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Factors Effecting Quality of Life (QOL)

Info: 4817 words (19 pages) Introduction
Published: 26th Aug 2021

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Tagged: Healthcare

INTRODUCTION

Quality of Life (QOL)

Quality of life is a broad concept relating in general to the overall level of wellbeing in society. It does not refer solely to the material resources available to individuals or households, but it focuses on enabling people to achieve their goals and choose lifestyle ideal for them.

As Robeyns and Veen (2007) wrote, “there is no generally accepted definition of ‘quality of life’. Quality of life has been defined by the World Health Organization (WHO) as individuals’ perception of their life in the context of culture and value system in which they live in relation to the goals, expectations, standards and concerns. QOL refers to those aspects of life and human functions that are considered essential for living a full life.

Quality of life interconnects many different elements of life such as social, physical and cultural aspects. Concept of quality of life acknowledges individuals’ need to belong in different places and social groups, as well as to differentiate oneself by pursuing aims and making decisions and choices.

Quality of life is also a dynamic concept; values and self-evaluations of life may change over time in response to life and health events and experiences. Each area of quality of life can also have knock on effects on the others. For example, retaining independence and social participation may promote feelings of emotional wellbeing, but are partly dependent on retaining health and adequate finances. These can also be influenced by local transport facilities, type of housing, community resources, and social relationships. Quality of life is multidimensional and its parts affect each other as well as the sum.

Models of quality of life

The main models of quality of life are

  • Objective indicator
  • Subjective indicator
  • Satisfaction of human needs
  • Psychological model
  • Health and functioning model
  • Social health model
  • Social cohesion and social capital
  • Environmental models
  • Ideographic

Objective indicators are standard of living, health and longevity, housing and neighborhood characteristics. These are typically measured with indicators of cost of living, mortality rates, health service provision, education levels, neighborhood structure and density, socio-economic structure and indicators of inequality and crime in the neighborhood. From the World Database of Happiness, which indicated individualization in the society makes citizens to enjoy their lives. Individualization includes people’s capability to choose, opportunities for freedom of political choice, freedom of economic choice and freedom of personal choices. The international data on quality of life has been produced by Mercer Human Resource Consulting (2003) analyzed 39 objective indicators of quality of life in 20 world cities, and which covered political, social, economic and environmental factors; personal safety and health, education, transport and other public services.

Subjective indicators are life satisfaction and psychological well-being, morale, individual fulfillment, happiness, measured using indicators of life satisfaction, morale, balance of affect, and self-worth (esteem).

Satisfaction of human needs is objective circumstances such as housing, security, food, warmth and opportunities for self-actualization. Needs-based satisfaction model is developed based on Maslow’s (1954) hierarchy. As per Maslow’s theory of self actualization, satisfaction is measured by how much they met the expectations of their life and human needs necessary for maintenance and existence (physiological, safety and security, social and belonging, ego, status and self-esteem, and self actualization). Maslow (1968) further argued that once these basic needs are satisfied, human beings pursue higher needs such as self-actualization, happiness and esteem. It has been argued that human needs are the foundations for quality of life, and hence quality of life can be defined in terms of human needs and the satisfactory fulfillment of those needs.

Psychological models are influencing and mediating variables which emphasize personal growth, cognitive competence, efficiency and adaptability, level of dignity, perceived independence; social competence, control , autonomy, self efficacy or self-mastery as well as optimism-pessimism. This model is similar to Bentham’s utilitarian philosophy which regarded well-being as the difference in value between the sum of pleasures of all sorts and the sum of pains of all sorts which a man experienced in a given period of time. Pleasure and satisfaction are insufficient for a good quality of life and a sense of purpose or meaning, self-esteem and self worth are crucial for good Quality of life. It also includes social comparisons-gap relativity models of past experience, present circumstances and aspirations for the future – the individual’s achievement of their expectations, hopes and aspirations, particularly in relation to social comparisons with others.

