Health status of well vs ill adolescents
B. Starfield, C. B. Forrest, S. A. Ryan, A. W. Riley, M. E. Ensminger and B. F. Green
Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md, USA.
BACKGROUND: Accountability of health services in meeting needs and
assessing outcomes is hampered by the absence of tools to assess health,
especially in children and youth. Because it is no longer adequate to
assess health by a narrow focus on biological and physiological measures,
instruments that assess functional status, person-focused general health
status, and overall well-being in a more comprehensive way are needed.
OBJECTIVE: To examine whether a health status instrument we have developed
discriminates between teenagers in schools and teenagers attending clinics
for acute or chronic conditions. METHODS: Teenagers (aged 11-17 years) in
schools and in general medical and specialty clinics completed a
questionnaire The Child Health and Illness Profile-Adolescent Edition
(CHIP-AE), comprehensively covering aspects of health in 6 domains:
discomfort, satisfaction with health, disorders, achievement of social
expectations, risks, and resilience. RESULTS: Acutely ill teenagers
reported more physical discomfort, minor illnesses, and lower physical
fitness; chronically ill teenagers reported more limitations of activity,
long-term medical disorders, dissatisfaction with their health, and less
physical fitness than teenagers in the school samples. Age, sex, and social
class did not explain the differences. Teenagers within the acutely and
chronically ill clinic populations differed substantially in their health
status. IMPLICATIONS: Availability of a comprehensive instrument (CHIP-AE)
to assess adolescent health provides a means of documenting health needs
and outcomes in populations of teenagers with acute or chronic illness. The
heterogeneity within these groups provides support for a person-focused
(rather than a disease-focused) approach to assessing both needs for care
and the influence of care on promoting health.
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