Page Contents
Framework Component
Indicator Description
Background and Context
Healthy People 2020 has set a pair of objectives for HRQOL:
• Increase the percentage of adults who self-report good or better physical health to 79.8 percent
• Increase the percentage of adults who self-report good or better mental health to 80.1 percent
Outcome Measures
| R11a. | Proportion of SNAP-Ed eligible adults or youth who self-report good or better physical health |
| R11b. | Proportion of SNAP-Ed eligible adults or youth who self-report good or better mental health |
| R11c. | Mean number of healthy days in the past 30 days |
| R11d. | Mean number of unhealthy days in the past 30 days |
What to Measure
- Would you say that in general your health is excellent, very good, good, fair, or poor?
- Now thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was your physical health not good?
- Now thinking about your mental health, which includes stress, depression, and problems with emotions, how many days during the past 30 days was your mental health not good?
- During the past 30 days, approximately how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?
The CDC recommends using the following calculations:
Unhealthy days are an estimate of the overall number of days during the previous 30 days when the respondent felt that either his or her physical or mental health was not good. To obtain this estimate, responses to questions 2 and 3 are combined to calculate a summary index of overall unhealthy days, with a logical maximum of 30 unhealthy days. For example, a person who reports 4 physically unhealthy days and 2 mentally unhealthy days is assigned a value of 6 unhealthy days, and someone who reports 30 physically unhealthy days and 30 mentally unhealthy days is assigned the maximum of 30 unhealthy days. Healthy days are the positive complementary form of unhealthy days. Healthy days estimates the number of recent days when a person’s physical and mental health was good (or better) and is calculated by subtracting the number of unhealthy days from 30 days.
While not every state, territory, or tribe administers the BRFSS, this survey represents the most definitive source on health at the state level. States or communities that do not administer the BRFSS could incorporate the aforementioned survey questions in their own locally administered health surveys. One area of potential confusion in R11 is that the survey was designed for telephone methodology. The nature of “healthy days” versus “unhealthy days” may require some explanation by a well-trained survey interviewer. Thus, if a SNAP-Ed program were to implement a paper and pencil or electronic survey, some additional explanation of these concepts may be necessary.
Other approaches to measuring quality of life in adults include the WHO (Five) Well-Being Index, a questionnaire that measures mental well-being in the previous 2 weeks. For youth aged 12–18 years, the Youth Quality of Life-Short Form Instrument (YQOL-SF) is a generic quality of life self-administered questionnaire. The tool is appropriate for surveillance in adolescent populations and can be added to ongoing school-based or other surveys.
Choose a survey that is appropriate for your population of interest, and conduct population-level assessments on an annual or biennial basis. Year one would become the baseline, and trends could be measured over time.
Population
Surveys and Data Collection Tools
Behavioral Risk Factor Surveillance System (BRFSS) [R11a-d] https://www.cdc.gov/hrqol/
- Would you say that in general your health is:
Responses: Excellent, Very good, Good, Fair, Poor - Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?
Responses: Number of Days _ _ , None - Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
Responses: Number of Days _ _ , None - During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?
Responses: Number of Days _ _ , None
[R11b] https://www.psykiatri-regionh.dk/who-5/who-5-questionnaires/Pages/default.aspx
- I have felt cheerful and in good spirits.
- I have felt calm and relaxed.
- I have felt active and vigorous.
- I woke up feeling fresh and rested.
- My daily life has been filled with things that interest me.
Responses: All of the time, Most of the time, More than half of the time, Less than half of the time, Some of the time, At no time
YOUTH
University of Washington Seattle Quality of Life Group [R11b] https://depts.washington.edu/seaqol/
Contact the University of Washington to access the YQOL-SF
Additional evaluation tools to measure R11 can be found in the SNAP-Ed Library.