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Positive Health: what is it and how do you measure it?

Health policy in the Netherlands is increasingly based on Positive Health. This approach sees health as much more than simply not being ill. There are more and more initiatives to promote Positive Health. But how do you know if these initiatives and policy are actually effective? LUMC researchers are working on a new tool to measure Positive Health.

The Ministry of Health, Welfare and Sport recently took a broader approach to health, stating in a national memorandum (in Dutch) that more attention should be paid to people’s personal context. ‘The extent to which people can afford a healthy lifestyle or feel resilient enough to influence their own health, for example,’ says Brian Doornenbal, a postdoc at the Department of Public Health and Primary Care.

Innovative concept

This broader view of health is based on Positive Health, an approach that divides health into six dimensions: mental well-being, participation in society, spiritual life, bodily functions, daily functioning and quality of life. These form the basis of a conversation tool that has been developed for healthcare providers and patients. This gives people an insight into how they are doing. And above all: what they want to do to feel healthier.

‘The concept of Positive Health is innovative, but there are some challenges to its use.’

‘The concept of Positive Health is innovative, but there are some challenges to its use,’ says Doornenbal. ‘If Positive Health is used in policymaking, you then need a measurement scale to evaluate its effects on health policy.’

Measuring impact

Together with Elske van den Akker-van Marle, a researcher at the Department of Biomedical Data Science, Doornenbal therefore researched how the dialogue tool can be turned into a measuring scale. But how exactly? ‘We tested the relationship between the six domains of Positive Health by presenting a representative group of Dutch people with a long list of statements from the dialogue tool. These were statements such as: “I feel fit”, “I’m in good contact with other people” and “I can plan what I need to do on a day”,’ says Elske van den Akker-van Marle.

Our research showed that the Positive Health measuring scale does in fact measure six different dimensions. To measure these dimensions in a decisive way, it helps to use 17 of the 42 statements from the dialogue tool. This finding is very encouraging. It ensures that initiatives can be assessed on health aspects that would otherwise receive too little attention,’ says Van den Akker-van Marle.


But the measuring scale is not ready yet. ‘The concept of resilience, the extent to which people can deal with setbacks, has been one of the important building blocks for Positive Health. But in our study we found that the tool is not very good at measuring resilience,’ says Van den Akker-van Marle. ‘If we claim that Positive Health can help make society more resilient, we have to have a clear picture of how it does that. Then it’s crucial to measure resilience.’

‘We are trying to change how people view health one step at a time’

The researchers are therefore adding another measurement of resilience to the tool in a follow-up study. ‘We are trying to change how people view health one step at a time and to offer concrete suggestions for policymaking and initiatives relating to this,’ says Doornenbal. They are sharing the interim results of the development of the measuring scale at www.gezondmeten.nl.

Population Health

The healthcare system is under pressure. Alongside innovations in academic care, we are helping devise solutions to keep healthcare accessible and affordable, also in the future. Population health is therefore one of the LUMC’s priorities. We study the transition from health to disease in the population and how to reduce the chance of disease. This includes developing and testing interventions to improve people’s health.

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