Health and functioning model is measured through the health status. Health and quality of life is highly correlated with self-reported health status and indicators of well-being (Zautra  & Hempel, 1984). Good levels of physical and mental functioning and general health status have long been associated with perceived well-being, morale and overall quality of life. Mental health, psychological resources and outlook are also key components of ‘successful ageing’ and wellbeing (Baltes & Baltes, 1990). It is a direct component of well-being and contributes to a person’s basic ability to function in their social roles, to pursue valued activities and goals in life, and to choose the life which they value.

Social health model is measured with indicators of social networks, support and activities. Social networks are the identified social relationships that surround an individual, their characteristics and individuals’ perceptions and valuations of them. Network characteristics include their size, density , boundedness , homogeneity, frequency of contact of members, their multiplexed (number of types of transactions within them), duration and reciprocity. Social support is the interactive process in which emotional, instrumental or financial aid is obtained from network members. Human ecology theory also focuses on the interactions and interdependent relationships between people, and postulates that families are an important resource and a rich environment for individual members (Rettig & Leichtentritt, 1999).

Social cohesion and social capital are includes societal, environmental and neighborhood resources. It is measured by objective indicators of indices of crime, pollution, cost of living, shopping facilities, access to areas of scenic quality, cost of owner occupied housing, education facilities, policing, employment levels, wage levels, unemployment levels, climate, access to indoor/outdoor sports, travel to work time, access to leisure facilities, quality of council housing, access to council housing cost of private rented accommodation.

Environmental models are concerned with the study of aging in ones place of residence and the importance of designing enabling internal and external environments in order to promote the independence and active social participation to the people.

Ideographic are individualized, hermeneutic approaches based on the individuals values, interpretations and perceptions, satisfaction with their position, circumstances and priorities in life.

Marital adjustment is also a variable that connected with Quality of life. It may be interchangeably used with subjective well-being. QOL reflects the difference and the gap between the hopes and expectations of a person and one’s present experience. Human adaptation is such that life expectations are usually adjusted so as to lie within the realm of what the individual perceives to be possible. A good quality of life can be said to exist when the hopes of individuals in the marital relations are matched and fulfilled by experience. A good marriage not only produces a satisfied life but it also generates a sense of wellbeing.

Social exchange theory postulate that, satisfaction between spouses increases   based on attaining the expectations in rewards they receive (Kassin et al., 2008). When partners fail to reach their expectations it generates dissatisfaction in their relationship (Nye, 1982). Marital quality tends to peak in the first few years of marriage and then to decline until midlife. After that point it rises steadily with increasing age and duration of marriage.

The process of improving quality of life often requires the sustained collective action of people, and indeed of generations. The quality of life of one person can hardly be traced in isolation, as Putnam demonstrates (2008).

Marriage

Being attracted is the fundamental motive of human being. Research found that people will sacrifice most other goals like getting good education, having a successful carrier or contributing to a better society to before giving up a good relationship (Hammersla and Frease, 1990).  Three basic components which involve in intimate relationship are feelings of attachment, affection and love, the fulfillment of psychological needs, interdependence between partners. These components have positive impact in developing and maintaining a relationship.

Marriage is the universal social institution. It s established by the human society to control and regulate the sex life of man, it is connected with family. In fact marriage and family are complementary to each other. A marriage is a legally recognized union between two people, generally a man and a woman, in which they are united sexually, cooperate economically, and may give birth to, adopt, or rear children. The union is assumed to be permanent although it may be dissolved by separation or divorce. (Strong, DeVault, & Cohen, 2010). Marriage is documented by law and has legal validity. There are rights and duties of married couple and that is well addressed and enforced by the court of law. There are some procedures if the partners want to split, that is not only untying the relationship but also it concentrated with the assets and liabilities, child caring, custody and maintenance etc.

In India, marriage is thought to be for life, and the divorce rate is extremely low. Only 1.1% of marriages in India result in a divorce compared with over 45.8% in the United States, though the Indian figure appears to be rising. With the advancement of time, spread of education and campaigns of human rights activists, divorce has become a way to break free from the marital clutches for many women. Couples facing difficulties in equating their levels of compatibility are now filing for divorce in order to renew their life afresh. In fact, the rate of divorce is rapidly rising in the Indian metropolis. (Chary, 2009; Jones & Ramdas, 2004 & Roberts, 1990)

Ingredients of happy and permanent marriage are: similar values, friendship, communication, sexual satisfaction, mutual respect, religious faith (The National Marriage Project and The National Opinion Research Center, 2002, Rutgers University).  Ability to take financial responsibility would be an ingredient of successful marriage. It is one aspect which can be a source of conflict and stress among couples.

