1.
Hompashe, Dumisani MacDonald, et al.
(författare)
The nurse did not even greet me' : How informed versus non-informed patients evaluate health systems responsiveness in South Africa
2021
Ingår i: BMJ Global Health. - : BMJ. - 2059-7908. ; 6:4
Tidskriftsartikel (refereegranskat) abstract
INTRODUCTION: Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients' experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction.METHODS: Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients' exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients' experiences of non-clinical dimensions.RESULTS: We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers' explanations of health conditions.CONCLUSION: Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.
2.
Burstrom, K., et al.
(författare)
Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States
2020
Ingår i: Pharmacoeconomics. - : Springer Science and Business Media LLC. - 1170-7690 .- 1179-2027. ; 38
Tidskriftsartikel (refereegranskat) abstract
Background and Objective Although value sets for the five-level version of the generic health-related quality-of-life instrument EQ-5D are emerging, there is still no value set available in the literature based on time trade-off valuations made by individuals experiencing the valued health states. The aim of this study was to estimate experience-based value sets for the EQ-5D-5L for Sweden using time trade-off and visual analogue scale valuation methods. Methods In a large, cross-sectional, population-based, self-administered postal health survey, the EQ-5D-5L descriptive system, EQ visual analogue scale and a time trade-off question were included. Time trade-off and visual analogue scale valuations of the respondent's current health status were used in statistical modelling to estimate a single-index value of health for each of the 3125 health states. Ordinary least-squares and generalised linear models were estimated with the main effect within each of the five dimensions represented by 20 dummy variables reflecting the additional decrement in value for levels 2-5 when the severity increases by one level sequentially beginning from having no problem. Interaction variables representing the occurrence of severity levels in at least one of the dimensions were tested: severity level 2 or worse (N2); severity level 3 or worse (N3); severity level 4 or worse (N4); severity level 5 (N5). Results A total of 896 health states (28.7% of the 3125 possible EQ-5D-5L health states) were reported by the 25,867 respondents. Visual analogue scale (n = 23,899) and time trade-off (n = 13,381) responders reported valuations of their currently experienced health state. The preferred regression models used ordinary least-squares estimation for both time trade-off and visual analogue scale values and showed consistency in all coefficients after combining certain levels. Levels 4 and 5 for the dimensions of mobility, self-care and usual activities were combined in the time trade-off model. Including the interaction variable N5, indicating severity level 5 in at least one of the five dimensions, made it possible to distinguish between the two worst severity levels where no other dimension is at level 5 as this coefficient is applied only once. In the visual analogue scale regression model, levels 4 and 5 of the mobility dimension were combined. The interaction variables N2-N4 were included, indicating that each of these terms reflect a statistically significant decrement in visual analogue scale value if any of the dimensions is at severity level 2, 3 or 4, respectively. Conclusions Time trade-off and visual analogue scale value sets for the EQ-5D-5L are now available for Sweden. The time trade-off value set is the first such value set based on experience-based time trade-off valuation. For decision makers with a preference for experience-based valuations of health states from a representative population-based sample, the reported value sets may be considered fit for purpose to support resource allocation decision as well as evaluating population health and healthcare performance.
3.
Gerdtham, Ulf G., et al.
(författare)
The relationship between happiness, health, and socio-economic factors : Results based on Swedish microdata
2001
Ingår i: Journal of Socio-Economics. - : Elsevier Inc. - 1053-5357 .- 1879-1239. ; 30:6, s. 553-557
Tidskriftsartikel (refereegranskat) abstract
This paper investigates the relationship between happiness (utility) and a host of socio-economic variables in a random sample of over 5,000 individuals from the Swedish adult population. The results show that happiness increases with income, health and education and decreases with unemployment, urbanisation, being single, and male gender. The relationship between age and happiness is U-shaped, with happiness being lowest in the age-group 45-64 years.
4.
Dackehag, Margareta, et al.
