1. Health related quality of life and satisfaction with life in Croatia Gorka Vuletic, BPsychol, PhD Andrija Stampar School of Public Health Medical Faculty, University of Zagreb Croatia

2. Republic of Croatia One of 6 former Yugoslavian republics Estimated Croatian population cca. 4,500,000 Capital city Zagreb ~ 800,000

3. How did Croatia become involved in QoL research? Deakin Uni 2001-2002 (PhD research) = basis for further research in Croatia  The 2003 Croatian National Health survey  Through the survey we obtained Population normative data for: Subjective quality of life (satisfaction with life) Subjective quality of life (satisfaction with life) Health status (SF-36) Health status (SF-36)

4. Project Croatian National Health Survey 2003 Founded by World Bank Founded by World Bank Co-operators: Co-operators: Republic of Croatia Ministry of Health Republic of Croatia Ministry of Health Canadian Society for International Health Canadian Society for International Health Project team was formed from: Project team was formed from: Andrija Stampar School of Public Health & Andrija Stampar School of Public Health & National Institute for Public Health

5. Sample  10,766 households were selected to participate in the survey (based on Census 2001).  Out of these selected households a response was obtained from 9,070 individuals (overall response rate 84.3%).  The questionnaire was administered face-to-face to respondents by trained public health nurses.  Representative for Croatian adult population in terms of its regional, gender and age structure.

6. Participants were asked about illnesses, health related behaviour, health related quality of life, use of health care services and subjective quality of life. Participants were asked about illnesses, health related behaviour, health related quality of life, use of health care services and subjective quality of life. Health related quality of life was measured by Health related quality of life was measured by → Health status questionnaire ( SF-36) which measure self perceived health status.

7. SF-36 8 dimensions of health Physical functioning Physical functioning Role limitation due to physical problems Role limitation due to physical problems Pain Pain General health perception General health perception Energy / vitality Energy / vitality Social functioning Social functioning Role limitation due to emotional problems Role limitation due to emotional problems Mental health Mental health Scored 0-100

8. Measure of Subjective Quality of Life: How are you satisfied with your life as a whole? CompletelyCompletely dissatisfied satisfied 0--------1----------2--------3--------4------5-------6-------7------8------9------10 Original scores were converted and presented in a form of percentage of scale maximum (% SM)

9. RESULTS Quality of life (QoL)

10. Croatian average satisfaction with life: Sample:N= 9,06856.96  26.06 %SM Men N= 2,88856.22  26.04 % SM Women N= 6,18057.31  26.07 % SM p = 0.064

11. Population mean: 60.11  25.12 % SM (based on weighted values) N= 3,479,134 According to 1991 census: population of Croatia = 4 437 469

12. Subjestive quality of life by age groups

13. Self perceived economic status and QoL 2004 2004  GDP per capita US $ = 7,724.2 Unemployment rate: 18%  Unemployment rate: 18%

14. RESULTS Health

15. Health status by dimensions Dimension MeanStandard Deviation Physical Functioning 70.2029.93 Role limitation due to Physical problems 62.7344.29 Pain 65.5130.16 General Health Perception 55.4722.81 Energy Vitality 53.9922.32 Social Functioning 74.5727.10 Role limitation due to Emotional problems 70.6642.48 Mental Health 63.2420.51

16. Comparison with other countries...

17. Health profiles – gender differences

18. Gender differences by age groups

19. Summaries Older women in the worst position Older women in the worst position Low QoL and not very good health Low QoL and not very good health Difficulties in everyday functioning due to poor health Difficulties in everyday functioning due to poor health

20. - Regional differences exist - Mediterranean area better

21. Factor analysis SF-36 - Croatian sample Component 12 pf.273.820 rp.329.810 bp.331.760 gh.553.598 vt.772.436 sf.677.506 re.663.362 mh.909.193 Compo- nent Rotation Sums of Squared Loadings Total % of Variance Cumulative % 1 physical health 2.91936.489 2 mental health 2.87735.96072.449

22. Predictors of subjective quality of life (SQOL) Best predictors of SQOL: Best predictors of SQOL: Mental health (23 % variance explained) Mental health (23 % variance explained) General health (2.8 % variance explained) General health (2.8 % variance explained) All together 8 dimensions explained 27% of SQOL Subjective quality of life and health related quality of life must be measured independently/separately Subjective quality of life and health related quality of life must be measured independently/separately Different concept & different content Different concept & different content

23. Conclusion (for further health surveys in Croatia) Importance of measuring QOL was recognised Importance of measuring QOL was recognised Subjective QOL incorporated in health surveys is independent of health related QOL measures so it will be measured independently. Subjective QOL incorporated in health surveys is independent of health related QOL measures so it will be measured independently.