Due to these problems of defining the concept of quality of life, researchers have attempted to create a clearer conceptual framework for the construct. They divided the quality of life measures according to who devised the measure or in terms of whether the measure is consider objective or subjective. In 1997, Browne differentiated between the standard needs approach and the psychological processes perspective. The first is based on the assumption that “a consensus about what constitutes a good or poor quality of life exists or at least can be discovered through investigation.” It also assumes that common needs, rather than wants, are central to quality of life. In contrast, the psychological processes approach considers quality of life to be “constructed from individual evaluations of personally salient aspects of life.” So Browne saw quality of life measures as being devised by researchers or individuals themselves.
In 1998, Muldoon provided an alternative conceptual framework for quality of life, based on the degree to which the domains being rated were objectively validated. It was argued that quality of life measures should be divided into those that assess objective functioning, the ones that describe an individual’s level of functioning that must be validated against directly observed behavioural performance, and those that assess subjective well-being, describing the individual’s own appraisal of their well-being. So some progress has been made to clarify the problems surrounding measures and quality of life, but an exact definition is still unclear. In 1990, Annes argued that the term should stop being used altogether.
The range of measures that have been developed are considered in terms of undimensional measures such as Goldberg’s ‘General Health Questionnaire’ developed in 1978, the ‘Hospital Anxiety and Depression Scale’ devised by Zigmond and Snaith in 1983, the ‘Beck Depression Scale’ and the ‘McGill Pain Questionnaire’. All of these measures assess one specific aspect of health, and are used in their own or in conjunction with others. Another type of measures are the multidimensional measures that assess health in the broadest sense. Patients are asked simple questions to determine their state of health on a scale rating from ‘poor’ to ‘perfect’. They are also asked to make judgements about their health based on a scale from ‘best possible’ and ‘worst possible’. In 1995 Idler and Kasl discovered that even though they weren’t very detailed, they did correlate highly with more complex measures and can be useful as outcome measures. But, even so, researchers tend to use composite scales.
Many different measures have been developed, due to the fact there are so many ways of defining quality of life. Some focus on particular populations. For example, Lawton investigated the elderly in 1972 and 1975, and people in their last year of life in 1990. Generic measures of quality of life have also been developed, that can be applied to any individual. An examples of this is the ‘Nottingham Health Profile by created by Hunt in 1986. These type of measures have been criticised for being too broad, and therefore result in a definition of quality of life that is too encompassing, vague and unfocused. In contrast, they have also been criticised for being too focused, and for potentially missing out aspects of quality of life that may be of specific importance to the individual concerned. It is believed that by asking individuals to rate statements that have been developed by researchers and answer a pre-defined set of questions that the individual’s own concerns may be missed. This has led to the development of individual quality of life measures.
These measures of subjective health status ask the individual to rate their own health, and are in contrast with any measures of mortality, morbidity and functioning that are usually completed by careers, researchers or observers. But, even though these type of measures enable individuals to rate their own health, they do not allow them to choose the dimensions in which to rate it. It is important to consider how one set of individuals, who happen to be researchers, know what is important to the quality of life of another set of individuals? So with this in mind, researchers have developed individual quality of life measures that ask the subjects to rate their own health in their own personally defined dimensions. An example of this is the ‘Schedule for Evaluating Individual Quality of Life’ devised by McGee in 1991. This asks subjects to select five areas of their lives that are important to them, and then rate them in terms on importance and how satisfied they currently are with each dimension.
Quality of life measures such as subjective health measures and simple/composite scales play a central role in many debates within health psychology, medical sociology, primary care and clinical medicine. Many funded trials are now required to include a measure of quality of life among their outcome variables.
