Measuring AgrAbility Outcomes with Quality of Life Indicators

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Measuring AgrAbility Outcomes with Quality of
Life Indicators

• Robert A. Wilson, Ph.D., M.Sc.
• University of Delaware
• Center for Applied Demography and Survey Research
• Newark, Delaware 19716
• rwilson_at_udel.edu
• Paper presented National AgraAbility Project
  Training Workshop
• Burlington, Vermont, November 8, 2005

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Types of Program Evaluations

• Process Evaluations
• Impact Evaluations

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Process Evaluations Analyze Program Inputs

• Client Records
• Outreach activity
• Services Delivered
• Procedures Followed
• Day-by-day Staff Activity
• Costs
• Materials

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Impact Evaluations Measure Program Outputs

• Productivity
• Farm output
• Individual farmer or waterman output
• Efficiency
• Benefits/Costs
• Satisfaction with services provided
• Improvements in Quality of Life

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Which AgrAbility outcome is most important?

• Improved Productivity?
• Satisfaction with services delivered?
• Improvements in the Quality of Life?

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A farmer could increase productivity as a
result of AgrAbility, but

• Register a low level of satisfaction with the
  services that were provided
• Experience no improvement in the quality of life

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A farmer could be very satisfied with the
services provided by AgrAbility but

• Register no changes in farm output
• Experience no improvement in the quality of life

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A farmer could experience an improvement in the
quality of life as a result of AgrAbility, but

• Be dissatisfied with the AgrAbility Program
• Register no changes in farm productivity as a
  result of the program

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The 3rd scenario may be common among

• Older Farmers
• Farmers with certain disabilities, e.g. arthritis
• Farmers who do not wish to retire from farming or
  who cannot retire from farming

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With an aging agricultural labor
force, improvements in the quality of life may be
particularly important for AgrAbility programs.
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Older farmers are particularly susceptible to the
degenerative diseases of aging

• Arthritis
• Coronary disorders
• Cancer
• Tobacco-related diseases
• Diseases associated with exposure to toxic
  chemicals
• Clinical Depression
• Dementia (including Alzheimers Disease)

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Degenerative diseases are normally marked with a
decline in the Quality of Life
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How is the quality of life measured in medicine
and in rehabilitative services?
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Quality of Life Measurements

• Disability-Adjusted Life Years (DALYs)
• Quality-Adjusted Life Years (QALYs)

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Disability Adjusted Life Years (DALYs)

• Used to measure the burden of disease in large
  populations countries, states, counties
• DALYs are a hybrid measure that combines
  premature mortality with time lived with a
  disease

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DISABILITY ADJUSTED LIFE YEAR (DALY)
One disability-adjusted life year (1 DALY)
indicates that one person either died a
year prior to life expectancy, or lived with a
disability for a year at a psychometric threshold
equivalent to death. If a disorder is severe,
it receives a weight that is closer to one (the
psychometric equivalent of death). If a
disorder is not severe, it receives a weight that
is closer to zero (the equivalent of perfect
health). DALYs can be aggregated for groups of
people and geographic areas.
Health Services Policy Research Group University
of Delaware
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Example
If a population had 10 people at the beginning of
2002
5 of the people lived in perfect health
throughout the year 0
DALYs 1 female, aged 80, died of
alcohol-related cirrhosis,
(Life Expectancy 82) 2 DALYs 1
male, aged 50, died of lung cancer,
(Life Expectancy 80) 30 DALYs
2 males, both aged 20, died in alcohol-related
accidents (Life
Expectancy 80) 120 DALYs 1 female
(any age) lived with alcohol-related
cirrosis for the entire year (1
year x disability weight .20) .20
DALYs _____________ Total 152.20 DALYs
Health Services Policy Research Group University
of Delaware
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Disability-Adjusted Life Years (DALYs) per 1000
Population (Age-Adjusted) Attributable to Alcohol
Dependence and Alcoholic Liver Cirrhosis by
Census Tract, State of Delaware, 1988-1993
Pennsylvania
New Jersey
Maryland
Atlantic Ocean
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Quality-Adjusted Life Years (QALYs)

• QALYs are a summary measure used to measure the
  health-related quality of life for both
  individuals and groups.
• QALYs are frequently employed to gauge changes in
  the quality of life associated with therapy or
  new drugs
• There are a number of standardized instruments
  from which QALYs may be generated
• One instrument is the SF-36, which we are
  currently using in a small sample of farmers
  which is being carried by Peggy Mack.

