Measuring AgrAbility Outcomes with Quality of Life Indicators Robert A. Wilson, Ph.D., M.Sc....
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Transcript of Measuring AgrAbility Outcomes with Quality of Life Indicators Robert A. Wilson, Ph.D., M.Sc....
Measuring AgrAbility Outcomes with Quality of Life Indicators
Robert A. Wilson, Ph.D., M.Sc. University of Delaware Center for Applied Demography and Survey
Research Newark, Delaware 19716
Paper presented National AgraAbility Project Training Workshop
Burlington, Vermont, November 8, 2005
Types of Program Evaluations
Process Evaluations Impact Evaluations
Process Evaluations Analyze Program Inputs
Client RecordsOutreach activityServices DeliveredProcedures FollowedDay-by-day Staff ActivityCosts Materials
Impact Evaluations Measure Program Outputs
ProductivityFarm outputIndividual farmer or waterman outputEfficiencyBenefits/Costs
Satisfaction with services providedImprovements in Quality of Life
Which AgrAbility outcome is most important?
Improved Productivity? Satisfaction with services delivered? Improvements in the Quality of Life?
A farmer could increase productivity as a result of AgrAbility, but
Register a low level of satisfaction with the services that were provided
Experience no improvement in the quality of life
A farmer could be very satisfied with the services provided by AgrAbility but Register no changes in farm output Experience no improvement in the quality of
life
A farmer could experience an improvement in the quality of life as a result of AgrAbility, but Be dissatisfied with the AgrAbility Program Register no changes in farm productivity as a
result of the program
The 3rd scenario: may be common among:
Older FarmersFarmers with certain disabilities, e.g.
arthritisFarmers who do not wish to retire
from farming or who cannot retire from farming
With an aging agricultural labor force, improvements in the quality of life may be particularly important for AgrAbility programs.
Older farmers are particularly susceptible to the degenerative diseases of aging
Arthritis Coronary disorders Cancer Tobacco-related diseases Diseases associated with exposure to toxic
chemicals Clinical Depression Dementia (including Alzheimer’s Disease)
Degenerative diseases are normally marked with a decline in the Quality of Life
How is the quality of life measured in medicine and in rehabilitative services?
Quality of Life Measurements
Disability-Adjusted Life Years (DALYs) Quality-Adjusted Life Years (QALYs)
Disability Adjusted Life Years (DALYs)
Used to measure the burden of disease in large populations: countries, states, counties
DALYs are a hybrid measure that combines premature mortality with time lived with a disease
One disability-adjusted life year (1 DALY) indicates that one person either died a yearprior to life expectancy, or lived with a disability for a year at a psychometricthreshold equivalent to death. If a disorder is severe, it receives a weightthat is closer to one (the psychometric equivalent of death). If a disorder is notsevere, it receives a weight that is closer tozero (the equivalent of perfect health). DALYs can be aggregated for groupsof people and geographic areas.
DISABILITY ADJUSTED LIFE YEAR (DALY)
7
Example:
If a population had 10 people at the beginningof 2002:
…5 of the people lived in perfect health throughout the year = 0 DALYs
…1 female, aged 80, died of alcohol-related cirrhosis, (Life Expectancy: 82) = 2 DALYs
…1 male, aged 50, died of lung cancer, (Life Expectancy: 80) = 30 DALYs
…2 males, both aged 20, died in alcohol-related accidents: (Life Expectancy: 80) = 120 DALYs
…1 female (any age) lived with alcohol-related cirrosis for the entire year (1 year x disability weight .20) .20 DALYs
_____________Total 152.20 DALYs
Health Services Policy Research GroupUniversity of Delaware
12
Disability-Adjusted Life Years (DALYs) per 1000 Population (Age-Adjusted) Attributable to Alcohol Dependence and Alcoholic Liver Cirrhosis by Census
Tract, State of Delaware, 1988-1993
Less than Delaware Mean
Delaware =8.4
Greater than Delaware MeanMissing Data
New JerseyPennsylvania
Maryland
Atlan
tic O
cean
Quality-Adjusted Life Years (QALYs)
QALYs are a summary measure used to measure the health-related quality of life for both individuals and groups.
