Health-Related Quality of Life: A Vital Health Assessment Tool

Overview

The concept of Health-Related Quality of Life (HRQOL) can be considered as an offshoot of the concept of 'Health'. The latter concept can be traced back to pre-biblical times. The term 'Health' originates from the old English word 'Hoelth' which means "being sound or whole."

Hippocrates, the legendary Greek physician and the 'Father of Western Medicine', proposed as far back as 400 BC, that human well-being is influenced collectively by all the environmental factors, such as climatic conditions, air purity, lifestyle, and availability of food and water.

In modern times, health has been considered to be multidimensional, encompassing physical, mental, and social domains.

Health-Related Quality of Life (HRQOL)

Historically, HRQOL has been associated with the field of oncology since 1949, when the scientists, Karnofsky and Burchenal, developed a clinical scale for the assessment of functional performance of cancer patients.

HRQOL is a multidimensional dynamic concept that encompasses several domains. These include physical fitness, mental stability, emotional integrity, and social functioning, as well as their collective interaction with the surrounding environment. These interactions can be influenced by disease severity and treatment efficacy at the individual level.

HRQOL is also dependent on an individual's past experiences, present circumstances, and future aspirations. Importantly, the concept of HRQOL goes beyond measures of population health, life expectancy, and mortality rates. Rather, it focuses on the impact of health status on the quality of life (QOL). In this context, it should be noted that the concept of HRQOL is intrinsically intertwined with the concept of well-being, which deals with the positive aspects of an individual's life, including positive emotions and satisfaction in life.

In order to understand the concept of HRQOL, it is imperative to first understand the meaning of QOL, which is a broad and amorphous term that refers to the collective goodness of life. QOL encompasses almost all aspects of life, especially the following:

• Subjective well-being of an individual i.e. how happy is their life as a whole
• Satisfaction pertaining to housing, employment, lifestyle, marital life, and spiritual life

Since the health system doesn't cater to the above human concerns, QOL has now been considered to be distinct from HRQOL.

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Difference Between Quality of Life and Health-Related Quality of Life

The terms QOL and HRQOL are often used interchangeably, but they are somewhat different from each other, as highlighted in Table 1.

Table 1: Difference Between Quality of Life and Health-Related Quality of Life

Quality of Life	Health-Related Quality of Life
Broad concept	Narrow concept
Covers all aspects of life	Focuses specifically on health aspects impacting QOL: Effect of illness Impact of treatment
Reflects an individual’s perception and response to non-health-related factors – employment, family, friends, and society	Reflects an individual’s perception and response to health-related factors – physical, emotional, and mental well-being

Characteristics of Health-Related Quality of Life

The major characteristics of HRQOL include the following:

• HRQOL is intricately linked to the concepts of health and QOL
• HRQOL is influenced by a person's perceptions, experiences, beliefs, and expectations
• HRQOL encompasses both positive and negative aspects of health:
• Positive Aspects: Include physical fitness and mental alertness for optimal functioning of the body and mind
• Negative Aspects: Include disease, dysfunction and illness

Applications of Health-Related Quality of Life

The concept of HRQOL is used by doctors and public health experts to measure the effects of the following on the health of an individual:

• Chronic illness
• Injuries
• Disabilities
• Treatments

Measurement of Health-Related Quality of Life: Utilization of CDC's HRQOL Scale

The Centers for Disease Control and Prevention (CDC), Atlanta, USA, has developed a 14-item scale, termed HRQOL-14 scale, which measures an individual's overall health and well-being. The HRQOL-14 scale has been tested in a variety of racial and ethnic groups of diverse socio-economic backgrounds, including White, Black and Asian populations. This scale is generally administered verbally and is broadly divided into the following three modules:

• Core Healthy Days Module: This module is designed to extract information about a participant's general health on the following 5-point scale:
• Excellent
• Very Good
• Good
• Fair
• Poor
• Activity Limitations Module: This module is designed to extract health-related information from the participants by asking the following questions:
• Do you have any health problem that limits your daily activities?
• What type of health problem limits your daily activities?
• How long have you been suffering from limited daily activities?
• Do you require assistance for completing your daily activities?
• Healthy Days Symptoms Module: This module is designed to extract information pertaining to a participant's feelings in the context of overall health and well-being, using the following terms:
• Very healthy
• Full of energy
• Worried
• Tensed
• Anxious

Importance of CDC's HRQOL Scale

Information extracted by using the HRQOL scale, can help predict the following:

• Likelihood of dying
• Possibility of hospitalization
• Utilization of healthcare services
• Rates of diseases, injuries and disabilities

These predictions can help doctors to provide better healthcare services to vulnerable populations.

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Importance of Health-Related Quality of Life

The importance of HRQOL lies in the fact that it can bridge the gap between disciplines, as well as social, mental, and medical services.

• HRQOL provides insight on chronic diseases, such as diabetes, breast cancer, arthritis, and hypertension, as well as their risk factors
• HRQOL helps estimate the burden of preventable diseases, injuries, and disabilities
• HRQOL provides valuable insights about various risk factors
• HRQOL helps to monitor progress in achieving national health objectives

Summary

• HRQOL is a multidimensional dynamic health concept
• It encompasses physical, mental, emotional and social well-being
• HRQOL data could help guide the improvement of the quality of life

HRQOL data can help identify vulnerable populations and design health interventions to improve their conditions, thereby averting more serious consequences. Collation, analysis and interpretation of these datasets can help develop robust policies and legislations for proper allocation and equitable distribution of scarce health resources. The generated data will also guide the development of strategic plans to monitor the effectiveness of various health interventions at the community, state and national levels.