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Can quality or quality-of-life be defined?

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Abstract

The aim of this paper is to examine the oft-heard concern that quality or quality-of-life cannot be defined. This concern persists today, even in the presence of countless studies that claim to be assessing quality or quality-of-life. There is obviously a disconnect here that warrants some attention, if not explanation. In this study, I summarize the extent of this disconnect and offer a number of potential explanations of why this situation exists. I review the role that operational definitions, statistical and empirical models, and content-specific definitions play in defining quality and/or quality-of-life. I conclude that none of these approaches provide a comprehensive definition of quality or quality-of-life. In its stead, I will argue that quality or quality-of-life represents a distinctive pattern of thinking. I establish this pattern by examining the cognitive–linguistic basis of these definitions and argue that when this is done it will be possible to identify an universal cognitive (hybrid) construct that describes how a person thinks about all types of qualitative assessments. The implication of this is that for a study to claim that it is defining or assessing quality or quality-of-life, it will first have to demonstrate the presence of the elements of this hybrid construct.

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Notes

  1. This article is partially based on Chap. 1, from a book [13] entitled; “Quality—Its Definition and Assessment as Applied to the Medically Ill.”

  2. The terms, quality, quality-of-life, and health-related quality-of-life (HRQOL) will be distinguished throughout this article. The term “quality,” or the phrase “qualitative assessment,” will be the most general form of expression, referring to all types of qualitative assessments (e.g., quality of an object, quality of the environment, quality of working life, quality of life, and so on). I am not using the term qualitative as those who use the term to refer to a particular type of data or to “qualitative methods”, rather I am using the term to refer to a class of judgments. Of course, qualitative judgments can be studied using both qualitative and psychometric research approaches. The phrase “quality-of-life” will be differentiated from the phrase “HRQOL” in that one refers to the general population, while the other refers to persons who are medically or psychiatrically ill.

  3. This discussion will focus mostly on the single global self-assessed items, including the self-assessed health status (SAHS) or other self-assessed quality-of-life items.

  4. The SAHS item is sometimes referred to as a quality-of-life self-report, but it is more appropriate to consider the item as an indicator of health status.

  5. In Chap. 8 of Barofsky [13], I make clear how a health status and HRQOL item differs. The information summarized in this paper is more about the value of a single global health status item, rather than informative about whether a single global quality-of-life item is a good predictor of mortality.

  6. It is also possible that a culture exists where a person may not have any experience with attaching numbers to feelings or other types of states. This would only be relevant if it could also be demonstrated that the members of this culture could not learn to do this task. If this was so, then providing a means whereby these people could be assessed would remain an issue.

Abbreviations

HRQOL:

Health-related quality-of-life

SAHS:

Self-assessed health status

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  1. The Quality of Life Institute, East Sandwich, MA, 02537, USA

    Ivan Barofsky

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  1. Ivan Barofsky
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Correspondence to Ivan Barofsky.

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Barofsky, I. Can quality or quality-of-life be defined?. Qual Life Res 21, 625–631 (2012). https://doi.org/10.1007/s11136-011-9961-0

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