RoseAnne Misajon

Developing a National Index of Subjective Wellbeing: The Australian Unity Wellbeing Index

The Australian Unity Wellbeing Index has beendesigned as a new barometer of Australianssatisfaction with their lives, and life inAustralia. It is based on, and develops, thetheoretical model of subjective wellbeinghomeostasis. The Index comprises two sub-scalesof Personal and National Wellbeing. Data werecollected through a nationally representativesample of 2,000 people in April/May 2001.Factor analysis confirmed the integrity of thetwo sub-scales and, confirming empiricalexpectation, the average level of lifesatisfaction was 75.5 percent of the scalemaximum score. Group comparisons revealed thatall age groups maintained their Personal Indexscore within the normal range. In addition,people in country areas were more satisfiedwith their personal lives than city-dwellers,but less satisfied about the nationalsituation, and people who had recentlyexperienced a strong positive event evidenced arise in wellbeing, whereas those who hadexperienced a strong negative event evidencedwellbeing in the low-normal range. It is arguedthat these data generally support homeostatictheory. However, an unusual result was thatfemales were more satisfied with their ownlives than males. A tentative argument isadvanced that this may represent aconstitutional difference. It is concluded thatthe Australian Unity Wellbeing Index haspotential as a valid, reliable and sensitiveinstrument to monitor national wellbeing.

Vision and Quality of Life: Development of Methods for the VisQoL Vision-Related Utility Instrument

Purpose: To describe the methods and innovations used in constructing the VisQoL, a vision-related utility instrument for the health economic evaluation of eye care and rehabilitation programs. Methods: The VisQoL disaggregates vision into six items. Utilities were estimated for item worst responses (the worst level for each item, with all other items at their best level) and VisQoL all-worst responses (all items at their worst level) using the time trade-off procedure. Time trade-off questions require people to imagine living a fixed number of years with a particular health condition and then indicate how many of those years of life they would be willing to trade to have perfect health. Where respondents indicated a health state was “worse than death” negative utilities were estimated. Time trade-off questions minimized the “focusing effect,” which occurs if respondents discount the fact that all other aspects of health are at their best when answering questions, by using pictorial and verbal aids. Results: Item utilities were combined using a multiplicative model, and VisQoL model utilities placed on a scale where 0.00 and 1.00 represent full health and death, respectively. The VisQoL allows utilities to be calculated for a wide range of vision-related conditions. Conclusion: The 6-item VisQoL has excellent psychometric properties and is specifically designed to be sensitive to vision-related quality of life. It is the first instrument to permit the rapid estimation of utility values for use in economic evaluations of vision-related programs.

Quality of life and sense of coherence in people with arthritis

This study investigated the physical and psychological impact of arthritis on peoples quality of life. A range of variables were examined in a sample of 375 participants who comprised three groups: people with arthritis receiving a support-based service from the Arthritis Foundation of Victoria, people with arthritis receiving standard treatment, and a group of people from the general population. The results revealed that the two arthritis groups reported a significantly higher level of functional impairment, pain, and negative affectivity, and lowered mood, positive affect, and Sense of Coherence, compared to the general population group. They also reported normal levels of importance, but lower levels of satisfaction on various life domains. After statistically controlling for pain however, group differences were eliminated on all variables except for functional impairment and for all satisfaction domains except health. These data are interpreted as evidence that the combination of low domain satisfaction coupled with high domain importance yields a negative psychological state. This, then suggests the possibility of a therapy based on reducing the perceived importance of health.

