**1. Introduction**

This is a review about the concept of quality of life: today this notion is very important and its definition is really complex; as a matter of fact, it has evolved over the years and become an increasingly articulated idea (i.e., it is specified by the perception of one's physical, psychological, and emotional health, by the degree of independence, by social relations, and by the type of interaction with one's context). We also can note that the quality of life construct is broader than that of health, it is not a synonym of it (as we will analyze). In this sense, being healthy is considered a dimension of quality of life and health-facilitating behaviors are considered the predictors of the quality of life itself [1]. These aspects and many other features are going to be analyzed in depth and clarified in this narrative review.

## **2. Historical overview: the concept's evolution and scientific assessment**

The debate regarding quality of life is quite ancient. Starting from early Greece, Plato had devoted several years of his life in developing a perfect government where quality of life for citizens is a mainstream. The precise term "quality of life" however had not yet been coined at that time; actually, it was introduced later, in the 1970s. We can synthetically define the quality of life as a person's judgment about various aspects of his/her own physical, social, and psychological wellbeing. The growing importance of personal evaluation of life aspects supported the development of a more precise definition of this concept and the need of a scientific assessment using psychometric standardized tests: thus, an initiative to develop a scientific quality of life assessment was born. The World Health Organization has therefore started a specific research aimed to create a rigorous measurement of this construct. The specific need to develop this research arose for several reasons. First, during recent years, beyond traditional health indicators (such as morbidity and mortality), there has been a broadening focus on the measurement of health outcomes [2], on the inclusion of measures of perceived health, on the impact of disease and impairment about daily activities and behavior [3], and on functional status/disability status measures. Furthermore, it is important to remember that it was also noted that while these questionnaires were beginning to provide a general measure of the impact of the disease, they did not actually assess the specific quality of the disease. This is the reason why, later, some specific questionnaires were developed to measure quality of life in the context of distinguishing diseases. A criticity arose because many measures of health status have been developed in the United Kingdom and in North America, the translation of which for their use in other settings appearing quite unsatisfactory and timeconsuming [4]. A third important reason was the need to go beyond the increasingly mechanistic model of medicine that deals only with the eradication of disease and symptoms. The awareness that this model is obsolete reinforced the need for the introduction of a new humanistic perspective into health care. It is widely recognized that health care is essentially a humanistic transaction where the patient's well-being is the primary aim; it no longer stops just at making the symptoms disappear, but it is more inclusive and complete. To deal with these reasons, the World Health Organization created the initiative to develop a quality of life assessment promoting a holistic approach to health and health care, as emphasized in the World Health Organization's definition of health as the "state of physical, mental and social well-being and not merely as the absence of disease and infirmity." Precisely in 1995, this organization defined in an extensive and articulated way the

**5**

*Quality of Life and Biopsychosocial Paradigm: A Narrative Review of the Concept and Specific…*

quality of life as the subjective perception that individuals have of their position in life, in their life context, culture and value system, and in relation to the achievement of their goals and their expectations, reference standards, and concerns. The result is a very complex concept in which the quality of life refers to various dimensions: the perception of one's physical, psychological, and emotional health, the degree of independence of the individual, social relations and the type of interaction with their own life context. As we have anticipated, the concept of quality of life therefore appears broader than that of "health," being not synonymous with "health" [5] but at the same time being intertwined with this notion and with the concept of a biopsychosocial paradigm. The definition of quality of life given by the World Health Organization links together a huge amount of studies [6–14], and in this way being in a state of good health is considered only one dimension of quality of life, and behaviors facilitating health are considered predictors of the quality of life itself. An acknowledgement of these aspects is necessary in order to distinguish the notion of quality of life from the notion of health. It is important to point that the definition of quality of life always includes a reference to the physical state of the subject, but it is not enough to describe the quality of a person's functionality. The latter can be detected with standardized parameters, since it is mostly correlated to the degree of satisfaction perceived with respect to these

standardized parameters and the level of physical functionality.

