The concept of quality of life has indeed evolved over the years and has become an increasingly articulated idea. That is, the perception of a person’s physical, psychological and emotional health, the degree of independence, social relationships, and the type of interaction with the person’s context. It is also important to know that the quality of life structure is broader than health, it is not synonymous. In this sense, being healthy is considered as a dimension of quality of life and health-facilitating behaviors are considered as predictors of quality of life. These aspects and many other features need to be thoroughly analyzed and clarified in this narrative study.
The Difference Between the Concept of Quality of Life and the Concept of Health
Often times, as mentioned earlier, the concept of quality of life is confused with the concept of health, but this is wrong. Because the term health is not sufficient to describe the quality of life. For example, some individuals may live with a poor functional condition or poor health, but they express a high quality of life and vice versa. Moreover, quality of life also cannot simply be equated in terms of lifestyle, life satisfaction, mental state, or well-being. As predicted in recent years, several scientific studies have attempted to better define this structure. He summarized the most appropriate fields and tools for studying and observing this concept. In fact, two types of complementary health status criteria have emerged in recent years and they are as follows:
Objective measurements of functional health status,
Subjective health and well-being measurements,
These measures are multilevel and multidimensional, and there are many published quality of life measures. A really important measurement scale is the World Health Organization’s Quality of Life scale. This questionnaire measures this specific area by examining the answers the subject can provide on a Likert scale (from 1 to 5). This survey is available in two versions and they are as follows:
World Health Organization Quality of Life scale – 100 (WHOQOL-100),
• World Health Organization Quality of Life Scale Summary (WHOQOL-Brief),
These scales can also be used to assess differences in quality of life between different cultures or to compare different subgroups. The WHOQOL-Brief is a 26-item version that summarizes the WHOQOL-100 (i.e. the longer 100-item version). Both of these questionnaires are useful in clinical settings, medical practice, audits, policy making, and evaluating the effectiveness of different treatments. The short version of WHOQOL can also be used in a variety of different cultural settings, is easily implemented and does not place a huge burden on the respondent. Answers are always given on a Likert scale (1 to 5). The questions covered in the short version of the test are as follows:
WHOQOL – 26 items
• How would you evaluate your quality of life?
• How satisfied are you with your health?
• To what extent do you feel that physical pain is preventing you from doing what you should be doing?
• How much do you need any medical treatment to function in your daily life?
• How much do you enjoy life?
• How meaningful do you feel your life is?
• How well can you concentrate?
• How safe do you feel in your daily life?
• How healthy is your physical environment?
• Do you have enough energy for daily life?
• Can you accept your bodily appearance?
• Do you have enough money to meet your needs?
• How clear is the information you need in your daily life?
• To what extent do you have opportunities for leisure activities?
• How well can you move around?
• How satisfied are you with your sleep?
• How satisfied are you with your ability to carry out your daily life activities?
• How satisfied are you with your working capacity?
• How satisfied are you with yourself?
• How satisfied are you with your personal relationships?
• How satisfied are you with your sex life?
• How satisfied are you with the support you get from your friends?
• How satisfied are you with the conditions where you live?
• How satisfied are you with your access to healthcare services?
• How satisfied are you with your transport?
• How often do you have negative emotions such as blue mood, hopelessness, anxiety, depression?
The creation of this survey includes a common approach to international tool development. The aim is to develop a questionnaire that can be filled in collaboratively and individually in a variety of settings. To achieve these results, several culturally diverse centers were involved in operationalizing the questions about the quality of life of the scale, as well as in question writing, question selection and pilot testing. Thanks to this approach, standardization and equivalence between different settings are guaranteed. Several centers in different geographic areas have been selected to include differences in levels of industrialization, types of health care, and other aspects of measuring quality of life (eg self-perception, perception of the dominant). To summarize, quality of life questionnaires should cover different areas and they are as follows:
Physical space (referring to physical senses, health, and pain),
• Psychological field (expresses feelings such as anxiety and helplessness),
Independence level field (refers to the autonomy of the individual in various spheres of life, from financial to physical),
• Social relations area (refers to social interactions with family, friends and professionals),
Environmental area (refers to those aspects of the environment that can promote a person’s development),
It is important to note that specific questionnaires for people with HIV or diabetes, such as WHOQOL, are available for measuring quality of life in disease states.
In summary, it is important to state that the definition of quality of life always refers to the physical state of the subject, but is no longer evaluated solely by the quality of a person’s functionality. It can be determined with standardized parameters because they are defined by the perceived degree of satisfaction with this level of functionality. This definition shifts the emphasis from the scope of objectively definable functionality to the scope of subjectivity. Detection of these two aspects could possibly constitute a reliable measure of quality of life.
In the field of objectivity, it is confirmed that the illness is understood as a defined clinical framework and different areas of functionality, namely physical, psychological, social and functional. In the context of subjectivity, the perception of disease and patient satisfaction are placed in various areas of life that may be thought to affect health status. As a result, it is possible to determine that the most common method of measuring the quality of life is questionnaire application and there are two questionnaire families.
A New Perspective on Wellbeing as Improving Quality of Life
Health professionals increasingly recognize that measures that focus solely on disease outcomes are an inadequate predictor of health status. Accordingly, today the focus has shifted from the idea of physical / psychological well-being as the elimination of a problem or a disease to the conceptualization of well-being as improving the quality of life. This change of perspective has radically changed not only the concept of health and illness, but also human life processes and crises. For a long time, well-being conditions have been defined on the basis of normative models that produce health models consistent with the biomedical model, which is very reductive.
However, relatively recently, and certainly thanks to the contribution of health psychology, a new approach has been introduced that claims the specificity of a discipline linked to the subject’s singularity and uniqueness. This uniqueness, which must be understood, also requires a reductionist perspective and an openness to a complex idea that can overcome dichotomies. Today, it is accepted that in order to understand a phenomenon, one must take into account the context, individual perspective, perception of the person involved in this context, and the multiple dimensions that contribute to the production and understanding of the reality being studied.
All these cognitive changes have a particularly significant impact on care systems and devices designed to respond to critical situations. They are also the result of the culture and context that can produce them and are consistent with illness, health, social representations. They are also scientific theories built on quality of life and these representations. Today there is a need to abandon the logic of restitutio ad integrum medicine, which adopts a new mindset that redirects approaches to reality. In addition, the concept of quality of life is now separated from the biomedical model, and this model has been surpassed by the biopsychosocial model that we will analyze in the next paragraph.
Author: Ozlem Guvenc Agaoglu