QALYs are frequently employed to gauge changes in the quality of life associated with therapy or new drugs
There are a number of standardized instruments from which QALYs may be generated
One instrument is the SF-36, which we are currently using in a small sample of farmers which is being carried by Peggy Mack.
The recommended QALY measure is The SF-36 instrument
The SF-36 Health Survey
1. In general would you say that your health is1. Excellent
2. Very Good
3. Good
4. Fair
5. Poor
2. Compared to a year ago, how would you rate your health now?
1. Much better
2. Somewhat better
3. About the same
4. Somewhat worse
5. Much worse
Vigorous activities,
Such as running, lifting heavy objects, participating in strenuous
sports?
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Lifting or carrying groceries
Climbing several flights of steps
Climbing one flight of steps
Bending kneeling, or stooping
Walking more than a mile
Walking several hundred yards
Walking one hundred yards
Bathing or dressing yourself
4. During the last 4 weeks how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health?-all of the time-most of the time-some of the time-a little of the time-none of the time
Cut down on the amount of time you spent on work or other activities
Accomplished less than you would like
Were limited in the kind of work or other activities
Had difficulty performing the work or other activities
5. During the last 4 weeks how much of the time have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as being depressed or anxious)?
-All of the time-Most of the time-Some of the time-A little of the time-None of the time
Cut down on the amount of time you spent on work or other activities
Accomplished less than you would like
Did work or activities less carefully than usual
6. During the last 4 weeks to what extent has your physical health or emotional problems interfered with your normal social activities with friends, neighbors or groups?-Not at all-Slightly-Moderately-Quite a bit-Extremely
7. How much bodily pain have you had during the last 4 weeks?-None-Very Mild-Mild-Moderate-Severe-Very severe
.During the last 4 weeks, how much did pain interfere with your normal work?-Not at all-A little bit-Moderately-Quite a bit-Extremely
9. These are questions about how you feel and how things have been with you during the last 4 weeks. For each question please give the 1 answer that comes closest to the way you have been feeling. How much of the time during the last 4 weeks…
Did you feel full of life?
All of the time Most of the time Some of the time A little of the time None of the time
Have you been very nervous?
All of the time Most of the time Some of the time A little of the time None of the time
Have you felt so down in the dumps that nothing could cheer you up?
All of the time Most of the time Some of the time A little of the time None of the time
Have you felt calm and peaceful?
All of the time Most of the time Some of the time A little of the time None of the time
Did you have a lot of energy?
All of the time Most of the time Some of the time A little of the time None of the time
Have you felt downhearted and depressed?
All of the time Most of the time Some of the time A little of the time None of the time
Did you feel worn out?
All of the time Most of the time Some of the time A little of the time None of the time
Have you been happy?
All of the time Most of the time Some of the time A little of the time None of the time
Did you feel tired?
All of the time Most of the time Some of the time A little of the time None of the time
10. During the past 4 weeks how much of the timehas your physical health or emotional problemsinterfered with your social activities(like visiting friends, relatives, etc.)?
•All of the time•Most of the time•Some of the time•A little of the time•None of the time
11. How TRUE or FALSE is each of the following statements for you?
Definitely true Mostly true Don’t Know Mostly false Definitely false
I seem to get sick a little easier than other people
I am as healthy as anybody I know
I expect my health to get worse
My health is excellent
The SF-36 is calculated for 8 health factors (0-100)1. Physical limitations
2. Limitations in social activities
3. Limitations in work and home roles
4. Bodily pain
5. Psychological distress and wellbeing
6. Limitations because of emotional problems
7. Energy and fatigue
8. General health perceptions
Outcome: Mean SF-36 Score
(Mean score for Experimental Group Time1-Mean Score for Experimental Group Time 2)
minus(Mean score for Control Group Time1-Mean
Score for Control Group Time 2)
2 Measurements
Time 1 Assessment at Program Intake
Time 2 Measurement following Intervention
Outcome: Mean SF-36 Score
(Mean score for Experimental Group Time1-Mean Score for Experimental Group Time 2)
minus(Mean score for Control Group Time1-Mean
Score for Control Group Time 2)
Or 4 Measurements:Experimental Design
Experimental Group
Time 1 Assessment at Program
Intake
Time 2 Measurement following
Intervention
Control Group
Time 1 Assessment at Program
Intake
Time 2 Measurement following
Intervention