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Erschienen in: BMC Public Health 1/2021

Open Access 01.12.2021 | Research article

Factors associated with quality of life among joint and nuclear families: a population-based study

verfasst von: Fahad Saqib Lodhi, Unaib Rabbani, Adeel Ahmed Khan, Owais Raza, Kourosh Holakouie-Naieni, Mehdi Yaseri, Umer Farooq, Ali Montazeri

Erschienen in: BMC Public Health | Ausgabe 1/2021

Abstract

Background

Advantages and disadvantages associated with joint and nuclear family systems can affect quality of life (QOL). However, there is scarcity of literature about QOL among joint and nuclear family systems. This study aimed to assess the factors associated with QOL in joint and nuclear family systems.

Methods

We conducted a population based cross sectional study in all 52 Union Councils (UCs) of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. Multistage cluster sampling technique was used to select participants from both nuclear and joint family houses. The validated Urdu version of World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) was used to assess quality of life among participants. Univariate and multivariate analyses were performed to explore the associations of different socio demographic variables with QOL among both family systems. Also a multilevel linear regression using backward analysis to obtain final model for each domain was performed to find out the variables that are associated with QOL score in each of family systems.

Results

A total of 2063 participants were included in this study (51.0% joint family, 49.0% nuclear family) with the response rate of 97.4%. In multiple linear regression analysis of each domain for joint and nuclear family systems, rural residence compared to urban (p < 0.001), being female (p < 0.001), older age (p < 0.001), having comorbidity (p < 0.001) and lower socioeconomic status (p < 0.001) were found to be a strong predictor of poorer QOL. Furthermore, social capital (p < 0.001) had a positive effect on joint and nuclear family QOL scores.

Conclusion

This study was the first of its kind which determined the factors of QOL in joint and nuclear families using the validated Urdu version of WHOQOL-BREF in Pakistan. Male gender, urban residence, younger age, higher socioeconomic status and social capital were positive predictors of QOL score while older age and presence of illness were associated with lower QOL scores among both family systems.
Hinweise

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Abkürzungen
QOL
Quality of life
WHOQOL-BREF
World Health Organization Quality of Life Questionnaire Brief version
SD
Standard deviation
β
Beta coefficient
CI
Confidence Interval
Ref
Reference group
SC-IQ
Social Capital Integrated Questioners

Introduction

In general family is one of the fundamental units of societies and takes care of the diverse needs of people [1]. It is also one of the basic sources of providing care to all of its members. Because of this fact elderly persons of the house occupy respectful position in Asian culture. Family system encourages the life of individuals in all aspects which enables them to live happy and productive life [2]. Culture has been shown to regulate the family network by building family type, family size and form [3, 4] and the family functioning by defining barriers, cooperation rules, connection patterns, adequate practices, regulation and ranking in the family [47].
Family is a social group of one or more parents and their children. Family systems refer to members and their interrelationship (structure) with each other. There are different classifications of family systems [8, 9]. Most commonly used classification has two types i.e. joint and nuclear family systems [10]. A nuclear family system is defined as ‘a two generation family consisting of a father and mother and children or a single, possibly widow, parent and his/her children’ [11]. Similarly, joint or extending family is defined as ‘three or more generations lived together with both vertical and lateral extension having a single line of authority, either patrilineal or matrilineal’ [11]. A number of advantages and disadvantages associated with each type of family has been reported such as social support, protection during crises, physical space, autonomy a freedom of decision making [12].
Extent of these systems varies from countries to countries and within countries as well. Traditionally Pakistan had joint family system and bonding within a family. Like other Asian countries, over the time, balance is shifting towards nuclear family system in Pakistan [13]. Multiple factors are responsible for this shifting trend from joint to nuclear system. These include; financial pressures, decreasing living space, movement for job and rapid urbanization [13]. It also seems to be an outcome of increasing prosperity. This trend is faster in urban areas than rural areas. The superiority of one of these systems is a matter of debate these days. The researchers are on a quest for evidence based information regarding the current debate about the quality of life of an individual, based on a family system [14].
In Pakistan, a large number of the aged people depend on their family especially on their children or grandchildren for physical, communal and financial support [2] which is more convenient in joint families. It was recommended by Mason (1992) that urbanization is expected to negatively affect the family’s capacity and willingness for care of the elderly and it will also decrease the chances of living grown up children with their parents [15]. Studies from Asian countries have shown that most of the help for the elderly people comes from their home by their children/grandchildren [16, 17].
Limited studies have been conducted on different study populations that have assessed the predictors of quality of life. A study conducted among elderly population in India reported that occupation, higher income, 60–69 years age group, staying with partner and absence of co-morbidity were found to be the determinants of better QOL [18]. Studies from Kuwait and Lebanon also reported that female gender, older age, social disadvantage, and presence of anxiety/ depression were associated with poor QOL [19, 20]. Although all of the works done before were on health-related QOL all around the world, there are no such study exploring the predictors of quality of life of people who live in nuclear or joint family system. Our study presented the predictors of quality of life scores in joint and nuclear family systems in Pakistani general population.

