This thesis focuses upon the surprising connection between two separate bodies of work: the capability approach and Daniel Hausman’s 2015 book Valuing Health: Well-Being, Freedom, and Suffering. Proponents of the capability approach, such as Martha Nussbaum, have argued that the state has an important role to play in promoting well-being. Hausman seems to hold a position quite dissimilar from this, as he argues that standard practices in health economics are seriously flawed because the liberal state should not be promoting well-being. However, I argue that there exists an unexpectedly great degree of similarity between the two positions and suggest that it seems as though Hausman is, in fact, calling for the promotion of well-being. In illuminating conceptual similarities between the two views, I also point to areas where Hausman’s proposals might be strengthened or enhanced by work from CA theorists. This paper provides the foundation for further research to be undertaken exploring how these views might enhance one another.

Abstract not available

The purpose of this study was to evaluate the methods currently available to measure the functional outcomes of physiotherapy treatment for low back problems. As a preliminary step, all extant questionnaires were located and evaluated against practical criteria to determine their likely utility in clinical practice. This process identified a large number of questionnaires, however, only six back-specific questionnaires fulfilled the practical criteria for clinical application. Four of these questionnaires were selected for further evaluation along with a generic health status assessment instrument, the SF-36 Health Survey. Current recommendations suggest that a low-back specific and a generic questionnaire are required for comprehensive assessment of the impact of low back problems. The four back-specific questionnaires selected were the Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire and the Waddell Disability Index. An evaluation of the literature on the clinimetric properties of these questionnaires revealed that little information was available for the Quebec and Waddell questionnaires and no information was available for any of the questionnaires for a clinical population of people with low back pain seeking physiotherapy treatment in an Australian setting. The primary aim of the research was identify which, if any, of the questionnaires should be recommended for measuring outcomes of physiotherapy treatment for low back pain. Consecutive ambulatory (non-admitted) patients presenting for physiotherapy treatment at three public hospital physiotherapy outpatient departments, three community health services, and four private practices were invited to enter the study. Patients were included if they were seeking treatment for a low back problem, were aged 18 or over, and could read and write English. Subjects completed the questionnaires on two occasions six-weeks apart. One hundred and forty subjects returned the first set of questionnaires, and 106 the second set. The mean age of the sample at pre-test was 51 (SD 17) and ranged from 18 to 89 years. Sixty-six percent were female, 41% were employed and 12% were receiving compensation for their back problem. Duration of the back complaint was more than six weeks for 56% of subjects, and 60% reported five or more previous episodes or continuous pain. Referred pain in the buttock thigh or leg was reported by 70% of subjects. The first aim was to compare the questionnaires for acceptability and comprehensibility. Data quality was high for all the questionnaires (less than 5% missing data). As expected, subjects found the more complex SF-36 Health Survey more difficult to complete than three of the low-back questionnaires. However, less than 10% of subjects found any of the questionnaires more than a little difficult to complete. The next aim was to explore the internal structure and inter-relationships of the low-back questionnaires and the three physical scales of the SF-36 Health Survey (Physical Functioning, Role-Physical and Bodily Pain). Analysis of item-item correlation, item-total correlation and Cronbach�s alpha confirmed that all scales were internally consistent. Factor analysis confirmed item homogeneity (unidimensionality) of all questionnaires except the Roland-Morris Disability Questionnaire. The questionnaires were significantly intercorrelated, but correlations exceeded .70 only for the Oswestry, Quebec and Waddell questionnaires. The next aim of the research was to compare test-retest reliability of the questionnaires. The Oswestry, Quebec and SF-36 Physical Functioning scale had sufficient reliability and scale width for clinical application. Despite previous reports of high reliability, the Roland-Morris scale was significantly less reliable than several of the other questionnaires. This indicates the importance of establishing the measurement properties of a test in the population or setting in which it will be used. The Waddell Disability Index, and the SF-36 Role-Physical and Bodily Pain scales had insufficient scale width to be useful in clinical practice. More than 15% of respondents had an initial score on these scales that would not allow change to be detected with 90% confidence. The next aim of the research was to compare the responsiveness of the questionnaires. None of the questionnaires was consistently identified as more or less responsive than the others although two methods (effect size and Liang�s standardized response mean) suggested the SF-36 Bodily Pain scale was more responsive than some other questionnaires. A secondary aim of this section was to evaluate the validity of the many available responsiveness indices and a novel �reliable change� method. A �known groups� strategy was used to determine whether the responsiveness index could discriminate between the low-back relevant questionnaires and the SF-36 General Health scale, the scores of which did not change across the retest period. With the exception of the novel �reliable change� method the responsiveness indices were all found to be valid indicators of responsiveness. Guyatt�s Responsiveness Index, effect size and Liang�s standardized response mean discriminated at 95% confidence between the reference scale and all the low-back questionnaires. The standardized response mean, t-test, correlation and ROC methods discriminated between the reference scale and five or six of the seven other questionnaires. Guyatt�s index was recommended as the best of the criterion-based methods, and the effect size the best of the distribution-based methods. The three questionnaires identified as having sufficient reliability and scale width, the Oswestry, Quebec and SF-36 Physical Functioning scale, were next analysed for data fit to a Rasch model. All three questionnaires had good data fit and item function was not affected by time, age, gender or whether or not subjects reported avoiding bending. The final aim of this research was to identify by Rasch analysis items to supplement the SF-36 Physical Functioning scale. The new scale, named the Low-Back SF-36 Physical Functioning18, showed comparable reliability and responsiveness to the SF-36 Physical Functioning scale. Further research is required to establish the measurement properties of the Low-Back SF-36 Physical Functioning18 scale in an independent sample. However, it has the potential to improve the clinical measurement of function by providing clinicians with a single measurement tool for comprehensive assessment of patients with low back pain.

