Underlying Assumptions and Potential Ramifications of Proxy Subjective Health Status or Evaluation Measures for Children or Those Unable to Speak for Themselves
In healthcare research and practice, assessing subjective health status or evaluating health outcomes is crucial for understanding the well-being and needs of individuals. However, when it comes to children or individuals who are unable to speak for themselves, proxy measures are often employed. Proxy measures involve obtaining information about an individual’s health status or experiences from another person, such as a parent or caregiver.
The use of proxy subjective health status or evaluation measures for children or those unable to speak for themselves is based on certain underlying assumptions. First and foremost, it assumes that the proxy is able to accurately report or evaluate the health status of the individual in question. This assumption rests on the belief that parents or caregivers have sufficient knowledge and awareness of the individual’s health condition and can provide reliable information. However, this assumption may not always hold true, as proxies may be influenced by their own biases, limited understanding of the individual’s condition, or subjective interpretations of symptoms.
Another assumption underlying the use of proxy measures is that the proxy is emotionally connected and empathetic towards the individual. It is assumed that the proxy’s relationship with the person they are assessing allows them to accurately gauge the individual’s experiences and report on their subjective health status. However, this assumption may also be flawed as proxies may struggle to fully comprehend the emotional and psychological aspects of the individual’s experiences, particularly in cases where the individual is unable to effectively communicate.
Moreover, proxy measures assume that the proxy’s perceptions and evaluations align with the individual’s own experiences and preferences, assuming that what the proxy reports is a true reflection of the individual’s subjective health status. Nevertheless, proxies can only provide their own interpretations and may not always take into account the individual’s unique perspectives, priorities, or values. This may lead to a discrepancy between the proxy-reported health status and the subjective experiences of the individual, thereby limiting the accuracy and relevance of the obtained data.
The use of proxy measures for children or those unable to speak for themselves can have several potential ramifications. One potential ramification is the possibility of misinterpretation or misrepresentation of the individual’s health status. Proxies may inadvertently overstate or understate the severity of symptoms, leading to biased assessments or inaccurate representation of the individual’s condition. This can impact the appropriateness and effectiveness of healthcare interventions, as decisions may be based on incomplete or distorted information.
Additionally, relying on proxy measures can obscure the individual’s own voice and agency in healthcare decision-making. By relying solely on the perspectives of proxies, the unique experiences, values, and preferences of the individual may be sidelined, potentially leading to suboptimal care or interventions that do not align with their needs. It is important to consider ways to incorporate the perspectives of individuals themselves, especially when they are capable of expressing their experiences in some form, such as through alternative communication methods.
In conclusion, the use of proxy subjective health status or evaluation measures for children or those unable to speak for themselves is based on underlying assumptions regarding the accuracy and validity of proxy reports. However, these assumptions may not always hold true, and there can be potential ramifications associated with relying solely on proxy measures. Future research and practice should seek to explore ways to integrate the perspectives of individuals themselves and improve the accuracy and relevance of subjective health assessments in these populations.
Dreyer, B., Mollborn, S., McLeod, L., & Armstrong, A. (2015). An investigation of proxy response bias in a study of adolescent psychological well-being. Survey Research Methods, 9(4), 241-254.
Forrest, C. B., Bevans, K. B., Riley, A. W., Crespo, R., & Louis, T. A. (2013). Health and school outcomes during children’s transition into adolescence. Journal of Adolescent Health, 52(2), 186-194.