Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012
Correspondence at : Nitasha Sharma, Clinical Instructor, National Institute of Nursing Education, PGIMER, Chandigarh A descriptive study to assess 'Quality of life' among non-working females residing in selected village of Punjab Nitasha Sharma, Sumandeep Kaur Abstract :The status of women in India has been studied in various forms. In that matter, the 'quality of life' is a relatively new concept. Quality of Life (QOL) is seen as the product of the interaction of a number of social, health, economic and environmental factors. The quality of life is a degree to which a person enjoys the important possibilities of his/her life. The present study was undertaken to assess the quality of life among non-working females residing in selected rural area of Punjab. A total of 50 subjects were included in the study using the convenience sampling technique. A 15 item "Quality of life scale "given by John Flanagan was used as research measure.The tool gives the overall QOL score and score in five domains: 1) Physical & Material well-being.2) Relations with other people. 3) Social, community & civic activities.4) Personal Development and fulfilment. 4) Recreation. The maximum mean score 6.3 was obtained in the item referring to relationship with parents, siblings and significant others & the lowest mean score was in the item referring to participation in organisational & public affairs. The maximum per cent score was obtained in domain of relationship, 84% and minimum score in domain of social, community and civic activity, 51%. The study supports the underlying conceptualisations about 'Quality of life' as a multidimensional construct. The study also recommends the need to create more learning experiences for rural non-working women to improve their knowledge and provide an outlet for creative expression. Key words : 'Quality of life', 'non- working females' Introduction Women- The word sounds so powerful. Since eternity, women have played a role more important than men and that is no exaggeration. India has the worlds largest number of professionally qualified women. India has more female doctors, surgeons, scientists and professors than the United States. On an average however, women in India are socially, politically and economically weaker than men. The reality of womens lives 180 Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 remains invisible, and this invisibility persists at all levels beginning with the family to the nation. 1 The status of women in any civilization shows the stage of evolution at which the civilization has arrived. In ancient India, women occupied important position in the society. The Ancient Indian mythol ogy witnesses that the status of Indian women in Vedic ages was honourable and respectable. During that time,women were at par with the men. There are references, which indicate that equal social and religious status was allowed to boys and girls in Vedic society. However in post- Vedic era and the medieval era, the status of women deteriorated. In that era women lost independence and became a subject for protection. The women were pre- ordained for procreation only. Due to the Islamic influence, the social evils like the Purdah system prevailed in society. The assumption of superiority of males has built up the idea of male dominance and female dependence. These cultural attributes left a deep impact on the women development in India. 2 The snapshot of Indi an women provides some alarming reports.The sex ratio in rural India depicts 914 females per 1000 males in age group of 0-6years, the state of Haryana & Punjab being lowest with ratios of 830& 846 per 1000 respectively as per 2011 census. 3 The common reasons for this disparity can be the social discrimination as well as the neglect of female child in the matters of health. The country is undoubtfully progressing as the Infant Mortality Rate (IMR) for the country declined by 30 points in last 20 years. However the female infant continues to experience a higher mortality than a male infant. Also the under 5 mortality rate shows decline by 54 points in last 20 years. Although the male female mor tality differential has narrowed down over years yet the gap remains significant. In terms of the total fertility rates, rural women (TFR 2.9) at National level would have about one child more than urban women.(TFR 2.0). 4 There are significant disparities in terms of literacy rates among men and women at different settings. The literacy rate for rural male is 71.48% whereas that for rural female is only 46.58%. In absolute numbers, the vast majority of women who cannot read and write are concentrated in Asia; illiterate women in this region alone account for over 77% of the world total 5 Long time back, Pt. Jawaharlal Nehru quoted: You can tell the condition of a nation by looking at the status of its women. The statement finds its validity even today.The status of women can be a better predictorofa nations general qualityoflife than GDP. 5 . The status of women in India has been studied in various forms. The major indicators to label the status of women in India are Gender gap variables, Maternal mortality