Managed Mental Health Care (MMHC) began blanketing the United States when cost of care rose exponentially. MMHC is one avenue many employers and insurance companies have chosen to provide employees with mental health treatment at controlled costs. However, not all employers view supplying their employees with mental health treatment beneficial, as they do not know mental health problems can significantly decrease work productivity. Brown and Jones (2005) used the Social Role Scale (SR) of the Severe Outcome Questionnaire (SOQ) to estimate work productivity in employees under the assumption that the scale measures work productivity. The purpose of this study was to move closer to an estimation of the relationship between improved mental health and improved workplace functioning by examining the relationships among a self-report measure of mental health (i.e., the SR), a self-report measure of work productivity (i.e., the Work Productivity and Activity Impairment Scale [WPAI]), and objective measures of work productivity (i.e., the quality and timeliness of institutional records, supervisor ratings, and sick hours used). It was thought that understanding the relationships among these measures might assist in estimating the cost/benefit of investing in psychotherapy. Participants in this study were employees and inpatients at the Utah State Hospital. Statistical analyses indicated the SR did predict two WPAI scales (i.e., Presenteeism and Activity Impairment) for employees. Specific relationships among measures, and suggestions for future research, are discussed.

No / Patient-reported outcome measurement has become accepted as an important component of comprehensive outcomes research. Researchers wishing to use a patient-reported measure must either develop their own questionnaire (called an instrument in the research literature) or choose from the myriad of instruments previously reported. This article summarizes how previously developed instruments are best assessed using a systematic process and we propose a system of quality assessment so that clinicians and researchers can determine whether there exists an appropriately developed and validated instrument that matches their particular needs. These quality assessment criteria may also be useful to guide new instrument development and refinement. We welcome debate over the appropriateness of these criteria as this will lead to the evolution of better quality assessment criteria and in turn better assessment of patient-reported outcomes.

本研究旨在探討公共圖書館青少年閱讀推廣活動成果評鑑之規劃與執行，研究目的包括：（1）探討公共圖書館青少年閱讀推廣活動成果評鑑方法與指標。（2）應用成果評鑑指標，進行圖書館青少年閱讀推廣活動成果評鑑，評定閱讀素養、閱讀興趣、閱讀習慣與使用圖書館是否提升成效。（3）探討公共圖書館青少年閱讀推廣策略。本研究採用焦點團體訪談建構成果評鑑指標，於執行活動後進行成果評鑑，以問卷及後續追蹤手冊蒐集資料，評估活動辦理成果。 本研究使用之成果評鑑面向包括：（1）活動滿意度、（2）閱讀興趣、（3）知識學習及（4）圖書館使用意願，活動選用臺北市立圖書館「翻轉知識系列活動─青少年經典閱讀週」。由本研究研究結論可知，此次成果評鑑面向與指標具有可行性，並經由研究分析之後提出十項結論：（1）後續追蹤手冊回收數量過少，可知學生的後續閱讀及圖書館利用不如預期。（2）成果評鑑面向的研究結果皆顯著。（3）量化分析中，平均數大部分達到四以上，可知對參與學生而言，整體系列活動為滿意。（4）科學主題、表演藝術主題活動想讓學生再次參與相關活動，電影及文學主題能夠影響學生借閱相關書籍或資源的意願。（5）有關學生閱讀行為，閱讀清單的規劃有自主性，以文學類書籍為主。（6）四主題活動參與學生對於圖書館皆有正向的意象。（7）整體研究發現，在活動主題與類型的搭配方面，電影、表演藝術適合帶領人活動類型，以提升學生的閱讀興趣，科學、文學主題活動適合規劃為長期活動，以逐步培養閱讀素養。（8）在閱讀推廣策略方面，本次活動透過「與學校合作」並「結合圖書館其他資源」達成綜效。（9）以活動參與者角度進行活動設計，結合生活、課業與未來規劃三訴求選定活動主題。（10）建立長期閱讀素養的初始階段，以「帶領人活動」之活動類型吸引青少年讀者參與閱讀活動。 最後，本研究針對研究結果提出研究建議，有關青少年閱讀推廣活動之建議：（1）與圖書館利用連結的推廣活動。（2）學生自選書單延伸推廣。（3）目標導向閱讀素養培養。（4）推廣紙本書籍以外的閱讀資源。有關後續研究之建議：（1）針對不同活動類型與主題的青少年閱讀推廣活動進行成果評鑑研究。（2）資料蒐集方式可再加強信度與效度。（3）改進後續追蹤設計形式及進行方式。