(författare)
Debt and mental health : new insights about the relationship and the importance of the measure of mental health
2019
Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 29:3, s. 488-493
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: Empirical research suggests that household debt and payment difficulties are detrimental to mental health. Despite well-known measurement problems that may contaminate analyses using subjective self-reported health measures, our knowledge is very limited concerning the effect of payment difficulties on 'objective' measures of mental health. Moreover, few studies use longitudinal data to examine the relationship. This study combines rich survey data and longitudinal data from administrative registers on a representative sample of the Swedish population to examine the relationship between payment difficulties and subjective and objective measures of mental health. METHODS: We use data from a large survey of Swedish inhabitants (The Swedish Living Conditions Surveys) combined with data from administrative registers. We investigate both directions of the relationship between mental ill health and payment difficulties, controlling for previous mental health status and previous experiences of payment difficulties. We compare the association between payment difficulties and a self-reported measure of anxiety with the associations between payment difficulties and objective measures of mental ill health from a register of psychopharmaceutical drug consumption. RESULTS: Payment difficulties associate with subjectively reported mental ill health, but less to psychopharmaca use. For objective measures, we find stronger evidence of a link running from mental ill health to later payment difficulties. CONCLUSIONS: Self-reported and objective measures of mental problems may convey different messages regarding the impact of payment difficulties on mental health. Policy measures depend on whether the primary target group is individuals with severe mental problems or individuals with mild anxiety.
5.
Gerdtham, Ulf G., et al.
(författare)
Income-related inequality in life-years and quality-adjusted life-years
2000
Ingår i: Journal of Health Economics. - 0167-6296 .- 1879-1646. ; 19:6, s. 1007-1026
Tidskriftsartikel (refereegranskat) abstract
We estimate the income-related inequality in Sweden with respect to life-years and quality-adjusted life-years (QALYs). We use a large data set from Sweden with over 40,000 individuals followed up for 10-16 years, to estimate the survival and quality-adjusted survival in different income groups. For both life-years and QALYs, we discover inequalities in health favouring the higher income groups. For men (women) in the youngest age-group (20-29 years), the number of QALYs is 43.7 (45.7) in the lowest income decile and 47.2 (49.0) in the highest income decile. (C) 2000 Elsevier Science B.V.
6.
Gerdtham, Ulf-G., et al.
(författare)
Trait self-control, exercise and exercise ambition : Evidence from a healthy, adult population
2020
Ingår i: Psychology, Health & Medicine. - : Informa UK Limited. - 1354-8506 .- 1465-3966. ; 25:5, s. 583-592
Tidskriftsartikel (refereegranskat) abstract
This study explores if self-control predicts exercise ambition and actual exercise, and if exercise ambition predicts actual exercise. Members and guests at a not-for-profit sports club were invited to participate. 264 individuals completed a self-reported (Self-Control Scale) measure of self-control, and responded to questions about actual exercise as well as exercise ambition prior to their workout. Main Outcome Measures are exercise ambition, actual exercise, and the difference between them. We find that trait self-control predicts both actual exercise and exercise ambition. Exercise ambition also predicts actual exercise. The results suggest a path from self-control, via exercise ambition, to actual exercise. Individuals with relatively low self-control might benefit from some aid in setting goals for their workouts and committing to exercise.
7.
Borg, Sixten, et al.
(författare)
Patient-reported outcome and experience measures for diabetes: development of scale models, differences between patient groups and relationships with cardiovascular and diabetes complication risk factors, in a combined registry and survey study in Sweden
2018
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:1
Tidskriftsartikel (refereegranskat) abstract
Purpose The Swedish National Diabetes Register (NDR) has developed a diabetes-specific questionnaire to collect information on individuals' management of their diabetes, collaboration with healthcare providers and the disease’s impact on daily life. Our main objective was to develop measures of well-being, abilities to manage diabetes and judgements of diabetes care, and to detect and quantify differences using the NDR questionnaire.Design, setting and participants The questionnaire was analysed with using responses from 3689 participants with type 1 and 2 diabetes, randomly sampled from the NDR population, combined with register data on patient characteristics and cardiovascular and diabetes complication risk factors.Methods We used item response theory to develop scales for measuring well-being, abilities to manage diabetes and judgements of diabetes care (scores). Test–retest reliability on the scale level was analysed with intraclass correlation. Associations between scores and risk factor levels were investigated with subgroup analyses and correlations.Results We obtained scales with satisfactory measurement properties, covering patient reported outcome measures such as general well-being and being free of worries, and patient reported experience measure, for example, access and continuity in diabetes care. All scales had acceptable test–retest reliability and could detect differences between diabetes types, age, gender and treatment subgroups. In several aspects, for example, freedom of worries, type 1 patients report lower than type 2, and younger patients lower than older. Associations were found between some scores and glycated haemoglobin, but none with systolic blood pressure or low-density lipoprotein cholesterol. Clinicians report positive experience of using scores, visually presented, in the patient dialogue.Conclusions The questionnaire measures and detects differences in patient well-being, abilities and judgements of diabetes care, and identifies areas for improvement. To further improve diabetes care, we conclude that patient-reported measures are important supplements to cardiovascular and diabetes complication risk factors, reflecting patient experiences of living with diabetes and diabetes care.
