Over the last 2 decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on patient centered dimensions. The HAQ was designed to represent a model of patient oriented outcome assessment and has played a major role in diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of nonsteroidal antiinflammatory drug gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. The HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. We review the development, content, and dissemination of the HAQ and provide reference sources for its uses, translations, and validations. We discuss contemporary issues regarding outcome assessment instruments relative to the HAQ's identity and utility. These include: (1) the issue of labeling instruments as generic versus disease-specific; (2) floor and ceiling effects in scales such as "disability"; (3) distances between values on scales; and (4) the continuing introduction of new measurement instruments and their potential effects.

https://www.jrheum.org/content/jrheum/30/1/167.full.pdf

The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation.

Service establishments would relish the opportunity to have their customers display customer voluntary performance (CVP) behaviors, which refer to helpful, discretionary customer behaviors that support an organization’s service performance and quality This article draws on resource exchange theory to offer an explanation as to why some customers display CVP in the form of customer citizenship and customer care behaviors The data reveal that customers who receive social-emotional support and, to a lesser extent, instrumental support from other customers in a service establishment reciprocate by exhibiting CVP toward the establishment and to customers in the establishment This article demonstrates that socially supportive service environments are beneficial for customers’ health and for organizational profitability

When Customers Receive Support From Other Customers: Exploring the Influence of Intercustomer Social Support on Customer Voluntary Performance:

Web 2.0 empowers online customers and social networks to engage in e-service processes such as service design, production and marketing. Although the impact of customer participation and inter-customer support on service quality is recognised, e-service quality conceptualisations and measurement models have failed to incorporate the impact of Web 2.0 on e-service delivery. After examining the role of Web 2.0 on customer participation and the gaps of previously developed e-service quality models, an extended e-service quality model is proposed that considers customer participation and inter-customer support in e-service settings. The theoretical and practical implications of the proposed model for website design and management are discussed.

E-service quality and Web 2.0: expanding quality models to include customer participation and inter-customer support

Objective: To explore the prevalence of work disability (WD) and to identify bio‐psychological factors that predicts future WD in rheumatoid arthritis (RA) over a 7‐year period.Methods: Patients were selected from the Oslo RA register. The prevalence of WD was studied cross‐sectionally among respondents <67 years (n = 526) in a postal survey. Mean age (SD) was 51.1 (11.9) years, mean disease duration 11.3 (9.4) years, and 49% of patients were RF‐positive. The patients studied for predictive factors for WD were respondents in postal surveys both at baseline and at the 7‐year follow‐up, in work at baseline and still in working age (<67 years) at follow‐up (n = 159). Mean age at baseline (SD) was 44.5 (9.7) years, mean disease duration 8.4 (6.6) years, mean years of formal education 12.7 (3.1) years, 48% were RF‐positive. Assessments included socio‐demographic variables and health status measures (MHAQ, AIMS2, SF‐36, fatigue and pain on VAS 0–100 mm, self efficacy, and RAI as a measure for helplessness).Resu...

Work disability in rheumatoid arthritis is predicted by physical and psychological health status: a 7-year study from the Oslo RA register.

Aim. To unpack and interpret descriptions of experiences of social relationships during pulmonary rehabilitation (PR) for people living with chronic obstructive pulmonary disease (COPD). Method. Inspired by interpretive phenomenology, individual qualitative interviews were conducted twice with 18 persons from COPD rehabilitation units in two general hospitals. Qualitative content analysis was performed. Results. Analysis of the interviews revealed the overarching theme of belonging. The participants emphasised social integration in rehabilitation groups as well as support from peers and health-care personnel as important dimensions of social relationships with regard to PR. Active participation in and engagement with the groups provided opportunities for patients to share their knowledge, encouraged mutual trust, and support and increased self-confidence, and motivation for self-care and further social participation. Integration in the groups and perceived support during PR made coping and adaptation easier and had a positive effect on quality of life. Conclusions. Patients’ perspectives on PR were strongly influenced by certain facets of social relationships, such as social integration and social support. Patients’, peers’ and health-care professionals’ strategies to promote social support and social integration should be further explored in the future, both in different contexts and for longer periods of time.

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'Belonging'. 'Patients' experiences of social relationships during pulmonary rehabilitation

The objective was to investigate the impact of physical disability and disease duration on the amount of social support received by female patients with rheumatoid arthritis. Two hundred sixty-four patients were assessed in a cross-sectional study. Disease duration had a negative relationship to daily emotional support; the length of disease duration was related to less emotional support. A combination of long disease duration and high disability was related to a low degree of problem-oriented emotional support. High physical disability was associated with less social companionship. Patients with high disability and few friends and patients with high disability and few neighbours reported less social companionship than patients with high disability and four or more friends or three or more neighbours. The combination high disability and few friends were associated with less problem-oriented instrumental support. Number of friends, age, and personality type all contributed to the variance in social support.

The impact of disability and disease duration on social support of women with rheumatoid arthritis.

To estimate how rheumatoid arthritis (RA), the disease duration, and level of physical disability, influence the total size of patients' social network and the size of different subsets.Two hundred sixty four female patients (mean age 57 yrs) with RA of more than 6 yrs duration (mean 20 yrs) were compared to 61 healthy controls matched for sex, age, and residential area. Network size was measured by Social Network Delineation Questionnaire (SNDQ), physical disability by Health Assessment Questionnaire (HAQ). RA patients had a significantly smaller total network compared to the healthy controls (RA: 15.8 persons; Controls: 18.1), mostly due to a significant difference in the subset of important others in favour of the controls (RA: 1.1; Controls: 2.3). There were no significant differences regarding the network size of family, friends, and neighbours. The same results remained after statistical control for sociodemographic variables. Neither disease duration nor physical disability had any significant asso...

Social network size of female patients with rheumatoid arthritis compared to healthy controls.

A partially-controlled intervention study was performed. Female patients with rheumatoid arthritis (RA) were allocated to three groups: the network intervention group (n = 104), the attention control group (n = 85), and the no-treatment control group (n = 75). The network intervention consisted of an assessment session and a network meeting. Patients were assessed at baseline and approximately 10 and 18 months after the intervention. The network intervention group reported an increase in network size. Daily emotional support increased for the intervention patients compared with patients in the attention control group. The degree of social dysfunction was reduced for patients in the intervention group compared to patients in the no-treatment control group. Furthermore, for single patients, the intervention significantly increased the social network size and improved both social functioning, and perceived overall health, compared to both control groups. The results suggest that the social needs of single patients should be given special attention in clinical settings.

Anne Glennås

Papers

The impact of disability and disease duration on social support of women with rheumatoid arthritis.

Social network size of female patients with rheumatoid arthritis compared to healthy controls.

The Effect of Social Network Intervention for Women with Rheumatoid Arthritis