Satisfaction with quality of life poststroke: effect of sex differences in pain response

OBJECTIVE: To study the relationship between sex differences among men and women in the response to pain and the effect on satisfaction with quality of life (QOL) in poststroke patients approximately 90 days after discharge from inpatient medical rehabilitation. DESIGN: Cross-sectional design. SETTING: Community based. PARTICIPANTS: The sample included 1724 patients (877 men, 847 women) aged 40 years and older with a history of stroke, according to information obtained from the IT HealthTrack database. The average age was 68.7 years; 79.3% were non-Hispanic white. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Satisfaction with QOL. RESULTS: Pain ratings for both the men and the women were significant and inversely associated with satisfaction with QOL after adjustments for possible confounding factors. However, among men with stroke, each 1-point increase in pain rating was associated with an 18% decreased odds of being satisfied with QOL (odds ratio [OR], .81; 95% confidence interval [CI], .77-.86). Conversely, among women with stroke, each 1-point increase in pain rating was associated with an 11% decreased odds of being satisfied with QOL (OR=.89; 95% CI, .84-.95). CONCLUSIONS: Our data indicate that pain after stroke is significantly associated with reduced satisfaction with QOL, particularly among men. Increased awareness and treatment of pain may improve satisfaction with QOL. Our findings suggest that sex differences and pain response are clinically important factors in examining satisfaction with QOL in the poststroke population.     

Predictors of quality of life among spouses of stroke patients during the first year after the stroke event

BACKGROUND: Stroke, a disease with severe consequences for patients and their families, often lead to psychosocial stress, and a decline in the quality of life (QoL) among carers. Predicting the QoL is essential in the development of effective nursing support interventions. AIM: The aim of the present study was to identify predicting factors for the general QoL among spouses of stroke patients, and to determine whether these predictors change during the first year after the patient's stroke event. DESIGN: One hundred spouses were followed three times during 1 year regarding QoL, own illness, economic situation, well being, life situation, sense of coherence, social network and the patients' ability in activities of daily living (ADL). Stepwise multiple linear regression analyses were conducted for the baseline, 6- and 12-month assessments respectively, with the present QoL as the dependent variable. RESULTS: Over time during the first year after the patients' stroke event, there were significant differences in the spouses perceived general QoL. Life situation and economic situation were the only predictors of the spouses' QoL, which emerged during the entire year after the patient's stroke event, while well being, education, own illness, social network and ADL ability (patient) emerged at one or two occasions. CONCLUSION: The psychosocial factors -- life situation, well being, social network, education and economy -- are important in predicting QoL among spouses of stroke patients, and these predicting factors change over time. Determining the predictors at an early stage, and continuously over time, will help to focus clinical nursing interventions on the spouses' changing needs.     

Predictors of poor outcome in patients with neck pain treated by physical therapy

OBJECTIVES: This study evaluated predictors of poor outcome in patients with neck pain treated by physical therapy, and sought to compare the findings of empirical data with physical therapy practitioners' subjective perceptions about predictors of outcome. METHODS: This study was a secondary analysis of data from a randomized controlled trial assessing physical therapy treatments for neck pain (n=346). A baseline questionnaire provided data on a number of potential risk factors of poor outcome at follow-up. Follow-up was conducted at 6 weeks and 6 months by postal questionnaire with outcome defined separately by perceived (global) change and minimal clinically important differences in the Northwick Park Neck Pain Questionnaire (MCID-NPQ). Therapists' perceptions of predictors for treatment outcome were captured using a separate questionnaire, and the ratings compared with ranks derived from the 6-month trial data. RESULTS: Baseline characteristics accounted for a much greater proportion of explained variance for global change compared with MCID-NPQ at 6 months. Independent biopsychosocial characteristics included manual social class, catastrophizing, anxiety and depression, low treatment expectations, severity of baseline neck pain/disability, presence of comorbid back pain, and older age. Physical therapist ranks correlated highly with those derived from the trial data. CONCLUSIONS: Significant predictors of outcome were identified, particularly at 6 months, including psychosocial, functional, and demographic indicators. Our findings suggest that physical therapists are collectively aware of the relative importance of physical and psychosocial factors in predicting clinical outcome. However, a significant amount of variability in outcomes in our prognostic models remained largely unexplained, indicating that we need to explore further underlying factors to inform clinical decision-making.     

