Unit: II.2.

Illness Sociology for Health Sciences

Unit: 2.2. Illness

Dr. G. Pitchaimani B.P.T., M.SC., PhD
Content
 Medicalization
 Illness, Sickness and Disease
 The Sick role and Illness behaviour
 Stigma
 Chronic Illness and Disability
 Disability social movement in India
 Models of Health and Illness;
Health-illness Continuum Model
High Level Wellness Model
Health Belief Model
Agent-Host-Environment Model
 Quality of Life

1. Medicalization

 Medicalization describes a process by which a non-medical problem becomes

defined an treated as a medical problem, usually in terms of illness an disorders.
 Medicalization used to be focused on deviance, now it focuses on a range of human
problems.
 Medicalization is increasing as technology advances.
 There are many things that have become medicalized such as Alcoholism, mental
disorders, and eating disorders etc.
 The factors are affect the degrees are the support of medical profession, available
treatment, and medical insurance.
 In the end medicalzation has increased the profitability and markets of pharmaceutical
and biotechnological firms.

Factors Contribute for Medicalization

 Many factors have contribute to the rise of medicalization.
 For instance the loss in religious, the increase of faith in science, rationality, progress,
increased prestige and the power of the medical profession.
 The medical profession and the expansion of medical jurisdiction were prime movers
for medicalization.
 Medicalization has also occurred through social movements. Doctors are not the only
ones involve in medicalization now, patients are active collaborators in the
medicalization of their problem.
 There are both positive and negative consequences to medicalization.

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Unit: II.2. Illness Sociology for Health Sciences

Positive Consequences
 With everything being medicalized, some people have a better chance functioning
well in society.
 If they are really shy, they will be diagnosed with Anxiety Disorder, and will be
medicated to interact efficiently in society.
 People are no longer depressed, disoriented because of medical intervention, for
example anorexia.
 It can really improve the self-esteem of some individuals.
Negative Consequences
Example:
 Attention Deficit Hyperactivity Disorder (ADHD)
 A child with a different learning size will be accused of having a learning disability
or having ADHD.
 By transforming all of these differences into pathologies, it will diminish our
tolerance for and appreciation of the diversity of human life.
 Eventually every person will be labelled as sick.
 Old Age is being medicalized.
 Medicalization has brainwashed people into thinking that somethings aren’t normal
when really they are.
 As people age they are pushed to take all of these medications to stay young and feel
good, when it should be acceptable to age.
 Child Birth
 Childbirth used to have been done in a hospital under drugs. Now woman have many
options on how they would like to give birth.
 Disabilities went from medical problem to societal problem.
 Medicalization plays a huge role in todays society.

2. Illness, Sickness and Disease.

Disease
 Coming down to the concept of disease, we can presume that disease is an abnormal,
pathological state that affects either parts of a human being or all the parts of
individual.
 Disease is a pathological process which makes an individual to deviate from his
normal state of being.
Cockerham.
In medical sociology, a disease is defined as “an adverse physical state consisting of a
physiological dysfunction within an individual, as compared to an illness (psychological
awareness of a disease) or a sickness (a social state)”.

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Unit: II.2. Illness Sociology for Health Sciences

Disease, Illness, Sickness

 Disease
The medical conception of a pathological abnormality diagnosed by means of signs
and symptoms.
 Illness
The subjective interpretation of probes that are perceived as health-related, i.e. the
experience of symptoms.
 Sickness
The social organization and performance of illness/disease, i.e. the “sick-role”.

Illness – Disease – Sickness

 One can be ill/suffer from disease without adopting the sick role
 Illness/disease involves suffering, but does not require complaint
 Disease may exist without subjectively experienced symptoms, e.g. cancer in
remission

The Illness Classifications

1. Acute Illness
 Generally has a rapid onset of symptoms and lasts only a relatively short time
Examples: Appendicitis, pneumonia, diarrhea, common cold
2. Chronic Illness
 A broad term that encompasses many different physical and mental alterations
Example: Diabetes mellitus, lung disease, arthritis.
Causes of Illness
 Biological causes:
 These are living organism of disease like bacteria, virus, fungi, protozoa.
 Nutritional causes:
 These are protein, fat, carbohydrate, vitamins, minerals and water any excess
or deficiency.
 Physical causes:
 Exposure to heat, cold humidity, pressure, radiation, electricity, sand etc.
 Chemical causes:
 Endogenous: creatinin, urea, bilirubin.
 Exogenous: metal

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Unit: II.2. Illness Sociology for Health Sciences

 Mechanical causes:
 Exposure to chronic friction and other mechanical forces may result in
crushing, tearing, sprains, dislocation.
 Absences or insufficiency or excess of a factor necessary to health:
 Chemical factors, nutritional factors, lack of parts and structure, chromosomal
factors and immunological factors.
 Social causes:
 Poverty, Smoking, abuse of drug and alcohol.

