Completing a dissertation involves getting into the weeds. As a bipolar disorder and quality-of-life researcher, I’ve found the swamp is quite vast. In recent years, quality of life has become an important outcome in chronic illness research (Flanagan et al. 2017)[1]. This is true in qualitative research, which explores how people experience illness, and in quantitative research, which tests hypotheses and measures outcomes. So how do we define and measure a fuzzy concept like “quality of life?”
Defining and Measuring Quality of Life
A crucial issue in quality-of-life research is that conceptual definitions are heterogeneous. The most commonly quoted definition comes from the World Health Organization: “an individual’s perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (The WHOQOL Group 1998[2]; Morton et al. 2017[3]). To me, this definition poses more questions than answers; we can quickly fall into a rabbit hole of fuzziness with nebulous terms like culture, goals, standards, and concerns.
To make this expansive concept measurable, researchers have developed multitudes of questionnaires that divide quality of life into tangible functional, physical, and mental health-related domains. For example, the questionnaire may ask how health limits a respondent’s ability to climb stairs or how emotional problems interfere with work productivity. What these questionnaires often cannot tell us is why. This is where my background as a nurse practitioner saunters in. Nurses and other health professionals are privileged to see “behind the scenes” of illness. In clinic, I can see the three-dimensional circumstances that give context to a two-dimensional score.
Measurement Is Only Half the Story…
Our exemplar, Bonnie, lives alone, has early-stage heart failure, and reports on the quality-of-life questionnaire that she is unable to climb stairs and that her emotional state has limited her work productivity. From the questionnaire and diagnosis alone, a healthcare provider might attribute these problems to disease progression or non-adherence to treatment. In reality, Bonnie is active and follows her treatment plan. The real story, unshown by the quality-of-life questionnaire, is that she broke her leg after her cat, Princess Jellybean, made a diabolically timed appearance underfoot on the treadmill during a Zoom conference call. In true feline fashion, Princess Jellybean was unscathed.
With a broken leg, Bonnie can’t navigate the steep, narrow staircase leading to the bedroom, so she’s been sleeping poorly on the couch downstairs. Adding insult to injury, important people at the company saw the incident on Zoom. Bonnie is embarrassed now during meetings, especially when leadership makes her the butt of jokes, leading to emotional distress and work absences. The backstory provides illumination that the questionnaire fails to. Although the questionnaire identifies limitations, it can’t explain the root cause or the ripple effect of the event. Unfortunately, health-related quality-of-life questionnaires leave no room for Princess Jellybean. Notably, they also leave little room for God.
By this, I don’t simply mean that many questionnaires lack a question about prayer or church attendance. Some do assess spirituality. But God cannot be tucked neatly into a “spirituality” compartment alongside physical functioning, mental health, and work productivity. Faith can permeate how a person understands each of these domains. A Christian conceptualization of quality of life also points beyond what any questionnaire can capture. An instrument may assess a person’s conditions, yet it cannot measure that person’s worth before God.
The Bleeding Woman, Health-related Quality of Life, and Transcendence
Developing a physical or mental disability, or losing the ability to work, can be devastating. Yet, Christianity tells us that God loves humankind unconditionally, even in our darkest times. Our worth as people, not just Christians, doesn’t hinge on our ability to be a successful YouTuber, the slickness of our cosmetic procedures or Gucci outfits, our dedication to grind culture, how prestigious our jobs are, being savvy on Wall Street, or the extent of our gym gains. The world shouts at us through our phones and the TV, “These are the things that make you worthy!” But God quietly and powerfully reminds us how much he loves and values the leper. The Gospels repeatedly direct our attention toward people whom the world regards as unclean, burdensome, or unworthy of notice.
One of my favorite stories is that of the chronically ill, hemorrhaging woman recounted in Mark 5, Matthew 9, and Luke 8. Today, she might receive a diagnosis such as uterine fibroids, which can be managed relatively simply through surgery. However, in antiquity, that option didn’t exist. Under purity practices described in Leviticus 15, her condition would’ve carried stigma and practical consequences, such as unemployment, housing instability, the inability to get married, and difficulty with worship. In addition, constant bleeding may have left her anemic and exhausted, adding an extra layer of difficulty to the challenges she already faced.
