controlled for gender, age, and education. Disclosure was significantly and positively associated with ARV adherence, and to both family functioning and social support. Family functioning and social support were significantly related to the PLH’s self-perceptions of health and mental health, as well as being significantly correlated with each other. Better family functioning was significantly associated with better quality of life, better perceived health, fewer symptoms of depression, and greater ARV adherence. Social support was significantly associated with better quality of life and fewer depressive symptoms. These results highlight the important role that an organized and structured family life and social support network can play in encouraging better health outcomes among PLH.     

中学生生活事件评定及其与焦虑、抑郁之间关系的研究

目的 :评定中学生生活事件发生频率 ,探讨生活事件应激强度与焦虑、抑郁症状的关系。方法 :运用自编的“中学生生活事件评定表”评定 10 36名某国家大型企业子弟中学学生一年来生活事件发生率和生活事件应激强度 :运用Zung编制的焦虑自评量表 (SAS)和抑郁自评量表(SDS)评定焦虑和抑郁症状。结果 :2 0项生活事件发生率 1.2 %～ 19.2 % ,生活事件强度无显著性差异。焦虑和抑郁症状检出率分别为 11.87%和 16 .6 0 % ,有抑郁症状的中学生的学习与学校生活、人际关系、家庭环境、性生理与性心理四个维度生活事件应激强度分显著高于对照组 ,有焦虑症状的中学生人际关系、家庭环境两个维度生活事件应激强度分显著高于对照组。结论 :中学生紧张性生活事件应激与焦虑、抑郁症状呈统计学关联     

Meaning behind measurement: self-comparisons affect responses to health-related quality of life questionnaires

Purpose  The subjective nature of quality of life is particularly pertinent to the domain of health-related quality of life (HRQOL) research. The extent to which participants’ responses are affected by subjective information and personal reference frames is unknown. This study investigated how an elderly population living with a chronic metabolic bone disorder evaluated self-reported quality of life. Methods  Participants (n = 1,331) in a multi-centre randomised controlled trial for the treatment of Paget’s disease completed annual HRQOL questionnaires, including the SF-36, EQ-5D and HAQ. Supplementary questions were added to reveal implicit reference frames used when making HRQOL evaluations. Twenty-one participants (11 male, 10 female, aged 59–91 years) were interviewed retrospectively about their responses to the supplementary questions, using cognitive interviewing techniques and semi-structured topic guides. Results  The interviews revealed that participants used complex and interconnected reference frames to promote response shift when making quality of life evaluations. The choice of reference frame often reflected external factors unrelated to individual health. Many participants also stated that they were unclear whether to report general or disease-related HRQOL. Conclusions  It is important, especially in clinical trials, to provide instructions clarifying whether ‘quality of life’ refers to disease-related HRQOL. Information on self-comparison reference frames is necessary for the interpretation of responses to questions about HRQOL.     

Is There Any Ideal of ‘High Quality Care’ Opposing ‘Low Quality Care’? A Deconstructionist Reading

The expressions ‘high quality care’ and ‘low quality care’ are cognitive and linguistic artefacts that help to structure people’s lives and thinking; for example, moves are now afoot internationally to pay bonuses to health professionals for delivering high quality care. United States programmes, most conspicuously, are assuming that high quality care can be validly distinguished from low quality care, and incentivised through bonuses. This distinction is always at least implicit, for high quality care has no meaning without low quality care. Through a ‘deconstructionist reading,’ this article discusses limitations of categorising the quality of care as either high or low. The limitations of this ‘binary opposition’ can include a lack of defining attributes; vagueness and fuzziness at the ‘boundaries’ between high quality care and low quality care; concealment of quality as a continuum; and use of the binary opposition to effect social order and control. Health policy implications of our analysis are discussed. Drawing upon the general medical services contract in the United Kingdom, we suggest an approach to overcoming the oversimplification and imprecision that categorisation tends to produce.     