rates, Overall literacy rate, Infant mortality rate and the Quality oflifevariables. Like gender equity, qual i t y of l i f e i s a relatively new concept in economic thinking. Quality of Life (QOL) is seen as the product of the interaction of a number of different factors: social, health, economic, and environmental conditions 6 . These factors often in unknown 181 Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 ways interact to affect both human and social development at the level of individuals and societies. The term Quality of Life relates to the description and evaluation of the nature or conditions of life of people in a certain country or region. One of the most popular aggregate measures of the quality of life is the individual estimation of ones happiness. Happiness here is defined as the degree to which an individual judges the overall quality of her/his life as-a-whole favourably. In the country of Bhutan, Gross National Happiness (GNH) is the main index for defining the quality of life in a more holistic and psychological term. The quality of life is a degree to which a person enjoys the important possibilities of his/her life. 7 The quality of life should not be confused with the standard of living. The standard indicators of quality of life include not only wealth and employment but also the built environment, physical and mental health, education, recreation, leisure time and social belongings.It reflects the difference, the gap, between the hopes and expectations of person and their present experience. The quality of life as an area of research has attracted an ever increasing amount of interest over the past two decades. This interest has increased not only in the area of rehabilitation, health and social services but also in areas like medicine, education and working and non-working persons life. 8 It was a presumption till late 60s that women with jobs/ working outside are generally happier and satisfied as compared to fulltime housewi ves or non-worki ng women. However various national surveys have consistently failed to support this hypothesis and have reported no significant differences in terms of life satisfaction in both groups. 9 But a study by Agarkala reported the significant difference in the life satisfaction of working and non-working women. Life-satisfaction was found to be higher among non-working women. 10 At same time one of the studies attempted to examine the self-efficacy and well-being among working and non-working women in terms of involvement. The results reported that the non-working women were low on both self-efficacy as well as well-being than the working women. 11 Another study tried to measure the quality of life among non- working and working women using indirect measures like mental health, self-esteem, mother role satisfaction and stress. The results revealed that non-working women had poorer mental health as well as the lower self-esteem as compared to the working women. The non- worki ng women al so repor ted more depression. The most common stressor repor ted by the non-working women was poor social life. 12 The family relationship and the family adjustment are two very crucial factors predicting the quality of life especially in women. In that matter one of the studies examined and compared the relationship between the marital adjustment, stress and depression among working and non-working women. The results revealed that working married women had to face more marital problems than the non-working women. 13 In the present study the quality of life of non- working females who were residing in selected village of Punjab was assessed. 182 Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 Main Objective To assess the quality of life among non-working females residing in selected village of Punjab. Materials and methods The current study had the cross sectional research design. The study was conducted in one of the villages in district Ludhiana, Punjab. The total population of the village was 1009 with 534 males and 475 females. The total numbers of non-working females were 234. The sample comprised of 50 females who were selected following the conveni ent sampl i ng techni que. The researcher visited the nearest houses and first fifty women encountered were recruited for the study. The research tools used was an interview schedule & the socio demographic profile sheet which was developed by the investigator keeping in view the objective of the study and the standardized Quality of life scale given by John Flanagan. 14,9 It is a 15 item, seven point rating scale ranging from 7 to 1, following the order as: 7: delighted, 6: mostly pleased, 5: satisfied,4: mixed, 3: mostly unsatisfied,2: unhappy &1: terrible. Each subject was asked to rate her level of satisfaction or dissatisfaction in reference to various QOL determinants on this seven point scale.The tool provides the comprehensive QOL score as well as the scores in five QOL domains. The five domains are 1) Physical & Material well-being.2) Relations with other people. 3) Social, community & civic activities. 4) Personal Development and fulfilment. 