Re: construction of 'health'

Duane Steward (
Fri, 13 Nov 1998 10:24:52 -0500

>I am interested in articles which deal with the construction of
>'health' (general health or mental health). If anyone knows of a good
>reference which deals with "health" from the perpective of PCP, and/or
>from a historical perspective - I would appreciate getting the
>Thank you,
>Uriel Meshoulam

Uriel and others interested in this thread,

I would not presume this work to be a "good reference", but it is a PhD
thesis in computer science that deals with the construction of 'health'
from the PCP perspective. I have recently defended my thesis entitled,
"Utility Assessment Based On Individualized Patient Perspectives." In this
work I promote a new protocol for quality-of-life measurement based on a
reconstruction of preference models with elements from Personal Construct
Theory, Decision Analytic Theory, Multi-attribute Utility Theory and what I
hope is common sense. Being a melting pot, it is not a rocket-science
application of any of these domains. This translates to a potential for
developing the sophistication of the idea in any number of directions by
those more adept in specific disciplines. The most unique aspect of my
contribution is the ability my protocol provides to capture the values of a
medical patient in his or her own words (thanks to the PCT perspective). At
the same time it delivers an output suitable for decision analysts, and
health care policy makers to plug into their work (cost-effectiveness,
guideline/protocol development, and resource allocation analyses).

The thesis research goes so far as to demonstrate the protocol's
feasibility for human administration. The structured interviews conducted
thus far suggest a four hour average for such administration, which is
impractical for routine health care. However, I assert in the thesis a
capacity for automation with artificially intelligent software instruments.
A prototype has been written. The feasibility of administration by computer
program and measurement of the protocol's reliability and validity in
psychometric terms are needed. At this time, a few grant proposals have
been submitted and a few more have been rejected. I am awaiting feedback to
know if now is the time to continue the pursuit.

I would like to take this opportunity to thank those contributing to this
listserv and the help it has been to my research over the past four years -
particular thanks to those who have helped individually!


Full Thesis:
FTP file download: (2 MB) or
.../ (10 MB) or
.../ (2 MB)

AdobeFormat on WWW:

10 page documentation for presentation to AAAI
(protocol only, no results from feasibility study):
FTP file download:

AdobeFormat on WWW:

Duane Steward, D.V.M., M.S.I.E., Ph.D., Fellow A.A.V.I.
Visiting Scientist in Medical Informatics
Clinical Decision Making Group; Laboratory for Computer Science; M.I.T.
NE43-415 545 Technology Square Cambridge, MA., 02139 URL:
(617) 253-3533 Group Office: 253-5860 Fax: (617) 258-8682