Health Psychology and Quality of Life Research I. [antikvár]

THE QUALITY OF HEALTH Marie Johnston^. University of St. Andrews Scotland INTRODUCTION A key issue for health psychology is the measurement of health and health outcomes. In both scientific research and applied practical branches of health psychology questions are asked about how factors such as social support, Type A behaviour, coping style, etc. affect health, whether psychological interventions such as stress management can improve health and whether health status affects psychological and behavioural functioning. Thus health may be the dependent variable in studies where psychological processes are being investigated as predictors of health or where psychological interventions are designed to improve health outcomes, or it may be an independent variable, as in studies of the impact of disease. Measuring health outcomes is difficult for a number of reasons. First, there may be a dilemma about whether one is measuring in a somatic or behavioural domain. When the health outcome is psychological this is relatively straightforward, but even for apparently somatic health outcomes, measurement may be sought in a behavioural domain. For example in measuring recovery from surgery, outcomes are typically assessments of return to normal functioning (Johnston, 1984). Second, it may be unclear whether the outcome should be health or reduction/absence of disease. Indeed early definitions of health were based on the absence of disease. It is important that the research question clarifies this point. Third, outcome measures involve value judgments by requiring that some outcomes are "better" than others and it is therefore essential to have some criterion for deciding that some outcomes are more valued to avoid arbitrary evaluations. It may be necessary to choose between outcomes and Kaplan (1990) suggests that there is a tendency to overvalue biochemical outcomes compared with behavioural outcomes. He proposes that behaviour is the more important outcome and that other outcomes, including death ("the point at which there is no observable behaviour"), are only important because they interfere with behaviour or "precisely because they are predictors or mediators of behavioral outcomes".