Methods

Study design and setting

We conducted a population based cross sectional study in all 52 Union Councils of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. We recruited 2063 participants for our study. Abbottabad is the main district of Khyber Pakhtunkhwa province of Pakistan having more than 1.2 million population living in 52 union councils. The primary language spoken here is Hindko (used by 94% of the rural population and 75% of urban residents) followed by Urdu which is also spoken and understood in rural & urban areas [21].

Sample size

We used the Statulator, an online statistical calculator for sample size determination [22]. Assuming a standard deviation of 12 units (derived from pilot study) and a design effect (DEFF) of 2, the study would require a sample size of 969 for each group (i.e. a total sample size of 1938, assuming equal group sizes), to achieve a power of 90% at 5% significance level (two sided) for detecting a true difference of 2.5 points in quality of life score between joint and nuclear family systems.

Sampling procedure

Participants were selected from all union councils (UCs) of District Abbottabad. Multistage cluster sampling technique was employed in this study. Each union council was further divided into several blocks called Mohallah. We did proportionate sampling according to the 1998 population census [23] of UCs for the selection of Mohallah & on the next stage households. In the first stage we randomly selected these blocks (Mohallah) in each of the UC from a list by using simple random sampling technique. In the next stage we selected households in that selected block by using a random sampling technique again. The total number of houses selected in each block was also proportional to the population size of respective block. For the selection of family type, from the list of household of each block, we made a list of joint & nuclear family system households and enrolled equal number of houses from both family types. A simple random sampling technique was used for the selection of person (≥18 years) from each house. Simple random sampling was done by applying the lottery method for selecting the ≥18 year’s participant for the study. The inclusion criteria used for selection of individual were age greater than 18 years and permanent resident of union council for at least 5 years. Guests and temporary residents were excluded from the study.

Measures

1.
We used the World Health Organization Quality of Life Questionnaire-Brief version (WHOQOL-BREF) for measuring quality of life. It is in public domain and contains 26-items that covers four domains of QOL (psychological 6 items, physical 7 items, social relationships 3 items and environmental 8 items). Each question scored on a scale from one to five, with high score indicating good QOL with the exception of three questions, which include pain and discomfort, need for medical treatment and negative feelings [24]. The seven items included in the physical health domain were mobility, daily life activities, pain, sleep, functional capacity and energy. The psychological domain measured negative thinking, self-image, positive approach, self-esteem, mindset, ability to learn, memory, consolidation, religion and the psychic conditions. Questions such as social support, sex-life and personal relationship come under the social relationship domain. The environmental health domain contains questions on financial assets, security, health and social services, living in natural environment, opportunities for advance learning experience, relaxation, and natural environment (air, noise, pollution and transportation) [25]. The total raw score for these four dimensions were transformed into 0 to 100 scale according to the standard procedure defined in WHO QOL user manual [24], and then analysis of this reconstruct score was done. Psychometric properties and validation of this WHOQOL-BREF questionnaire was done in the national language “Urdu”. The Cronbach’s alpha for each of four domains were 0.78, 0.71, 0.73 and 0.65, respectively [26]. To assess the feasibility and clarity of the items, a pilot study was conducted on 30 individuals conveniently selected from the study area.
 
