Development of a self-report measure of capability wellbeing for adults: the ICECAP-A

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Abstract

Purpose

The benefits of health and social care are not confined to patient health alone and therefore broader measures of wellbeing may be useful for economic evaluation. This paper reports the development of a simple measure of capability wellbeing for adults (ICECAP-A).

Methods

In-depth, informant-led, interviews to identify the attributes of capability wellbeing were conducted with 36 adults in the UK. Eighteen semi-structured, repeat interviews were carried out to develop a capability-based descriptive system for the measure. Informants were purposively selected to ensure variation in socio-economic status, age, sex, ethnicity and health. Data analysis was carried out inductively and iteratively alongside interviews, and findings were used to shape the questions in later interviews.

Results

Five over-arching attributes of capability wellbeing were identified for the measure: “stability”, “attachment”, “achievement”, “autonomy” and “enjoyment”. One item, with four response categories, was developed for each attribute for the ICECAP-A descriptive system.

Conclusions

The ICECAP-A capability measure represents a departure from traditional health economics outcome measures, by treating health status as an influence over broader attributes of capability wellbeing. Further work is required to value and validate the attributes and test the sensitivity of the ICECAP-A to healthcare interventions.

Related collections

Most cited references 16

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Statements like "quality of care is more highly valued than waiting time" can neither be supported nor refuted by comparisons of utility parameters from a traditional discrete choice experiment (DCE). Best--worst scaling can overcome this problem because it asks respondents to perform a different choice task. However, whilst the nature of the best--worst task is generally understood, there are a number of issues relating to the design and analysis of a best--worst choice experiment that require further exposition. This paper illustrates how to aggregate and analyse such data and using a quality of life pilot study demonstrates how richer insights can be drawn by the use of best--worst tasks.

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Ini Grewal, Jane Lewis, Terry Flynn … (2006)

Current UK policy with respect to the provision of health and social care for older people suggests that greater integration is required. Economists' attempts to assist resource allocation decisions, however, are very health focused, with concentration on the use of health-related quality of life measures. This paper reports an attempt to determine attributes for a new index clearly focusing on quality of life for older people rather than health or other influences on quality of life. In-depth interviews were conducted with 40 purposively selected informants aged 65 and over in private households to explore their views about what is important to them in terms of quality of life. Data were analysed using Framework qualitative analysis. Initial discussions tended to concentrate upon factors influencing quality of life including activities, relationships, health, wealth and surroundings. Further probing and analysis suggested five conceptual attributes: attachment, role, enjoyment, security and control. The data also suggested that the quality of informants' lives was limited by the loss of ability to pursue these attributes. So, for example, it is not poor health in itself, which reduces quality of life, but the influence of that poor health upon each informant's ability to, say, be independent, that is important. Amartya Sen's work on functioning and capability is particularly pertinent here. Using this work, it is possible to interpret the five conceptual attributes as a set of functionings-important for older people in the UK in the 21st century-but noting that it is the capacity to achieve these functionings that appears to be of importance. This suggests that further development of this measure should focus on an index of capability rather than preference-based utility.

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Health technology assessment (HTA) is a dynamic, rapidly evolving process, embracing different types of assessments that inform real-world decisions about the value (i.e., benefits, risks, and costs) of new and existing technologies. Historically, most HTA agencies have focused on producing high quality assessment reports that can be used by a range of decision makers. However, increasingly organizations are undertaking or commissioning HTAs to inform a particular resource allocation decision, such as listing a drug on a national or local formulary, defining the range of coverage under insurance plans, or issuing mandatory guidance on the use of health technologies in a particular healthcare system. A set of fifteen principles that can be used in assessing existing or establishing new HTA activities is proposed, providing examples from existing HTA programs. The principal focus is on those HTA activities that are linked to, or include, a particular resource allocation decision. In these HTAs, the consideration of both costs and benefits, in an economic evaluation, is critical. It is also important to consider the link between the HTA and the decision that will follow. The principles are organized into four sections: (i) "Structure" of HTA programs; (ii) "Methods" of HTA; (iii) "Processes for Conduct" of HTA; and (iv) "Use of HTAs in Decision Making."

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Author and article information

Contributors

: +44-121-4158483 , h.aljanabi@bham.ac.uk

Journal

Journal ID (nlm-ta): Qual Life Res

Title: Quality of Life Research

Publisher: Springer Netherlands (Dordrecht )

ISSN (Print): 0962-9343

ISSN (Electronic): 1573-2649

Publication date (Electronic): 20 May 2011

Publication date PMC-release: 20 May 2011

Publication date (Print): February 2012

Volume: 21

Issue: 1

Pages: 167-176

Affiliations

[1 ]Health Economics Unit, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT UK

[2 ]University of Technology Sydney, Broadway, PO Box 123, Sydney, NSW 2007 Australia

Article

Publisher ID: 9927

DOI: 10.1007/s11136-011-9927-2

PMC ID: 3254872

PubMed ID: 21598064

SO-VID: d9baf576-b47e-4259-9a88-229a80fc750c

History

Date accepted : 2 May 2011

Custom metadata

ScienceOpen disciplines: Public health

Keywords: capability approach,outcome measurement,health economics,quality of life,qualitative research

Data availability:

ScienceOpen disciplines: Public health

Keywords: capability approach, outcome measurement, health economics, quality of life, qualitative research

Development of a self-report measure of capability wellbeing for adults: the ICECAP-A

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