The purpose of this study was to evaluate the methods currently available to measure the functional outcomes of physiotherapy treatment for low back problems. As a preliminary step, all extant questionnaires were located and evaluated against practical criteria to determine their likely utility in clinical practice. This process identified a large number of questionnaires, however, only six back-specific questionnaires fulfilled the practical criteria for clinical application. Four of these questionnaires were selected for further evaluation along with a generic health status assessment instrument, the SF-36 Health Survey. Current recommendations suggest that a low-back specific and a generic questionnaire are required for comprehensive assessment of the impact of low back problems. The four back-specific questionnaires selected were the Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire and the Waddell Disability Index. An evaluation of the literature on the clinimetric properties of these questionnaires revealed that little information was available for the Quebec and Waddell questionnaires and no information was available for any of the questionnaires for a clinical population of people with low back pain seeking physiotherapy treatment in an Australian setting. The primary aim of the research was identify which, if any, of the questionnaires should be recommended for measuring outcomes of physiotherapy treatment for low back pain. Consecutive ambulatory (non-admitted) patients presenting for physiotherapy treatment at three public hospital physiotherapy outpatient departments, three community health services, and four private practices were invited to enter the study. Patients were included if they were seeking treatment for a low back problem, were aged 18 or over, and could read and write English. Subjects completed the questionnaires on two occasions six-weeks apart. One hundred and forty subjects returned the first set of questionnaires, and 106 the second set. The mean age of the sample at pre-test was 51 (SD 17) and ranged from 18 to 89 years. Sixty-six percent were female, 41% were employed and 12% were receiving compensation for their back problem. Duration of the back complaint was more than six weeks for 56% of subjects, and 60% reported five or more previous episodes or continuous pain. Referred pain in the buttock thigh or leg was reported by 70% of subjects. The first aim was to compare the questionnaires for acceptability and comprehensibility. Data quality was high for all the questionnaires (less than 5% missing data). As expected, subjects found the more complex SF-36 Health Survey more difficult to complete than three of the low-back questionnaires. However, less than 10% of subjects found any of the questionnaires more than a little difficult to complete. The next aim was to explore the internal structure and inter-relationships of the low-back questionnaires and the three physical scales of the SF-36 Health Survey (Physical Functioning, Role-Physical and Bodily Pain). Analysis of item-item correlation, item-total correlation and Cronbach�s alpha confirmed that all scales were internally consistent. Factor analysis confirmed item homogeneity (unidimensionality) of all questionnaires except the Roland-Morris Disability Questionnaire. The questionnaires were significantly intercorrelated, but correlations exceeded .70 only for the Oswestry, Quebec and Waddell questionnaires. The next aim of the research was to compare test-retest reliability of the questionnaires. The Oswestry, Quebec and SF-36 Physical Functioning scale had sufficient reliability and scale width for clinical application. Despite previous reports of high reliability, the Roland-Morris scale was significantly less reliable than several of the other questionnaires. This indicates the importance of establishing the measurement properties of a test in the population or setting in which it will be used. The Waddell Disability Index, and the SF-36 Role-Physical and Bodily Pain scales had insufficient scale width to be useful in clinical practice. More than 15% of respondents had an initial score on these scales that would not allow change to be detected with 90% confidence. The next aim of the research was to compare the responsiveness of the questionnaires. None of the questionnaires was consistently identified as more or less responsive than the others although two methods (effect size and Liang�s standardized response mean) suggested the SF-36 Bodily Pain scale was more responsive than some other questionnaires. A secondary aim of this section was to evaluate the validity of the many available responsiveness indices and a novel �reliable change� method. A �known groups� strategy was used to determine whether the responsiveness index could discriminate between the low-back relevant questionnaires and the SF-36 General Health scale, the scores of which did not change across the retest period. With the exception of the novel �reliable change� method the responsiveness indices were all found to be valid indicators of responsiveness. Guyatt�s Responsiveness Index, effect size and Liang�s standardized response mean discriminated at 95% confidence between the reference scale and all the low-back questionnaires. The standardized response mean, t-test, correlation and ROC methods discriminated between the reference scale and five or six of the seven other questionnaires. Guyatt�s index was recommended as the best of the criterion-based methods, and the effect size the best of the distribution-based methods. The three questionnaires identified as having sufficient reliability and scale width, the Oswestry, Quebec and SF-36 Physical Functioning scale, were next analysed for data fit to a Rasch model. All three questionnaires had good data fit and item function was not affected by time, age, gender or whether or not subjects reported avoiding bending. The final aim of this research was to identify by Rasch analysis items to supplement the SF-36 Physical Functioning scale. The new scale, named the Low-Back SF-36 Physical Functioning18, showed comparable reliability and responsiveness to the SF-36 Physical Functioning scale. Further research is required to establish the measurement properties of the Low-Back SF-36 Physical Functioning18 scale in an independent sample. However, it has the potential to improve the clinical measurement of function by providing clinicians with a single measurement tool for comprehensive assessment of patients with low back pain.

