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Measuring Wellness Indicators Clinical Physiological Behavioral Measures Perceived constructs Psychological well-being Mental well-being Subjective well-being General well-being Morale Happiness Life satisfaction Hardiness Sense of Coherence Optimism Self-Esteem

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measuring wellness
Measuring Wellness
  • Indicators
    • Clinical
    • Physiological
    • Behavioral
  • Measures
    • Perceived constructs

Troy B. Adams, Ph.D.

measuring wellness6
Psychological well-being

Mental well-being

Subjective well-being

General well-being

Morale

Happiness

Life satisfaction

Hardiness

Sense of Coherence

Optimism

Self-Esteem

Measuring Wellness

Troy B. Adams, Ph.D.

evidence
Evidence
  • Behavior change theories
  • Social support
  • Self-efficacy
  • Learned optimism
  • Cognitive behavioral therapy
  • Mindfulness meditation
  • Perceived health epidemiology

Troy B. Adams, Ph.D.

slide9

The Conceptualization

And Measurement of

Wellness

Troy B. Adams, Ph.D.

measuring wellness10
Measuring Wellness
  • Multi-dimensional
    • Physical
    • Spiritual
    • Psychological
    • Social
    • Emotional
    • Intellectual

Troy B. Adams, Ph.D.

measuring wellness11
Measuring Wellness

Troy B. Adams, Ph.D.

measuring wellness12
Measuring Wellness

Expectations or Perceptions of:

  • Physical - physical health
  • Spiritual - meaning and purpose
  • Psychological - good will ultimately emerge
  • Social - support available/valued support provider
  • Emotional - self-identity and self-regard
  • Intellectual - optimal intellectually stimulation

Troy B. Adams, Ph.D.

perceived health
Perceived Health
  • Perceived Health in population studies
    • Compared to people your age, how would you rate your health?
      • Excellent
      • Good
      • Fair
      • Poor

Troy B. Adams, Ph.D.

perceived health16
Perceived Health
  • Perceived Health (PH) is stable over time even after changes in objective health

Ware J (1976). Scales for measuring general health perceptions. Health Services Research, 4, 396-415.

Mossey JM & Shapiro E (1982). Self-rated health: a predictor of mortality among the elderly. American Journal of Public Health, 72(8), 800-08.

Idler EL & Kasl S (1991). Health perceptions and survival, do global evaluations of health status really predict mortality? Journal of Gerontolology, 46(2), S55-65.

Martikainen P, Aromaa A, Heliovaara M, et al (1999). Reliability of perceived health by sex and age. Social Science in Medicine, 48: 1117-1122.

Troy B. Adams, Ph.D.

perceived health17
Perceived Health
  • Among Finish elderly people, PH did not change over a 5 year period despite worse objective health in 50% of them

Leinonen R, Heikkinen E, Jylha M (1998). Self-rate health and self-assessed change in health in elderly men and women – a five-year longitudinal study.

Social Science in Medicine, 46: 591-597.

Troy B. Adams, Ph.D.

perceived health18
Perceived Health
  • PH, independent of objective health, is one of the most powerful predictors of morbidity and mortality
    • PH died two years earlier
    • The gap between poor and excellent PH mortality grew wider over time

Palmore EB, Burchett BM. (1997). Predictors of disability in the final year of life. Journal of Aging and Health, 9(3): 283-297.

Kaplan GA & Camacho, T (1983). Perceived health and mortality: a nine-year follow-up of the human population laboratory cohort.

American Journal of Epidemiology, 117(3), 292-304.

Singer E, Garfinkel R, Cohen SM, & Srole L (1976). Mortality and mental health: evidence from Midtown Manhattan restudy. Social Science and Medicine, 10, 517-25.

Sundquist J, Johansson S (1997). Self-reported poor health and low educational level predictors for mortality: A population based follow-up study of 39,156 people in Sweden.

Journal of Epidemiology and Community Health 51:35-40.