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The recommended QALY measure is The SF-36
instrument
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The SF-36 Health Survey

• In general would you say that your health is
• Excellent
• Very Good
• Good
• Fair
• Poor

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2. Compared to a year ago, how would you rate
your health now?

• Much better
• Somewhat better
• About the same
• Somewhat worse
• Much worse

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Vigorous activities,

• Such as running, lifting heavy objects,
  participating in strenuous sports?

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Moderate activities, such as moving a table,
pushing a vacuum cleaner, bowling, or playing golf
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Lifting or carrying groceries
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Climbing several flights of steps
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Climbing one flight of steps
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Bending kneeling, or stooping
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Walking more than a mile
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Walking several hundred yards
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Walking one hundred yards
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Bathing or dressing yourself
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4. During the last 4 weeks how much of
the time have you had any of the following
problems with your work or other regular daily
activities as a result of your physical
health?-all of the time-most of the time-some
of the time-a little of the time-none of the
time
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Cut down on the amount of time you spent on work
or other activities
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Accomplished less than you would like
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Were limited in the kind of work or other
activities
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Had difficulty performing the work or other
activities
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5. During the last 4 weeks how much of the
time have you had any of the following problems
with your work or other regular daily activities
as a result of any emotional problems (such as
being depressed or anxious)?
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-All of the time-Most of the time-Some
of the time-A little of the time-None of the
time
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Cut down on the amount of time you spent on work
or other activities
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Accomplished less than you would like
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Did work or activities less carefully than usual
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6. During the last 4 weeks to what
extent has your physical health or emotional
problems interfered with your normal social
activities with friends, neighbors or
groups?-Not at all-Slightly-Moderately-Quite
a bit-Extremely
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7. How much bodily pain have you had
during the last 4 weeks?-None-Very
Mild-Mild-Moderate-Severe-Very severe
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.During the last 4 weeks, how much did
pain interfere with your normal work?-Not at
all-A little bit-Moderately-Quite a
bit-Extremely
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9. These are questions about how you feel
and how things have been with you during the last
4 weeks. For each question please give the 1
answer that comes closest to the way you have
been feeling. How much of the time during the
last 4 weeks
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Did you feel full of life?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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Have you been very nervous?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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Have you felt so down in the dumps that nothing
could cheer you up?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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Have you felt calm and peaceful?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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Did you have a lot of energy?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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Have you felt downhearted and depressed?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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Did you feel worn out?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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Have you been happy?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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Did you feel tired?

• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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• 10. During the past 4 weeks how much of the time
• has your physical health or emotional problems
• interfered with your social activities
• (like visiting friends, relatives, etc.)?
• All of the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

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11. How TRUE or FALSE is each of the following
statements for you?

• Definitely true
• Mostly true
• Dont Know
• Mostly false
• Definitely false

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I seem to get sick a little easier than other
people
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I am as healthy as anybody I know
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I expect my health to get worse
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My health is excellent
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The SF-36 is calculated for 8 health factors
(0-100)

• Physical limitations
• Limitations in social activities
• Limitations in work and home roles
• Bodily pain
• Psychological distress and wellbeing
• Limitations because of emotional problems
• Energy and fatigue
• General health perceptions

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Outcome Mean SF-36 Score

• (Mean score for Experimental Group Time1-Mean
  Score for Experimental Group Time 2)
• minus
• (Mean score for Control Group Time1-Mean Score
  for Control Group Time 2)

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2 Measurements

• Time 1
• Assessment at Program Intake
• Time 2
• Measurement following Intervention

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Outcome Mean SF-36 Score

• (Mean score for Experimental Group Time1-Mean
  Score for Experimental Group Time 2)
• minus
• (Mean score for Control Group Time1-Mean Score
  for Control Group Time 2)

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Or 4 MeasurementsExperimental Design

• Experimental Group
• Time 1
• Assessment at Program Intake
• Time 2
• Measurement following Intervention

• Control Group
• Time 1
• Assessment at Program Intake
• Time 2
• Measurement following Intervention