2.
We also developed a structured demographic questionnaire which included variables such as age, gender, marital status, type of family (joint and nuclear), residence type (urban and rural), house ownership (owner, not owner), respondent education (no education, madrassa, can read/write, primary- up to grade 5, secondary education-up to grade 12 and tertiary-up to grade 16 or above), working status (employed, unemployed and retired).
 
3.
The socio-economic characteristics were assessed by taking household conditions, sources of drinking water, sanitation facilities, availability of electricity, housing facilitates, possession of durable goods, mean of transport, inventory of house hold and personal items such as chairs, clocks, buckets, radios, television sets, fans, stoves or cookers, cars, and telephones. This list was composed of 21 such items used in the Pakistan Demographic and Health Survey 2013 [27]. Wealth index was measured by an index constructed from principle component analysis (PCA) [28] of items indicating ownership of household durables and dwelling characteristics.
 
4.
The World Bank’s Social Capital Integrated Questionnaire (SC-IQ) was also used to study social capital among families. It is an open-domain questionnaire and consists of 27 questions in six domains [29]. Of these five questions on overall trust, trust in local government, trust in central government, community cooperation and safety at home were selected and used in this study. These questions were translated by the research team into Urdu and then back translated into English by independent bilingual expert to assess the validity of the translation. The internal consistency of the items as assessed by the Cronbach’s alpha coefficient was found to be acceptable (alpha = 0.64). The concurrent validity as assessed by correlation between the trust subscale of the SC-IQ and the social relationship of the WHOQOL-BREF showed satisfactory result (r = 0.74).
 

Data collection

One-day training session was conducted for administering the questionnaires prior to data collection for lady health workers of all UCs by principal investigator. In 1994, Pakistan’s Ministry of Health (MOH) implemented the Lady Health Worker Program (LHWP) as part of a national strategy to reduce poverty and improve health by bringing health services to the doorsteps of underserved communities. Lady health workers are out reach health workers who provide preventive and health promotion services specially for maternal and child health issues [30]. The questionnaire was administered through face to face interviews in the households by trained lady health workers of that union council. To ensure privacy and confidentiality, interviews were conducted in an independent room or area separate from other members of the family.

Statistical analysis

The data was analyzed using the Stata version 13.0 (Stata Corp, College Station, TX, USA). First, we conducted descriptive analyses such as frequencies, proportions and means. Then, we carried out univariate linear regression analyses with domain scores as dependent and other variables as independent variables. Next, in the multivariate analysis, we included all independent variables and used stepwise backward approach to eliminate variables with a p value > 0.05. Finally, multi-level analysis was performed with two –level continuous random intercept model with individuals nested within clusters was applied to explore the variability explained by individuals and cluster level variables taking the correlated nature of data into account. P-value of < 0.05 was considered as significant.

Results

Demographic characteristic of study participants

A total of 2116 households were approached. Of these, 56 refused (non-response 2.64%) to participate in this study giving a total number of 2063 [1053 (51.04%) belonged to joint family system and 1010 (48.6%) to nuclear family]. Younger (18–30 years) and elderly (> 50 years) were more in joint families (39%) and (20%) respectively compared to (20%) and (10%) in nuclear families. Educational status of the participants was comparable in two groups as proportions of individuals with no education were 15.5% and 15.7 in joint and nuclear families respectively. Majority were living in their own houses 849 (80.5%) in joint and 750 (74.3%) in nuclear family. A higher proportion of the participants (80.5%) in joint family groups owned a house compared to (71%) in nuclear family group. Proportions of employed persons were (56.5%) in joint families and (56.1%) in nuclear families. Higher proportion of the participant were satisfied in living in joint family system (87.5%) compared to (81%) in nuclear family system (Table 1).
Table 1
Socio-demographic characteristic of the study participants (n = 2063)
 