Marriage is not only a private contract, but a social institution of great public value and concern. The advantage of marriage to the society is unique because it is the foundation of the family and the basic building block of the society. It brings significant stability and meaning to human relationships. It is ideal for raising children. It plays an important role in transmitting culture and civilization to future generations. (Coleman, 1994)

Some of the important reasons for getting married are:

  • To love and to be loved
  • To protect and be cared for
  • For emotional intimacy which fosters compassion and support
  • To be socially recognized and give birth to children legally.
  • To flee from a life of loneliness isolation.
  • To share responsibilities.

Marital patterns:

  • Polygamy, Polyandry, Monogamy, Group marriage (Shankar, 2005)
  • Bigamy, Same-sex marriage, Cohabitation. In most cultures, monogamy is considered ideal. (Browne, 2011)

In Indian society there are mainly three different kinds of marriages:

  1. The arranged marriage, which is managed by the family of the bride and the groom.
  2. The love marriage, solemnized by the choice of the life partners themselves, and,
  3. The love-cum-arrange marriage, where the boy and girl select each other but the marriage is organized by their parents.

Whether it is arranged, love or any other kind of marriage, the most valuable thing for the couples is to maintain satisfaction in their married life. In fact, marital satisfaction is an important research theme in all the studies concerning factors contributing to marriage. As marital satisfaction is a variable of this study, it asses the satisfaction level of wives of expatriate husbands.

Marital satisfaction:

Individual’s most central goals in life is satisfying marriage or relationship, across diverse cultures (Levinger & Huston, 1990). Indeed, marital happiness exceeds satisfaction in other domains (e.g., health, work, or children) as the strongest single predictor of overall life satisfaction. Marital satisfaction is relevant to mental health, general happiness, professional achievement and social interaction. Uniquely, it is a relatively stable attitude and attribute which reflects the individual‘s overall evaluation of the relationship. It depends upon the individual‘s needs, expectations, and desires for the relationship. (Snyder, 2010)

Marital satisfaction is a mental state that reflects the perceived benefits and costs of marriage to a particular person. Satisfaction in romantic partnership depends on finding a delicate balance between positive and negative interactions across time (Gottman, 1994).

Studies revealed that marital adjustment is problematic in the early years of marriage, as per the data the probability of divorce is highest during the first years of marriage between 2 and 4 years (Kreider & Fields, 2002). Also managing the employment and marriage is problematic to the newlyweds in the early months of marriage, and most of the newlyweds scored in distressed range on marital satisfaction and marital adjustment (Schramm, et al., 2005).

Additional sources of problem in the newly married couples are demands from parents & in-laws, religion, education or social class background. In these areas the couples have to compromise so many things, if they fail to compromise it develops the marital distress. Certain lifestyle decision may generate tension. The couple must establish a mutually satisfying sexual relationship. They must carry out an agreement on spending and saving money. They must respond to each other’s sleep patterns, food preferences, work pattern, toilet habit etc. For the better adjustment with the partner psychological commitment is very important. The factors which works to protect the marriage includes

  • Respect
  • Appreciation
  • Commitment
  • Mutual affection
  • Trust
  • Communication
  • Adjustment

Effective communication and the ability to cope or solve the conflict are essential for the intimacy and high level of satisfaction. Studies found that people with high degree of marital satisfaction report frequent, pleasurable interactions and high degree of disclosure. Disclosure reciprocity means you tell a person what you are thinking about, and that person tells you what he or she thinking aboutassociated with greater relationship satisfaction (Lippert and Prager, 2001).

Self disclosure, partner’s disclosure and partner responsiveness are the important predictor of marital satisfaction. In contrast negative interactions and conflicts are associated with distress. Differences in the power between the partners, especially differences in the control of resources and ongoing disagreements about the allocation of resources are underlying source of marital conflict.

