Why is self-perceived health an important indicator in the healthcare setting?
Methodological strength of self-perceived health
What factors affect self-perceived health?
Self-perceived health is defined as the perception of an individual’s health in general. It is a subjective perception of how healthy an individual feels. Health is defined as not only the absence of injury or disease, but as a function of physical, mental, and social well-being.
Self-perceived health Is often used as a form of subjective assessment for health. It is useful in evaluating the general health status of the population, as well as uncovering health inequalities and highlighting healthcare needs at the population level.
According to the World Health Organisation, self-perceived health can be considered to be a valid and robust predictor of morbidity and mortality of several diseases which include cancer, stress, cardiovascular disease, among other chronic long-term health conditions. Low self-perceived health is associated with frequent use of healthcare services. Across different patient subgroups and among the elderly, self-perceived health has been used to evaluate the effectiveness of healthcare interventions.
The way in which self-perceived health is measured is via a single-item question, which includes a rating of health status from poor to excellent on a 5-point scale. As such, it is a popular metric as it is simple and cost-effective to deploy and evaluate.
The questionnaire presented to individuals is structured using a Likert Scale. When responders are presented with a Likert item (which typically takes the form of a single or series of statements), they are asked to specify their level of agreement or disagreement using a symmetric scale ranging from agree to disagree.
While the exact wording of the question may take many forms. In general, it is framed in the following way: “in general, would you agree that your health is excellent, very good, good, fair, or poor?”. It may also ask the question “how would you rate your health, in general, today?”; with the responses ranging from “excellent” or “very good”, to “good, moderate, bad/poor, or very bad/poor”. This latter form of categorization is used by the World Health Organisation.
Not all responses are limited to five choices, there may be more or less included in the scale. It is important to note that the question is purposely vague in order to capture an individual’s assessment of health according to their definition. It is also hinged on subjective ideas of how individuals perceive and define health; despite this, it remains a statistically powerful predictor of mortality in the overall population and has been proven to be instrumental in predicting morbidity.
As stated, there is a strong association between self-perceived health and mortality. This is therefore taken as proof that this measurement is valid, as mortality is regarded as an objective measurement of the general health of an individual.
With regards to reliability, self-perceived health questioning is found to be a reliable measurement of general health as it has been shown that respondents rated the same general health assessment across a period through which their health was unlikely to change. Owing to the vague nature of the question used to determine self-perceived health, this measurement is considered low in the reliability test relative to other self-rated measurements that assess a more specific aspect of health.
How individuals perceive their health is influenced by complex factors which include environmental, socio-economic, and cultural conditions. Other factors include:
- Family perception of health
- Pair understanding of health and how to attain it
- How health is portrayed in the media
- Personal beliefs, preconceptions, experiences, and values
- The value individual places on health
- Previous experience is an individual has had related to health (fitness, illness, injury, participation in sport or other forms of physical activity, and disease)
- Environment (this includes access to health information technology as well as geographical location)
For example, there is a correlation between age and reduced perception of health which occurs for both men and women.
According to EU estimates, 87.5% of women and 89.2% of men aged between 16 and 44 reported feeling as though they were in good health. They subsequently decreased to 66.8% of women and 69.4% of men for those in the category 45 to 64 years. This figure dropped further still in those aged over 65 (38.2% and 44.0% for men and women, respectively.
In the EU, Man rather than women have a higher perception of being in good health with the disparity increasing with age.
Despite the apparent subjectivity of self-perceived health, literature has demonstrated that it can accurately and reliably capture population health in a manner similar to objective health status. It also offers the benefit of enhancing the focus on patient-centered care, which healthcare systems worldwide are moving towards.
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