Promoting the health and well being of older carers : a proactive strategy

Research has indicated that carers are concerned about their ageing status, their deteriorating health and their ability to continue to care for their dependants. Given that the health care system will become increasingly reliant on carers the health care needs of carers should be a concern for all health care professionals. This paper describes the first stage of a project designed to enhance older carers health promotion knowledge and skills and improve their health promoting behaviours. This stage investigated the mental and physical health status of older carers. It also sought information on older carers' levels of participation in health related and social activities and identification of barriers to participation in these types of activities. The results highlighted that carers responding to the survey experienced compromised physical and mental health. Many carers reported being unable to participate in social and health-type activities as they were unable to leave the care recipient. Of note, is that carers identified their own mental fragility and felt they needed further emotional support.

Well-being and menopause: an investigation of purpose in life, self-acceptance and social role in premenopausal, perimenopausal and postmenopausal women

Objectives: Many studies have investigated anxiety and depression during the menopausal transition. However, there is little understanding of positive aspects of well-being among menopausal women. This paper reports on two studies which investigated how menopausal stage and age accounted for how women felt about their purpose in life, self-acceptance and social role. Method: In Study One, 304 women from a community sample completed structured questionnaires which included questions relating to demographic background and two subscales of the Psychological Well-being Inventory: purpose in life and self-acceptance. In Study Two, 203 participants from Study One returned a follow-up structured questionnaire related to purpose in life and social role. Results: Study One found that the effects of age group and menopausal group could not be separated: All women felt they would be more positive about these well-being measures in the future than they had been in the past and at present. Study Two found that women who were perimenopausal and postmenopausal did not feel as positive about their role/s in life as premenopausal women, regardless of their age. Conclusions: The results suggest that the menopause may indicate to women that their role/purpose in life is changing. It is important that any understanding of the menopause incorporate psychosocial aspects of women''s lives. Further longitudinal studies are needed to explore well-being factors and the menopause.

Multisensory environments for leisure: promoting well-being in nursing home residents with dementia

Multisensory environments such as Snoezelen^® rooms are becoming increasingly popular in health care facilities for older individuals. There is limited reliable evidence of the benefits of such innovations, and the effect they have on residents, caregivers, and visitors in these facilities. This two-stage project examined how effective two types of multisensory environments were in improving the well-being of older individuals with dementia. The two multisensory environments were a Snoezelen room and a landscaped garden. These environments were compared to the experience of the normal living environment. The observed response of 24 residents with dementia in a nursing home was measured during time spent in the Snoezelen room, in the garden, and in the living room. In the second part of the project, face-to-face interviews were conducted with six caregivers and six visitors to obtain their responses to the multisensory environments. These interviews identified the components of the environments most used and enjoyed by residents and the ways in which they could be improved to maximize well-being.

HRQOL and subjective well-being: noncomplementary forms of outcome measurement

This review considers some of the broad principles that concern quality of life assessment. These are discussed in relation to health-related quality of life (HRQOL) and the measurement of subjective well-being. It is argued that there are serious logical and methodological issues concerning HRQOL measurement, to the extent that the instruments may not be regarded as valid measures of life quality as this term is generally understood. It is recommended that HRQOL measurement be abandoned in favor of three separate forms of measurement as medical symptoms, subjective well-being and specific dimensions of psychological ill-being.

The effects of economic disadvantage on psychological well-being and quality of life among people with multiple sclerosis

This study investigated the impact of economic disadvantage among people with multiple sclerosis (MS) on their psychological well-being and quality of life. Participants were 113 people with MS (31 males, 82 females). Information was obtained on income, lost income, costs of MS, economic pressure, coping, psychological well-being and quality of life. Economic pressure, and not actual MS-related costs predicted psychological well-being. Costs, economic pressure and coping predicted quality of life. These results demonstrate that pressure due to changed economic circumstances, as well as coping with these pressures is important in the quality of life of people with MS.

Health and well-being naturally: 'contact with nature' in health promotion for targeted individuals, communities and populations

Issue addressed: The increase in mental health disorders worldwide makes it important to recognise health promotion interventions that are effective, accessible and affordable. Although natural spaces are coming to be recognised as health-promoting settings for general populations, little is understood about the use of nature contact in treatment and care for individuals experiencing ill-health.