Three dimensions of conflict are

  • Negative communication
  • Coercive escalation
  • Different perception of approach

Congruence between partners in how they think, they and their partner are approaching the resolution of conflict is significantly related to marital satisfaction where as lack of Congruence is significantly related to marital dissatisfaction and distress (Acitelli, 1997)

Criteria for Successful Marriage

Areas of agreement that partners will have generally include:

a) Friendship: Successful partners develop a significant friendship at the core of their relationship. They genuinely like each other, amuse and comfort one another, and prefer to spend time with each other.

b) Role expectations: The partners reach agreement with regards to how household responsibilities are to be divided and how they will behave with each other.

c) Emotional intimacy: Successful partners learn to trust each other, to be vulnerable to each other, to laugh together, and to support each other in times of need.

d) Sexual expectations: This may further dictate the kinds and patterns of sexual activities that each partner will and will not engage in. As sexual activity is strongly rewarding and bonding for couples, it is best for marriages when partners agree upon sexual expectations and are both satisfied with their lovemaking.

e) Vision/Goals: Successful partners agree that they want to pursue the same life paths, values and goals and mutually commit to those paths, values and goals. Examples might include decisions to have children or not, to attend or not to attend religious services, to raise a child in a particular faith, to save or spend money, or to live frugally or extravagantly, etc. (Dombeck, 2006).

Loneliness

Loneliness is a complex and usually unpleasant emotional response to isolation or lack of companionship. Loneliness typically includes anxious feelings about a lack of connection or communication with other beings, both in the present and extending into the future. The cognitive perspective assumes that loneliness results from an unacceptable discrepancy between the personal relationships people have and the relationships they would like to have. The notion of a discrepancy between people’s desires and reality suggests that we should examine not only the actual networks of personal relationships but also the preferences people have in this respect to gain insight into differences in feelings of loneliness (Dykstra, 1990)

Certain types of relationships within a person’s social network may result in feelings of loneliness is based on the assumption that different types of relationships serve different, more or less unique functions. Based on different type of relationships there two types of loneliness which is the loneliness of social isolation and the loneliness of emotional isolation. The married women were found to suffer from social isolation: though the married women are happy, they lacked a wider circle of friends and acquaintances who could give them a sense of belonging, of companionship, and of being a member of a community. The single parents, most of whom had put an end to an unhappy marriage, felt lonely because they no longer had a partner. They suffer from emotional isolation and the accompanying feelings of desolation and insecurity and of not having someone to turn to (Dykstra and Fokkema, 2007).

Social loneliness can be attributed primarily to unfulfilled needs in the wider network of support givers. Emotional loneliness, however, is associated primarily with the absence of a partner, that is, with the absence of an exclusive, close, and intimate tie (Dykstra and Fokkema, 2007).

Effects of loneliness

Feeling lonely is not mental health problem but loneliness and mental health is correlated. Having mental health problem may leads to feel lonely or feeling lonely may negatively affect the mental health. Chronic loneliness is not only correlated with mental health but also with physical health. The chronic loneliness is associated with the physical problem like stroke; cardiovascular diseases.

Marriage is associated with substantially less loneliness; being married was considerably more predictive of loneliness than cohabitation, indicating that companionship alone does not account for the protective nature of marriage. Both marriage and parental status were associated with lower levels of loneliness among men than women; marriage is associated with decreased loneliness independent of two intervening processes: marriage’s association with both health and financial satisfaction (Stack, 1998).

Migration

Technical advancement changed the structure of entire globe or society. This made different group of people to live together for the purpose of work or because of migration. Changes in the society or the social changes are like any single alteration, modification or transformation in the organization and operation of social activity.