5) Recreation. The instrument is scored by summing the items to make a total score. The higher the score was, the better the Quality of Life. The score varying from 15-45 denotes poor QOL, 46-75 corresponds to an average QOL & a score of 76-105 corresponds to the better than average QOL. The domain scores are obtained by summing up the item scores corresponding to each domain. The tool was translated into Punjabi and then re-translated into English. The data was collected after obtaining the written permission from the village Sarpanch. The verbal consent was obtained from each subject. The verbal assurance was given to each subject in terms of maintaining the confidentiality of obtained information. The data was collected using the personal interviews in which the researcher read each item of the tool orally and noted down the respondents answer. The total time spent on each subject varied from 15-20 minutes. Each subject was individually thanked and opportunity was provided to each subject to clarify their doubts if any. The analysis of data was done using the spss & Microsoft excel programme employing the tests like mean and standard deviation. Results The socio-demographic profile of the subjects is shown in table 1 which shows that 30 % of subjects were in the age range of 26- 35 years and another 24 % comprised of the age group of 36-45 years. In terms of the educational status, 62 % subjects had educational level of less than 10 th standard. There were only 2% graduate subjects and another 2 % were post graduate. In terms of 183 Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 the type of family, half of the subjects belonged to joint family and other half to the nuclear family. In terms of monthly family income, 46% of them had the monthly family income of less than Rs 3000/- It was only 16 % of them whose family income was above Rs 9000/- Table 1 Socio-demographic variables N=50 Socio-demographic variable n(%) Age (years) 16- 25 9(18) 26-35 15(30) 36-45 12(24) 46-55 10(20) 55 above 4( 8) Educational status < 10 th standard 31(62) 10 th standard 10(20) 12 th standard 7(14) Graduate 1( 2) Post graduate 1( 2) Monthly Income (Rs) < 3000 23(46) 3000-6000 11(22) 6000-9000 8(16) >9000 8(16) Type of family Joint 25(50) Nuclear 25(50) Tabl e 2 shows the frequency distribution of subjects with respect to various ratings made by them on the 7 point rating scale. The item for which the maximum number of subjects (n=30) rated Delighted was from Domain 2, Item1 i.e. Relationship with parents, siblings and others. However the maximum mean score was obtained in the item 2 of Domain 1 assessing the QOL in regard to having & rearing children with the mean score of 6.5. The second highest mean score was found in item1 of same domain referring toRelationships with parents, siblings & other relatives- communicating, visiting, helping with mean score 6.3. There were seven subjects who reported Terrible feelings in regard to the physical health and fitness as shown in item 2 of Domain 1.In the domain 3 : Social, community & civic activity, for item 2, twenty three subjects rated that they were Unhappy in regard to participation in organisational & public affairs. In Domain 4,there were only 2 subjects who were Del i ghted wi th respect to attendi ng school.The mean scores and the S.D. were also calculated for each of the five major domains of QOL as shown in Table 3. Since the numbers of items on each domain were variable, hence for the purpose of comparison, the mean percent scores were calculated for each domain which are depicted in table3. The highest mean percent score was found in the domain of relationship with score of 84%, showing that the relationship domain was the major contributor for QOL among non working women. This was followed by domain of recreation with mean percent score of 76%. Physical & material wellbeing were also important contributors for QOL wi th mean percent score of 75.5%.However the domai n of soci al , community & civic activities had minimum mean percent scores of 51%. 184 Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 Table 2: Frequency distribution of subjects based on rating for each item & Mean Score(S.D.) for each item Statements D e l i g h t e d : 7 n ( % ) P l e a s e d : 6 n ( % ) M o s t l y S a t i s f i e d : 5 ( n ( % ) M i x e d : 4 n ( % ) M o s t l y D i s s a t i s f i e : 3 n ( % ) U n h a p p y : 2 n ( % ) T e r r i b l e : 1 n ( % )
Mean score (S.D.) N=50
Domain 1: Physical & material well being 1.Material comforts home, food, conveniences, financial security 2. Health: Being physically fit and vigorous.
14(28)
14(28)
19(38)
12(24)
3(6)
8(16)
12(24)
7(14)
1(2)
1(2)
-
1(2)
1(2)
7(14)
5.6(1.3)
5(2.0) Domain 2: Relationships 1. Relationships with parents, siblings & other relatives- communicating, visiting, helping. 2.Having and rearing children 3.Close relationships with spouse or significant other 4.Close friends
30(60)
13(26) 10(20)
10(20)
14(28)
26(52) 16(32)
16(32)
3(6)
5(10) 5(10)
5(10)
1(2)
2(4) 3(6)
3(6)
-
1( 2) 11(22)
11(22)
1( 2)
3 (6) 5(10)
5(10)
1(2)
- -
=
6.3(1.2)
6.5(0.8) 5.7(1.2)
4.9(1.7) Domain 3: Social, Community & Civic Activity. 1. Helping and encouraging others, volunteering, giving advice. 2. Par ticipating in organizations and public affairs.