Troy B. Adams, Ph.D.

perceived health19
Perceived Health
  • Only age or sex are more powerful predictors
  • The independent risk of mortality remains after controlling for demographic, health status, behavior variables or psychological variables
  • These findings are consistent across countries and age groups, and within U.S. ethnic cohorts

Mossey JM & Shapiro E (1982). Self-rated health: a predictor of mortality among the elderly. American Journal of Public Health, 72(8), 800-08.

Idler EL & Kasl S (1991). Health perceptions and survival, do global evaluations of health status really predict mortality? Journal of Gerontolology, 46(2), S55-65

Singer E, Garfinkel R, Cohen SM, & Srole L (1976). Mortality and mental health: evidence from Midtown Manhattan restudy. Social Science and Medicine, 10, 517-25.

McGee DL, Liao Y, Cao G, Cooper RS (1999). Self-reported health status and mortality in a multiethnic US cohort. American Journal of Epidemiology, 149(1): 41- 46.

Idler EL & Angel (1990). Self-rated health and mortality in the NHANES-I epidemiologic follow-up study. American Journal of Public Health, 80(4), 446-452.

Troy B. Adams, Ph.D.

perceived health20
Perceived Health
  • PH Mechanism?

1. PH is an intuitive indicator of physiological health

      • Tested by comparing mortality that occurred in early versus late follow-up period.

Troy B. Adams, Ph.D.

perceived health21
Perceived Health
  • PH Mechanism?

2. Healthy behaviors lead to better PH

      • Health risks and behaviors are associated with PH but generally do not contribute to the predictive ability of PH.
      • Changing exercise behavior does not appear to change PH.

Manderbacka K, Lundberg O, Martikkainen. (1999). Do risk factors and health behaviors contribute to self-ratings of health. Social Science and Medicine, 48, 1713-1720.

Schechtmann KB & Ory MG (2001). The effects of exercise on quality of life of frail older adults: A preplanned meta-analysis of the FISCIT trials. Annals of Behavioral Medicine, 23(3): 186-97.

Troy B. Adams, Ph.D.

perceived health22
Perceived Health
  • PH Mechanism?

3. The association is mediated by latent variables

      • Psychological variables augment the predictive power of PH
      • PH predicted mortality “beyond the contribution of a comprehensive set of predictors.”

Fylkesnes K & Førde OH (1991). The Tromsø study: predictors of self-evaluated health-has society adopted the expanded health concept?

Social Science and Medicine, 44(2), 241-49.

Ren XS (1997) Marital status and quality of relationships: The impact on health perceptions. Social Science and Medicine, 48, 1713-1720.

Cott CA, Gignac MAM, Dadley EM (1999). Determinants of self-rated health for Canadians with chronic disease and disability.

Journal of Epidemiology and Community Health, 53:731-736.

Idler EL & Kasl S (1991). Health perceptions and survival, do global evaluations of health status really predict mortality? Journal of Gerontolology, 46(2), S55-65.

Troy B. Adams, Ph.D.

perceived health23
Perceived Health
  • PH Mechanism?

4. PH is health protective

      • “Health optimism” may influence outcomes through psychophysiological processes.
      • “Health pessimism” may increase risk for new morbidity which leads to increased mortality.
      • Those with fair/poor PH but good/excellent objective health had slightly greater mortality than those with good/excellent PH but fair/poor objective health.

Kaplan GA & Camacho, T (1983). Perceived health and mortality: a nine-year follow-up of the human population laboratory cohort.

Idler EL & Kasl S (1991). Health perceptions and survival, do global evaluations of health status really predict mortality? Journal of Gerontolology, 46(2), S55-65.

Troy B. Adams, Ph.D.

perceived health24
Perceived Health
  • Summary
    • About 66% agreement between objective health status and PH but PH still predicts mortality independent of objective health status.
    • PH operates independent of health practices, psychological, and social variables.
    • Those with poor PH, who are also socially disconnected and have poor health practices have an 8 fold increase risk of mortality.

Troy B. Adams, Ph.D.