Evaluating quality of life in children with cancer using children's self-reports and parent-proxy reports

BACKGROUND: Assessment of quality of life (QOL) of children is complex due to the developmental differences in understanding the content being measured. The validity of parent-proxy reports versus children's self-reports remains to be clarified. OBJECTIVES: To examine the agreement on QOL measures between children's self-reports and parent-proxy reports at different points in time, including at baseline and at 6-month follow up, as well as the change in scores between 6-month follow up and baseline. METHOD: A longitudinal study of QOL assessment of children with cancer for parents and children was conducted. At baseline assessment, 126 children with cancer and at least one of their parents participated (n = 252). Forty boys, 25 girls, and their parents (n = 130) completed the 6-month follow up assessment. RESULTS: Parents tended to report better QOL than did the children at both baseline and 6-month follow up assessments in both the on- and off-treatment groups. Agreement on QOL measure between children and parent proxies varied as a result of the following factors: treatment status (on and off treatment), time (at baseline vs. at 6-month follow up), and changes in score between the time of the baseline assessment and the 6-month follow up. The effects of time, age, gender, and severity of illness had different degrees of significance as predictors on various subscales. DISCUSSION: The predictors of agreement between patients' reports and parent-proxy reports, including the passage of time (from baseline to 6-month follow up), gender, age, and illness severity, have not been conclusively determined. Further studies are needed to examine patient-proxy agreement during a longer follow up period at more than two points in time and using the same patients through the stages of confirmation of diagnosis, acceptance of diagnosis, treatment, and after treatment.     

Psychosocial factors as predictors of functional status at 1 year in patients with left ventricular dysfunction

Chronic heart failure patients often experience significant functional impairments. A better understanding of the biopsychosocial correlates of functional status may lead to interventions that improve quality of life in this population. Social isolation, mood disturbance, low socioeconomic status, and non-White ethnicity were evaluated as possible correlates of impaired functional status in 2,992 U.S. patients with left ventricular ejection fractions (LVEFs) 相似文献   

Predictors of life satisfaction: a spinal cord injury cohort study

OBJECTIVE: To determine unique demographic, medical, perceived health, and handicap predictors of life satisfaction 2 years after spinal cord injury (SCI), as well as the predictors of change in life satisfaction from year 1 to year 2. DESIGN: Prospective predictive study performed by using longitudinal data from 18 Spinal Cord Injury Model Systems. SETTING: University physical medicine and rehabilitation department. PARTICIPANTS: Adults with traumatic onset SCI (N = 940) evaluated at 1 and 2 years' postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Satisfaction with Life Scale (SWLS) 2 years post-SCI. Predictor variables: demographic characteristics, impairment and disability classifications, and 1 year post-SCI measures of life satisfaction (SWLS), medical complications, self-perceived health (Medical Outcomes Study 12-Item Short-Form Health Survey), and extent of handicap (Craig Handicap Assessment and Reporting Technique). RESULTS: The factors uniquely associated with an increased risk of lower self-reported life satisfaction at year 2 post-SCI included being male and unemployed, with poor perceived health, decreased mobility, and decreased social integration. After controlling for year 1 estimates of life satisfaction (ie, examining change in life satisfaction), only mobility and perceived health were uniquely related to life satisfaction 2 years post-SCI. CONCLUSION: Mobility and perceived health appear to be the consistent predictors of life satisfaction at year 2 post-SCI, as well as change in satisfaction from year 1 to year 2. Because both factors are amenable to change, they are reasonable targets of intervention programs. Identifying specific mechanisms of perceived health and mobility associated with life satisfaction should be an important area of continued research.     