In this chapter, we present a definition of quality of life that shifts the emphasis from the scope of objectively definable functionality to the focus on subjectivity. In the field of objectivity, the disease is described as a defined clinical and physical state (the disease) and as the different areas of functionality (work area, psychological area, social area, etc.). It is also important to consider that quality of life refers to a subjective point of view, which is embedded in a cultural, social, and environmental context. In different geographic areas, there can be different concepts and different cultural values that can influence people's perception. It is also important to state that the World Health Organization's quality of life definition focuses on the respondents' "perceived" quality of life; it does not require a measure of any detailed symptoms, conditions, or diseases, nor disability as objectively judged, but rather the perceived effects of disease and health interventions on the person's quality of life. Starting from this point of view, an assessment of this multidimensional concept was developed, incorporating the individual's perception of health status, psychosocial status, and other aspects of life. For several years, the importance of going beyond an observation of the quality of life from an individual point of view was also underlined, and already in 2003 an Italian researcher, Ingrosso, encouraged a collective and social research in this field. In particular, he states that the topic of quality of life can characterize the perspective about a local community and its dynamics. In this broader definition of quality of life, Ingrosso refers to the evaluation that individuals of a population make about the correspondence of certain personal and collective endowments with respect to their own scale of needs and values, based on their own orientations and experiences. He put as example how citizens of a specific local community can express judgments about the adequacy or inadequacy of policies or complexes of interventions that are implemented in a specific geographic territory [15]. He also pointed out that in recent years the debate about the quality of life has partially gotten lost in generalities. The debate was also divided between the extendibility of the objective component and the subjective one, thus losing the perspective about the sense of collective, contextual, relational, and operational evaluation with which the term was originally used as from the 1970s. Scientific research can thus modify the collective knowledge about this topic, to stimulate the citizens, whether directly or indirectly, to think about some

*DOI: http://dx.doi.org/10.5772/intechopen.91877*

#### *Quality of Life and Biopsychosocial Paradigm: A Narrative Review of the Concept and Specific… DOI: http://dx.doi.org/10.5772/intechopen.91877*

quality of life as the subjective perception that individuals have of their position in life, in their life context, culture and value system, and in relation to the achievement of their goals and their expectations, reference standards, and concerns. The result is a very complex concept in which the quality of life refers to various dimensions: the perception of one's physical, psychological, and emotional health, the degree of independence of the individual, social relations and the type of interaction with their own life context. As we have anticipated, the concept of quality of life therefore appears broader than that of "health," being not synonymous with "health" [5] but at the same time being intertwined with this notion and with the concept of a biopsychosocial paradigm. The definition of quality of life given by the World Health Organization links together a huge amount of studies [6–14], and in this way being in a state of good health is considered only one dimension of quality of life, and behaviors facilitating health are considered predictors of the quality of life itself. An acknowledgement of these aspects is necessary in order to distinguish the notion of quality of life from the notion of health. It is important to point that the definition of quality of life always includes a reference to the physical state of the subject, but it is not enough to describe the quality of a person's functionality. The latter can be detected with standardized parameters, since it is mostly correlated to the degree of satisfaction perceived with respect to these standardized parameters and the level of physical functionality.

In this chapter, we present a definition of quality of life that shifts the emphasis from the scope of objectively definable functionality to the focus on subjectivity. In the field of objectivity, the disease is described as a defined clinical and physical state (the disease) and as the different areas of functionality (work area, psychological area, social area, etc.). It is also important to consider that quality of life refers to a subjective point of view, which is embedded in a cultural, social, and environmental context. In different geographic areas, there can be different concepts and different cultural values that can influence people's perception. It is also important to state that the World Health Organization's quality of life definition focuses on the respondents' "perceived" quality of life; it does not require a measure of any detailed symptoms, conditions, or diseases, nor disability as objectively judged, but rather the perceived effects of disease and health interventions on the person's quality of life. Starting from this point of view, an assessment of this multidimensional concept was developed, incorporating the individual's perception of health status, psychosocial status, and other aspects of life. For several years, the importance of going beyond an observation of the quality of life from an individual point of view was also underlined, and already in 2003 an Italian researcher, Ingrosso, encouraged a collective and social research in this field. In particular, he states that the topic of quality of life can characterize the perspective about a local community and its dynamics. In this broader definition of quality of life, Ingrosso refers to the evaluation that individuals of a population make about the correspondence of certain personal and collective endowments with respect to their own scale of needs and values, based on their own orientations and experiences. He put as example how citizens of a specific local community can express judgments about the adequacy or inadequacy of policies or complexes of interventions that are implemented in a specific geographic territory [15]. He also pointed out that in recent years the debate about the quality of life has partially gotten lost in generalities. The debate was also divided between the extendibility of the objective component and the subjective one, thus losing the perspective about the sense of collective, contextual, relational, and operational evaluation with which the term was originally used as from the 1970s. Scientific research can thus modify the collective knowledge about this topic, to stimulate the citizens, whether directly or indirectly, to think about some

