Health Perceptions, Energy/Fatigue, and Health Distress Measures

Published in: Measuring Functioning and Well-Being: The Medical Outcomes Study Approach / edited by Anita L. Stewart and John E. Ware, Jr., (Durham, N.C.: Duke University Press, 1992), Chapter 8, p. 143-172

Posted on on January 01, 1992

by Anita Stewart, Ron D. Hays, John E. Ware

Health perceptions are personal beliefs and evaluations of general health status and focus on general rather than physical or mental health. They are the best predictor of utilization of general medical services and mental health services. We wanted to determine the best method for aggregating information into an overall health perception index, and began by reviewing the Health Perceptions Questionnaire (HPQ), which assesses (1) current health, (2) prior health, (3) health outlook, (4) resistance to illness, (5) sickness orientation, (6) health worry/concern. The first two items are direct indicators of health status. The HPQ was studied extensively in the Health Insurance Experiment (HIE). Measures of health worry focus on only the worry component of a broad range of negative emotions resulting from health problems, such as frustration, despair, and discouragement; thus a measure that assesses these other aspects of distress that are attributable to health problems needs to be developed. We also focused on the General Health Rating Index (GHRI), which was developed from the HPQ to achieve a single summary measure of individual differences in disease status, self-reported limitations in physical and role functioning due to poor health, self-reported acute physical and psychosomatic symptoms, and self-reported psychological distress and well-being, as an overall health perception index. Fatigue is associated with nearly all chronic illnesses, is a common symptom of depression, and is a somatic expression of psychological distress. A problem in developing a measure of fatigue is disagreement on how to define fatigue, because positive (energy) and negative (fatigue) states that are conceptually and empirically distinct from similar concepts such as depressive, positive affect, cognitive function, and sleep problems are difficult to distinguish. This chapter describes the pilot studies that were conducted to resolve these definitional problems and to refine HPQ concepts by testing four surveys. It includes tables of distribution of responses to items, item-scale correlation matrixes for different-scale models, content and scoring of scales and indexes, and descriptive statistics. MOS found that current health is the core concept underlying all of the general health measures. It was also successful at disaggregating the original HIE measure of health worry/concern into two measures--health concern and health distress--and developed a new measure of health distress, the psychological distress attributed to health problems, that taps feeling of frustration, despair, and other negative emotions resulting directly from health problems. The MOS also successfully constructed an energy/fatigue scale that is balanced in terms of positively and negatively worded items and is distinct from similar concepts such as sleep problems--the first time a measure of energy/fatigue has been included in a comprehensive set of health measures. This inclusion is valuable because of the importance of fatigue in primary care.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.