Shared and independent associations of psychosocial factors on work status among men with subacute low back pain

OBJECTIVES: Psychosocial variables are acknowledged predictors of back disability, but multivariate studies are needed to understand their independent and overlapping effects. The objective of this prospective cohort study was to evaluate independent and shared associations of psychosocial variables on work status after first onset of low back pain (LBP) in working men. METHODS: One hundred forty male military personnel reporting subacute, first onset LBP (2 mo average duration) completed an interview-based and survey-based psychosocial assessment within the domains of job satisfaction, stress and coping, pain perceptions and beliefs, perceived functional disability, and mood disturbance. Work status was assessed at baseline, 6 and 12-month postpain onset. RESULTS: In logistic regression analyses at baseline, work status was associated with pain interference and perceptions of physical impairment. Beyond 2 months, the extent to which pain was believed to interfere with function was the only significant predictor of subsequent changes in work status. Job dissatisfaction was associated with more impaired work status, but not after controlling for income. Depressive and anxious mood symptoms were prevalent but failed to explain additional variance in work status. DISCUSSION: After first onset of men with subacute LBP, self-reported pain intensity and functional limitation account for most of the variance in work status explained by psychosocial factors; however, the resulting disability can be accompanied by mild to moderate mood symptoms. This suggests that interventions to improve function, if commenced early in the course of subacute pain, might prevent work disability.     

A structural model of stress, psychosocial resources, and symptomatic experience in chronic physical illness

The purpose of this investigation was to test a theory-based structural model describing the relationships among psychosocial resources (strength of psychosocial attributes and basic need satisfaction), perceived stress, disease severity, and symptomatic experience in people with chronic obstructive pulmonary disease (COPD). One hundred nine subjects (58 males and 51 females) participated in the cross-sectional mail survey. Psychosocial attribute strength was a significant predictor of basic need satisfaction; basic need satisfaction was a significant predictor of perceived stress; and basic need satisfaction, perceived stress, and disease severity were significant predictors of symptomatic experience. The psychosocial attributes variable was a significant predictor of basic need satisfaction for both sexes. For males, basic need satisfaction and stress were significant predictors of symptomatic experience, while psychosocial attributes were not. For females, the psychosocial attributes variable was a significant predictor of symptomatic experience, while basic need satisfaction and stress were not. The findings suggest that psychosocial resources and perceived stress may be important factors in the symptomatic experience of adults with COPD. Males and females seem to differ in the role psychosocial attributes and basic need satisfaction play in the dynamics of the proposed model.     

Predictors of hostility among university students in Jordan

Scand J Caring Sci; 2010; 24; 125–130
Predictors of hostility among university students in Jordan
Objective:  The study aimed at examining predictors of hostility among university students in Jordan.
Methods:  Two-step multiple hierarchical regression analysis was used to examine the relationship between hostility, perceived stress, perceived social support, depression, moral commitment, life satisfaction and optimism utilizing data collected from 428 university students were recruited from six different universities in Jordan.
Results:  Life satisfaction, depression and perceived stress were significant predictors of hostility among university students (p < 0.05). Life satisfaction was inversely related, whereas depression and perceived stress were positively related to hostility. Male and female university students were not different in their hostility scores.
Conclusion:  Assessment of psychosocial well being is an important component to manage hostility among university students. The importance of psychosocial well being is highlighted and implications for mental health nurses and professionals are presented.     

The validity of prospective and retrospective global change criterion measures

OBJECTIVE: To assess the validity of retrospective versus prospective criterions of change. DESIGN: Single cohort pretest-posttest design. SETTING: Physical or occupational therapy outpatient clinics. PARTICIPANTS: Volunteer sample of 211 patients with upper-extremity musculoskeletal problems. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disabilities of the Arm, Shoulder, and Hand questionnaire, the Shoulder Pain and Disability Index, the Patient-Rated Wrist Evaluation, the Medical Outcomes Study 12-Item Short-Form Health Survey; global disability rating (GDR), retrospective global rating of change (GRC), and patient satisfaction. RESULTS: Correlations were calculated among the baseline, 3-month follow-up, and change scores for each outcome measure with the change criterion instruments. Retrospective GRC and patient satisfaction ratings showed moderate correlations with the 3-month follow-up scores, but nonsignificant correlations with baseline scores. By contrast, the prospective GDR criterion showed significant correlations with both baseline and 3-month follow-up scores ranging between 0.3 and 0.4 (absolute value). CONCLUSIONS: Retrospective self-report measures of change do not accurately reflect true change over time. The retrospective GRC and patient satisfaction were heavily influenced by current (posttreatment) status whereas the prospective global change measure reflected both baseline and posttreatment status equally and thus appeared to be a more valid measure of change over time. This study demonstrates the need for an alternative criterion for establishing true individual change.     

