Anything working less well? Focus group members discussed how they strived to retain balance in the face of external challenges, such as major life events, like sickness or job changes, or in response to smaller, day-to-day hassles. Group members commonly shared instances of where they had felt tipped off balance and described strategies that they had adopted to regain equilibrium. When seeking care from a provider like Nuffield Health, one major theme that emerged was the importance of feeling supported and protected during a period of acute disruption and anxiety.
For service users who had received a diagnosis or treatment in particular, the speed with which they were attended to was centrally important to their wellbeing, helping to ease anxiety and worry. Additionally, the competency of hospital staff was also an important factor in allaying worry and ensuring that patients and family members felt secure and safe while seeking care.
When asked to reflect on their experiences interacting with the types of preventative health services provided by Nuffield Health, group members were most familiar with fitness centres. Here, service users mentioned that the primary role that these centres played in their wellbeing was as a place they could go to take time out and relieve stress on a regular basis. Additionally, fitness centres themselves also appeared to play a key wellbeing-promoting role by acting as spaces that afford opportunities for positive and regular social interactions to occur. Considering our second research question pertaining to staff and service users views on a selection of candidate measurement tools for capturing wellbeing in a healthcare context, one clear theme to emerge was that questionnaires that provide a single outcome score that reflects a global end-state e.
For example, service users commented that these types of questionnaire are unable to pinpoint the independent influence of a health service, aside from other causal factors, on their own wellbeing. Staff voiced similar concerns to service users regarding the purpose of wellbeing questionnaires in a healthcare context, suggesting that these may be more appropriate, and have a greater chance of being accepted, if they can provide actionable insight.
Questionnaires that give a single global outcome score were, therefore, seen to offer scant guidance for staff on how to generate health service improvements. In general, staff members discussed how they saw the value of this type of wellbeing questionnaire lying in their potential use as screening tools.
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A further theme to emerge in relation to wellbeing measurement in a healthcare context was the fact that the chosen questionnaire needs to accurately reflect patient understandings of wellbeing. Nuffield Health and other healthcare organisations already routinely use these tools for the purposes of outcome monitoring, yet their relevance as potential measures of wellbeing is uncertain. Two further wellbeing questionnaires that were reviewed in relation to our second research question incorporated indices of life satisfaction — the ONS-4, which also measures experiential and eudemonic wellbeing, and the LISAT-9, which captures degree of satisfaction with different life domains e.
For the ONS-4, service users commented favourably on the short time scale covered by this measure e. When considering these tools, and in particular the ONS-4, conversations tended to turn towards how wellbeing is construed as a constantly fluctuating phenomenon, varying considerably throughout the day, and so is hard to assign an average score to that reflects their experiences seeking treatment as a whole.
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Associated with theme 8, an additional theme to emerge concerned what causes fluctuations in wellbeing, both in general and in a health care context. Within discussions of this theme, the LISAT-9 was referred to favourably by service users as it has the benefit of pinpointing specific contributory causes of overall life satisfaction across a range of domain areas.
Hence, this questionnaire was seen as valuable for promoting an understanding of cause-effect relationships. However, focus group members did add that this questionnaire incorporated domains that are not, and are unlikely to be, a target for wellbeing for a healthcare provider like Nuffield Health. For example, questions probing existing levels of satisfaction with sexual and financial situations were seen as intrusive and irrelevant when asked in this context. Staff discussed feeling uncertain that they were sufficiently knowledgeable to help service users identified as having distinct mental-health needs.
In order to enhance uptake of wellbeing questionnaires in a health care context, both staff and service users commented on the fact that measurement must not only yield data that is useful for the organisation, but that can offer service users real and tangible benefits. For many service users, the service context in which the wellbeing questionnaire is delivered appeared to be an important consideration and one that is likely to influence participation in the measurement process. Confidentiality concerns were frequently voiced, along with a sentiment that Nuffield Health may be over-reaching in asking wellbeing-related questions, especially in contexts outside of primary and secondary care.
Finally, in relation to our third research question, staff group members, in particular, discussed the practicalities involved in the measurement process. This theme was also linked to further discussions surrounding mode of data collection, with service users clearly stating that they are unlikely to prioritise filling out any questionnaire outside the context of a direct consultation e. Acknowledgements The authors thank Flamingo staff Milly Fearon and Yasmin Scott and who recruited and ran focus group sessions with staff and service users.
Funding This research was funded by Nuffield Health. Compliance with Ethical Standards Disclaimers None. Appleby, J. Measuring NHS success. Google Scholar. Batbaatar, E. Determinants of patient satisfaction: a systematic review. Perspectives in Public Health, 2 , 89— CrossRef Google Scholar.
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Benning, T. Exploring outcomes to consider in economic evaluations of health promotion programs: what broader non-health outcomes matter most? Braun, V. Using thematic analysis in psychology. Qualitative Research in Psychology, 3 2 , 77— Coulter, A. Measuring what matters to patients. BMJ , j Diener, E.