Stages of illness
According to Suchman (1979), he describe five Stages of illness
Stage I : Experiencing symptoms
Stage II : Assuming the sick role
Stage III : Medical care contact
Stage IV : Assuming a dependent role
Stage V : Achieving recovery and rehabilitation

Impact of Illness on Patient and Family

 Illness is never an isolated life event.
 Behavioural and emotional changes
 Impact on body image
 Impact on self concept
 Impact on family roles
 Impact on family dynamics

3. The Sick Role and Illness Behaviour

Concept of Sick
 Sick role theory, as described by researcher Talcott Parsons in 1951, is a way of
explaining the particular rights and responsibilities of those who are ill.
 Parsons was a functionalist sociologist, who argued that being sick means that the
sufferer enters a role of 'sanctioned deviance'.
 This is because, from a functionalist perspective, a sick individual is not a productive
member of society.
 Therefore this deviance needs to be policed, which is the role of the medical
profession.
 Genuinely, Parsons argued that the best way to understand illness sociologically is to
view it as a form of deviance which disturbs the social function of the society.
 The general idea is that the individual who has fallen ill is not only physically sick,
but now adheres to the specifically patterned social role of being sick.
 ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself
customary rights and obligations based on the social norms that surround it.
 Role
 Behaviour & obligations expected from a person occupying a particular social
position e.g. “student”, “daughter”, “wife”, “mother”, “nurse”.

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Unit: II.2. Illness Sociology for Health Sciences

 Sick role
 Behaviour & obligations expected from a sick person.
Rights and Obligations
The Theory outlined two rights of a sick person and two obligations:
 Rights:
1. The sick person is exempt from normal social roles.
2. The sick person is not responsible for their condition.

 Obligations:
1. The sick person should try to get well.
2. The sick person should seek technically competent help and cooperate with
the physician.
Rights

1. The sick person is exempt from “normal” social roles.

 An individual’s illness is grounds for his or her exemption from normal role
performance and social responsibilities.
 This exemption, however, is relative to the nature and severity of the illness. The
more severe the illness, the greater the exemption.
 Exemption requires legitimation by the physician as the authority on what constitutes
sickness.
 Legitimation serves the social function of protecting society against malingering
(attempting to remain in the sick role longer than social expectations allow – usually
done to acquire secondary gains, or additional privileges afforded to ill persons).
2. The sick person is not responsible for his or her condition.
 An individual’s illness is usually thought to be beyond his or her own control.
 A morbid condition of the body needs to be changed and some curative process apart
from person will power or motivation is needed to get well.
Obligations
1. The sick person should try to get well.
 The first two aspects of the sick role are conditional upon the third aspect, which is
recognition by the sick person that being sick is undesirable.
 Exemption from normal responsibilities is temporary and conditional upon the desire
to regain normal health. Thus, the sick person has an obligation to get well.
2. The sick person should seek technically competent help and cooperate with the
physician.
 The obligation to get well involves a further obligation on the part of the sick person
to seek technically competent help, usually from a physician.
 The sick person is also expected to cooperate with the physician in the process of
trying to get well.

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Unit: II.2. Illness Sociology for Health Sciences

Criticisms
Rejecting the sick role.
 This model assumes that the individual voluntarily accepts the sick role.
 Individual may not comply with expectations of the sick role, may not give up social
obligations, may resist dependency, may avoid public sick role if their illness is
stigmatised.
 Individual may not accept 'passive patient' role.
Doctor Patient Relationship
 Going to see doctor may be the end of a process of help seeking behaviour.
 This model assumes 'ideal' patient and 'ideal' doctor roles.
 Differential treatment of patient, and differential doctor patient relationship-
variations depend on social class, gender and ethnicity.
Blaming The Sick
 'Rights' do not always apply.
 Sometimes individuals are held responsible for their illness, i.e. illness associated with
sufferers lifestyle.
 In stigmatised illness sufferer is often not accepted as legitimately sick.
Chronic Illness
 Model fits acute illness (measles, appendicitis, relatively short term conditions).
 Does not fit chronic/long-term/permanent illness as easily, getting well not an
expectation with chronic conditions such as blindness, diabetes.
 In chronic illness acting the sick role is less appropriate and less functional for both
individual and social system.
 Chronically ill patients are often encouraged to be independent.

