TY - JOUR
T1 - Using path analysis to investigate the relationships between standardized instruments that measure health-related quality of life, capability wellbeing and subjective wellbeing
T2 - An application in the context of spinal cord injury
AU - Engel, Lidia
AU - Bryan, Stirling
AU - Noonan, Vanessa K.
AU - Whitehurst, David G.T.
N1 - Funding Information:
The authors would like to thank Professor John Brazier (University of Sheffield, UK) for his comments on an earlier version of this paper at the 34th EuroQol Plenary meeting in Barcelona, Spain (21–22 September 2017). We would also like to thank the anonymous reviewers for their constructive and comprehensive comments. Financial support for this study was provided by a grant from the Rick Hansen Institute (Rick Hansen Institute Translational Research Program , Grant # 2012–29 : Spinal Cord Injury & Secondary Complications: A Mixed-Methods Evaluation of Preference-Based Instruments). The funding agreement ensured the authors' independence in designing the study, interpreting data, and writing/publishing reports. We would also like to thank Health Utilities Inc. for the New Investigator Grant awarded to Dr. Whitehurst.
Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/9
Y1 - 2018/9
N2 - While economic evaluations typically embrace health maximization as the maximization objective using quality-adjusted life years, there is increasing interest in the measurement of capability wellbeing and subjective wellbeing (SWB) for informing policy decisions. The objective of this study was to investigate the relationships between health-related quality of life (HRQoL), capability wellbeing and SWB. Data were used from 364 individuals living with spinal cord injury (SCI) who previously completed a web-based, cross-sectional survey (March–June 2013). Regression analyses were used to study the impacts of secondary health conditions on HRQoL, capability wellbeing and SWB; subsequently, a path analysis was used to assess direct and mediated pathways. HRQoL was measured using the EQ-5D-5L and the Assessment of Quality of Life 8-dimension (AQoL-8D) questionnaire; capability wellbeing was assessed using the ICEpop CAPability measure for Adults (ICECAP-A), and SWB was based on a single life satisfaction item (0–10 rating scale). Mean scores were 0.492, 0.573, 0.761 and 6.319 for EQ-5D-5L, AQoL-8D, ICECAP-A and SWB, respectively. Beta coefficients from the regression analyses indicated that secondary health conditions had the greatest negative impact on individuals’ HRQoL (β AQoL-8D = −0.668, β EQ-5D-5L = −0.542), followed by SWB (β SWB = −0.481) and capability wellbeing (β ICECAP-A = −0.477). Capability wellbeing mediated the effect of secondary health conditions on HRQoL and SWB. The indirect effect of secondary health conditions on SWB through HRQoL was not statistically significant when using EQ-5D-5L; indirect effects were found when using AQoL-8D, one through HRQoL only and one through both capability wellbeing and HRQoL. This study highlights the different impacts of secondary health conditions on HRQoL, capability and SWB in the context of SCI. While the greatest impact was observed on individuals’ HRQoL, our results provide further evidence that capability wellbeing (here, the ICECAP-A) adds complementary information about outcomes that could be used in economic evaluation.
AB - While economic evaluations typically embrace health maximization as the maximization objective using quality-adjusted life years, there is increasing interest in the measurement of capability wellbeing and subjective wellbeing (SWB) for informing policy decisions. The objective of this study was to investigate the relationships between health-related quality of life (HRQoL), capability wellbeing and SWB. Data were used from 364 individuals living with spinal cord injury (SCI) who previously completed a web-based, cross-sectional survey (March–June 2013). Regression analyses were used to study the impacts of secondary health conditions on HRQoL, capability wellbeing and SWB; subsequently, a path analysis was used to assess direct and mediated pathways. HRQoL was measured using the EQ-5D-5L and the Assessment of Quality of Life 8-dimension (AQoL-8D) questionnaire; capability wellbeing was assessed using the ICEpop CAPability measure for Adults (ICECAP-A), and SWB was based on a single life satisfaction item (0–10 rating scale). Mean scores were 0.492, 0.573, 0.761 and 6.319 for EQ-5D-5L, AQoL-8D, ICECAP-A and SWB, respectively. Beta coefficients from the regression analyses indicated that secondary health conditions had the greatest negative impact on individuals’ HRQoL (β AQoL-8D = −0.668, β EQ-5D-5L = −0.542), followed by SWB (β SWB = −0.481) and capability wellbeing (β ICECAP-A = −0.477). Capability wellbeing mediated the effect of secondary health conditions on HRQoL and SWB. The indirect effect of secondary health conditions on SWB through HRQoL was not statistically significant when using EQ-5D-5L; indirect effects were found when using AQoL-8D, one through HRQoL only and one through both capability wellbeing and HRQoL. This study highlights the different impacts of secondary health conditions on HRQoL, capability and SWB in the context of SCI. While the greatest impact was observed on individuals’ HRQoL, our results provide further evidence that capability wellbeing (here, the ICECAP-A) adds complementary information about outcomes that could be used in economic evaluation.
KW - Canada
KW - Capability wellbeing
KW - Economic evaluation
KW - Health-related quality of life
KW - Outcome measurement
KW - Spinal cord injury
KW - Subjective wellbeing
UR - http://www.scopus.com/inward/record.url?scp=85050851628&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2018.07.041
DO - 10.1016/j.socscimed.2018.07.041
M3 - Article
C2 - 30081357
AN - SCOPUS:85050851628
SN - 0277-9536
VL - 213
SP - 154
EP - 164
JO - Social Science & Medicine
JF - Social Science & Medicine
ER -