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New well-being measures: short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97 2 , — Dolan, P. Measuring subjective wellbeing for public policy. Office for National Statistics, 6 February , 19— Losing sight of the wood for the trees: Some issues in describing and valuing health, and another possible approach. PharmacoEconomics, 30 11 , — Dooris, M. Perspectives in Public Health, , 93— Enns, J. Mapping interventions that promote mental health in the general population: a scoping review of reviews.
Preventive Medicine, 87 , 70— Ettorchi-Tardy, A. Benchmarking: a method for continuous quality improvement in health. Fornells-Ambrojo, M. Experience of outcome monitoring in service users with psychosis: findings from an improving access to psychological therapies for people with severe mental illness IAPT-SMI demonstration site. British Journal of Clinical Psychology, 56 3 , — Glasgow, R. What does it mean to be pragmatic?
Pragmatic methods, measures, and models to facilitate research translation. Health Education and Behavior, 40 3 , — Guise, J. A practice-based tool for engaging stakeholders in future research: a synthesis of current practices. Journal of Clinical Epidemiology, 66 6 , — Headey, B. Subjective well-being: revisions to dynamic equilibrium theory using national panel data and panel regression methods. Social Indicators Research, 79 3 , — Hilton, L.
Mindfulness meditation for chronic pain: systematic review and meta-analysis. Annals of Behavioral Medicine, 51 2 , — In summary, this series will provide invaluable support to anyone studying or practising in the field of public health, in a range of different settings. Claire Bradford graduated from Nottingham University Medical School in the s and pursued a clinical career as a haematologist.
Her professional interests include knowledge management, maternal and child health and reduction in health inequalities. John Harvey is currently a director of a limited company providing public health consultancy. He trained as a public health consultant after working for nine years in the Yemen doing mainly maternal and child health programmes. He has experience as Director of Public Health in three different settings — Newcastle upon Tyne, Jersey and the London borough of Havering, where he was a visiting professor of public health at London South Bank University.
After medical qualification and junior doctor posts, he trained as a general practitioner. For the next 8 years he worked for different health programmes in Nepal, initially as a clinician but with increasing involvement in community health projects. On his return to the UK he trained in public health.stb.dev3.develag.com
He has been a consultant and doctor of public health in the North East since then, apart from another recent 2-year spell in Nepal. Vicki Taylor has worked in public health since in a range of different roles at local, regional and national levels, and is now Director of the Roundhouse Consultancy MK Ltd, which offers consultancy in public health and leadership and management.
She has a strong interest in public health development and, in particular, the development of public health leadership and management. She has substantive experience of public health and public health practitioner development in a number of geographical areas, spanning a period of more than 25 years. In these roles Vicki has influenced and championed the development of public health practitioner schemes. Rhonda Ware is a registered nurse who has worked at a senior level in the commercial, charity, local authority and health sectors, including private and the NHS.
Rhonda was a senior manager in public health, having previous expertise in children's health and education, learning disabilities and care of the elderly. She is now Co-Director of Tiger Health Limited, which offers consultancy in healthcare and public health. Rhonda has a particular interest in leadership and change management, governance and quality improvement.
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Chapter 2 was written by John Harvey with contributions to the activities from Vicki Taylor. The editors and publisher would like to thank the following for permission to reproduce copyright material:. Stockholm Institute for Future Studies for Figure 1. BMJ , — BMJ , Every effort has been made to trace all copyright holders within the book, but if any have been inadvertently overlooked the publisher will be pleased to make the necessary arrangements at the first opportunity.
This book explores the knowledge and skills required to undertake meaningful measures of health and wellbeing. One of the most important tasks we have as a society is to promote the health and wellbeing of our population, looking to improve their long-term quality of life. To do this we must understand two main issues: what determines health and wellbeing and how that influences the needs of any given population; and what impact interventions, whether a public health programme, a new social policy, a housing development or a health and social care service, have on individuals and the population — so-called outcomes.
This understanding is informed by measuring health and wellbeing. This is a vital aspect of public health practice. The practitioner must be able to plan and undertake straightforward need assessment for a local community or wider population. This requires a knowledge of how different measures are produced, the competence to give relevant interpretation of those measures and the skill to present the information in a compelling way.
This book is one of a series of four books aimed at addressing the core standards for public health practice as set out in the UK Public Health Skills and Career Framework Bringing together a basic understanding of need and measures used to express need and methods for doing health needs assessment HNA this book provides a practical resource that can be applied to public health and health promotion practice. It aims to make accessible from the vast health surveillance and population assessment literature some key concepts that may have relevance to measuring health and wellbeing.
Through the use of case studies and activities, this book seeks to support the achievement of health improvement and health promotion goals.