Joint family system (n = 1053)
Nuclear family system (n = 1010)
All (n = 2063)
No. (%)
No. (%)
No. (%)
Age
 18–30
412(39.2)
308(20.6)
720(34.9)
 31–40
277(26.3)
359(35.4)
636(30.8)
 41–50
149(14.2)
240(23.7)
389(18.8)
  > 50
215(20.4)
103(10.2)
318(15.4)
Gender
 Males
553 (52.5)
505 (50)
1078 (52.2)
 Females
500 (47.5)
505 (50)
1005(48.7)
Marital status
 Married
843 (80.0)
796 (78.8)
1639 (79.4)
 Widowed/Widower
36 (3.4)
24 (2.37)
60 (2.9)
 Divorced
4(0.3)
2 (0.1)
6 (2.0)
 Separated
5(0.4)
4(0.3)
9 (0.4)
 Never Married
165 (15.6)
184(18.2)
349(16.9)
Education
 No education
163(15.4)
159(15.7)
322(15.6)
 Informal education
17(1.6)
30(2.9)
47(2.2)
 Can read / write
111(10.5)
100(9.9)
211(10.2)
 Primary (up to grade 1)
344(32.6)
293(29)
637(30.8)
 Secondary (up to grade 2)
321(30.4)
337(33.3)
658(31.8)
 Tertiary (up to grade 3)
97(9.2)
91(9)
188(9.1)
Place of residence
 Urban
297(28.3)
301(29.8)
598(29)
 Rural
756 (71.7)
709(70.2)
1465(71)
Ownership of residence
 Owner
849(80.5)
750(74.3)
1599(77.5)
 Not owner
204(19.5)
259(25.7)
463(22.4)
Occupation
 Not working
397 (37.7)
413(40.9)
810(39.3)
 Working
595 (56.5)
567(56.1)
1162(56.3)
 Retired
61 (5.8)
30(3)
91(4.4)
Socioeconomic status
 High
391(37.1)
296(29.3)
687(33.3)
 Intermediate
375(35.6)
315(31.2)
690(33.4)
 Low
287(27.3)
399(39.5)
686(33.3)
Respondent disease
 Physical disability
13(1.2)
15(1.5)
28(1.4)
 Hypertension
79(7.5)
75 (7.4)
154(7.5)
 Diabetes
34(3.2)
24(2.4)
58(2.8)
 Other
492 (47)
488(48.3)
980(47.5)
 None
435(41.3)
408(40.4)
843(41)
Respondent satisfaction
 Satisfied
921(87.5)
817(81)
1738(84.2)
 Unsatisfied
132(12.5)
193(19)
325(15.8)
Social Capital
 Low
96(9.1)
118(11.7)
214(10.4)
 Moderate
816(77.5)
755(74.7)
1571(76.1)
 High
141(13.4)
137(13.6)
278(13.5)

Joint family system WHO QOL-BREF scores

Table 2 shows mean score of WHOQOL-BREF scores of participants in joint families. Those living in the urban areas, had significantly higher scores in all four dimensions. Male had higher scores in physical and psychological domains compared to females. However, no differences were observed in relationship and environmental domains. Younger age group < 30 years had higher scores than elderly > 50 years of age. Divorced had highest scores in physical and psychological domains while married had highest scores in relationship domain. No significant differences were observed in environment domain between different categories of marital status. Lack of education, presence of any physical disability or disease, unemployment, lower socio-economic status and low social capital were associated with lower scores in all domains.
Table 2
QOL scores among different subgroups in joint family system, Abbottabad, Pakistan (n = 1053)*
 