Measuring the impact and distress of osteoarthritis from the patients' perspective

BackgroundTo assess the internal construct validity of the Perceived Impact of Problem Profile (PIPP), a patient based outcome measure based on the International Classification of Functioning, Disability and Health (ICF), which assesses impact and distress, in an osteoarthritis (OA) cohort.MethodsA questionnaire comprising the 23-item PIPP, which assesses five domains (mobility, participation, self care, psychological well being and relationships), the Western Ontario McMasters University Osteoarthritis Index (WOMAC), the General Well-Being Index (GWBI), and the Hospital Anxiety and Depression Scale (HADS) was posted to people with clinician diagnosed OA. Assessment of the internal construct validity of the PIPP was undertaken using Rasch analysis performed with RUMM2020 software and concurrent validity through comparator measures.ResultsTwo hundred and fifty-nine participants with OA responded. Analysis of the five individual domains of the PIPP indicated that there was good fit to the Rasch model, with high person separation reliability. One item required removal from the Mobility subscale and the Participation subscale. There were strong correlations between the PIPP Mobility scores and the WOMAC disability and pain subscales (rho = .73 and rho = .68), and between the PIPP Psychological well-being and HADS Depression (rho = .71) and GWBI (rho = -.69). High inter-correlations between the impact and distress subscales for each domain (range rho = .85 to .96), suggested redundancy of the latter.ConclusionThis study demonstrates that the PIPP has good psychometric properties in an OA population. The PIPP, using just the impact subscales, provides a brief, reliable and valid means of assessing the impact of OA from the individuals perspective and operationalizing the bio-psychosocial model by the application of a single multi-domain questionnaire.

Subjective wellbeing and ‘felt’ stigma when living with HIV.

PurposeThe impact of stigma on subjective wellbeing was explored in adults living with HIV in Australia and the USA. It was hypothesised that this population would report poorer subjective wellbeing than the general population and that ‘felt’ stigma would contribute significantly to reported levels of subjective wellbeing.MethodsA total of 274 participants were recruited through Australian AIDS councils and HIV-specific online support groups. Participants completed a composite questionnaire comprising the personal wellbeing index—adult (PWI-A), the HIV version of the unsupportive social interactions inventory (USII) and demographic and health-related items. The PWI-A total score was used to form a personal wellbeing index, ranging from 0 to 100.ResultsParticipants reported mean PWI-A total scores of 54.7, considerably below the normative range of 70–80 for Western populations. There was a strong negative correlation between PWI-A total scores and USII total scores with the experience of high levels of unsupportive social interactions being associated with reduced levels of subjective wellbeing.ConclusionsOur study suggests that despite antidiscrimination legislation, ‘felt’ stigma in the form of unsupportive social interactions continues to exert a negative impact on subjective wellbeing. Reduced subjective wellbeing may increase the risk of adverse health behaviours, such as medication non-adherence, substance abuse, risky sexual behaviours and non-disclosure of HIV serostatus.

Impact, distress and HRQoL among Malaysian men and women with a mobility impairment.

BackgroundAlthough non-communicable and chronic disease now accounts for 47% of the global burden of disease, little is known of the everyday experiences and social aspects of disability and disablement in middle and low income countries. This article aims to address this gap by exploring the subjective experience of mobility impairment in Malaysia. Specifically, it examines health-related quality of life and the impact and distress related to impaired mobility, and investigates any gender differences in relation to the experience of disability.MethodsThe data were collected as part of an interdisciplinary, multi-country study known as RESILIENCE (Research into Social Inclusion, Locomotive Impairment and Empowerment through Networking, Collaboration and Education). Cluster sampling was used to administer the EQ-5D and the Perceived Impact of Problems Profile (PIPP) to 210 adults from Selangor state, west coast Peninsular Malaysia.ResultsThe participants consisted of 94 males and 116 females, aged between 18–90 years (mean 60 years), with the majority being Malay. The majority of participants were also married, from rural areas and had primary education only. Very few participants lived alone. In addition, males were more likely to attribute their impaired mobility to an accident. The majority of participants with mobility impairment experienced a moderate to high level of pain/discomfort (79%) and anxiety/depression (72%), and at least some problems with performing usual activities (71%), as measured by the EQ-5D. In addition, using the Perceived Impact of Problems Profile (PIPP), participants also reported high levels of impact and distress related to participation in community life. In general, males reported higher impact and distress across several items, most significantly in regard to participation in community activities, moving around the neighbourhood, ability to live independently, and ability to assist their family members.ConclusionThis paper provides preliminary data regarding the health-related quality of life among Malaysians with impaired mobility, and highlights the multifaceted impact of disability and the importance of acknowledging the diverse cultural contexts in which disability can occur. It also raises questions regarding gender differences in the subjective experience of disability in Malaysia.

