International projects

ASCOT is used in a number of international research projects. Click on the headings to learn more about the projects in these countries.


Project title: Care customer activation (Hoitava liikunta-aktivointi)

A short summary is presented below, but for more information please contact the Study Lead, Marina Steffansson at the Diakonia University of Applied Science at

Aims: The key purpose of the project was to increase the municipal residents’ wellbeing through physical exercise. The effects of the customer activation model were assessed in the project, and the costs of the model as well as the potential savings to the city of Pieksämäki were also estimated.

Timeline: May 2015 – September 2017

Results: The follow-up data were collected from physically inactive persons (n=79) who had participated in physical education instruction. The follow-up periods varied from 6 to 12 months. Objective measures showed that participants’ average weight and visceral fat decreased significantly during the 6-month follow-up. When the follow-up period was a year, the results still showed a decrease, but it was no longer so significant. The average blood sugar levels decreased but not significantly, and the average blood lipids increased slightly. The ASCOT and 15D measures showed significant increase both in the average quality of life for follow-up periods of 6 months and one year. Concerning the average activity levels in physical exercise, there was a significant increase for the 6-month follow-up, but the one-year results showed no increase or even a slight decrease in physical activity. The Kykyviisari measure showed improvement in the average work and functioning capability.

The costs of this customer activation model were 1,232 euros per person. Health care costs took into account improved wellbeing through physical exercise in three different types of illnesses: depression, back and neck pain, and type 2 diabetes. In line with the results of the study, information about improved wellbeing for estimating its effects on the changes seen in health care utilisation rates and the savings in health care were used. In all three disease types, physical exercise instruction did not reduce costs compared with current forms of care; it even increased costs in the short term. When the increased wellbeing was studied over a longer period, cost savings were observable as early as 12 months after the physical exercise instruction. When physical activity levels remain the same or increase, greater savings will be achieved.


ASCOT service user study

Project title: The application of a social care outcome measurement tool in the administration of a local community-based integrated care system.

Background and aims: There is a need for an outcome measurement tool in the community-based integrated care system in Japan. This study will: 1) develop and test a translation of the ASCOT into Japanese; 2) integrate domains from the Japanese version ASCOT into the local governments’ survey of older people including long-term care users, and 3) investigate how the social care related quality of life data can be utilised for effective management of long-term care, especially community-based integrated care, at the local administration level in Japan.

Funder: This project is supported by Grant-in-Aid for Scientific Research (KAKENHI) for Japan Society for the Promotion of Science (JSPS) 16H03722.

Timelines: 2016-2019

Project members: Mie MORIKAWA, Ph.D. (Tsuda University), Yoko MORIYAMA, Ph.D. (National Institute of Public Health), Takeru SHIROIWA, Ph.D. (National Institute of Public Health), Masaaki OTAGA, Ph.D. (National Institute of Public Health), Takuya MATSUSHIGE, Ph.D. (National Institute of Public Health), Takashi FUKUDA, Ph.D. (National Institute of Public Health), Hiromi NAKAMURA-Thomas, Ph.D. (Saitama Prefectural University).

Contact person (principal investigator): Mie MORIKAWA, Ph.D. Professor, Department of Policy Studies, Tsuda University, 1-18-24 Sendagaya, Shibuya City,Tokyo151-0051 TEL: +81-3-6447-5937 E-mail:

ASCOT Carer study 

Project title: Development of Comprehensive Care Model based on multifaceted evaluation of Quality of Care focusing on Carers’ Quality of Life.

Background and aims: In the Japanese comprehensive care system, supporting carers is an important issue but there is a lack of discussion around carers’ wellbeing from their own perspective. Thus, the aims of this project are to understand carers’ subjective wellbeing and to develop a comprehensive care model based on multifaceted evaluation of Quality of Care focusing on Carer’s QOL.

Translation of the Japanese version of ASCOT Carer SCT4 was conducted as the initial part of CarerQOL Project by the Japanese research team at the Japan Lutheran College (3-10-20, Osawa, Mitaka city, Tokyo, 181-0015, Japan).

Funder: The project is funded by the Japan Society for the Promotion of Science (JSPS), Grants-in-Aid for Scientific Research (KAKEN)-B 16H03715 (in Japanese).

Timelines: This project started in April 2016 and will end in March 2020.

Project members: The Japanese research team is led by Dr Mai Yamaguchi, Professor, Japan Lutheran College and the team members are Dr Ikushi Yamaguchi, Professor, Meiji University, Dr Machiko Ohara, Professor, Japan College of Social Work, Dr Hiromi Nakamura-Thomas, Professor, Saitama Prefectural University, Dr Akemi Matsuzawa, Associate Professor, Ibaraki Christian University and Professor Eiko Horikoshi, Japan Women’s  University.

Contact (Project Lead): Mai Yamaguchi at


Title: Measuring and valuing Quality of Life in older adults with the ASCOTNL

Background: The Netherlands Organisation for Scientific Research (NWO) funded a Dutch project to develop an instrument to measure Quality of Life of older people living at home (319-20-001). Older adults increasingly live independently and receive care in their own home. The Adult Social Care Outcomes Toolkit (ASCOT) was used to evaluate the outcomes of care services provided to older adults living at home.

Aims: The ASCOT-NL project has three aims:

1) to develop a Dutch version of the ASCOT (ASCOT-NL) by adopting the ASCOT SCT4 instrument for evaluating outcomes of care services for older adults living at home

2) to develop a set of Dutch preference weights for the ASCOT SCT4 instrument

3) to assess the normative adequacy and applicability of ASCOT-NL for policy purposes

Methods: The ASCOT-NL project runs from 2014 to 2018 and has three phases. In phase 1 we will further develop the ASCOT-NL (based on the Dutch translation of the SCT4 instrument) using a mix of philosophical analysis, literature review and qualitative empirical research resulting in the final version of ASCOT-NL. In phase 2, Dutch preference-based weights for the ASCOT-NL will be developed using a combination of Best Worst Scaling and Time Trade Off techniques. In phase 3, we will investigate philosophical debates concerning resource allocation and discuss consequences of using preference-based weights by policy makers, and we will identify facilitators and barriers for implementation of ASCOT-NL in a pilot study in two Dutch care organisations.

Research team: The ASCOT-NL project is a collaboration between the Department of Health Sciences of the Vrije Universiteit and the Department of Medical of the VU University Medical Center Amsterdam in the Netherlands. Futhermore, the societal partners ‘LOC zeggenschap in Zorg’, ‘GGZ InGeest’ and ‘Zorginnovaties voor kwetsbare ouderen van Zuyd Hogeschool/Sevagram’ are involved.

Team members in the Netherlands: Raymond Ostelo, Guy Widdershoven, Judith Bosmans, Karen van Leeuwen, Miriam van Loon.

Please contact Karen van Leeuwen for further information.

For further details, please see the project website and follow it on twitter.

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