Physical
Psychological
Relationship
Environmental
General facet
Mean ± SD
Mean ± SD
Mean ± SD
Mean ± SD
Mean ± SD
Type of residence
 Urban
68.6 ± 15.6
71.0 ± 14.4
74.1 ± 15.8
59.9 ± 14.2
69.4 ± 16.0
 Rural
63.7 ± 14.9
65.9 ± 14.7
71.0 ± 16.6
53.7 ± 14.5
69.2 ± 16.9
P value (t test)
< 0.001
< 0.001
< 0.001
< 0.001
0.891
Gender
 Male
66.7 ± 15.6
69.0 ± 14.5
72.4 ± 16.8
56.5 ± 13.6
68.6 ± 17.3
 Female
63.4 ± 14.6
66.6 ± 14.2
72.3 ± 17.0
56.5 ± 14.2
70.0 ± 15.8
P value (t test)
< 0.001
< 0.006
0.896
0.988
0.161
Age
  < 30
67.8 ± 14.0
68.7 ± 13.4
73.8 ± 15.4
56.9 ± 14.00
70.4 ± 15.4
 31–40
65.3 ± 14.6
68.4 ± 15.1
72.1 ± 17.0
56.0 ± 14.3
69.7 ± 17.1
 41–50
64.3 ± 16.0
68.2 ± 13.8
72.0 ± 18.0
57.0 ± 15.3
69.4 ± 17.7
  > 50
60.4 ± 16.8
65.1 ± 15.3
69.7 ± 18.6
56.0 ± 14.4
66.4 ± 17.4
P value (F statistic)
< 0.001
0.020
0.038
0.829
0.041
Residence ownership
 Owner
65.0 ± 15.2
67.7 ± 14.21
72.6 ± 16.8
56.5 ± 14.3
68.3 ± 17.2
 Not owner
66.1 ± 15.1
70.2 ± 16.4
70.1 ± 16.5
58.2 ± 15.0
69.6 ± 18.5
P value (t test)
0.590
0.208
0.276
0.340
0.361
Marital status
 Married
64.6 ± 15.0
67.8 ± 14.4
73.0 ± 16.9
56.5 ± 14.4
69.3 ± 16.7
 Widow
56.2 ± 15.7
60.4 ± 15.2
65.5 ± 17.2
52.0 ± 13.9
61.4 ± 18.3
 Divorced
76.8 ± 10.7
76.0 ± 10.4
60.4 ± 14.2
53.1 ± 6.8
65.6 ± 12.0
 Separated
69.6 ± 20.7
63.5 ± 15.0
68.7 ± 17.2
52.3 ± 8.6
65.6 ± 21.3
 Never married
69.4 ± 14.8
70.0 ± 13.6
71.0 ± 16.3
57.9 ± 14.1
71.3 ± 15.3
P value (F statistic)
< 0.001
0.006
0.038
0.227
0.029
Education
 No education
59.5 ± 15.8
62.9 ± 16.0
67.8 ± 19.4
54.5 ± 15.2
62.3 ± 19.0
 Informal education
65.4 ± 19.5
71.1 ± 16.0
72.9 ± 14.7
58.8 ± 17.1
71.1 ± 13.5
 Can read / write
63.0 ± 16.6
63.9 ± 14.9
68.6 ± 18.9
55.3 ± 13.8
66.2 ± 16.8
 Primary (up to grade 5)
66.0 ± 14.5
68.1 ± 13.4
73.3 ± 16.2
57.2 ± 13.6
69.2 ± 16.2
 Secondary (up to grade 12)
67.5 ± 14.8
71.1 ± 13.7
74.0 ± 15.3
57.2 ± 14.0
73.1 ± 15.0
 Tertiary (up to grade 16 or above)
63.3 ± 14.0
68.8 ± 13.1
75.7 ± 16.0
56.4 ± 14.7
71.8 ± 16.1
P value (F statistic)
< 0.001
< 0.001
< 0.001
0.317
< 0.001
Disease
 Physical disability
58.8 ± 17.5
61.8 ± 18.1
69.2 ± 12.9
51.7 ± 13.5
63.5 ± 14.8
 Hypertension
61.3 ± 18.0
65.2 ± 15.4
79.0 ± 18.0
57.0 ± 15.8
65.7 ± 17.8
 Diabetes
57.0 ± 19.2
61.8 ± 18.8
69.4 ± 19.3
56.5 ± 15.6
59.2 ± 24.9
 Other
64.0 ± 15.1
66.8 ± 14.0
72.0 ± 17.1
55.1 ± 14.2
69.2 ± 16.4
 None
68.0 ± 13.8
70.1 ± 13.8
73.7 ± 16.1
58.2 ± 13.8
71.1 ± 15.5
P value (F statistic)
< 0.001
< 0.001
0.095
0.017
< 0.001
Employment status
 Not working
62.8 ± 16.3
66.3 ± 14.5
72.0 ± 16.9
56.4 ± 14.4
66.5 ± 17.4
 Working
66.8 ± 14.0
69.0 ± 14.8
72.4 ± 17.0
56.5 ± 14.3
71.3 ± 15.8
 Retired
63.0 ± 18.3
67.5 ± 14.4
74.3 ± 17.0
59.0 ± 14.9
68.1 ± 17.0
P value (F statistic)
< 0.001
0.016
0.605
0.402
< 0.001
Socioeconomic status
 High
67.8 ± 15.3
71.5 ± 13.2
76.5 ± 15.1
61.2 ± 13.3
74.3 ± 15.3
 Intermediate
65.6 ± 15.1
68.4 ± 14.1
73.1 ± 15.6
56.9 ± 13.5
69.1 ± 15.4
 Low
60.7 ± 15.3
62.2 ± 14.6
65.8 ± 18.7
50.0 ± 14.4
62.8 ± 17.6
P value (F statistic)
< 0.001
< 0.001
< 0.001
< 0.001
< 0.001
Social capital
 High SC
67.1 ± 14.9
71.3 ± 13.7
76.8 ± 16.1
59.8 ± 14.0
74.7 ± 14.5
 Moderate SC
65.2 ± 15.1
67.8 ± 14.7
72.4 ± 16.5
56.4 ± 14.2
69.0 ± 16.3
 Low SC
62.3 ± 16.4
64.4 ± 14.4
66.3 ± 18.2
50.9 ± 16.6
64.1 ± 19.9
P value (F statistic)
0.059
< 0.001
< 0.001
0.005
< 0.001
*Using the 0–100 scoring method

