What do you consider when thinking about the benefits of preventive or social care interventions? Probably not only health-related benefits, right? To be able to adequately capture all benefits of interventions we need broader outcome measures. In this blogpost I will inform you about the efforts our team, consisting of Esther de Bekker-Grob, Werner Brouwer, Job van Exel, Daphne Voormolen and myself, has taken to develop such an outcome measure capturing overall well-being.
Why develop a broader outcome measure?
Before explaining more about the newly developed outcome measure, it is important to explain why we started the development of this new instrument. The basic task of any economic evaluation in a health technology assessment (HTA) framework is to identify, measure, value, and compare the costs and benefits of the health interventions being considered. As said, some health interventions do not necessarily lead to improved health or deliver much more than health benefits alone. Think for example about care for people with a chronic illness or about social care interventions that lead to enhanced community or financial well-being.
Not capturing the full benefits of these types of care potentially leads to suboptimal decisions on the prioritization of interventions in the health and social care sectors. The ambition of our team is to improve welfare economic evaluations in health care by going beyond the health benefits only, which will contribute directly to the main aim of the Erasmus Initiative achieving smarter choices for better health. Specifically, we aim to develop an instrument to measure individual well-being in the adult population (18+).
The process of developing a new outcome measure
This new instrument should capture all items that are important for someone’s wellbeing, should measure these items in a valid way and should successfully differentiate between different levels of well-being, for example between groups in the population or before and after an intervention. To develop an instrument adhering to all these requirements, we started from the currently available well-being literature and identified all existing well-being measures, their theoretical background and the domains of well-being covered by these measures.
The results of this review were synthesised in a conceptual framework, which we took as the starting point for the development of our new instrument. Using this framework, we identified the most important domains of well-being, and for each domain (e.g. ‘financial situation’ or ‘relationships’) we developed a description and scoring levels. This process led to a first version of the instrument consisting of 10 items: The Well-being instrument-10 (WiX).
To make sure that we are adequately measuring well-being with these ten items, we conducted interviews with several experts in the field of benefit assessment in health and social care. Next, we asked members of the public to complete the instrument in a ‘think-aloud’ format, meaning we encouraged them to verbalize their thoughts while reading and scoring the items of the instrument. These interviews helped us to gain insight into whether and how respondents understand the items, their descriptions, and the scoring levels.
Recently, we completed a study in which we asked a large sample of members of the public to answer questions regarding the relevance, comprehensiveness and comprehensibility of the different items and scoring levels. These consecutive validation steps have aided us in assuring the WiX covers the most important domains of well-being for adults, fine-tuning the wording of the instrument and verifying it works for measuring well-being in a variety of groups.
We now have a version of the WiX that captures the most important domains as well-being and is comprehensible and feasible for members of the public. Curious about the content of the instrument or the first validation findings? A working paper will soon become available here. This fall we will proceed with validation studies and the development of utility weights so that the scores on the 10 items of the instrument can be adequately summarized in a single well-being score.
About the author
Judith Bom is an Assistant Professor at the department of Health Economics at the Erasmus School of Health Policy and Management. Her main focus is on long-term care and well-being of care takers and recipients. You can contact Judith via e-mail.