**5. The biopsychosocial paradigm**

*Quality of Life - Biopsychosocial Perspectives*

friends, and professionals)

for people with HIV or diabetes.

desperation),

To summarize, quality of life questionnaires should include different domains:

• level of independence domain (which refers to the autonomy of the person in

• social relationships domain (which refers to social interactions with family,

• environmental domain (which refers to aspects of the environment that can

It is also important to mention that with regard to the measurement of quality of life in illness situations, there are specific questionnaires [17] such as the WHOQOL

In summary, we can state that it is important to note that the definition of quality of life always includes a reference to the physical state of the subject, but is no longer considered only on the basis of the quality of the functionality of a person, detectable with standardized parameters, since they are described in relation to the degree of satisfaction perceived with respect to this level of functionality: this definition shifts the emphasis from the scope of objectively definable functionality to that of subjectivity; the detection of both these two aspects can probably constitute a reliable measure of the quality of life [1]. Finally, we can affirm that within the sphere of objectivity, disease is understood as a defined clinical framework and the different areas of functionality: physical, psychological, social, and work. In the context of subjectivity, the perception of disease and patient satisfaction are placed in the various areas of life, in which it is conceivable that the state of health may influence. Concluding, we can detect that the most common method of measuring quality of life is the administration of questionnaires, and that there are two

• physical domain (which refers to physical sensations, health, and pain),

• psychological domain (which refers to emotions, such as anxiety and

various life areas, from the financial to the physical one),

families of questionnaires: generic and specific for pathology [1].

**4. A new perspective: well-being as a promotion of quality of life**

focused on disease outcomes are an insufficient determinant of health status. Accordingly, nowadays the focus has shifted from the idea of physical/psychological well-being as the elimination of a problem or a disease to a conceptualization of well-being as a promotion of quality of life. This shift of perspective has radically changed not only our concept of health and disease, but also that of the human being, of his/her life process and crises [18]. For a long time, the conditions of well-being have been defined on the basis of normative models that have produced health models consistent with the biomedical model, which was very reductive. Only in relatively recent times, and certainly thanks to the contribution of health psychology, we have begun to implement a new approach that claims the specificity of a discipline connected to the singularity and uniqueness of the subject. This uniqueness, to be grasped, also requires openness to a complex thought, capable of overcoming the reductionist perspective and the dichotomies [18]. Today we accept that to understand a phenomenon we have to take into account the context, the

Health care professionals are increasingly recognizing that measurements only

promote the development of a person) [16].

**8**

The biopsychosocial paradigm characterizes health psychology [19] and the specific areas regarding quality of life that are analyzed in depth by this discipline. The perspective of the biopsychosocial paradigm was introduced by George Engel who coined the term "Biopsychosocial Approach" as a privileged modality both to decode and understand the processes of health and disease throughout the existential path, and to articulate forms of care [20, 21]. The biopsychosocial model is inspired by the paradigm of complexity, in sharp contrast to biomedical reductionism, as well as to the hierarchization of sciences. It adopts the perspective of the general theory of systems developed by Von Bertalanffy [22], which considers a set of interrelated events as a system that manifests specific functions and properties according to the level to which it is placed compared to a wider system. In fact, this systems theory states that all levels of the organization are connected to each other, so that the change of one affects the change of the other; for example, a biological change affects the psychological level and social level and vice versa [20, 21]. The biopsychosocial model refers to three basic principles: dialogue-connection, relationship, and humility. This paradigm considers the person as a "whole": as a genetic heir, a subject of reflection and decision, as well as a historical-cultural and family subject. The axioms of this model are inclusive (focused on the understanding of diversity) and not exclusive, the perspectives of this approach are conceived as global, always considering biological, psychological, and social facets together [19]. Today we therefore refer to the biopsychosocial model whose fundamental assumption is that every condition of health or disease is a consequence of the interaction between biological, psychological, and social factors and we therefore move beyond the old dualism that separated the body from the mind; it is therefore an attempt to see people in their entirety. It is based on the key concept that the person represents a biological unit made of both body and mind, that is, not only of a biological body but also of psychic and emotional factors, which play a decisive role not only in balancing the life of the individual but also in the genesis and development of organic diseases. Health can therefore be understood as the product of the interaction between a physical-mental-social unit. As a matter of fact anyone who wants to sufficiently understand another person cannot simply observe the individual aspects, which, although important, do not allow to understand his/her overall situation, but must approach him/her on the contrary by seizing his/her entirety and his/ her complexity. The centrality of this model has been confirmed and validated by scientific literature. This model marked the shift from a traditional medical model centered only on the body (and on illness as a purely biological event) to a medicine centered on the person [20, 21]. Today there is the awareness that a biopsychosocial

screening, more than a compartmentalized approach of medical and psychosocial models, can help the planning of a more effective treatment in case of illness and can also prevent distress [23]. Human beings tend to grow through the development of complex systems that are intertwined with each other and affect the three main areas explored by the model biopsychosocial paradigm:


These three areas are always interacting with each other and are always present in every vital event, so any alteration of the patient's state of health will be recognized by a change in the integration between these three systems that are linked and intertwined [24].