Multivariate linear regression model for joint family system

Table 3 shows the results of the multivariate linear regression model for joint family system. In multivariate model, rural residence was negatively associated with physical, psychological and environmental domains QOL scores and there was 4.59 units [95% CI: − 7.77 to − 1.41], 3.54 units [95% CI: − 6.44 to − 0.63] and 5.32 units [95% CI: − 8.75 to - 1.89] reduction when changing from urban to rural (P = 0.001) respectively. There was no significant association with relationship domain. Female gender was also negatively associated with QOL scores in physical, psychological and social relationship domains − 3.94 units [95% CI: − 5.88 to − 0.01], − 3.10 units [95% CI: − 4.7 to − 1.47] and − 0.11 units [95% CI:-3.06 to- 0.84] respectively, and no significant association was observed in environmental health domain. Increasing age was negatively associated with QOL scores. One-decade increase in age lead to 0.22 units [95% CI: − 0.29 to − 0.19], 0.11 units [95% CI: − 0.2 to - 0.05] and 0.12 units [95% CI: − 0.19 to − 0.05] reduction in scores of physical, psychological and relationship domains respectively. Presence of disease was also significantly associated as scores declined with the presence of disease in physical and psychological domains. However, there was no significant association of disease status with relationship and environment domains. Socio-economic status also had a significant association as a change in SES from high to low resulted in a reduction of QOL scores in all the domains. Similarly increase in social capital was also positively associated with QOL scores in all four domains.
Table 3
Multivariate linear regression analysis for physical, psychological, social and environmental health domains of joint family in Abbottabad, Pakistan (n = 1053)*
 
