The Relationship Between Individual Social Capital And Health Related Quality Of Life Among Old Adults In Rural Areas

BackgroundThe growing aging population seriously threatens the long-term population security and the economic development of a country and the harmony and stability of the society. It is not optimistic when comes to the health status of the old adults in rural areas. Health inequalities are widespread. The old adults are faced with lots of troubles such as poor mental health, illnesses, lack of life care, economic burdens, personal safety and so on. And the insufficient pension support, labor migration and other issues in rural areas further increase the difficulties for supporting the old adults. For the old adults, the social resources embedded in traditional rural social networks have great effects on their life and health. The social capital based on "social network perspective" means the resources which are accumulated in networks by network members are helpful for achieving certain goals. Ownership and utilization of these resources will directly affect the old adults’quality of life. However, such researches in the whole world are still in a preliminary stage. And none study has taken advantage of the perspective to explore the relationship between social capital and health related quality of life (HRQOL) among old adults in China.ObjectivesBased on the social network perspective, the aim of this study is to explore the social capital status of rural old adults and analyze the association between individual social capital and HRQOL. Thus, we can provide a scientific basis for future improvement of rural old adults’quality of life through promoting social capital.MethodsThe data sources of this study included literatures, questionnaire survey and qualitative interview. A questionnaire survey was conducted among 975 qualified old adults living in 3 counties of Shandong province through random sampling method and a qualitative interview was conducted among 42 old adults taken at random from the quantitative population. General information, HRQOL, individual social capital status, the influence of social capital on HRQOL and other information of rural old adults were investigated.A thematic framework analysis method was used to analyze the data of qualitative interview. SF-36 scale was evaluated by split-half reliability and Cronbach’a coefficients, principal components analysis and Pearson correlation analysis. Mokken scale analysis and Spearman correlation analysis were used to test the reliability and validity of the resource generator scale. The relationship between individual social capital and HRQOL among rural old adults was identified by single factor analysis and generalized linear regression analysis. The above statistical analyses were conducted by SPSS 19.0 and MSP 5 software.Main Results(1) Evaluation of the resource generator scale. According to the Mokken scale’s confirmatory test, each item of the domestic resources scale, expert advice scale, personal skills scale and problem solving resources scale generated by "resource generator" had a good acceptability and discriminability. Spearman correlation analysis showed that the correlation coefficient of each subscale and total scale ranged from 0.51 to 0.80, and the correlation coefficients among subscales ranged from 0.23 to 0.34. The results suggested that the revised rural old adults’ resource generator scale has good reliability and validity.(2) Individual social capital of rural old adults. In social resources respect, most old adults could access to the domestic resources. The accessibilities followed by domestic resources were expert advice resources and problem solving resources. The old adults’accessibility of personal skills resources needed to be improved urgently. In the structural respect, the size of the network was relatively larger, but the gap of network was smaller and the top of network was lower.(3) Influence factors of rural old adults’ individual social capital. Rural old adults’ individual social capital is impacted by both sociodemographic and socio-economic factors. The gap of old men’s network was significantly larger than women’s. The total social capital, expert advice resources and personal skill resources owned by men were much more than women. Total social capital decreased along with the growth of the age, but the network size presented a U-type change which was first increased and then decreased. Compared with the non-married old adults, the married ones held a relatively larger network both in size and gap, and whose top of network was higher. They also owned more total social capital, domestic resources, expert advice resources, personal skill resources and problem solving resources. For old adults, more annual family income resulted in larger network both on size and gap, higher top of network and more total social capital. The similar situation was observed for the higher education old adults and who engaged in non-agricultural occupations.(4) Influence factors of rural old adults’HRQOL. Rural old adults’HRQOL varied with gender, income, individual social capital and health status. The old men were significantly more likely to report better HRQOL than women. For old adults, the more annual family income was, the better HRQOL was. The more personal skill resources and problem solving resources were, the better HRQOL was. Compared with the chronic patients, the old adults without chronic diseases had better HRQOL.(5) The relationship between individual social capital and HRQOL among rural old adults. When applied in health studies, the validity of position generator data might therefore show some systematic shortcoming. The relationship between total social capital and four dimensions generated by resource generator with the old adults’ HRQOL showed greater correlations. This study found that the old women and the older adults could benefit more from total social capital and the old adults with lower education levels could benefit more from problem solving resources.Conclusions and SuggestionsThis study found that social networks and social relationships among rural old adults were still limited. And the size, the top and the gap of networks as well as the social resources varied among individuals. In terms of quality of life, chronic patients, women and the old adults of lower socio-economic status are the vulnerable populations. For the old, the women as well as those persons of lower education levels, it is more helpful for them to improve the HRQOL via enhancing their resource-based social capital. Therefore, in order to improve the overall quality of life of rural old adults, this study puts forward the following recommendations:(1) Propagate the culture of filial piety. Children should support their parents in both material and spiritual respects. (2) The government departments of health should take some measures such as periodic physical examinations and popularizing the knowledge about chronic disease to enrich the rural old adults’ expert advice resources. (3) Strengthen the construction of rural community service institutions and enhance the rural communities’ social capital; increase social support for the older, the women as well as those person of lower education levels by utilizing community resources. (4) Consummate endowment insurance and health insurance system of rural old adults, and give play to social charity organizations’ function of social assistance to increase the financial support for the old adults. (5) Enlarge the investment for rural public places and facilities and hold entertainment and fitness activities regularly to enrich the elderly’s skill resources.