Effects of self-efficacy, social support and knowledge on adherence to PEFR self-monitoring among adults with asthma: a prospective repeated measures study

BACKGROUND: Long-term adherence to self-monitoring of peak expiratory flow rate (PEFR) is essential for early detection of declining lung function in individuals with asthma. Psychosocial and cognitive factors can influence adherence to PEFR self-monitoring behaviors. OBJECTIVES: The specific aims of this prospective, repeated measures study were to: (1) determine the effects of asthma self-efficacy, perceived satisfaction with social support and asthma knowledge on adherence to PEFR self-monitoring behavior; and (2) examine whether adherence to PEFR self-monitoring mediates the effects of psychosocial/cognitive factors on lung function and asthma symptoms in adults with asthma. DESIGN: Sixty-eight participants completed standardized questionnaires three times at baseline, 1 month, and 3 months and kept the records of PEFR self-monitoring behaviors twice a day. Data were analyzed using multiple linear regressions. Adherence rates to PEFR self-monitoring were 93.5% and 74.9% at 1 and 3 month, representing those who remained in the study (n=39). Other participants withdrew from the study. FINDINGS: Both at 1 and 3 month, psychosocial/cognitive factors as a whole did not account for a significant variance in adherence to PEFR self-monitoring. Univariate analyses, however, indicated that baseline asthma self-efficacy and asthma knowledge at 1 month were significant independent predictors for adherence to PEFR self-monitoring at 3 month. CONCLUSION: Adherence to PEFR self-monitoring did not mediate the effects of asthma self-efficacy, perceived satisfaction with social support, and asthma knowledge on lung function and asthma symptoms. Lung function was low, but participants reported low asthma symptoms, both of which remained stable over time. Because of a small sample size and high attrition, the findings of the study need to be interpreted with caution. Given the importance of long-term adherence to self-management in asthma and other chronic illnesses, factors influencing adherence need to be further investigated to set a basis for future interventions.     

Sexual knowledge, attitudes and activity of older people in Taipei, Taiwan

Aims. We examined sexual activity and predictive factors among older people in Taipei, Taiwan. We aimed to characterize the older population engaged in sexual activity and determine influencing factors, exploring aspects of sexuality that may influence elders’ health and quality of life (QOL). Background. Studies of sexual attitudes and behaviour have found that sexual difficulties are common among mature adults worldwide, influenced in men and women by physical health, ageing, psychosocial and cultural factors. Design and methods. We conducted a community‐based retrospective study involving a random sample of 412 men and 204 women over age 65. A questionnaire on demographics and social situations was administered, along with a Sexuality Knowledge and Attitudes Scale; 34 questions evaluated sexual knowledge and 18 evaluated sexual attitudes. Results. Two‐hundred and twenty participants were sexually active (35·7%), 185 mainly with spouses (84·1%); frequency was 21·4 (SD 16·9) times per year (range: 1–120). Multiple logistic regressions identified five significant predictors of sexual activity: gender, age, being with spouse, sexual knowledge and sexual attitudes. Sexual activity was significantly associated with higher education levels, lower stress and more self‐reported daily activities. Conclusions. Our results agreed with Western studies linking sexual activity with better health and higher QOL in older adults. Older peoples’ stress and daily activity levels are recognized quality‐of‐life measures; lower stress and more daily activities among sexually active older people suggests a connection between sexual activity and higher QOL. Increasing knowledge and improving attitudes about sexuality may help older people build healthier relationships and enhance health and QOL. Relevance to clinical practice. If healthcare professionals possess greater understanding of older peoples’ sexuality, healthcare systems may find ways to increase sexual knowledge and foster healthier attitudes and relationships to improve older peoples’ overall health and QOL.     

Postpartum depression and related psychosocial variables in Hong Kong Chinese women: findings from a prospective study

Research on predictors of postpartum depression (PPD) in Hong Kong (HK) Chinese women is scant. A prospective study with 385 HK Chinese postpartum women was conducted to identify correlations between PPD and demographic variables, and antenatal depression and psychosocial variables, and to determine which of these variables were predictors of PPD. Using the Edinburgh Postnatal Depression Scale (EPDS), we classified 19.8% of participants as postnatally depressed. Fifty-six percent of the variance in PPD was explained by social support and stress factors. However, social support factors accounted for only a small percentage of that variance. The major predictors were antenatal depression, postnatal perceived stress, and childcare stress. HK women may benefit from a culturally appropriate intervention focused on reducing stress in the postpartum period.     