4. Chronic Illness and Disability

 Chronic illness refers to those forms of long-term health disorders that interfere with
social interaction and role performance.
 Disability is a more controversial concept, defined as physical functioning by some,
and as social discrimination by others.
Characteristics of a Chronic Illness
 It is a permanent change
 It causes, or is caused by, irreversible alterations in normal anatomy and
physiology
 It requires special patient education for rehabilitation
 It requires a long period of care or support

 Medical sociology has long had an interest in the study of illness experience and
especially of chronic illness.
 The public health and demographic reasons for this are not hard to find.

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Unit: II.2. Illness Sociology for Health Sciences

 In the last 40 to 50 years most developed countries (and now many ‘developing’ nations)
have undergone a ‘demographic transition’.
 A decline in mortality at all ages, but especially in infancy and early adulthood, has led to
an increase in average life expectancy from birth and (in the presence of low fertility
rates) an ageing population.
 Today the majority of men and women can expect to live into old age.
 As deaths from infections have declined and as a greater proportion of the population
comprises the elderly, those disorders associated with adult and later life have grown in
prominence.
 Many of these are chronic disorders, such as arthritis, stroke, dementia, Parkinson’s
disease and some forms of heart disease and cancer
Impact of Chronic Illness and Disability
 Age ,
 Gender,
 Relationship
 Stress,
 Life style
 Social Stigma
5. Stigma
 'Stigma' has been defined as an attribute that is deeply discrediting, and the
stigmatized individual is one who is not accepted and not accorded the respect and
regard of his peers, one who is disqualified from full social acceptances (Goffman,
1963).
 Stigma is typically a social process, experienced or anticipated, characterized by
exclusion, rejection, blame, or devaluation that results from experience, perception, or
reasonable anticipation of an adverse social judgment about a person or group. Stigma
refers to unfavourable attitudes and beliefs directed toward someone or something,
which may be broadly grouped as:
Goffman also describes three main groups of stigmatized individuals.
 Firstly, those with physical deformities,
 Secondly, those with blemishes of character (mental ill), and
 Thirdly, those with tribal stigma (Race).
Process of Stigma

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Unit: II.2. Illness Sociology for Health Sciences

Types of Stigma
 Felt Stigma:
It refers to the negative attitudes the community adopts towards those with a
stigmatized condition.
 Internalised Stigma (Self Stigma):
It refers to the way people, who are the sufferers, feel themselves. This usually is due
to reduced self-esteem, feeling hopelessness and feeling of guilt or blame by self.
 Enacted Stigma:
It means actual occurrence of discrimination such as divorce, denying access to public
services or performed negative behaviour of people or community to the person
affected by leprosy.

Stigma affects people with:

 Mental illness – most stigmatised group
 Disabilities
 Person affected with HIV/AIDS, Leprosy, Tuberculosis
 Addictions
 Minority groups

Why stigma exists and how it is maintained:

 History of misunderstanding and mistreatment
 Myths and misconceptions
 The media
 Prejudice and discrimination
 Negative judgments and labels
 Stigmatizing phrases

Consequences of Stigma
 Loss of employment
 Loss of housing
 Rejection by family
 Being ostracized by community
 Denied schooling
 Denied marriage
 Restrictions on movement
 Physical and verbal abuse and threats
 Interferes with disease prevention and treatment services

Increased Education Helps Reduce Stigma

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Unit: II.2. Illness Sociology for Health Sciences

6. Disability Social Movement in India

Disability
A disability is an impairment that may be cognitive, developmental, intellectual,
mental, physical, sensory, or some combination of these. It substantially affects a person's life
activities and may be present from birth or occur during a person's lifetime.
World Health Organization
Disabilities is an umbrella term, covering impairments, activity limitations, and
participation restrictions.
An impairment is a problem in body function or structure; an activity limitation is a
difficulty encountered by an individual in executing a task or action; while a participation
restriction is a problem experienced by an individual in involvement in life situations.
Disability is thus not just a health problem. It is a complex phenomenon, reflecting the
interaction between features of a person’s body and features of the society in which he or she
lives.
Disabled Population in India as per Census 2011
 In India out of the 121 Cr population, 2.68 Cr persons are disabled which is 2.21% of
the total population.
 Among the disabled population 56% (1.5 Cr) are males and 44% (1.18 Cr ) are
females.
 Majority (69%) of the disabled population resided in rural areas (1.86 Cr disabled
persons in rural areas and 0.81 Cr in urban areas).
 Disability in India is affected by other social divisions such as class, gender,
and caste. Statistics show that women with disabilities in India are more marginalized
than their male counterparts.
Types of Disability Total Male Female
In Seeing 18.8 17.6 20.2
In Hearing 18.9 17.9 20.2
In Speech 7.5 7.5 7.4
In Movement 20.3 22.5 17.5
Mental Retardation 5.6 5.8 5.4
Mental Illness 2.7 2.8 2.6
Any other 18.4 18.2 18.6
Multiple Disability 7.9 7.8 8.1

