Measuring AgrAbility Outcomes
with Quality of Life Indicators
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Robert A. Wilson, Ph.D., M.Sc.
University of Delaware
Center for Applied Demography and Survey
Research
Newark, Delaware 19716
rwilson@udel.edu
Paper presented National AgraAbility Project Training Workshop
Burlington, Vermont, November 8, 2005
Types of Program Evaluations
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Process Evaluations
Impact Evaluations
Process Evaluations Analyze
Program Inputs
Client Records
Outreach activity
Services Delivered
Procedures Followed
Day-by-day Staff Activity
Costs
Materials
Impact Evaluations Measure
Program Outputs
Productivity
Farm output
Individual farmer or
waterman output
Efficiency
Benefits/Costs
Satisfaction with services
provided
Improvements in Quality of Life
Which AgrAbility outcome is
most important?
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Improved Productivity?
Satisfaction with services delivered?
Improvements in the Quality of Life?
A farmer could increase
productivity as a result of
AgrAbility, but
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Register a low level of satisfaction with the
services that were provided
Experience no improvement in the quality of
life
A farmer could be very satisfied
with the services provided by
AgrAbility but
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Register no changes in farm output
Experience no improvement in the quality of
life
A farmer could experience an
improvement in the quality of life
as a result of AgrAbility, but
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Be dissatisfied with the AgrAbility Program
Register no changes in farm productivity as a
result of the program
The 3rd scenario:
may be common among:
Older Farmers
Farmers with certain disabilities, e.g.
arthritis
Farmers who do not wish to retire
from farming or who cannot retire from
farming
With an aging agricultural labor
force, improvements in the quality
of life may be particularly
important for AgrAbility programs.
Older farmers are particularly
susceptible to the degenerative
diseases of aging
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Arthritis
Coronary disorders
Cancer
Tobacco-related diseases
Diseases associated with exposure to toxic
chemicals
Clinical Depression
Dementia (including Alzheimer’s Disease)
Degenerative diseases are
normally marked with a decline in
the Quality of Life
How is the quality of life measured
in medicine and in rehabilitative
services?
Quality of Life Measurements
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Disability-Adjusted Life Years (DALYs)
Quality-Adjusted Life Years (QALYs)
Disability Adjusted Life Years
(DALYs)
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Used to measure the burden of disease in
large populations: countries, states, counties
DALYs are a hybrid measure that combines
premature mortality with time lived with a
disease
DISABILITY ADJUSTED LIFE YEAR (DALY)
One disability-adjusted life year (1 DALY)
indicates that one person either died a year
prior to life expectancy, or lived with a
disability for a year at a psychometric
threshold equivalent to death. If a
disorder is severe, it receives a weight
that is closer to one (the psychometric
equivalent of death). If a disorder is not
severe, it receives a weight that is closer to
zero (the equivalent of perfect health).
DALYs can be aggregated for groups
of people and geographic areas.
Example:
If a population had 10 people at the beginning
of 2002:
…5 of the people lived in perfect health
throughout the year =
0 DALYs
…1 female, aged 80, died of alcohol-related cirrhosis,
(Life Expectancy: 82) = 2 DALYs
…1 male, aged 50, died of lung cancer,
(Life Expectancy: 80) = 30 DALYs
…2 males, both aged 20, died in alcohol-related
accidents:
(Life Expectancy: 80) = 120 DALYs
…1 female (any age) lived with alcohol-related
cirrosis for the entire year
(1 year x disability weight .20) .20 DALYs
Health Services Policy Research Group
7
University of Delaware
_____________
Total
152.20 DALYs
Disability-Adjusted Life Years (DALYs) per 1000 Population (Age-Adjusted)
Attributable to Alcohol Dependence and Alcoholic Liver Cirrhosis by Census
Tract, State of Delaware, 1988-1993
Pennsylvania
New Jersey
Delaware =8.4
Less than Delaware Mean
Greater than Delaware Mean
Missing Data
Maryland
Atlantic
Ocean
12
Quality-Adjusted Life Years
(QALYs)
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QALYs are a summary measure used to measure
the health-related quality of life for both individuals
and groups.
QALYs are frequently employed to gauge changes
in the quality of life associated with therapy or new
drugs
There are a number of standardized instruments
from which QALYs may be generated
One instrument is the SF-36, which we are currently
using in a small sample of farmers which is being
carried by Peggy Mack.