11(22)
-
10(20)
-
5(10)
-
12(24)
4(8)
6(12)
15(30)
6(12)
23(46)
-
8(16)
4.8(1.7)
2.3(0.8) Domain 4: Personal Development & Fulfilment 1. Learning- attending school, improving understanding, getting additional knowledge 2. Understanding yourself - knowing your assets and limitations - knowing what life is about 3.Work in home 4.Expressing yourself creatively
2(4)
6(12)
12(24) 7(14)
7(14)
12(24)
17(34) 8(16)
4(8)
15(30)
13(26) 6(12)
6(12)
13(26)
5(10) 8(16)
6(12)
1( 2)
2( 4) 10(20)
18(36)
3( 6)
1( 2) 11(22)
7(14)
-
- -
3.2(1.8)
5(1.2)
5.6(1.1) 4.2(1.7) Domain 5: Recreation Socializing - meeting other people, doing things, parties, etc. 2. Reading, listening to music, or observing entertainment. 3. Par ticipating in active recreation
11(22)
5(10)
7(14)
17(34)
26(52)
21(42)
12(24)
8(16)
10(20)
3(6)
6(12)
5(10)
3(6)
3(6)
4(8)
4(8)
2(4)
3(6)
-
-
-
5.3(1.4)
5.3(1.2)
5.2(1.3) 185 Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 Table 3: Domain wise Mean Scores (S.D.) and Per cent scores N=50 Domains Mean * Mean percent score(S.D.) score 1. Physical & Material well Being( 2 items) 10.6 (2.8) 75.5% 2. Relationship (4 items) 23.5 (3.0) 84.0% 3. Social, community & civic activity (2 items) 7.1( 2.1) 51.0% 4. Personal Development & Fulfilment (4 items) 18.0 (3.7) 64.3% 5. Recreation (3 items) 17.5( 3.0) 76.0% *each items maximum score = 7 Table 4: Frequency Distribution of Subjects according to QOL total scores N=50 QOL ( Score range ) No. of subjects (%) Poor QOL (15-45) 1( 2) Average QOL (46-75) 24(48) Better than average( 76-105) 25(50) On the basis of total score obtained by each subject, the overall QOL is shown in table 4. As per table 4 the 50% subjects had better than average QOL, whereas another 48% had average QOL. There was only one subject with poor QOL. Discussion The Quality of Life is a multi-dimensional as well as an intangible construct affected by various physical, psychological, social and cultural factors. Complying with the multi- dimensional character of QOL, the current study was undertaken to assess QOL of non- working females using a standardized scale. The scale included the various determinants of QOL involving physical health, relationship, social activity, personal development & recreation. The current study revealed that the maxi mum mean per cent scores were obtained in the domain of relationship. This included the satisfaction in terms of relation with the spouse, the family members and close friends. A study by Emilians also projected the role of family in predicting the quality of life of its members. The study revealed the association between the family functionality and the members Quality Of Life. The family was found to have a strong association with global QOL and specifically the mental well-being and physical well- being. 15 Thus, the study by Emilians too supports this finding of the current study. In the current study the mean score of 5.3 was obtai ned i n i tem referri ng to materialistic wellbeing which was indirect measure to assess satisfaction with financial si tuati on. Al though the maj ori ty of respondents had family monthly income of <Rs. 3000/-, despite of that they were mostly 186 Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 satisfied in terms of their financial situations. This particular finding supports the fact that the quality of life is not merely the measure of income or the standard of living rather its a highly complex construct with more complex conceptualizations and insights. Also this highly subjective concept cant be measured by a few objective indices like income. However a study by Wai, Tsang and Chan in Hong Kong repor ted that low income is associated with a worse health related QOL. 16 This further present the idea that QOL has multiple dimensions, for that matter, the financial situation is one. And that multiple dimensions of QOL are interrelated and influence each other in variable fashion. In present study the minimal contribution to the QOL was related to the domain of creative self-expression and learning. Learning here refers to attendi ng school , i mprovi ng understandi ng and getti ng addi ti onal knowledge. This finding was expected as the 62% of the subj ects had educati onal qual i fi cati on of bel ow 10 th cl ass. The educational attainment and QOL seems to be positively correlated overtly 17 . This was also shown by E.Regider et al, wherein they established a significant association between level of education and health related QOL. 6 Generally, the relationship between physical activity and vitality is well documented, but multiple recent studies have also revealed an increasingly stronger link between social interaction and mental & physical wellbeing. The social and family activities in accordance with the nature and capacity of a person can be highly fruitful. The social activity helps to maintain a sharp mind, increases feeling of happiness and develop a sense of wellness. 