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

Nicolette Stogios; Troy Francis; Rachel G Peiris; Aleksandra Stanimirovic; Valeria Rac; Robert P Nolan

doi:10.3389/fpubh.2025.1522133

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.

Authors

Nicolette Stogios^#^{1

2}, Troy Francis^#^{3

4}, Rachel G Peiris⁵, Aleksandra Stanimirovic^{3

4}, Valeria Rac^#^{3

4}, Robert P Nolan^#^{1

6}

Affiliations

¹ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
² Cardiac eHealth, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
³ Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁵ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁶ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

^# Contributed equally.

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.