The recommended QALY measure
is The SF-36 instrument
The SF-36 Health Survey
In general would you say that your health is
1.
1.
2.
3.
4.
5.
Excellent
Very Good
Good
Fair
Poor
2. Compared to a year ago, how
would you rate your health now?
1.
2.
3.
4.
5.
Much better
Somewhat better
About the same
Somewhat worse
Much worse
Vigorous activities,
Such as running, lifting heavy
objects, participating in strenuous
sports?
Moderate activities, such as
moving a table, pushing a vacuum
cleaner, bowling, or playing golf
Lifting or carrying groceries
Climbing several flights of
steps
Climbing one flight of steps
Bending kneeling, or stooping
Walking more than a mile
Walking several hundred yards
Walking one hundred yards
Bathing or dressing yourself
4. During the last 4 weeks how
much of the time have you had
any of the following problems with
your work or other regular daily
activities as a result of your
physical health?
-all of the time
-most of the time
-some of the time
-a little of the time
-none of the time
Cut down on the amount of time
you spent on work or other
activities
Accomplished less than you
would like
Were limited in the kind of
work or other activities
Had difficulty performing the
work or other activities
5. During the last 4 weeks how
much of the time have you had
any of the following problems with
your work or other regular daily
activities as a result of any
emotional problems (such as
being depressed or anxious)?
-All of the time
-Most of the time
-Some of the time
-A little of the time
-None of the time
Cut down on the amount of time
you spent on work or other
activities
Accomplished less than you
would like
Did work or activities less
carefully than usual
6. During the last 4 weeks to what
extent has your physical health or
emotional problems interfered
with your normal social activities
with friends, neighbors or
groups?
-Not at all
-Slightly
-Moderately
-Quite a bit
-Extremely
7. How much bodily pain have you
had during the last 4 weeks?
-None
-Very Mild
-Mild
-Moderate
-Severe
-Very severe
.During the last 4 weeks, how
much did pain interfere with your
normal work?
-Not at all
-A little bit
-Moderately
-Quite a bit
-Extremely
9. These are questions about how
you feel and how things have
been with you during the last 4
weeks. For each question please
give the 1 answer that comes
closest to the way you have been
feeling.
How much of the time during the
last 4 weeks…
Did you feel full of life?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
Have you been very nervous?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
Have you felt so down in the
dumps that nothing could cheer
you up?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
Have you felt calm and
peaceful?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
Did you have a lot of energy?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
Have you felt downhearted and
depressed?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
Did you feel worn out?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
Have you been happy?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
Did you feel tired?
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All of the time
Most of the time
Some of the time
A little of the time
None of the time
10. During the past 4 weeks how much of the time
has your physical health or emotional problems
interfered with your social activities
(like visiting friends, relatives, etc.)?
•All of the time
•Most of the time
•Some of the time
•A little of the time
•None of the time
11. How TRUE or FALSE is
each of the following
statements for you?
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Definitely true
Mostly true
Don’t Know
Mostly false
Definitely false
I seem to get sick a little easier
than other people
I am as healthy as anybody I
know
I expect my health to get
worse
My health is excellent
The SF-36 is calculated for 8 health
factors (0-100)
1.
2.
3.
4.
5.
6.
7.
8.
Physical limitations
Limitations in social activities
Limitations in work and home roles
Bodily pain
Psychological distress and wellbeing
Limitations because of emotional problems
Energy and fatigue
General health perceptions
Outcome: Mean SF-36
Score
(Mean score for Experimental Group Time1Mean Score for Experimental Group Time
2)
minus
(Mean score for Control Group Time1-Mean
Score for Control Group Time 2)
2 Measurements
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Time 1
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Assessment at Program Intake
Time 2
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Measurement following Intervention
Outcome: Mean SF-36
Score
(Mean score for Experimental Group Time1Mean Score for Experimental Group Time
2)
minus
(Mean score for Control Group Time1-Mean
Score for Control Group Time 2)
Or 4 Measurements:
Experimental Design
Experimental Group

Time 1
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Assessment at Program
Intake
Time 2
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Control Group
Measurement following
Intervention

Time 1
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Assessment at Program
Intake
Time 2
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Measurement following
Intervention