Identifying measurement biases is foundational to person-centred practice in diverse populations: Insights from the measurement of emotional wellbeing [PCC047] Passed
Aims: Ensuring unbiased measurements that represent the perspectives of diverse people is foundational to person-centred practice, organization and governance. As part of our research on “Equitable People-Centred Health Measurement” (https://www.healthyqol.com), we examined emotional well-being and the extent to which: a) responses to emotional well-being items are heterogeneous, and b) social determinants of health (SDOH) and health-related variables explain measurement bias. Methods: Data were obtained via an online survey of 10,076 adults in Canada. The questionnaire included: a) the “Emotional Well-Being” item bank (43 items) of the CAT-5D-QOL; b) The “Screening for Poverty and Related social determinants to improve Knowledge of and links to resources” tool to collect information about SDOH, including demographics (e.g., immigration, gender identity, racial background), social needs (e.g., finances, housing, social isolation, transportation) and disability; and c) health-related variables (health conditions, healthcare utilization, medications). Latent variable mixture models were used to examine heterogeneity in measurement model parameters across latent classes. Measurement bias was estimated as the differences between standardized emotional well-being scores from a 1-class model (no heterogeneity) and a k-class model (accommodating heterogeneity). Multivariable regression was used to explain measurement bias. Results: The sample was heterogeneous, with optimal results obtained for a 4-class model (class proportions = .09, .08, .41, and .41; entropy = .88). For 41% of the sample, measurement bias was positive (ranging from 0.01 to 0.54 for the 10th and 90th percentiles), with SDOH and health-related variables explaining 17% and 10% of the variance. For 59% of the sample, measurement bias was negative (ranging from −0.01 and −0.31 for the 10th and 90th percentiles), with SDOH and health-related variables explaining 5% and 4% of the variance. Conclusions: Ignoring SDOH and various health-related differences could result in biased measurements of emotional well-being, leading to some people’s perspectives of their emotional well-being being misrepresented.
Adjunct Professor Nursing School of the University of Coimbra
Filipa Ventura is an Adjunct Professor at the Nursing School of the University of Coimbra, Portugal, and a researcher in the Health Sciences Research Unit: Nursing. Her work focuses on person-centred oncology care, health services innovation, implementation science, and the development and evaluation of complex health interventions.
She has been involved in national and international research projects aimed at improving care continuity, digital health support, and person-centred practices in outpatient oncology. Her current research interests include the use of participatory and implementation approaches to support meaningful, feasible, and sustainable improvements in healthcare services.
With a background in oncology nursing and health care sciences, Filipa combines clinical expertise, research experience, and academic teaching to contribute to evidence-informed nursing practice, professional development, and healthcare transformation. She is particularly committed to strengthening the role of nursing in developing responsive, safe, and person-centred care systems.
Professor & Canada Research Chair Trinity Western University
Richard Sawatzky, Mathilde Verdam, Ava Mehdipour, Pamela A. Ratner, Carl F. Falk, Jeanette Jackson, Jae-Yung Kwon, Joakim Öhlén, Kara Schick-Makaroff, Cathy Son, Bruno D. Zumbo, Equity People-Centred Health Measurement Project Team
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