Daphne Voormolen, PhD
Erasmus University – ESHPM

What do you consider when thinking about the benefits of preventive or social care interventions? Probably not only health-related benefits, right? To be able to adequately capture all benefits of interventions, we need broader outcome measures. For the past 2 years, a research team from the Erasmus School of Health Policy and Management has developed such an outcome measure capturing overall well-being. The instrument is called the 10-item Well-being instrument (WiX), for which the ‘W’ refers to ‘well-being,’ ‘i’ to instrument,’ and ‘X’ to the 10 domains of well-being that the instrument covers.

Why develop a broader outcome measure?

Before explaining more about the newly developed outcome measure, it is important to explain why we started the development of this new instrument. The basic task of any economic evaluation in a health technology assessment (HTA) framework is to identify, measure, value and compare the costs and benefits of the health interventions being considered. As said, some health interventions do not necessarily lead to improved health or deliver much more than health benefits alone. Think for example about care for people with a chronic illness or about social care interventions that lead to enhanced community or financial well-being. Furthermore, increasing demand for health and social care stresses the need for efficient allocation of scarce resources.

Not capturing the full benefits of care potentially leads to suboptimal decisions on the prioritization of interventions in the health and social care sectors. The ambition of our team is to improve welfare economic evaluations in health care by going beyond the health benefits only. Specifically, we aimed to develop an instrument to measure individual well-being in the adult population (18+).

The process of developing a new outcome measure

This new instrument should capture all items that are important for someone’s wellbeing, should measure these items in a valid way, and should successfully differentiate between different levels of well-being, for example between groups in the population or before and after an intervention. To develop an instrument adhering to all these requirements, we started from the currently available well-being literature and identified all existing well-being measures, their theoretical background and the domains of well-being covered by these measures.

The results of this review were synthesised in a conceptual framework, which we took as the starting point for the development of our new instrument. Using this framework, we identified the most important domains of well-being, and for each domain (e.g. ‘financial situation’ or ‘relationships’) we developed a description and scoring levels. This process led to a first version of the instrument consisting of 10 items.

To make sure that we were adequately measuring well-being with these ten items, we conducted interviews with several experts in the field of benefit assessment in health and social care. Next, we asked members of the public to complete the instrument in a ‘think-aloud’ format, meaning we encouraged them to verbalize their thoughts while reading and scoring the items of the instrument. These interviews helped us to gain insight into whether and how respondents understand the items, their descriptions, and the scoring levels.

In addition, we have completed a study in which we asked a large sample of members of the public to answer questions regarding the relevance, comprehensiveness and comprehensibility of the different items and scoring levels. We now have a version of the WiX that captures the most important domains of well-being and is comprehensible and feasible for members of the public, suggesting the WiX is a promising instrument for measuring the full benefits of interventions in health and social care for economic evaluations.

In future steps, we will proceed with validation studies and the development of utility weights so that the scores on the 10 items of the instrument can be adequately summarized in a single well-being score. The instrument will also be validated in different countries and translated into multiple languages, which will enable usage globally.

Abstract will be presented in Oral Session 101 on Thursday, 20 October, 1:45 pm – 3:15 pm. 

This newsletter editorial represents the views of the author and does not necessarily reflect the views of ISOQOL. 

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