title: Comprehensively Measuring Health-Related Subjective Well-Being: Dimensionality Analysis for Improved Outcome Assessment in Health Economics.
abstract: BACKGROUND
  Allocation of inevitably limited financial resources for health care requires assessment of an intervention's effectiveness. Interventions likely affect quality of life (QOL) more broadly than is measurable with commonly used health-related QOL utility scales. In line with the World Health Organization's definition of health, a recent Delphi procedure showed that assessment needs to put more emphasis on mental and social dimensions.
  
  
  OBJECTIVE
  To identify the core dimensions of health-related subjective well-being (HR-SWB) for a new, more comprehensive outcome measure.
  
  
  METHODS
  We formulated items for each domain of an initial Delphi-based set of 21 domains of HR-SWB. We tested these items in a large sample (N = 1143) and used dimensionality analyses to find a smaller number of latent factors.
  
  
  RESULTS
  Exploratory factor analysis suggested a five-factor model, which explained 65% of the total variance. Factors related to physical independence, positive affect, negative affect, autonomy, and personal growth. Correlations between the factors ranged from 0.19 to 0.59. A closer inspection of the factors revealed an overlap between the newly identified core dimensions of HR-SWB and the validation scales, but the dimensions of HR-SWB also seemed to reflect additional aspects. This shows that the dimensions of HR-SWB we identified go beyond the existing health-related QOL instruments.
  
  
  CONCLUSIONS
  We identified a set of five key dimensions to be included in a new, comprehensive measure of HR-SWB that reliably captures these dimensions and fills in the gaps of the existent measures used in economic evaluations.
authors.affiliation: Department of Social Psychology, Tilburg Institute for Behavioral Economics Research, Tilburg University, Tilburg, The Netherlands; Radboud University, Institute for Computing and Information Sciences (iCIS), Data Science Department, Nijmegen, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: de Vries
authors.affiliation: Faculty of Social and Behavioural Sciences, Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands.
authors.forename: Wilco H M
authors.initials: WH
authors.lastname: Emons
authors.affiliation: Department of Social Psychology, Tilburg Institute for Behavioral Economics Research, Tilburg University, Tilburg, The Netherlands.
authors.forename: Arnoud
authors.initials: A
authors.lastname: Plantinga
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Pietersma
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wilbert B
authors.initials: WB
authors.lastname: van den Hout
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: vandenakker@lumc.nl.
authors.forename: M Elske
authors.initials: ME
authors.lastname: van den Akker-van Marle
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003362:Cost-Benefit Analysis; D003697:Delphi Technique; D004644:Emotions; D005163:Factor Analysis, Statistical; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research / Q000191:economics*; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D018803:Models, Economic; D010549:Personal Satisfaction; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D012649:Self Concept; D012919:Social Behavior; D011795:Surveys and Questionnaires
keywords: factor analysis; quality of life