*Quality of Life - Biopsychosocial Perspectives*

This is a review about the concept of quality of life: today this notion is very important and its definition is really complex; as a matter of fact, it has evolved over the years and become an increasingly articulated idea (i.e., it is specified by the perception of one's physical, psychological, and emotional health, by the degree of independence, by social relations, and by the type of interaction with one's context). We also can note that the quality of life construct is broader than that of health, it is not a synonym of it (as we will analyze). In this sense, being healthy is considered a dimension of quality of life and health-facilitating behaviors are considered the predictors of the quality of life itself [1]. These aspects and many other features are going to be analyzed in depth and clarified in this narrative review.

**2. Historical overview: the concept's evolution and scientific assessment**

Plato had devoted several years of his life in developing a perfect government where quality of life for citizens is a mainstream. The precise term "quality of life" however had not yet been coined at that time; actually, it was introduced later, in the 1970s. We can synthetically define the quality of life as a person's judgment about various aspects of his/her own physical, social, and psychological wellbeing. The growing importance of personal evaluation of life aspects supported the development of a more precise definition of this concept and the need of a scientific assessment using psychometric standardized tests: thus, an initiative to develop a scientific quality of life assessment was born. The World Health Organization has therefore started a specific research aimed to create a rigorous measurement of this construct. The specific need to develop this research arose for several reasons. First, during recent years, beyond traditional health indicators (such as morbidity and mortality), there has been a broadening focus on the measurement of health outcomes [2], on the inclusion of measures of perceived health, on the impact of disease and impairment about daily activities and behavior [3], and on functional status/disability status measures. Furthermore, it is important to remember that it was also noted that while these questionnaires were beginning to provide a general measure of the impact of the disease, they did not actually assess the specific quality of the disease. This is the reason why, later, some specific questionnaires were developed to measure quality of life in the context of distinguishing diseases. A criticity arose because many measures of health status have been developed in the United Kingdom and in North America, the translation of which for their use in other settings appearing quite unsatisfactory and timeconsuming [4]. A third important reason was the need to go beyond the increasingly mechanistic model of medicine that deals only with the eradication of disease and symptoms. The awareness that this model is obsolete reinforced the need for the introduction of a new humanistic perspective into health care. It is widely recognized that health care is essentially a humanistic transaction where the patient's well-being is the primary aim; it no longer stops just at making the symptoms disappear, but it is more inclusive and complete. To deal with these reasons, the World Health Organization created the initiative to develop a quality of life assessment promoting a holistic approach to health and health care, as emphasized in the World Health Organization's definition of health as the "state of physical, mental and social well-being and not merely as the absence of disease and infirmity." Precisely in 1995, this organization defined in an extensive and articulated way the

The debate regarding quality of life is quite ancient. Starting from early Greece,

**1. Introduction**

**4**

aspects regarding the lines of intervention consistent with their own expectations. Therefore, not only quantitative methods like indicators and surveys, but also qualitative surveys and dynamic surveys, such as participatory research-process methods, are useful for the purposes of these surveys. These methodologies are often indicated as the first fundamental step when carrying out interventions in a city or territory [15]. Today the social aspect of quality of life is increasingly present, so the concept of quality of life now is often strictly related to the terms "livable" and "livability," referring to the more or less desirable economic and social environment of a town, a metropolis, or a country: nowadays, these terms have become part of the common language.