Disability Right Movements

 A number of social movements took place during the second half of the 20th century
in India. These included the women’s movement, environmental
movement, Dalit movement, etc.
 One such movement was the disability rights movement which originated during the
late 1980s.
 Towards the end of the 80s, people started to focus on Persons with Disabilities
(PwDs) on medical grounds, and tried to reduce their suffering using medical

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Unit: II.2. Illness Sociology for Health Sciences

treatments, technical help and medical equipment. This is also only for those
individuals who were literate, so called modern, well-off people influenced others and
sensitized like these.
 In 1986, the Indian government established the Rehabilitation Council of India (RCI).
Following year, the Mental Health Act was also implemented.
Persons with Disabilities Act 1995
1990s
 India witnessed drastic changes in the final decade of the last millennium within its
disability sector.
 In the year 1995, the Parliament enacted the PwDs Acts along with signing of
Proclamation of Equality Rights & Full Participation of People with Disabilities in the
Asian & Pacific Region.
 Immediately after that, PwDs were provided with a reservation of 3% in government
services and educational institutions.
In the Year 2016
 The Disability Acts was thoroughly rectified.
 In fact, in earlier Acts there were only 7 types of disabilities included, but in new
Acts all left out disabilities have been counted and in total there are 21 types of
disabilities that have been included.
 As of now, there are plenty of Indian organisations for persons with disabilities,
both government and non-government, throughout the country that support the rights
and causes of PwDs. They have been doing great work to promote equal opportunities
for the differently abled and help them lead dignified lives in the modern society.
 The Indian government has also enacted initiatives such as the Accessible India
Campaign to make public spaces and transportation barrier-free for persons with
disabilities.
The 21 Disabilities are:
1. Blindness 12. Chronic Neurological conditions
2. Low-vision 13. Specific Learning Disabilities
3. Leprosy Cured persons 14. Multiple Sclerosis
4. Hearing Impairment 15. Speech and Language disability
(deaf and hard of hearing) 16. Thalassemia
5. Locomotor Disability 17. Hemophilia
6. Dwarfism 18. Sickle Cell disease
7. Intellectual Disability 19. Multiple Disabilities including deaf and
8. Mental Illness blindness
9. Autism Spectrum Disorder 20. Acid Attack victim
10. Cerebral Palsy 21. Parkinson's disease
11. Muscular Dystrophy

Persons with "benchmark disabilities" are defined as those certified to have at least
40%of the disabilities specified above.

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Unit: II.2. Illness Sociology for Health Sciences

International Day of Persons with Disabilities:

 In 1992, the United Nations announced that December 3 would be observed every
year as International Day of Persons with Disabilities.
 While disabled persons continue to struggle to secure employment and navigate their
way around with poor infrastructure, and are still treated as “others”, it is worth
recalling the advances in legislation on disability over the years.
National Institutes for The Disabled:
 Ali Yavar Jung National Institute for the Hearing Handicapped (AYJNIHH),
Mumbai
 National Institute for Empowerment of Persons with Multiple Disabilities (NIEPMD),
Chennai
 Swami Vivekanand National Institute of Rehabilitation Training & Research
(SVNIRTAR), Cuttack
 National Institute for Orthopaedically Handicapped (NIOH), Kolkata
 National Institute of Visually Handicapped (NIVH), Dehradun
 National Institute of Mentally Handicapped (NIMH), Secundrabad
 Pandit Deen Dayal Upadhyaya Institute for the Physically Handicapped (IPH), New
Delhi
Facilities for PwDs
 Railway Concessions

Category of Persons Percentage of Concession

Physical disability:  50% concession in the first and second class

AC compartments. 75% concession in 2nd SL, 1st
Mental disability
class, 3AC, AC Chair car.
Full hearing and speech  25% concession in 3AC & AC chair car of Rajdhani
disability (100% disability) /Shatabdi.
 One escort is also eligible for same element of
concession.
Full visual disability  50% concession in the 2nd SL and 1st class.
(100% disability):  One escort is also eligible for same element of
concession.