Utility weights for the vision-related Assessment of Quality of Life (AQoL)-7D instrument.

Purpose: To obtain utility weights consistent with the needs of economic evaluation for the Assessment of Quality of Life (AQoL)-7D, a generic instrument created to increase the sensitivity of the measurement of quality of life amongst people with impaired vision. Methods: Two extant instruments were combined, the Vision-related Quality of Life Index (VisQoL) and the AQoL-6D. Utilities were obtained from patients with visual impairment and from the general population using time trade-off (TTO) methodology. Dimensions were combined and an econometric adjustment used to eliminate the effects of instrument redundancy. Bias was tested by comparison of holistic TTO values with utility scores predicted from the AQoL-7D scoring formula. Results: The AQoL-7D instrument consists of 26 items and 7 dimensions each with good psychometric properties. Their combination into a single instrument resulted in significant redundancy which was successfully eliminated. Utility formulae for both the public and patients produced bias-free estimates of the utility of holistic health states describing visual impairment. Results imply differing valuations of health states by the public and by people with impaired vision. Conclusions: The AQoL-7D can detect changes in health states affecting people with impaired vision which are likely to be overlooked by other generic instruments due to content insensitivity. The utilities it produces are generated using a “mainstream” methodology, the TTO. Quality-adjusted life year values based on the AQoL-7D may therefore be used for economic evaluation of programs.

Measurement of indirect costs for people with vision impairment.

From a societal perspective, chronic eye diseases can affect not only the person who has vision impairment but also the economics of that society. To obtain comprehensive medical and non‐medical expenditures for people with impaired vision, direct and indirect costs should be collected. Indirect costs are usually not included in cost evaluation in health economics due to the difficulty of the data collection and analysis. Questionnaires and cost diaries have been developed in this study to estimate total resource use, expenses, and lost production from the participants or their caregivers due to the participants’ vision loss. Pilot testing was conducted to verify the format, clarity of instructions, relevance of content and completeness of the questionnaires and diary. Modifications were then made to the format from feedback from the participants. Diaries using large print, audio and Braille facilitate data collection for people with impaired vision.

More Than SF-36? Using Narratives to Elaborate Health and Well-Being Data in Recent Lower-Limb Amputees

Limited research has been conducted on the health-related quality of life of people who have undergone a major amputation. This paper explores the complexities of this population, through narratives elicited during in-depth interviews to elaborate data collected through administration of the SF-36 on self-reported health and well-being. Sixty inpatients aged 21-89 were recruited following the amputation of one or both lower limbs whilst at four (two rural, two urban) rehabilitation centres in Victoria, Australia. Results indicated a significant decrease in health-related quality of life in relation to the physical components of the SF-36. However, these limitations were viewed as temporary, and people anticipated a return to higher levels of physical functioning post-rehabilitation. No significant difference was found in regard to mental health (amount of time a person experienced feelings of nervousness, anxiety, depression and happiness) or the overall mental component summary scores, but participants scored signifi- cantly lower on three of the four mental components compared with Australian

Pinoy TV: imagining the Filipino-Australian community

Abstract Both ethnic community television and representations of Filipino-Australian community are underrepresented areas in Australian cultural studies scholarship. With existing work focusing on the ways in which Asian Australian communities may consume media sources, this article examines cultural representations of Filipino-Australians and modes of addressing an imagined Filipino-Australian ‘community’. Through a nuanced reading of the creation and development of Pinoy TV, Australias only Filipino-Australian community television producer, we contextualise the sociocultural positioning of contemporary Filipino-Australians within the broader national culture. The article examines issues crucial to Filipino-Australian community identity-building, including language, gender and generational differences.