Finally, we can state that in order to approach the concept of quality of life and the knowledge and care of the person in his/her complexity also means to examine the relations between these three systems simultaneously.

### **6. Conclusions**

To summarize, we can affirm that the concept of quality of life (as it is intended in the field of medicine and health psychology) refers mainly to the well-being of the individual from a physical, cultural, social, and psychological point of view, also considering the cultural context and its value and, furthermore, considering the individual's objectives, standards, and life expectancy [25]. Several studies have therefore proposed to develop a quality of life model that would integrate objective and subjective perspectives; some authors also focused on multidimensional nature of this construct by analyzing in depth some key areas: physical well-being, emotional well-being, the material well-being, potential development of the subject and his/her daily activities [26, 27]. Other authors have proposed a holistic model that describes the quality of life as a dynamic process that links the individual reality with the social reality emphasizing the importance of environmental factors and personal factors, and the relationship that the person establishes with the constraints and resources of the environment in which he/she lives [28].

We can conclude by stating that the quality of life construct refers to an indicator of material well-being expressed by money gain and economic resources, of psychophysical well-being of the individual, and the outcome related to the effectiveness of the programs implemented in support of various individuals [29]. The assessment of quality of life can be carried out according to different methodological approaches, but we have to note that making an univocal operationalization of this construct can be sometimes quite difficult for its complexity [30]. Finally, we can also point out that a key distinction between self-report questionnaires can be done according to their targets: they can be generic, or they can refer to the quality of life in relation to a specific disease, such as HIV, as we anticipated. In particular, we can use the first type of generic measurement indifferently on a heterogeneous population, like intelligence tests. We can also divide generic measuring instruments into two macro categories: profile tests, in which the scaffolding represents the evaluation of multiple dimensions of quality of life, which can be observed individually, or we can find tests that offer a single synthetic score. Every approach

**11**

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

has its pros and cons, to be considered when choosing them for a specific objective. According to another methodological approach, instead, the subjective dimension of the illness experience is privileged to allow an in-depth analysis of the quality of life understood as a life process capable of facing pathological events. From this point of view, the semi-structured interview may also be useful [31]. In any case, it is always important to integrate the objective observation with the subjective part because (as we stated) the biological, social, and psychological dimensions are

Concluding, we can consider that it makes sense to refer in this context to what was declared by the International Society for Quality of Life Studies [32], which stated overall that the quality of life includes both an objective point of view and a subjective point of view, and involves areas relating to material wellbeing, health, productivity, affectivity, safety, society, and inner well-being. The objective area includes a sound measure of objective well-being while the subjective sphere includes personal satisfaction. Personal satisfaction has to be linked to the importance assigned by the individual to some subjective and cultural values; however, we can note that the definition of objective could be misleading: social indicators are usually chosen from a theory, or are based on the availability of individual valuation data, influencing researchers' choices. Also the social situation in which the survey is developed has a great influence, but unfortunately these aspects are often ignored or undervalued [19]. On the other hand, it must be specified also that if the perception of quality of life is reduced to a simple psychological survey of consumer satisfaction, it is a really limited perspective because all the relational, social, and cultural facets that the quality of life assessment should contain (referring to the biopsychosocial paradigm) are lost [20, 21]. Certainly all the sets of knowledge obtained through the assessments should be collected with a scientific method that is based on technically reliable and shared hypotheses. It is also necessary to rely on constructive epistemological and methodological interpretations, and it is important that the researchers should not attribute to the data collected an indisputable value of reality, but rather of a map that, because of its characteristics and controllability, allows it to express an orientation. The goal cannot in fact be just abstractly cognitive, but rather that of triggering a process of knowledge, elaboration, and participation in the population concerned, especially if the investigation aimed at finding a shared priority scale [19]. It is also important to note that it is the duty of every mental health professional to work in the direction of maximizing people's well-being and quality of life, but this task cannot be the sole responsibility of the professionals of this discipline. On the contrary, it must be a common goal of all those who, in any capacity, deal with individuals, groups, organizations, and institutions [33]; to do this better, we have to consider human beings in their complexity, and this is possible by using the biopsychosocial paradigm [34] and

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

always intertwined with each other.

the articulated concept of quality of life.