Community activities and individuals' satisfaction with them: quality of life in the first year after traumatic brain injury

OBJECTIVE: To investigate the relations between community activities and satisfaction with these activities, desires to change them, and global life satisfaction. DESIGN: Interview study with follow-up 1 month after rehabilitation discharge and 12 months postinjury. SETTING: Community. PARTICIPANTS: One hundred sixty-two individuals hospitalized with mostly moderate-to-severe traumatic brain injury. About 90% were reached (mostly by phone) 1 month after rehabilitation discharge; 84.6%, at 12 months postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Community Integration Questionnaire-2, augmented by individuals' ratings of satisfaction or dissatisfaction with and desire to change each activity; and the Satisfaction With Life Scale. RESULTS: Although significant correlations were found for some items, most correlations between activities and ratings of global quality of life (QOL) were low and nonsignificant. Individuals reported that they were satisfied with most of their community activities, but there were exceptions (eg, paid work). Correlations between activity-specific satisfaction and general life satisfaction were generally weak and nonsignificant. Dissatisfaction with an activity correlated strongly with desire to change the activity, but general life satisfaction did not correlate with desire to change activities. CONCLUSIONS: The lack of association between frequency of activities and subjective appraisals of them is a challenge to outcomes measurement and has implications for the targeting of rehabilitative interventions and evaluation of their worth. More research is needed to understand how individualizing functional objectives might maximize the effects of rehabilitation on the QOL of persons served.     

Emergency Medical Technician Schedule Modification: Impact and Implications during Short- and Long-term Follow-up

Objective: To determine whether modifying work schedules from 24- to 12-hour shifts results in favorable improvements across a range of psychological and social variables among emergency medical technicians (EMTs).
Method: Sequential (before and after) surveys were completed voluntarily by EMTs at 1 month prior to, 2 months after, and 1 year after a workshift modification (change from 24- to 12-hour shifts). The surveys assessed job satisfaction, occupational burnout, and attitudes toward work schedules. The questionnaires were completed at emergency medical service stations.
Results: Of 70 EMTs in the system, 51 (73%) completed the first 2 stages of this study; 35 (50%) completed all 3 stages. Paired-sample t-tests revealed significant differences between baseline and 2-month posttest scores on the following variables: the Maslach Burnout Inventory: Emotional Exhaustion Scale (less perceived exhaustion at 2 months); the Schedule Attitudes Survey: General Affect (perceived more positive view toward schedule at 2 months); Social/Family Impact (perceived less disruption of social/family life at 2 months); and Composite (less overall disruption in quality of life at 2 months). Statistically significant differences between baseline and 1-year posttest scores were found on the following: Schedule Attitudes Survey: General Affect (more positive view toward schedule at 1 year); Social/Family Impact (less disruption in social/family life at 1 year); and Composite (less overall disruption in quality of life at 1 year).
Conclusion: Modifying EMTs' work schedules from 24- to 12-hour shifts was associated with improvements in EMTs' general attitudes toward their schedules, less disruption of social and family life, and decreased levels of emotional exhaustion at 2 months after the change. While the improvements in EMTs' attitudes toward their schedules persisted at the 1-year follow-up, the measure of emotional exhaustion returned to baseline.     

Social risks for disabling pain in older people: a prospective study of individual and area characteristics

Pain is common in adult life, and the extent to which pain interferes with daily activities rises with age. Little is known about the social factors associated with disabling pain. The objective was to determine the individual and neighbourhood social factors that predict pain that interferes with daily activities. This was a prospective cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 and over registered with six general practices were sent baseline and 3-year questionnaires. Individual predictors of the onset of pain interference were determined through multilevel modelling. Neighbourhood impact was examined using measures of deprivation taken from the UK Index of Multiple Deprivation 2004. 19% of the 3644 people without pain interference at baseline reported it at follow-up. Baseline social factors were weaker predictors than baseline age, multiple-site pain and anxiety or depression. However, perceived financial strain was a significant predictor (OR 1.5; 95% CI: 1.2, 1.8). Onset of pain interference varied by local area deprivation status. Those living in areas of high health deprivation had an increased risk of developing pain interference (OR 1.6; 95% CI: 1.1, 2.3). Whilst the onset of pain which disrupts daily life is influenced mainly by the characteristics of the pain and by the psychological factors, there are links with the social factors, particularly individual measures of perceived income adequacy. The onset of disabling pain is also influenced by the place where one lives. Policies to prevent disabling pain need to consider the contribution of neighbourhood deprivation and income inequalities to the extent of the problem.     

