Creating a conceptual framework

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386 HEALTH PSYCHOLOGY
their scale (e.g. Stewart and Ware 1992). Furthermore, Fallowfield (1990) defined the
four main dimensions of quality of life as psychological (mood, emotional distress,
adjustment to illness), social (relationships, social and leisure activities), occupational
(paid and unpaid work) and physical (mobility, pain, sleep and appetite).
Creating a conceptual framework
In response to the problems of defining quality of life, researchers have recently
attempted to create a clearer conceptual framework for this construct. In particular,
researchers have divided quality of life measures either according to who devises the
measure or in terms of whether the measure is considered objective or subjective.
Who devises the measure?
Browne et al. (1997) differentiated between the standard needs approach and the
psychological processes perspective. The first of these is described as being based on
the assumption that ‘a consensus about what constitutes a good or poor quality of
life exists or at least can be discovered through investigation’ (Browne et al. 1997: 738).
In addition, the standard needs approach assumes that needs rather than wants are
central to quality of life and that these needs are common to all, including the
researchers. In contrast, the psychological processes approach considers quality of
life to be ‘constructed from individual evaluations of personally salient aspects
of life’ (Browne et al. 1997: 737). Therefore, Browne et al. (1997) conceptualized
measures of quality of life as being devised either by researchers or by the individuals
themselves.
Is the measure objective or subjective?
Muldoon et al. (1998) provided an alternative conceptual framework for quality of life
based on the degree to which the domains being rated can be objectively validated. They
argued that quality of life measures should be divided into those that assess objective
functioning and those that assess subjective well-being. The first of these reflects those
measures that describe an individual’s level of functioning, which they argue must be
validated against directly observed behavioural performance, and the second describes
the individual’s own appraisal of their well-being.
Therefore, some progress has been made to clarify the problems surrounding
measures of quality of life. However, until a consensus among researchers and clinicians
exists it remains unclear what quality of life is, and whether quality of life is different
to subjective health status and health-related quality of life. In fact, Annas (1990)
argued that we should stop using the term altogether. However, ‘quality of life’,
‘subjective health status’ and ‘health-related quality of life’ continue to be used and their
measurement continues to be taken. The range of measures developed will now
be considered in terms of (1) unidimensional measures and (2) multidimensional
measures.
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