As India is a developing country it faces many problems. Unemployment is a major curse to developing country like India. Kerala is the only state of India that has 100 % of literacy rate, and facing lots of unemployment problems. Kerala has higher rate of migrated youth. Unemployment is the main reason for the migration to Gulf countries. Since 1950s people from India are migrating to other countries. After the second half of 1970, it has reached sizable proportion. The number increased in the last few years and it become smaller after the 2008 when international financial crisis began to affect the GCC region. Initial wave of migration usually known as “Gulf boom”, that refers to a large number of people migrating to gulf. In   Kerala the period 1972 to 1983 is known as “Kerala Gulf boom”. According to Kerala migration survey 90% of migrants are in Gulf countries out of which 22 lack migrant workers are from Kerala (NOKRA, 2014).

People are motivated to migration for better job and prosperity in life. 70% of the migrants are married. Temporariness of the work or the high cost of living in the gulf countries made some of the emigrant to keep their family back home and save money for the future.

Impacts of migration

Migration or expatriation is like “tipping points”, which means situation that are previously rare becomes dramatically more common. Progress of international migration is very high and significant in the global scape. Broader development processes is both a cause and effect of migration and a fundamental facet of our ever globalizing world. Migration is most common from developing countries to developed countries primarily in the expectation of fast access to healthier economic opportunity. Developed nations are considering migration as a “positive force for development”. As migration increases its impacts becomes visible. Huge buildings, modern household equipments, sophisticated electronic machineries, perfumes and stereos add to the comforts of the families of the migrants. The outfit of family members, ornaments clad, attitude of shopping, etc speaks about it. Children too enjoy the enhanced economic security and get into educational institutions paying huge donations. Though the whole situation appears to be fascinating to the outsiders, the changes are mostly structural in nature.

Impact on Families 

Economical development is the main effect on family; individual can earn drastically higher income and can help the family. The change in living style of the expat and family members of expat is noticeable. As economical changes occur the opportunity of getting higher education and getting higher position in the society will increase. Along with this long term familial separation also takes place, this may cause complicated direct and indirect impact on children and between spouses.

Parental Migration Influences Child Development

Economical stability is the motivation for migration. Greater investment to a child’s multiple development is based on the family recourses so greater family income can afford greater investment on this. Studies in the West find a strong association between higher household incomes and a variety of child development outcomes.

But long term parental absence is the negative outcome of the migration. The impact differs based on the absence of mother or father or significant caretaker. Psychological research has found that parental support is a significant predictor of student’s capacity to deal with stress, anxiety and loss of control. Children with strong parental support do better in school and develop mature psychological traits. They aspire to do good work, experience pleasure in one’s work, and develop both initiative and a sense of control over events, and are better behaved. Environments that destabilize a child’s sense of self control over their life may increase the likelihood of internalizing problems. Research on other contexts in which parents are absent (e.g., single parenthood, divorce, military separation) focus mostly on father absence, which is usually negatively associated with a variety of child level outcomes in developed countries. Children who live in single mother families have been found to have lower academic achievement scores, more likely to suffer from psychological or behavioral problems, and are more likely to drop out of school(Park, Lee & deBrauw, 2010).

Impact on Spouse Left Behind

Migration has reflective impact on females left behind. These females may be mothers, sisters, daughters or wives. The impact of migration differs from female to female based on the social category and size of their family. The impact leads to be serious and sever in wives left behind.

Mainly, the expatriate wives have to take important familial decision in the absence of their spouse. The entire family responsibilities lie on them including disciplining the children.  At the same time they have to develop and maintain harmonious relationship with other family members.

Thousands of married women are in Kerala lives away from their husbands because of migration. Marriage may be reduced to two-and-a-half months of joy in every two years for the wives and the children hardly get to know their fathers during this period. A prolonged separation in the early period of marriage seriously curtails the marital life of many a young couple. Suppressed sobs and plaintive murmurs linger behind the facade of the luxurious togs and exotic perfumes that make up the world of these women. According to the Kerala migration study these women are hardly equipped to cope up with the separation (Zacharaih, Mathew and Rayan, 2000).

Research findings have also shown that women in the migrant households face many tensions, pressures, conflicts and anxieties. These women definitely face problems of loneliness, added responsibilities. The burden and burn out of these women will be doubled when they begin a career of their own. The dual role as a working woman and a care taker at home, that too without support, makes these women depressed and helpless (M.S, 2011).

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