18 Social contact may be as effective as physical activity in improving mood and QOL. In present study the social activities which contributed maximum to the QOL were meeti ng other peopl e and hel pi ng and encouraging others. However the QOL was lowered due to lack of par ticipation in organizations and public affairs. This particular finding might be coloured by the cultural and traditional restrictions imposed on non- working females. Social par ticipation and social support networks are paramount to long term positive outcomes. The current study recommends the need to provide more opportunities for rural women. Educational content for rural women should be made more relevant to their par ticular existence and needs. The study provides the insight to the need for creation of various learning experiences for rural women so as to improve their understanding and make knowledge accessible to them. The study implicates the need to promote the acti ve par ti ci pati on of r ural women i n organi zati ons and publ i c affai rs. The community health nurse can promote such activities by providing the rural women a platform for creative expression in form of various suppor t groups. The community health nurse can aid in this process by acting as a catalyst and a source of information. More investment in improving the quality of life of rural women could create a virtuous circle of better education, improved health and higher income. 187 Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 References: 1. Swayam: Ending violence against women. The status of women: A reality check. Facts on inequality and crime against women. [cited 2011 Oct 23]Available from :http:// www. swayam. i nf o/swayam_gi _l eaf l et _ 31mar.pdf 2. Prakash N. Status of women in Indian Society: Issues & challenges in process of Empowerment. Proceedings of the 11th International GASAT Conference; 2003 July 6-11; Mauritius. 3. Sex ratio in India, 2011 census; 2011 July 17. [cited 2011 Nov]Available from :http:// updateox.com/india/sex-ratio-in-india-2011- census/ 4. Office of the Registrar General, India. Maternal & Child Mortality and Total Fertility Rates. Sample Registration System (SRS); 2011 July 7.[cited 2011 Dec] Available from:http:// ce nsusi ndi a. gov. i n/ v i t al _st at i st i cs/ SRS_Bulletins/MMR_release_070711.pdf 5. Bhandari R, Smith FJ. Rural Women in India: Assessment of Educational Constraints and the Need for New Educational Approaches. Journal of Research in Rural Education 1997;13, 3: 183-196 6. Eisler R, Loye D, Norgaard K. Women, Men, and the Global Quality of Life. Beijing: The Center for Partnership Studies; 1995.[cited 2012 Jan] Avai l abl e from :http:// www. par t ner shi pway. or g/ l ear n- mor e/ partnership-books/books/women-men-and-the- global-quality-of-life 7. School of planning and architecture. Monograph on quality of life indicators. New Delhi Department of environment planning; 2009:1- 70.[cited 2011 March] Available from http:// www.spaenvi s.ni c.i n/pdfs/monographs/ QOL_FINALE.pdf 8. Wright James D. Are working women really more satisfied? Evidence from several national surveys. Journal of Marriage & the Family 1978; 40(2): 301-313.doi:10.2307/350761 9. Surila Agarwala. Life Satisfaction: Working versus Not Working. 2001 .[cited 2011 July] Available from http://hdl.handle.net/10755/ 183562 10. Sahu FM. Rath S. Self-efficacy and Wellbeing in Working and Non-working Women: The Moderating Role of Involvement. Psychology Developing Societies 2003;15(2):187-200. doi:10.1177/097133360301500205 11. Usha RR, Cooper C, Kerslake H. Working and non-working mothers: a Comparative study, Women In Management Review1997; 12 (7): 264 275 12. Hashmi HA, Khurshid M, Hassan I. Marital adjustment, stress and depression amongworkingand non working married Women. Internet Journal of Medical Update 2007;2(1):17-22. 13. Saadat A. Compare Efficiency with Working and Non Working Women. European Journal of Scientific Research. 2009: 32(4) :533- 540. [cited 2011 March ]Available from :http:// www.eurojournals.com/ejsr.htm 14. Burckhardt CS. The Flanagan Quality of Life Scale: Evidence of construct validity. Health Qual Li f e Out comes. 2003; 1: 59. doi:10.1186/1477-7525-1-59 15. Sanchez ER. et al. Relationships between quality of life and family function in caregiver.BMC Family Practice 2011;12,19:19doi:10.1186/ 1471-2296-12-19 16. Ko GT, Wai HP, Tsang PC,Chan HC. Hong Kong men with low incomes have worse health-related quality of life as judged by SF-36 scores. Hong Kong Med J.2006 Oct;12 (5):351- 4. 17. Velkoff VA. Women Education in India. Economics and Statistics Administration, Bureau of the census; October 1998. [cited 2012March] Available from http://www.indiaedu.com/ education-india/women-education.html 18. Siegrist J. Wahrendorf M. Participation in socially productive activities and quality of life in early old age: findings from SHARE. Journal of European Social Policy 2009;19,4: 317-326. doi:10.1177/1350506809341513