Methods: This paper provides a summary of key research findings and presents a case study examining the self reported health and well-being benefits of nature contact for a small clinical sample. The 'Spectrum of Interventions for Mental Health Problems and Mental Disorders' provides a conceptual framework for ordering current and future information relating to nature-based interventions.

Results: Evidence demonstrates that separately, physical activity, social connection, and contact with nature enhance human health and well-being. The case example illustrates how 'active', 'social' and 'adventurous' contact with nature may be combined within a treatment intervention to protect and enhance the health of individuals experiencing chronic mental, emotional and physical health difficulties.

Conclusions: 'Contact with nature' constitutes a health promotion strategy with potential application in prevention, early intervention, treatment and care. Recommendations include further research to investigate the benefits of nature contact within existing interventions, and the impacts of 'active' and 'social' nature contact within tailored interventions for targeted individuals and communities.

Human health, well-being and global ecological scenarios

This article categorizes four kinds of adverse effects to human health caused by ecosystem change: direct, mediated, modulated, and systems failure. The effects are categorized on their scale, complexity, and lag-time. Some but not all of these can be classified as resulting from reduced ecosystem services. The articles also explores the impacts that different socioeconomic–ecologic scenarios are likely to have on human health and how changes to human health may, in turn, influence the unfolding of four different plausible future scenarios. We provide examples to show that our categorization is a useful taxonomy for understanding the complex relationships between ecosystems and human well-being and for predicting how future ecosystem changes may affect human health.

Linking future ecosystem services and future human well-being

Ecosystem services are necessary, yet not sufficient for human well-being (however defined). Insufficient access to the ecosystem provisioning service of food is a particularly important factor in the loss of human well-being, but all ecosystem services contribute in some way to well-being. Although perhaps long obvious to ecologists, the links between ecosystems and aspects of human well-being, including health, have been less well understood among the social science community. This situation may now be starting to change, thanks in part to the Millennium Ecosystem Assessment (MA). Causality between ecosystem services and well-being is bidirectional; it is increasingly clear that functioning societies can protect or enhance ecosystem services, and accordingly, that societies with impaired well-being (best documented in the case of chronic diseases such as malaria and HIV/AIDS) can also experience a related decline in ecosystem services.

The future state of human well-being and of ecosystem services is more than the co-evolution of these two fundamental elements. Human well-being also depends, critically, upon the human institutions that govern relationships between human individuals and groups, and also between humans and ecosystem services.

The scenarios working group of the MA found that human well-being is highest in the Global Orchestration scenario, which assumes the fastest evolution of beneficial institutions, and is lowest in the Order from Strength scenario. Human well-being was found to be intermediate in the other two scenarios (Adapting Mosaic and Techno-Garden) even though these scenarios share a much greater recognition of the importance of ecosystem services to human well-being.

The health and well-being of adolescents: a school-based population study of the self-report child health questionnaire

Purpose: To evaluate a new generic measure of adolescent health status, the self-report version of the Child Health Questionnaire (CHQ), and provide population-based data. Furthermore, we aimed to examine the impact of common adolescent illness and health concerns on their health and well-being.

Methods: A stratified, two-stage, random cluster sampling design was used to obtain a cross-sectional sample of subjects through schools. A written questionnaire included the 80-item 12-scale self-report CHQ and items measuring health concerns, illnesses/health conditions, and sociodemographics.

Results: A total of 2361 adolescents participated (response rate of 70%). Reliability was high: Tests of internal consistency and discriminant validity reported 90% of item-scale correlations >.4; all scales had Cronbach alpha coefficients >.7. Adolescents with illnesses/conditions or health concerns reported lower scores and larger differences for content-related scales, supporting content and construct validity. Statistically significant age and gender trends were observed for Mental Health, Self-Esteem, General Health, and Family Cohesion scales. Health status worsened as health concerns increased (X2 linear trend, p = .00) with deterioration in health of 5–20% on all scales for emotional health concerns (40% of sample).