When she sought healing from Jesus, we find out she’d been suffering from her condition for twelve years and that she’d spent all her money on ineffective medical treatments. Many people today can relate to this experience, whether personally or through a family member facing chronic illness, unsuccessful treatments, and exorbitant medical debt. Cultural and physical metrics tell us that her health-related quality of life was in the toilet. But this isn’t where her story ends…
She wasn’t just healed. Her story was preserved in all three Synoptic Gospels for future generations to read about. That’s remarkable. The Gospels extol an unnamed woman with an intimate and stigmatizing illness during an era when women’s bodies and experiences were rarely given this kind of narrative attention. Gynecological conditions remain difficult to discuss even today, including in the twenty-first-century United States (Hong 2026)[4].
The Gospels commemorate her as someone who acted with extraordinary faith, courage, and persistence. She moves through a crowded public space, reaches toward Jesus (the equivalent of a rockstar in 1st-century Israel), and risks being seen because she believes healing is inevitable…if she can just barely touch his clothing. Jesus then does more than confirm that her bleeding has ceased. He stops the chaotic crowd, recognizes her, allays her fear of being recognized, praises her faith in front of everyone, and calls her “Daughter.” Her body brought her to Jesus, but it didn’t define who she was to him. Borrowing the words of a participant in my research, the bleeding woman’s actions seem to proclaim, “I’m more than my diagnosis.” And when Jesus recognizes her and renames her “Daughter,” God confirms that our fundamental identity flows first from our relationship with Him.
The Future of Integrated Quality of Life Research
If our quality-of-life measures primarily ask whether people can climb stairs and complete their work, they may inadvertently suggest that health, independence, and productivity are the ingredients of a good life. Instead, we see through this woman that while her health-related quality of life was poor, she was incredibly rich in something far more intangible. The Gospels therefore give us a fuller picture than either a symptom count or a functional score could provide. They reveal her not only as readers might see her, or even as she may have seen herself, but as Jesus, the Divine Physician, saw her: as “Daughter.” To him, she was his beloved child, highlighting the profound relationship each of us can have with God, despite our station. Our quality of life is a fluid state of being, whereas our value as people remains constant.
Princess Jellybean reminds us that every measure has a backstory, and the bleeding woman reminds us that every backstory belongs to a person who deserves to be seen. Research should therefore integrate nursing, medical, and allied health practices by asking, “Tell me more.” In doing so, we echo Jesus, who stops in the crowd to recognize the person who reached out to him.
Despite the limitations of health-related quality-of-life measures, following Jesus doesn’t mean abandoning questionnaires completely. In clinical settings, standardized measures can help us identify suffering, compare outcomes, and determine whether interventions are working or need revision. However, researchers should clearly disclose what the instruments measure, seek input from the people who will complete them, and remain attentive and transparent to what chosen domains leave out. Measures can begin a conversation, but they shouldn’t be mistaken for the entire story. Only a holistic view of quality of life can help us develop interventions that serve not merely isolated medical conditions, but the living, breathing people behind them.
[1] Sarah Flanagan, Sarah Damery, and Gill Combes, “The Effectiveness of Integrated Care Interventions in Improving Patient Quality of Life (QoL) for Patients with Chronic Conditions: An Overview of the Systematic Review Evidence,” Health and Quality of Life Outcomes 15 (2017): 188, https://doi.org/10.1186/s12955-017-0765-y.
[2] The WHOQOL Group, “Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment,” Psychological Medicine 28, no. 3 (1998): 551–58, https://doi.org/10.1017/S0033291798006667
[3] Emma Morton, Erin E. Michalak, and Greg Murray, “What Does Quality of Life Refer to in Bipolar Disorders Research? A Systematic Review of the Construct’s Definition, Usage and Measurement,” Journal of Affective Disorders 212 (2017): 128–37, https://doi.org/10.1016/j.jad.2017.01.026.
[4] Ze Hong, “The Evolutionary-Cognitive Foundation and Cultural Persistence of Menstrual Taboos in Human Societies,” Evolution and Human Behavior 47, no. 4 (2026): 106899, https://doi.org/10.1016/j.evolhumbehav.2026.106899.