This study involved designing an instrument to estimate self care knowledge levels of post myocardial infarction patients. The instrument subscales were diet, smoking, exercise, signs and symptoms of cardiac distress, medications, stress and high blood pressure. Twenty-six subjects were tested following hospital discharge and again two weeks later. Test-retest reliability was performed to establish stability of the instrument. The preset criterion level of.70 for the total scale was not met. The medication subscale did meet the.70 criterion level. Reliability estimates were conducted to establish internal consistency of the instrument. The preset criterion level of.70 was not met for the total scale; however, the stress subscale did meet the.70 criterion level on the retest. Concurrent validity was estimated by comparing subscale knowledge scores with self report behavior. Point biserial coefficients did not meet the preset.70 criterion levels. These results suggest that reliability and validity estimates in the post myocardial infarction patient population were not statistically significant. (Abstract shortened with permission of author.)

Global health is an emerging concern in a rapidly changing world in which health issues transcend international borders. This study developed and validated a new self-report questionnaire to assess self-perceived global health competencies among international medical students and how they are influenced by international clinical experiences. A tool consisted of two scales and four subscales with moderate internal consistency. Comparisons between participants who completed retrospective pretest (after the intervention retrospectively) and those who completed traditional pretest (before the intervention) revealed that those participants who completed the questionnaires retrospectively provided lower pretest scores, suggesting that response-shift bias had occurred. Significant increases in scores after international clinical experience were reported for the majority of global health competency measures in IFMSA group. Linear regression identified participant’s age, gross national income (GNI) of country of medical studies, GNI of the country visited, duration of international clinical experience and years of medical school completed, as significant predictors of global health scores. This study contributes valuable information about the newly developed global health competencies measurement tool.

Are health inequalities unjust, and if so, how should we measure and evaluate them? This thesis explores the central moral debates that underlie these sorts of questions about health inequalities, and it argues in support of one particular framework for measuring health inequalities. I begin by shedding light on the questions that need to be asked when attempting to determine which types of health inequalities are unjust. After explaining the complexities of several possible views of health inequity, I use these perspectives to inform my discussion of the debate about whether we ought to measure health inequalities in terms of individuals or groups. I evaluate the key tensions between these two opposing points of view. I then introduce a third possible view, which is Yukiko Asada’s idea that both individual and group-based measures of health inequality leave out important moral information, so it is therefore necessary to include both in order to get a full picture of a population’s health inequality. Next, I respond to objections that the proponents of using either a group or individual measurement of inequality on its own might make to the claim that neither measure is sufficient on its own. Finally, I propose some small changes to Asada’s measurement framework, which I believe will demonstrate why those opposed to her view actually ought to embrace it. I conclude that this approach is a promising solution to some of the difficulties defining health inequities that I have called attention to.

Poor health and early exit from labour force: an analysis using data from Survey of Health, Ageing and Retirement in Europe Václav Hausenblas May 12, 2011 Abstract Health is considered to be one the main determinants of retirement decision. A majority of empirical studies implements health using self- perceived health status measures. According to the justification hypoth- esis such a method may introduce a bias into estimation, and moreover, this bias may vary from country to country. The aim of this thesis is to make use of a dataset rich in objective measures of health from the second wave of Survey of Health, Aging and Retirement in Europe and to put side by side the estimates based on subjective measures as well as IV estimates using more objective variables and thereby to assess the mag- nitude of possible endogeneity and measurement error. It applies these identification methods on the model of early exit from labour force and discusses gender differences and specifics of given EU countries. 1