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

has its pros and cons, to be considered when choosing them for a specific objective. According to another methodological approach, instead, the subjective dimension of the illness experience is privileged to allow an in-depth analysis of the quality of life understood as a life process capable of facing pathological events. From this point of view, the semi-structured interview may also be useful [31]. In any case, it is always important to integrate the objective observation with the subjective part because (as we stated) the biological, social, and psychological dimensions are always intertwined with each other.

Concluding, we can consider that it makes sense to refer in this context to what was declared by the International Society for Quality of Life Studies [32], which stated overall that the quality of life includes both an objective point of view and a subjective point of view, and involves areas relating to material wellbeing, health, productivity, affectivity, safety, society, and inner well-being. The objective area includes a sound measure of objective well-being while the subjective sphere includes personal satisfaction. Personal satisfaction has to be linked to the importance assigned by the individual to some subjective and cultural values; however, we can note that the definition of objective could be misleading: social indicators are usually chosen from a theory, or are based on the availability of individual valuation data, influencing researchers' choices. Also the social situation in which the survey is developed has a great influence, but unfortunately these aspects are often ignored or undervalued [19]. On the other hand, it must be specified also that if the perception of quality of life is reduced to a simple psychological survey of consumer satisfaction, it is a really limited perspective because all the relational, social, and cultural facets that the quality of life assessment should contain (referring to the biopsychosocial paradigm) are lost [20, 21]. Certainly all the sets of knowledge obtained through the assessments should be collected with a scientific method that is based on technically reliable and shared hypotheses. It is also necessary to rely on constructive epistemological and methodological interpretations, and it is important that the researchers should not attribute to the data collected an indisputable value of reality, but rather of a map that, because of its characteristics and controllability, allows it to express an orientation. The goal cannot in fact be just abstractly cognitive, but rather that of triggering a process of knowledge, elaboration, and participation in the population concerned, especially if the investigation aimed at finding a shared priority scale [19]. It is also important to note that it is the duty of every mental health professional to work in the direction of maximizing people's well-being and quality of life, but this task cannot be the sole responsibility of the professionals of this discipline. On the contrary, it must be a common goal of all those who, in any capacity, deal with individuals, groups, organizations, and institutions [33]; to do this better, we have to consider human beings in their complexity, and this is possible by using the biopsychosocial paradigm [34] and the articulated concept of quality of life.

*Quality of Life - Biopsychosocial Perspectives*

• the part of the mind and,

of it;

intertwined [24].

**6. Conclusions**

areas explored by the model biopsychosocial paradigm:

• last but not least, the interpersonal/social part.

the relations between these three systems simultaneously.

straints and resources of the environment in which he/she lives [28].

screening, more than a compartmentalized approach of medical and psychosocial models, can help the planning of a more effective treatment in case of illness and can also prevent distress [23]. Human beings tend to grow through the development of complex systems that are intertwined with each other and affect the three main

• the biological part, consisting of all the systems and subsystems that are part

These three areas are always interacting with each other and are always present in every vital event, so any alteration of the patient's state of health will be recognized by a change in the integration between these three systems that are linked and

Finally, we can state that in order to approach the concept of quality of life and the knowledge and care of the person in his/her complexity also means to examine

To summarize, we can affirm that the concept of quality of life (as it is intended in the field of medicine and health psychology) refers mainly to the well-being of the individual from a physical, cultural, social, and psychological point of view, also considering the cultural context and its value and, furthermore, considering the individual's objectives, standards, and life expectancy [25]. Several studies have therefore proposed to develop a quality of life model that would integrate objective and subjective perspectives; some authors also focused on multidimensional nature of this construct by analyzing in depth some key areas: physical well-being, emotional well-being, the material well-being, potential development of the subject and his/her daily activities [26, 27]. Other authors have proposed a holistic model that describes the quality of life as a dynamic process that links the individual reality with the social reality emphasizing the importance of environmental factors and personal factors, and the relationship that the person establishes with the con-

We can conclude by stating that the quality of life construct refers to an indicator of material well-being expressed by money gain and economic resources, of psychophysical well-being of the individual, and the outcome related to the effectiveness of the programs implemented in support of various individuals [29]. The assessment of quality of life can be carried out according to different methodological approaches, but we have to note that making an univocal operationalization of this construct can be sometimes quite difficult for its complexity [30]. Finally, we can also point out that a key distinction between self-report questionnaires can be done according to their targets: they can be generic, or they can refer to the quality of life in relation to a specific disease, such as HIV, as we anticipated. In particular, we can use the first type of generic measurement indifferently on a heterogeneous population, like intelligence tests. We can also divide generic measuring instruments into two macro categories: profile tests, in which the scaffolding represents the evaluation of multiple dimensions of quality of life, which can be observed individually, or we can find tests that offer a single synthetic score. Every approach

**10**

*Quality of Life - Biopsychosocial Perspectives*