8.
Asuman, Derek, et al.
(författare)
Pain and labor outcomes : A longitudinal study of adults with cerebral palsy in Sweden
2023
Ingår i: Disability and Health Journal. - : Elsevier BV. - 1936-6574 .- 1876-7583. ; 16:3
Tidskriftsartikel (refereegranskat) abstract
Background: Pain is a global health concern with substantial societal costs and limits the activity participation of individuals. The prevalence of pain is estimated to be high among individuals with cerebral palsy (CP).Objectives: To estimate the association between pain and labor outcomes for adults with CP in Sweden.Methods: A longitudinal cohort study based on data from Swedish population-based administrative registers of 6899 individuals (53,657 person-years) with CP aged 20-64 years. Individual fixed effects regression models were used to analyze the association between pain and labor outcomes (employment and earnings from employment), as well as potential pathways through which pain might affect employment and earnings.Results: Pain was associated with adverse outcomes varying across severity, corresponding to a reduction of 7-12% in employment and 2-8% in earnings if employed. Pain might affect employment and earnings through increased likelihood of both sickness leave and early retirement.Conclusion: Pain management could potentially be important to improve labor outcomes for adults with CP, in addition to improving the quality of life.& COPY; 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
9.
Heckley, Gawain, et al.
(författare)
A general method for decomposing the causes of socioeconomic inequality in health
2016
Ingår i: Journal of Health Economics. - : Elsevier BV. - 0167-6296 .- 1879-1646. ; 48, s. 89-106
Tidskriftsartikel (refereegranskat) abstract
We introduce a general decomposition method applicable to all forms of bivariate rank dependent indices of socioeconomic inequality in health, including the concentration index. The technique is based on recentered influence function regression and requires only the application of OLS to a transformed variable with similar interpretation. Our method requires few identifying assumptions to yield valid estimates in most common empirical applications, unlike current methods favoured in the literature. Using the Swedish Twin Registry and a within twin pair fixed effects identification strategy, our new method finds no evidence of a causal effect of education on income-related health inequality.
10.
Linder, Anna, et al.
(författare)
Inequalities in the economic consequences of depression and anxiety in Europe : a systematic scoping review
2020
Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 30:4, s. 767-777
Forskningsöversikt (refereegranskat) abstract
Background: Depression and anxiety are associated with adverse outcomes in educational achievements and economic performances. Moreover, the prevalence of these disorders is unequally distributed among different population subgroups. Our objective is to investigate whether the economic consequences of depression and anxiety differ between population subgroups of different gender, socioeconomic status (SES), ethnicity and age, in Europe. Methods: A systematic scoping literature review was performed to identify studies where exposure to depression or anxiety was identified at baseline and consequences in education, sickness absence, disability pension, unemployment and income/earnings were measured at follow-up. Results: Seventeen articles were included in this review and most of these were conducted in the Nordic countries. The consequences of depression and anxiety were stratified by gender in most of the articles. However, only in a few studies, the findings were stratified by SES, age and ethnicity. The negative consequences of depression in educational performance, disability pension and income are larger for men compared to women. Moreover, low SES individuals have more depression- and anxiety-related absence from work than high SES individuals. Conclusion: Our findings imply that the economic consequences of depression differ between population subgroups in Europe. This could have an impact on social stratification, shifting people who experience mental ill-health to lower SES groups or reinforcing an already disadvantaged position. More research is needed on unequal economic consequences of depression and anxiety in different population subgroups in Europe.