The concept of quality of life can become very important to patients with serious diseases such as HIV. In 1988, George noticed that even though there were many reports of high levels of psychological distress and psychiatric symptomatology in HIV patients, there wasn’t much literature on any intervention studies. One popular method was invented by Beck in 1976. He created the ‘Cognitive-Behavioural Model of Treatment’ in order reduce stress and improve coping skills and quality of life of diagnosed patients. There is a substantial body of evidence that suggests that this type of therapy can benefit patients with psychological symptomatology. This model contains three assumptions, the idea that thoughts can determine emotion and behaviour, that unrealistic and negative thoughts can result in an emotional disorder, and that decreasing negative, unrealistic thoughts and increasing positive, realistic thoughts can reduce emotional symptomatology. A common misapprehension is that this type of therapy just simply encourages positive thinking, but it does, in fact, comprise of a number of techniques that address dysfunctional cognitions and behaviours within a structured therapy session. These techniques come into action in circumstances such as, dealing with helping the HIV positive patients to face their realities. This can be hard, so a technique called ‘decatastrophisation’ is used that attempts to separate the reality from the accompanying global negative feelings and allows the patient to explore alternative ways of coping. It also plays a major part in preventing anxiety or a severe depressive response. Hawton and Kirk in 1989, and Selwyn and Antoniello in 1993, commented on the model by stating that the problem-solving approach does aim to support individuals in making informed decisions about their present difficulties, and to provide them with the general skills and strategies required to deal with any future problems. George examined HIV patients six to twelve months after they had received individual, cognitive-behavioural interventions, and found a significant reduction in stress and many improvements in the levels of anxiety and depression. In 1990, Hedge, James and Green also reported increases in self-esteem and decreases in anxiety and depression after studying an intervention aimed at increasing coping skills. Fawzy, Namir and Wolcott in 1989, Moulton in 1990 and Lamping in 1993, all stated that this type of group intervention was successful in reducing distress and improving the patient’s quality of life.
There is a growing awareness among health care specialists that quality of life is an important health outcome in chronic diseases such as cancer. Relaxation training is seen as a promising intervention that is widely used as it helps to decrease anxiety, pain and nausea from treatments such as chemotherapy. In 1986, Bridge, Benson, Pietroni and Priest found that combinations of relaxation training with stress management and blood pressure monitoring were proven to be useful in the treatment of essential hypertension. This, combined with improvements in physical fitness, can visibly improve the patients’ quality of life.
A popular time of life to consider a quality of life is old age, where death seems easier, as the elderly are generally more prepared to face the prospect of it. They tend to typically die from degenerative diseases such as cancer, a stroke or heart failure. The terminal phase of illness is also often shorter and generally dignified. In contrast to other age groups, health goals for the elderly have always been more focused on the reduction of mortality than on improving their quality of life. But, statistics compiled over the past fifteen years suggest that progress has been made in this area. People aged sixty-five and up have experienced more active days over the years, emphasising the fact that the importance of improving their quality of life has taken precedence in general health policy concerns. ‘Ageism’, a term coined by Butler in 1969, is generally used when elderly people are referred to as sick, sedentary, sexless, senile and impoverished individuals, and can be damaging. This can be helped by a positive attitude from the medical profession, and can sometimes help to improve the elderly population’s ideas about their quality of life and how important it is to them in their final years. This concept can be carried out by advising them to compensate for any physical impairment brought about by the ageing process by pacing their daily routine. Sexual labels can also be hurtful, such as an elderly man’s interest in sexual matters being labelled as ‘a dirty old man’. Reports made by Kinsey in 1948 and 1953 showed that most females maintained an interest in sexual relations until their sixties, and males in sound physical health were found to expect adequate sexual performance beyond eighty years of age. Despite these facts, the for-mentioned labels can result in elderly individuals being shamed into concealing their sexuality or sexual interest to the point where they begin to see themselves as sexless beings. The expression of love, emotional bonding and sexual activity in later life can help to improve their ideas of their quality of life.
So, to conclude, the concept of quality of life is broad, but well documented. There are many different definitions and ideas about what the term actually means or represents. It also means different things to different people, and is used in different contexts in different societies and professions. But it is mainly used in the medical profession, in areas such as chronic illness or the elderly, as they have many reasons to reflect on their lives before they move onto the next stage. Quality of life is a well-known, well-used term that refers to the idea of making an individual’s life as comfortable and enjoyable as possible in many different types of circumstances.
