J. Ormel et al., QUALITY-OF-LIFE AND SOCIAL PRODUCTION-FUNCTIONS - A FRAMEWORK FOR UNDERSTANDING HEALTH-EFFECTS, Social science & medicine, 45(7), 1997, pp. 1051-1063
Citations number
100
Categorie Soggetti
Social Sciences, Biomedical","Public, Environmental & Occupation Heath
Quality of life (QofL) has emerged as a new outcome paradigm. It is no
w the endpoint in various taxonomies of patient outcomes, in which rel
ationships are modeled amongst biological abnormalities, symptom statu
s, functional status, disability, health perceptions and quality of li
fe. Although current models and taxonomies point at important determin
ants of QofL, they do not provide a heuristic that guides the conceptu
alization of QofL and the systematic development of an explanatory the
ory of how ill health affects QofL. General mechanisms linking ill hea
lth, behavior, and QofL are lacking. In this paper we propose social p
roduction function (SPF) theory as providing such a heuristic, relatin
g the effects of ill health, the activities that patients engage in to
maintain QofL, and QofL itself. This theory basically asserts that pe
ople produce their own well-being by trying to optimize achievement of
universal human goals via six instrumental goals within the environme
ntal and Functional limitations they are facing. Three important notio
ns of SPF theory are: (1) the linkages between goals, needs, and well-
being; (2) the distinction between universal needs and instrumental go
als; and (3) substitution among instrumental goals, activities and end
owments according to cost-benefit considerations, whereby costs refer
to scarce resources such as functional capacity, time, effort and mone
y. We will argue that SPF theory meaningfully relates the ''biomedical
model''-with its focus on pathological processes and biological, phys
iological and clinical outcomes-to the ''quality of life'' model, with
its focus on functioning and well-being We describe SPF theory and ho
w SPF theory can be used to: (I) operationally define and measure QofL
; (2) clarify persistent measurement problems; and (3) develop an expl
anatory framework of the effects of disease on QofL. In the discussion
section, we address the limitations of the SPF approach of QofL and i
ts relationship with personality. (C) 1997 Elsevier Science Ltd.