Empirical evidence for a process-based model of health-related quality of life using network analysis

Front Public Health. 2025 Jan 21:13:1522133. doi: 10.3389/fpubh.2025.1522133. eCollection 2025.

Abstract

Background: Health-related quality of life (HRQL) is the perceived impact of a medical condition on one's overall wellbeing. While contemporary assessments are structured to evaluate an individual's HRQL state, we propose a complementary process-based model, which is defined as an appraisal that evolves over time as it reflects and informs a self-regulatory process of adapting to dynamic changes in bio-psycho-social life domains. In support of this approach, we developed a novel HRQL assessment tool called the EUROIA: EvalUation of goal-diRected activities to prOmote wellbeIng and heAlth, which uses self-report data to assess the frequency with which individuals engage in a sample of goal-directed activities in pursuit of living well.

Methods: We conducted a network analysis to evaluate the hypothesis that the EUROIA subscales would demonstrate a meaningful pattern of associations with an established HRQL measure and associated indices of psychosocial functioning and efficacy in self-managing a chronic medical condition.

Results: The EUROIA is associated with established indices of HRQL in a manner that is theoretically consistent with our process-based model. Stability coefficients (i.e., betweenness, closeness, and strength) of the analysis revealed high reliability for the network.

Conclusion: This analysis provides support for the validation of a process-based approach to HRQL assessment, which is represented, in part, by the EUROIA. A process-based approach complements and expands conventional measures of HRQL by focusing on how a patient's capacity to engage in goal-directed activities for living well is affected by their medical condition.

Keywords: chronic heart failure; chronic kidney disease; health-related quality of life; network analysis; patient-reported outcomes; process-based approach.

MeSH terms

  • Adult
  • Aged
  • Chronic Disease / psychology
  • Female
  • Health Status*
  • Humans
  • Male
  • Middle Aged
  • Quality of Life* / psychology
  • Self Report
  • Surveys and Questionnaires

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The following grants supported the trials reported in the manuscript: Canadian Institutes of Health Research (CIHR) Grant # PJT173222 and Canadian Institutes of Health Research (CIHR) Grant # MS2173076.