COMPREHENSIVELY MEASURING SUBJECTIVE WELL-BEING: DIMENSIONALITY ANALYSIS FOR IMPROVED OUTCOME ASSESSMENT

Purpose:

Allocation of inevitably limited financial resources for health care requires judgments about the effectiveness of interventions. Health-related Quality of Life (QoL) scales are commonly used in economic evaluations, but interventions are likely to affect QoL more broadly than is measurable with existent scales. In traditionally used measures, physical dimensions like ‘mobility’ are prominently present. In line with the WHO definition of health, a recent Delphi-procedure shows that value assessment needs to put more emphasis on mental and social dimensions. Our main objective was to identify the core dimensions of subjective well-being (SWB) for a new, more comprehensive outcome measure.

Method:

Building on a previous review of the literature and existing QoL and SWB measures, followed by a three-stage online Delphi consensus-procedure among five stakeholder groups (i.e., patients, family of patients, clinicians, scientists and general public) to identify the key domains of QoL, we formulated about 3 items per domain for an initial, Delphi-based set of 21 domains of well-being. We tested these questions in a large sample (N=1143) and used dimensionality analyses to narrow down the initial set of domains and find a smaller number of latent factors. 

Result:

Exploratory factor analysis suggested retaining 5 dimensions. The five-factor model explained 65% of common variance and revealed dimensions of physical health/daily functioning, positive affect/happiness,  personal growth,  autonomy, and mental health. We propose this 5-factor model for measuring SWB in economic evaluations.

Conclusion:

We identified a set of key dimensions to be included a new, comprehensive measure of SWB which reliably captures these dimensions and fills in the gaps of existent measures used in economic evaluations. These efforts are intended to further develop standardized methodology in economic evaluations by providing a more comprehensive and more accurate estimate of outcomes, resulting in more comparable judgments of outcomes in economic evaluations.