 Bus Concessions
 Niramaya Health Insurance
 To provide affordable Health Insurance to persons with Autism, Cerebral
Palsy, Mental Retardation & Multiple Disabilities
 ADIP SCHEME (scheme of assistance to disabled persons for purchase / fitting of
aids/appliances)
 Disability Pension
 Scholarship for education
 Incentive award for marriage between disabled and non-disabled
 One time Grant from Social Welfare Department to by artificial limbs

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Unit: II.2. Illness Sociology for Health Sciences

7. Models of Health Illness

Health, Illness and Wellness
 Health:
 A state of complete physical, mental, social well being, not merely the absence of
disease.
 Illness:
 The unique response of a person to a disease
 Wellness:
 An active state, oriented toward maximizing the potential of the individual.
Model of Health and Illness
 Health model is a complex concept that is gives the explanations and relationship
between the health and illness or injury. These models can be helpful in assign the
need of health and wellness.
 The Models of Health Illness:
 Health-illness Continuum Model,
 High Level Wellness Model,
 Health Belief Model,
 Agent-Host-Environment Model.

7.1. Illness-Wellness Continuum

 The Illness-wellness continuum developed by John W Travis (1972)
 Composed of two arrows pointing in opposite directions and joined at a neutral point.

Movement to the right on the arrows (towards high-level wellness) equals an

increasing level of health and well-being.
o Achieved in three steps:
 Awareness, Education and Growth
 Movement to the left on the arrows (towards premature death) equates a progressively
decreasing state of health.
o Achieved in three steps:
 Signs, Symptoms and Disability

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Unit: II.2. Illness Sociology for Health Sciences

 Most important is the direction the individual is facing on the pathway

o If towards high-level health, a person has a genuinely optimistic or positive
outlook despite his/her health status
o If towards premature death, a person has a genuinely pessimistic or negative
outlook about his/her health status.
Compares a treatment model with a wellness model
 If a treatment model is used, an individual can move right only to the neutral point
 E.g., a hypertensive client who only takes his medications without making any
other life-style changes
 If a wellness model is used, an individual can move right past the neutral point
 E.g., a hypertensive client who not only takes his medications, but stops
smoking, looses weight, starts an exercise program, etc.

7.2. High Level Wellness Model

High Level Wellness Model- Halbert L Dunn, (1959)]
• Dunn, describes a health gird in which a health axis and an environmental axis
intersect.
• The girds demonstrate the interaction of the environment with illness-wellness
continuum.
Composed of two axis's
 A Health axes which ranges from peak wellness to death
 A Environmental axes which ranges from very favourable to very
unfavourable
The two axis's form four quadrants

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Unit: II.2. Illness Sociology for Health Sciences

Four Quadrants
1. High-level wellness in a favourable environment
 E.g., A person who implements healthy life-style behaviours and has the
biopsychosocialspiritual resources to support this life-style.
2. Emergent high-level wellness in an unfavourable environment
 E.g., A woman who has the knowledge to implement healthy life-style practices but
does not implement adequate self-care practices because of family responsibilities,
job demands, or other factors.
3. Protected poor health in a favourable environment
 E.g., An ill person whose needs are met by the health care system and who has access
to appropriate medications, diet, and health care instruction.
4. Poor health in an unfavourable environment
 Poor health due to unfavourable environment.
 E.g., A young child who is starving in a drought ridden country.

7.3. Health Belief Model

 Health belief model proposed Rosenstock (1974). It is biased on what people

perceived or believe to be true about them in relation to health. The health belief
model is based on motivational theory.
 It is composed of three components:
 Individual Perceptions
 Modifying Factors
 Likelihood of Action
Individual perceptions
 Perceived susceptibility - A family history of a certain disorder, such as diabetes or
heart disease, may make the individual feel at high risk.
 Perceived seriousness - In the perception of the individual, does the illness cause
death or has serious consequences?
Example:
 The spread of acquired immune deficiency syndrome (AIDS) reflects the general
public's perception of the seriousness of this illness.
 Perceived threat - perceived susceptibility and perceived seriousness combine to
determine the total perceived threat of an illness to a specific individual.
Example:
 A person who perceives that many individuals in the community have AIDS may
not necessarily perceive a threat of the disease; if the person is a drug addict or a
homosexual, however, the perceived threat of illness is likely to increase because
the susceptibility is combined with seriousness.