Physical Domain
Psychological Domain
Relationship Domain
Environmental Domain
β (95% CI)
β (95% CI)
β (95% CI)
β (95% CI)
Fixed effects
Residence
  Urban
Ref.
Ref.
Ref.
Ref.
  Rural
−4.59(−7.77 to −1.41)
−3.54(−6.4 to −0.63)
−5.32(−8.75 to − 1.89)
Gender
 Male
Ref.
Ref.
Ref.
Ref.
 Female
−3.94(−5.88 to −2.01)
−3.10(−4.7 to −1.47)
−1.11(− 3.06 to −0.84
Age (Decades)
−0.22(− 0.29 to − 0.19
−0.11(− 0.2 to − 0.05)
−0.12(− 0.19 to − 0.05)
Disease
 None
Ref.
Ref.
Ref.
Ref.
 Physical disability
−10.3(− 17.8 to − 2.80)
− 8.79(− 15.8 to − 1.7)
 Hypertension
−5.26(−9.3 to − 1.85
−5.26(− 8.87 to − 1.7)
 Diabetes
−8.05(− 13.13 to − 2.9)
−6.17(− 10.9 to − 1.3)
 Others
−4.26(− 6.59 to − 1.94)
− 3.36(− 5.5 to − 1.18)
Socio-economic status
 High
Ref.
Ref.
Ref.
Ref.
 Intermediate
−0.33(−2.39 to 1.73)
− 2.20(− 4.1 to − 0.25)
−3.09(− 5.37 to − 0.80)
−3.76(− 5.61 to − 1.90)
 Low
− 3.81(− 6.17 to − 1.45)
− 7.60(− 9.8 to − 5.40)
−9.86(− 12.4 to − 7.30)
−9.06(− 11.2 to − 6.94)
Social capital
0.12(0.06 to 0.17)
0.13(0.08 to 0.19)
0.16(0.10 to 0.22)
0.13(0.08 to 0.18)
Random-effects
Level 1: Union Council
  Gender
0.02(0.00 to 4.54)
0.97(0.24 to 3.95)
0.43(0.21 to 4.53)
2.44(1.38 to 4.30)
  Age
0.02(0.00 to 6.64)
0.05(0.00 to 0.51)
0.06(0.02 to 0.18)
0.05(0.01 to 0.24)
  Social capital
0.04(0.01 to 0.21)
0.06(0.03 to 0.11)
0.02(0.00 to 1.22)
0.02(0.00 to 1.39)
  Constant
3.0(1.02 to 8.81)
0.01(0.00 to 0.48)
0.01(0.00 to 0.20)
0.99(0.52 to 10.86)
Level 2: Cluster number
 Constant
3.30(2.04 to 5.36)
4.20(3.07 to 5.75)
5.50(4.15 to 7.31)
5.10(3.96 to 6.57)
 Residual
13.07(12.4 to 13.71)
12.14(11.5 to 12.7)
14.6(13.97 to 15.34)
11.5(10.93 to 12.0)
*Explanations: Β Beta coefficient, CI Confidence interval, Ref Reference group; The linear regression multivariate model adjusted for residence ownership, marital status, education and employment status in Physical domain and Psychological domain. Type of residence, residence ownership, marital status, education, employment status and disease for Social domain; Residence ownership, marital status, age, sex, education, employment status, and disease in Environmental domain; The short dashes (−) mean that the variable was removed by the stepwise deletion process in regression analysis

Nuclear family system WHOQOL-BREF scores

The mean score of each domain among different subgroups in joint family system is presented in Table 4. Pattern of differences between the subgroups in nuclear family system was similar to joint family system. The mean of all four domains was significantly higher among those living in urban areas. Male had higher scores than female. Younger age people < 30 years of age had significantly higher scores than elderly in physical domain only. There were no significant differences in other three domains with respect to age. House ownership did not affect the QOL scores in any of the domain. Significant differences in scores were observed across different marital status strata. Those with no education generally had lower scores than others. Presence of any disease or disability significantly reduced the QOL scores. Compared with working/employed subjects, unemployed subjects had lower QOL scores. Participants with higher socioeconomic status, and social capital levels had higher QOL scores in all domains.
Table 4
QOL scores among different subgroups in nuclear family system, Abbottabad, Pakistan (n = 1010)*
 