Quality of life and its predictors among women with gynaecological cancers

BackgroundSurvival rates among gynaecological cancer patients have increased over time; however, patients must now cope with long-term treatment-related issues affecting their quality of life (QOL). Little is known about the factors influencing QOL in patients with gynaecological cancers in the Chinese population.AimTo identify QOL predictors among patients with gynaecological cancers, and examine the relationship between QOL and demographics, stress, coping strategies, and social support. Methods: A cross-sectional survey was conducted with 111 patients who were recruited from the gynaecological oncology outpatient department of a hospital in Taiwan.FindingsPatients’ QOL was positively correlated with marriage, emotion-focused coping, problem-focused coping, and social support. QOL was negatively correlated with malfunctioning coping strategies and stress. Regression models accounted for 19%–30% of the variance across the four domains of QOL. Stress was a significant predictor of all QOL domains. Social support was the main predictor of the social relationships and environment QOL domains. The lowest QOL score was for sexual life.DiscussionPatients with gynaecological cancers reported lower levels of satisfaction with the social relationships and psychological health domain of QOL. Diagnosis and treatment for a gynaecological cancer may impact how women perceive their femininity and relationship with their husband.ConclusionsThis study provides a comprehensive picture for nurses to understand the factors associated with QOL among patients with gynaecological cancers in the Chinese cultural context. Screening for stress is important since stress was the main predictor for all domains of QOL among patients. Providing support, especially familial and emotional support, to patients with Chinese cultural backgrounds is critical because of their family values. Offering a private space to discuss the patients’ concern and carefully observing their non-verbal language are essential because these patients often do not talk about their cancer and sexual life openly and publicly.     

Predicting the outcomes of living with asthma

The purpose of this study was to explore the impact of person and disease predictors on psychosocial and morbidity outcomes in adults with chronic asthma. Ninety-five asthmatic adults were followed for 60 days with standardized questionnaires and three interviews. Amount of distress during an asthma episode, perceived danger from asthma, and appraisal of social support were predictors of emergency room visits. Self-care, perceived life stress, nocturnal symptoms, and amount of distress during an asthma episode were predictors of depression. Financial status and the absence of nocturnal symptoms of asthma predicted life satisfaction. © 1993 John Wiley & Sons, Inc.     

Coronary artery bypass grafting: quality of life of patients in Karachi

In the Third World, cardiac patients often suffer not only from the nature of their illnesses, but also the insufficiency of the facilities available. Although the effectiveness of coronary artery bypass grafting (CABG) is being evaluated in terms of mortality, complications or recurrence of symptoms, empirical studies assessing the change in patients' quality of life (QOL) after CABG within the Pakistani cultural context are lacking. Aims: The aims of the present study are to assess and compare the change in health-related quality of life before and 1 month after CABG and to assess the differences in QOL with respect to age, gender and cardiac rehabilitation programme attendance. Method: A prospective single group pre- and post-study design was used, whereby patients completed a questionnaire before and 1 month after surgery. Questions considered the person's physical capacity, psychological wellbeing, social relationships and satisfaction from their health condition. Results: The results indicated a significant improvement in patients' physical and psychological health, satisfaction with social relationships and overall health status. Younger patients showed significantly lower scores on the social domain (reflecting greater dissatisfaction with their sex life and personal relationships). Female participants showed significantly lower scores in psychological health post surgery. Lastly, participants of the cardiac rehabilitation programme scored significantly higher in psychological health compared with non-participants. Conclusion: QOL improved from prior to and 1 month after CABG while differing (in specific domains) with respect to age, gender and cardiac rehabilitation programme attendance. The findings can be used to develop interventions to improve health and QOL in specific domains with respect to specific groups.