Conclusions: The self-report CHQ is a reliable and seemingly valid measure of health and well-being for adolescent health research, although additional measures may be required where scales have high ceiling values. The significantly lower scores reported by adolescents with illness and/or health concerns lend support to the use of standardized health measures and longitudinal research to further examine the impact of adolescent comorbidities and their causal determinants.

Agreement between adolescent self-report and parent reports of health and well-being: results of an epidemiological study.

Objective To examine parent and adolescent agreement on physical, emotional, mental and social health and well-being in a representative population.
Methodology An epidemiological design was used to obtain parent–child/adolescent dyad data on comparable items and scales of a generic measure of health and well-being, the Child Health Questionnaire (parent/proxy report 50 item, self-report 80 item). Scale analysis included intraclass correlations (ICCs) to examine strength of parent–child associations and independent t-tests for differences between adolescents (with or without an illness). Where there were significant differences in scale scores, analysis of variance and two sample t-tests were used to examine the influence of social, demographic, health concern and school variables. Single items were examined for trends in response categories.
Results 2096 parent–adolescent dyads (adolescent mean age of 15.1 years, males 50%, maternal parent 83.2%, biological parent 93.5%). ICCs were strong. Overall, adolescents reported poorer emotional and social health, and clinically significant differences were observed for perceptions of general health (mean difference 8.1/100), frequency and amount of body pain (5.94/100), experience of mental health (5.14/100), and impact of health on family activities (12.43/100), which widen significantly for adolescents with illness. Social, health and school enjoyment and performance significantly widened parent–child differences.
Conclusions All adolescents were much less optimistic about their health and well-being than their parents, and were only in close agreement on aspects of health and well-being they rated highly. Adolescent reports are more likely to be sensitive to pain, mental health problems, health in general and the impact of their health on family activities.

Measuring Australia's well-being using hierarchical needs

A new approach to well-being measurement is presented in this paper based on multidimensional hierarchical human needs and motivation. This paper empirically applies this new measure of well-being to Australia for the period 1985–2000. This hierarchical approach is underpinned by a rigorous psychological theory of human motivation. Hierarchical human needs are classified into five categories. Eight indicators have been chosen to reflect these categories. A composite indicator of these eight indicators is calculated. This paper concludes that it is necessary to consider multidimensional human needs and motivation when analysing and seeking to improve well-being through economic and social development activities.

Measuring human well-being in Thailand : a normative social choice approach

Numerous methods exist within the literature to measure human well-being. A limitation of some approaches however is that they fail to explicitly consider society's views, choices and preferences on how human well-being should be defined. It is possible though to explicitly incorporate society's value judgements in defining and measuring human well-being through normative social choice theory. Normative social choice theory reflects the views, opinions and perspectives of societies of differing economic and social circumstances so that measures of human well-being retain their relevance for public policy makers in those countries. This paper reviews two indicators based on this theory for Thailand over the 25 year period, 1975-1999. The first indicator focuses on certain hierarchical needs and the second is a measure of adjusted national income. It is concluded that both measures provide important insights.

Geographical dislocation and adjustment in university students: the impact of attachment, autonomy and coping behaviour on stress and well-being

The relative contribution of geographical dislocation, attachment styles, coping behaviours, and autonomy, to successful student adjustment, was examined in relation to stress and well-being. A sample of 142 on campus first year university students, across four Victorian university campuses completed self-report questionnaires. Questionnaires included demographic, social network, intrapsychic (attachment and autonomy), and coping variables. Multiple regression analysis revealed that being female, not having made a friend to confide in personal matters, lower achieved autonomy, and use of emotion-focused coping predicted higher levels of student stress. A second multiple regression analysis revealed that living away from home, and preferring others to approach oneself to initiate conversation or friendships predicted lower well-being, whilst increased frequency of phone and email contact, and greater secure parent and peer attachment, predicted greater well-being. Pearson's correlations indicated that securely attached students used more problem focused coping and social support, whereas insecurely attached students used more emotion focused coping. Qualitative data indicated student concerns about being away from family and friends, finance, course direction and structure, social opportunities on campus, and generally adjusting to the university culture. It was concluded that first year on-campus students would benefit from program initiatives targeting enhancement of on-campus social opportunities, development of autonomy, problem focused coping behaviour, interpersonal and social assertiveness.