Quality of Life: Introducing the Holistic Hexagon

Jan 28, 2024

As we collectively move into the new year, many will take the opportunity to focus on hitting the reset button on personal and professional goals.  While I generally discourage creating New Year’s resolutions, I do support using the turnover of the year as an opening to take stock and refresh accordingly. Frankly, one can choose any date during the year to do that – a birthday, a special day for you, or any random date. As we consider changes we’d like to make in the service of better health, relationships, career path, etc, we’re moved to take stock in our current quality of life. It so happens that January was International Quality of Life month and according to the World Health Organization, quality of life (QoL) is measured in the context of one’s culture, their standard of living, and the value system of a nation. However, the concept of QoL differs from one person to another and can include access to healthcare, work-life balance, personal finances, interpersonal relationships and the like. Importantly, QoL is based on each person’s perception of their position in life in those various areas and is impacted by the disparity between one’s reality and their goals. We cannot presume, based on our own concept of QoL, how another experiences quality in their life experience.

At ERPHealth, we have our own way of learning about the QoL of the patients who use our GRO platform as part of their behavioral healthcare. The Holistic Hexagon is a measure of QoL across various domains that was created by CEO, Eric Gremminger. It posits that health satisfaction is a multidimensional concept…with one’s Employment, Recreation, Physical health, Mental health, Friends, and Family all having an impact on overall QoL. In 2023, patients were asked to rate satisfaction across these domains over 35,000 times and their clinicians leveraged that data to drive treatment planning and interventions. At an individual level, learning a patient’s satisfaction with their physical health or interpersonal relationships, for example, gives the clinician the most effective target areas for therapy sessions. At an aggregated population level, understanding if and when there are dips in satisfaction in one of these areas, an organization can better design treatment group topics, patient education initiatives, or employee programming in the case of employer-sponsored plans. Resource and personnel allocation can all be better informed by understanding satisfaction across these domains. 

Looking one step further, we know that results on the Holistic Hexagon have a negative relationship, or correlation, with scores on other well-known measures like the PHQ9, GAD7, or Perceived Stress Scale. That is, as severity of depression, anxiety, or perceived stress increase, scores on the Holistic Hexagon decrease. It stands to reason that an increase in the severity of mental health symptoms leads to a decrease in satisfaction across various areas of life. The opposite, of course, can also be true as there is a reciprocal relationship. However, parsing out those areas of life in this brief measure allows the patient to consider what area(s) are most pressing to address in session and will result in a more effective and efficient approach to care. 

As we look toward our goals for 2024 and take a moment to consider our current QoL, where would we like to turn our attention in these next steps?

About The Author

Cori McMahon, Psy.D., NCCE, Chief Clinical Officer at ERPHealth

Dr. Cori McMahon is a digital health clinical leader and clinical health psychologist with over 20 years’ experience across academic, clinical, and behavioral health tech industries. She was most recently a key member of the senior team taking a SaaS-based behavioral health organization to acquisition at 12x its valuation. Dr. McMahon is the former Director of the Division of Behavioral Medicine at Cooper University Hospital and maintains part-time work in integrated primary care as a Ryan White-funded psychologist serving persons living with HIV. She has presented 40+ peer-reviewed projects nationally and chaired multiple panel discussions as SME on measurement-based care, integrated behavioral health, and patient-reported outcomes in digital health.

Dr. McMahon is an Associate Professor of Clinical Medicine at Cooper Medical School of Rowan University and serves as lead for the Trauma-Informed Care project in the Department of Infectious Disease in collaboration with the state of NJ.