Change of perspective: a measurable and desired outcome of chronic disease self-management intervention programs that violates the premise of preintervention/postintervention assessment

Objective: To determine if participants in chronic disease self-management courses have a change of perspective of their health status (a response shift), and if this is measurable with a paper-based questionnaire.

Methods: Nine items were developed to measure potential benefits of self-management courses. These were based on the constructs of a previous questionnaire, the Health Education Impact Questionnaire (HEI-Q). Cognitive interviews elicited spontaneous statements about the reasons for paper-based answers. Sensitivity, specificity, and overall accuracy of items were calculated using the interview as a relative gold standard. Response shift can be negative (i.e., after the course, participants realize that, before the course, they were worse than they thought they were), positive (i.e., participants now realize they were better than they thought they were), or absent (no change).

Results: Interviews (n = 39) reflected that true response shift occurred in approximately half the replies to questionnaire items. Of these, 31% were negative response shift, 20% were positive response shift. Response shift was absent in 32% of replies. Presence or absence of response shift could not be determined in 17% of replies across items. Significant concordance between questionnaires and cognitive interviews (average overall accuracy 0.79) indicated that the HEI-Q Perspective questionnaire detects response shift in participants of self-management courses. The questionnaire revealed that 87% of participants had response shift in at least 1 item.

Conclusion: This study suggests that preintervention/postintervention assessments of interventions such as self-management courses are confounded by a change in perspective of a large proportion of respondents. It also indicates response shift is a valuable outcome of self-management courses that can be measured with a paper-based questionnaire.

Increasing population happiness through the distribution of resources

This paper concerns the ways in which public policy regarding the distribution of resources might be used to increase the happiness of the Thai population. The term happiness refers to the subjective side of life quality, which in contemporary science is more commonly referred to as subjective wellbeing (SWB). The SWB construct is described within the theoretical context of SWB homeostasis. This is a proposed management system which has the role of maintaining a positive view of the self. It will be described how the homeostatic system can be challenged by hardship. The resources that the system requires to manage such challenges will also be described. Recommended forms of SWB measurement will be considered. It is concluded that public policy which directs resources to disadvantaged population sectors may be one of the most effective initiatives to enhance population wellbeing and national productivity.