Health-related quality of life (HRQoL) domains most valued by urban IsiXhosa-speaking people

Purpose The aim of the study was to investigate and identify aspects of health-related quality of life (HRQoL) that are most valued by IsiXhosa-speaking people resident in underresourced areas of Cape Town, South Africa. Methodology Fifty-seven domains of HRQoL were identified as important through group discussions with IsiXhosa-speaking people. Participants randomly selected from the community (n = 601) and from individuals seeking medical attention at a local clinic (n = 102) graded the domains on a visual analogue scale (VAS) ranging from 0 for “not at all important” to 10 for “ very important”. The domains were then mapped to the categories of the International Classification of Functioning, Disability and Health. Results The domains regarded as being most important were Food availability [9.5, standard deviation (SD) = 1.52), Owning a brick house (9.4, SD = 1.57), Access to medical services (9.4, SD = 1.55) and Family safety (9.4, SD = 1.7). Having no bodily pain ranked 40th. Environmental Factors were valued significantly more than the other two categories, and those related to Body Functions were valued higher than domains in the category of Activity and Participation. Discussion and conclusion Despite being asked specifically to answer the questions in relation to their health status, the participants apparently did not differentiate between general quality of life (QoL) and specific HRQoL. It appears that members of an underresourced community regard socioeconomic and service delivery aspects of their lives as integral to their perceived state of health. It may be that it is not possible to separate out factors relating to general QoL from those specifically related to HRQoL in an underresourced population, and such populations might not be suitable for inclusion in certain clinical trials where an improvement in HRQoL is the required outcome. Alternatively, if an HRQoL instrument is to be used to monitor the impact of medical interventions, the inclusion of Environmental Factors should be considered.     

贵州省苗族和仡佬族人群生命质量及其影响因素分析

目的 评价贵州省苗族和仡佬族人群生命质量并探讨其影响因素。方法 采用自行设计的生命质量问卷调查582人，同时进行家庭一般情况和个人健康相关行为、2周患病和慢性病患病情况等调查。采用多个独立样本比较的秩和检验和多元逐步回归方法进行统计分析。结果 苗族人群生命质量得分相对最高，汉族居中，仡佬族最低；三个民族的生命质量在多个领域存在差异，生命质量的影响因素也不尽相同，主要有性别、年龄、2周是否患病、是否患慢性病、是否饮用生水、是否吸烟以及受教育程度和家庭生活支出费用的多少等。结论 加强医疗卫生服务，推行合作医疗、加强慢性病的预防和治疗、通过健康教育倡导良好的健康相关行为、发展经济是提高少数民族人群生命质量的关键。     

Factors Affecting Students’ Evaluation in a Community Service-Learning Program

A community service-learning curriculum was established to give students opportunities to understand the interrelationship between family and community health, the differences between community and hospital medicine, and to be able to identify and solve community health problems. Students were divided into small groups to participate in community health works such as home visits etc. under supervision. This study was designed to evaluate the community service-learning program and to understand how students’ attitude and learning activities affected students’ satisfaction. The results revealed that most medical students had a positive attitude towards social service and citizenship but were conservative towards taking the role to serve people in the community. Students had achieved what they were required to learn especially the training in communication skills and ability to identify social issues. Students’ attitude towards social service did not affect their opinions on the quality of the program and subjective rating on their achievement. The quality of the program was related to the quality of learning rated by the students.     

Predictors of the Extent of Agreement for Quality of Life Assessments Between Terminally Ill Cancer Patients and their Primary Family Caregivers in Taiwan

The use of family caregivers to report patients’ dying experiences has been suggested as a way of resolving the problem of non-response bias and missing data in end-of-life research. There is a dearth of information in the literature about the predictors of the extent of agreement for quality of life (QOL) assessments between patients and family informants outside of Western countries. In addition, to date there has been little progress made in deciphering meaningful influencing factors on the levels of agreement between patient and family QOL assessments. The purpose of this study was to identify the impact of the demographics and disease characteristics of patients and families, relationships of the patient to family caregiver, and caregiving burden on the extent of agreement for QOL assessments between Taiwanese terminally ill cancer patients and their family caregivers. Results from assessments by 114 dyads of Taiwanese terminally ill cancer patients and their family caregivers indicated that the extent of agreement between patient and family assessments of patient QOL was negatively influenced by the caregiving burden (amount of care needed and the impact of caregiving on caregiver’s health), positively influenced by the patient’s poorer health status, and there were a mixed effect of the demographics and the relationship between the patient and the family. Providing clinical care tailored at empowering families and aimed at reducing their unmet caregiving needs may improve family caregivers’ abilities to assess patient QOL sensitively.