Developing a capability-based questionnaire as an alternative method for assessing well-being in patients with chronic pain

This paper reports a qualitative study which sought to operationalise Sen’s capability approach in the context of chronic pain. The resulting capability-instrument will allow treatments and services to be evaluated according to whether they enable users to achieve those things which they value in life. This is particularly important in chronic conditions, where the emphasis is often on helping the patient to live their life as fully as possible despite persistent symptoms. Participatory methods were used to identify a list of capabilities deemed important to those with chronic pain. Respondents were recruited through a Pain Management Clinic in the East of England (n = 16). Focus groups were followed-up by individual interviews (n = 6). The following eight capabilities were identified as being important: Love and social inclusion; Enjoyment; Respect and Identity; Remaining physically and mentally active; Independence and autonomy; Societal and family roles; Physical and mental well-being; Feeling secure about the future. These have been developed into a questionnaire for self-completion by service users. The impact of chronic pain on well-being extends well beyond health symptoms and the range of health functionings typically considered when evaluating services. The capability-instrument is intended to supplement current evidence by assessing what service users are enabled to do. In its current form it will also be a useful tool for those seeking to deliver patient-centred care. Additional research into valuation and a decision-rule will progress capability as a stand-alone alternative economic framework.