The overall goal of the thesis was to investigate the nature of the healthy human self and the process of achieving health. This was undertaken by reviewing established self-theory and presenting a summary of each theory and its position with regard to self-composition, self-agency and the nature of the healthy self. An inclusive self-theory was then developed, congruent with reviewed literature, which positioned spirituality as the essential core of self. From the foundational Spiritual Theory of Self and the findings of the first study in this thesis, the Health Change Process Theory was developed to explain and predict how people achieve sustainable health. Three subsequent studies resulted in the construction and testing of a quantitative measure which enabled scientific investigation of the nature of the healthy self and the process of achieving health. Method The methodology of the four studies in this thesis was based on the instrumental approach which posits that, while there are procedural differences between qualitative and quantitative methodologies, philosophically speaking, there is no fundamental difference as they are both equally applicable and valuable. Consequently, the methodology judged to be the most appropriate instrument to investigate each study's topic of inquiry was chosen rather than allegiance to either qualitative or quantitative methodology. The first study was qualitative, as it investigated the definition of health and the process by which it was achieved from the perspective of 30 people with chronic musculoskeletal impairments. The findings from this study provided the theoretical basis for the three subsequent questionnaire development and validation studies. The second study used qualitative methodology with 59 participants to identify participant-generated items used in a new quantitative holistic health questionnaire and then employed quantitative methods to perform preliminary tests of the reliability and validity of this measure. The third study used quantitative methods with 233 participants to evaluate more robustly the reliability, content and concurrent validity of the original developmental measure and another, behaviourally-orientated assessment instrument, which used the identical item content but re-framed in the past tense. The fourth study employed qualitative and quantitative methods with 205 participants to evaluate the clinical validity of the scale found to possess reliability and validity in the previous investigation. Results The critical review of self-theory concluded with the development of the Spiritual Theory of Self. The initial study supported this theory as a robust explanation and predictor of the determinants of a healthy self. Furthermore, the findings of this study and a review of relevant literature concluded with the development of a Health Change Process Theory, which was based on the Spiritual Theory of Self. The Health Change Process Theory explains and predicts the process by which a healthy self develops. The subsequent questionnaire development and validation studies sought to provide a quantitative holistic assessment tool, congruent with the Health Change Process Theory, and found the 28-item QE Health Scale (QEHS) to be a reliable and valid measure of holistic health. These results also demonstrated that the Health Change Process Theory and the underpinning Spiritual Theory of Self were robust. With regard to clinical application, the QEHS was found to aid assessment, therapeutic intervention, a client-centred holistic approach to healthcare and evidenced-based practice. The Patient Profile, derived from QEHS responses, provided a tool that enabled theory to be applied to practice by identifying the key indicator personal attributes determining holistic health status. Conclusion The research results demonstrated that the Spiritual Theory of Self and the Health Change Process Theory provide valid explanations of the constructs that enable people with musculoskeletal disorders to remain otherwise healthy with such conditions. Furthermore, the relationship between the findings and established self-theories suggest that the Spiritual Theory of Self and the Health Change Process Theory may advance knowledge of the predictors and interventions that enable all people to undertake a health-enhancing process of change when confronted with adversity. The QEHS and associated Patient Profile were found to be reliable and valid tools that facilitated assessment and enhancement of the holistic health status for people with musculoskeletal impairments. These tools identified barriers to achievement of holistic health, predicted by the Health Change Process Theory; facilitated the therapeutic process through a focus on issues meaningful to those receiving healthcare; aided treatment decision making; and enabled quantitative evidence-based evaluation of the efficacy of interventions. Moreover, the overall results have advanced psychological knowledge with implications for all fields of psychology involved in the study of people. The evidence of the research undertaken provides a basis for promoting knowledge and research of chronic healthcare delivery and a spiritually based conception of self and health. The QEHS and associated theories provide a tool and basis for investigations where people are experiencing traumatic, irreversible crises. However, the initial aims of further research should be to refine the QEHS and the associated Patient Profile to enable the use of theory and the QEHS across a diverse range of research populations and to investigate the applicability of these to facilitate the maintenance or achievement of a healthy self.

Global health is an emerging concern in a rapidly changing world in which health issues transcend international borders. This study developed and validated a new self-report questionnaire to assess self-perceived global health competencies among international medical students and how they are influenced by international clinical experiences. A tool consisted of two scales and four subscales with moderate internal consistency. Comparisons between participants who completed retrospective pretest (after the intervention retrospectively) and those who completed traditional pretest (before the intervention) revealed that those participants who completed the questionnaires retrospectively provided lower pretest scores, suggesting that response-shift bias had occurred. Significant increases in scores after international clinical experience were reported for the majority of global health competency measures in IFMSA group. Linear regression identified participant’s age, gross national income (GNI) of country of medical studies, GNI of the country visited, duration of international clinical experience and years of medical school completed, as significant predictors of global health scores. This study contributes valuable information about the newly developed global health competencies measurement tool.