Diese Arbeit verfolgt das Ziel, soziale Wirkungen einer ausgewählten Bibliothek gültig und verlässlich nachzuweisen. Sie beschäftigt sich mit dem vielschichtigen Problem, Tätigkeitszusammenhänge zu untersuchen, die bedeutsame Veränderungen hervorrufen und fragt nach dem Einfluss der Bibliothek in individueller und gesellschaftlicher Hinsicht. Dies steht im Zusammenhang mit der Leistungsbeurteilung einer Bibliothek. Ausgehend von verschiedenen Wirkungsdefinitionen im Kontext ihres theoretischen Hintergrundes (Kapitel eins) werden unterschiedliche Ansätze der Leistungs- und Wirkungsmessung verglichen (Kapitel zwei). Darauf aufbauend wird die Wahl des social-process-audit-Ansatzes begründet und führt im Kapitel drei zur Darstellung des Forschungsdesigns. Im Kapitel vier werden die Forschungsergebnisse vorgestellt. Die Ergebnisse dieser empirischen Untersuchung zeigen, dass die Wirkungen der ausgewählten Bibliothek gesellschaftlich bedeutsam sind. Durch ihr Angebot bewirkt diese Bibliothek nicht nur vielfältigen Nutzen, sondern auch Veränderungen innerhalb der Lebensbereiche ihrer Interessengruppen. Diese langfristigen sozialen Wirkungen können für die Bibliothek von strategischer Bedeutung sein. Die Besonderheiten der Arbeit bestehen darin, (1) dass gesellschaftliche Wirkungsbezüge gültig nachgewiesen worden sind, (2) dass nicht auf Nutzungszusammenhänge eingeschränkt, sondern im Kontext des Auftrages der Bibliothek untersucht wurde und (3) dass das Einbeziehen der Positionen aller relevanter Interessengruppen – sowohl in Hinblick auf das Ermitteln der erwünschten Wirkungen als auch der erreichten Wirkungen – eine entscheidende Grundlage darstellte. Die im Kapitel fünf enthaltenen Schlussbetrachtungen beschäftigen sich mit Problemen der wissenschaftlich-empirischen Methode des Interviewens, der Verallgemeinerung der Untersuchungsergebnisse und ausgewählten aktuellen Fragestellungen. / This thesis aims at validly and reliably proving social effects (Impact, Outcome) of a selected library. It deals with the complex problem of surveying the context of activities causing significant changes. Apart from that, it looks into the library''s influence on the individual and on society, thus furnishing results which facilitate the assessment of a library''s achievements. Starting with various definitions of outcomes in the context of their theoretical background (chapter one), different approaches to assessing performace, impact and outcome are compared (chapter two). Based on that, the selection of the social-process-audit approach is justified and then the research design described (chapter three). In chapter four, the results of the survey are presented. The empirical study proves that the effects of the selected library are socially significant. This library''s offer does not only bring about a variety of benefits, but it also causes changes in its stakeholders'' lives – long-term social effects that may be of strategic significance for the library. The special features of the thesis are (1) the valid proof of social effects, (2) the fact that the survey has not been restricted to ways of use, but has been carried out in the context of the library''s task and (3) that the inclusion of the positions of all relevant interest groups (stakeholders) – with regard to both determining the intended effects and the ones that have been actually reached – has built a decisive basis. The concluding remarks (chapter five) consider problems of the scientific-empirical method of interviewing and contain a generalization of the thesis''s results as well as selected topical questions.