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Unit: II.2. Illness Sociology for Health Sciences

Modifying Factors
 Demographic variables - Demographic variables include age, sex, race, and ethnicity.
Example:
 Infant does not perceive the importance of a healthy diet; an adolescent may
perceive peer approval as more important than family approval and as a
consequence may participate in hazardous activities or adopt unhealthy eating and
sleeping patterns.
 Sociopsychologic variables - Social pressure or influence from peers or other
reference groups (e.g., self-help or vocational groups) may encourage preventive
health behaviours even when individual motivation is low. Expectations of others may
motivate people.
Example:
 Not to drive an automobile after drinking alcohol.
 Structural variables - Knowledge about the target disease and prior contact with it
are structural variables that are presumed to influence preventive behaviour.
 Cues to action- Cues can be either internal or external.
 Internal cues include feelings of fatigue, uncomfortable symptoms, or
thoughts about the condition of an ill person who is close.
 External cues are mass media campaigns, advice from others, reminder
postcard from a physician or dentist, illness of family member or friend,
newspaper or magazine article.

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Unit: II.2. Illness Sociology for Health Sciences

Likelihood of action
 The likelihood of a person's taking recommended preventive, health action depends
on the perceived benefits of the action minus the perceived barriers to the action.
 Perceived benefits of the action - Examples include refraining from smoking
to prevent lung cancer, and eating nutritious foods and avoiding snacks to
maintain weight.
 Perceived barriers to action - Examples include cost, inconvenience,
unpleasantness, and lifestyle changes.

7.4. Agent-Host-Environment Model

Agent-Host-Environment Model - Leavell and Clark (1965)
 The agent host environment model describes the cause of illness. It is used primarily
in predicting illness rather than promoting wellness
 The model is composed of three dynamic, interactive elements –
 Agent, Host and Environment

Ecological model of health equilibrium

 The agent - Any factor or stressor. It can be biological, chemical, physical,
mechanical, and psychosocial
 The host- Living beings (e.g., human or animal)
 Environment - This includes all the external factors that make illness more or less
likely to occur.
 According to the model the health and illness -
 Health is seen when all three elements are in balance
 Illness is seen when one, two, or all three elements are not in balance.

8. Quality of Life
Quality of Life
 Quality of life is the general wellbeing of an individual or society, experiencing the
standard of health, comfort and happiness and it is a highly subjective measure.
Quality of life is important to everyone, particularly health.
 The WHO defines Quality of Life as an individual's perception of their position in
life in the context of the culture and value systems in which they live and in relation
to their goals, expectations, standards and concerns (WHO, 1995).

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Unit: II.2. Illness Sociology for Health Sciences

 This definition considers the person's physical and psychological health, social
relationships, personal beliefs, environment and their relationship to salient features of
their environment.
Health-Related Quality of Life (HRQoL)
 The concept of health-related quality of life (HRQOL) and its determinants have
evolved since the 1980s, to encompass those aspects of overall quality of life, that can
be clearly shown to affect health, either physical or mental.
 On the individual level, HRQOL includes physical and mental health perceptions and
their correlates, including health risks and conditions, functional status, social support,
and socioeconomic status.
 On the community level, HRQOL includes community-level resources, conditions,
policies, and practices that influence a population’s health perceptions and functional
status.
 The Centre for Disease Control and Prevention, USA, in the year 2000, defined the
health-related quality of life as “An individual’s or group’s perceived physical and
mental health over time”, which covers broad domains including physical,
psychological, economic, spiritual and social wellbeing.
 Measuring the HRQOL can bridge boundaries between disciplines and among social,
mental, and medical services.
Measurement Tools such as;
o World Health Organization Quality of Life (WHOQOL-BREF)
o Short Form-36 (SF-36)
o Psychological General Well-Being Index (PGWBI)
o Disease specific instrument
Domains of Health Status
Four essential domains should be included in all HRQoL instruments:
 Physical functioning
 Psychological functioning
 Social functioning
 General health perception
Factors affecting health related quality of life
 It is a multi-domain concept which represents the patient’s general perception
of the effect of illness and treatment on various aspects of life such as physical,
psychological, and social.
 Some other aspects also can be predicted to affect HRQOL like - economical,
disease symptoms, adverse drug reactions, patient-education, disease-treatment
given to the patient

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