Patient reported outcome (PRO) measurement of disability is integral to a patient-centered approach to health care and gauging the biopsychosocial impact of health conditions from the patient's perspective. This thesis investigates disability after proximal humerus, elbow and distal radius fractures; conditions that constitute a major burden in musculoskeletal health care and a substantial impact on health-related quality of life (HrQoL). Disability is defined by the World Health Organisation (WHO) International Classification of Disability, Functioning and Health (ICF) as ‘a multi-dimensional construct involving a dynamic interaction between impairment, activity limitations and participation restrictions, that are influenced by contextual factors'. This international, consensus-based framework acts as a guide for the application of outcome measures in performing scientific research. The WHO ICF also considers other patient perspectives on health and health care systems, including patient experience and patient activation within the contextual factors component. Patient experience encompasses aspects such as satisfaction, expectation management and confidence with care, and is measured using a variety of scales and questionnaires. Patient activation relates to 'the knowledge, skills and confidence a person has in managing their own health and health care'. This concept is quantified using patient activation measures (PAMs). The overarching goal of this thesis is to identify the most influential factors predicting disability after proximal humerus, elbow and distal radius fractures. This work also aimed to define the relationship between disability, experience and activation to inform the development of a patient-centred approach to managing these challenging injuries. The first systematic review highlights the dominance of psychosocial factors in influencing disability associated with a range of upper extremity conditions. Few studies have assessed this relationship in specific trauma populations. The second review underlines the paucity of upper extremity PRO measures incorporating fracture populations in their original development. It also reports the highly variable quality of initial studies introducing these measures. The final review demonstrates the superior measurement properties of computer adaptive tests (CATs), a contemporary form of PRO measurement, over fixed-scale instruments. Few studies apply CATs in trauma and few have been performed outside the U.S. These reviews collectively informed the selection of PRO measures for the experimental studies in this thesis. Firstly, a pilot study establishes a methodology for addressing the key objectives and the feasibility of using a web-based platform for measuring patient outcomes. Strong correlation between PROMIS Physical function CAT, a computer adaptive measure of physical function, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), a region-specific, fixed scale is observed. The core experiment (n=734) expands upon this work and demonstrates correlations between a range of generic and region-specific measures in an upper extremity trauma population. Disability is shown to correlate with satisfaction, and the strength of this correlation increases over time. Applying PRO measures of disability in populations with shoulder, elbow and wrist fractures show that self-efficacy (i.e. coping ability) within 6 weeks of injury was the strongest predictor of medium-term disability at 6-9 months. In proximal humerus and elbow fractures, kinesiophobia (i.e. fear of movement) within a week of injury was also a strong predictor of disability. The final study concludes that greater patient activation is associated with greater health-related and experiential outcomes. However, psychosocial factors including self-efficacy, superseded activation in predicting disability and satisfaction. This thesis contributes evidence for musculoskeletal health care professionals (HCPs) to consider specific psychosocial factors, such as coping abilities, and patient activation early in the recovery process to improve disability following these injuries.

Mental health problems are associated with significant losses in work productivity and, consequently, have significant ramifications for business entities and the general economy. Several instruments have been developed to measure productivity-related constructs such as absenteeism and presenteeism. The current study examines the utility of the Outcome Questionnaire-45 (OQ), a commonly used mental health questionnaire, in predicting work productivity. This relationship is explored as a preliminary step in assessing the degree to which changes in mental health brought about by psychotherapy will improve work productivity. Forty-nine participants were recruited from a call center in a small market research firm based in the Western United States. Work productivity was measured using four subscales of the Work Productivity and Activity Impairment (WPAI) questionnaire as well as an objective measure. The OQ and WPAI were administered on a weekly basis over the course of five weeks. Participant characteristic variables and work-time variables were also measured. A mixed models analysis of covariance (ANCOVA) with repeated measures showed that the Social Role (SR) Scale, a subscale of the OQ, was a significant predictor of Presenteeism, Overall Work Impairment, and Activity Impairment subscales. Latent growth modeling (LGM) was used to examine the relationship between the variables while accounting for individual trajectory differences. Although the results suggested that an unconditional model of Overall Work Impairment with SR as a time-varying covariate provided a good fit for the data, standardized regression weights between the variables were not significant. Implications of findings, limitations, and recommendations for future research are discussed.

INTRODUCTION: Despite evidence showing that tinnitus can have a detrimental impact on significant others (SOs), no standardized self-reported measure is currently available that specifically assesses the presence of third-party disability for tinnitus. The aim of this study was to develop and assess the psychometric properties of a newly developed self-reported measure for SOs of tinnitus and assess how scores could be meaningfully interpreted. METHODS: The research consisted of two phases. During Phase I, the Consequences of Tinnitus on Significant Others Questionnaire (CTSOQ) was developed using the The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Phase II included the assessment of psychometric properties of the CTSOQ including the construct validity, internal consistency, interpretability, and responsiveness. Pairs of 194 individuals with tinnitus and their SOs completed a series of online questionnaires. SOs completed the CTSOQ measure while individuals with tinnitus completed measures related to tinnitus distress, anxiety, depression, insomnia, and quality of life. RESULTS: A 25 item CTSOQ was developed using a formative model. The questionnaire validation process indicated good psychometric properties with an internal consistency of 0.93 and inter-item correlation of 0.60. Support was found for the construct and discriminative validity of the measure. Floor and ceiling effects were negligible. Scores can be meaningfully interpreted to indicate mild, significant, or severe effect of tinnitus on SOs. The questionnaire was also found to be responsive to treatment-related changes. CONCLUSIONS: The CTSOQ was found to have sufficient measurement properties suggesting that it is a suitable measure of third-party disability for SOs of individuals with tinnitus. Further research should be initiated to measure face validity and what scores reflect clinically meaningful change.