Physical
Psychological
Relationship
Environmental
General facet
Mean ± SD
Mean ± SD
Mean ± SD
Mean ± SD
Mean ± SD
Type of residence
 Urban
67.4 ± 15.8
70.5 ± 15.2
73.0 ± 16.0
58.5. ± 14.8
66.6 ± 18.5
 Rural
63.7 ± 14.8
65.5 ± 15.2
70.8 ± 16.0
52.6 ± 15.0
67.1 ± 18.6
P value (t test)
< 0.001
< 0.001
< 0.001
< 0.001
0.714
Gender
 Male
66.0 ± 15.6
68.4 ± 14.4
72.5 ± 14.9
55.6 ± 14.7
66.0 ± 18.9
 Female
63.6 ± 14.8
65.5 ± 16.1
70.4 ± 17.2
53.2 ± 15.5
68.0 ± 18.1
P value (t test)
< 0.001
< 0.003
0.037
0.011
0.079
Age
  < 30
67.8 ± 14.4
68.3 ± 15.0
69.6 ± 16.8
54.5 ± 15.4
68.8 ± 17.9
 31–40
64.2 ± 14.0
66.0 ± 15.1
72.4 ± 15.7
53.4 ± 14.8
66.8 ± 18.2
 41–50
64.0 ± 15.2
67.7 ± 15.3
72.5 ± 15.5
55.4 ± 14.1
65.7 ± 18.2
  > 50
60.4 ± 17.3
64.6 ± 16.9
71.2 ± 15.9
54.5 ± 17.6
64.7 ± 21.6
P value (F statistic)
< 0.001
0.079
0.87
0.476
0.128
Residence ownership
 Owner
64.8 ± 15.0
66.9 ± 15.1
71.3 ± 15.9
54.1 ± 15.0
68.3 ± 17.2
 Not owner
65.3 ± 17.0
67.8 ± 17.1
72.3 ± 17.5
54.4 ± 16.2
69.6 ± 18.5
P value (t test)
0.700
0.560
0.509
0.818
0.361
Marital status
 Married
63.9 ± 14.7
67.2 ± 15.0
72.6 ± 15.3
54.5 ± 14.9
67.3 ± 18.1
 Widow
53.3 ± 19.2
49.3 ± 20.6
56.3 ± 24.2
37.4 ± 09.6
43.7 ± 26.0
 Divorced
76.8 ± 12.6
73.0 ± 8.9
66.7 ± 23.6
73.4 ± 15.5
81.2 ± 8.9
 Separated
72.6 ± 11.5
76.4 ± 15.0
68.7 ± 17.2
57.3 ± 11.0
79.2 ± 7.2
 Never married
70.1 ± 15.4
68.3 ± 14.8
68.9 ± 15.7
55.5 ± 15.7
68.3 ± 17.2
P value (F statistic)
< 0.001
< 0.001
< 0.001
< 0.001
< 0.001
Education
 No education
58.3 ± 15.3
59.8 ± 16.9
66.8 ± 16.2
48.0 ± 15.7
58.0 ± 22.5
 Informal education
63.2 ± 17.9
76.2 ± 13.5
74.4 ± 10.9
58.0 ± 14.0
70.7 ± 16.1
 Can read / write
60.6 ± 14.9
64.0 ± 16.4
69.0 ± 16.1
52.5 ± 14.5
63.2 ± 18.3
 Primary (up to grade 5)
65.5 ± 14.8
67.4 ± 14.6
72.7 ± 15.7
55.3 ± 14.2
67.7 ± 17.8
 Secondary (up to grade 12)
68.0 ± 14.9
70.0 ± 14.7
72.3 ± 16.5
56.4 ± 15.2
69.4 ± 17.0
 Tertiary (up to grade 16 or above)
67.4 ± 12.6
70.0 ± 13.7
73.9 ± 14.9
55.5 ± 15.4
74.7 ± 12.2
P value (F statistic)
< 0.001
< 0.001
< 0.001
< 0.001
< 0.001
Disease
 Physical disability
56.4 ± 21.4
62.2 ± 17.4
51.70 ± 13.5
55.4 ± 14.0
63.3 ± 22.9
 Hypertension
61.3 ± 15.2
66.8 ± 15.9
57.0 ± 15.8
52.6 ± 17.4
66.7 ± 17.7
 Diabetes
53.3 ± 15.7
62.5 ± 16.3
56.5 ± 15.6
47.8 ± 15.0
63.5 ± 16.8
 Other
63.4 ± 15.3
65.6 ± 15.6
55.1 ± 14.2
54.1 ± 15.4
64.9 ± 19.8
 None
68.2 ± 14.0
69.2 ± 14.4
58.20 ± 13.8
55.6 ± 14.3
70.0 ± 16.5
P value (F statistic)
< 0.001
0.002
0.249
0.109
< 0.001
Employment status
 Not working
63.4 ± 15.6
65.0 ± 17.1
70.4 ± 16.4
53.0 ± 15.8
64.5 ± 21.1
 Working
66.0 ± 14.6
68.7 ± 13.7
72.3 ± 15.8
55.4 ± 14.7
69.0 ± 16.8
 Retired
63.3 ± 18.9
62.7 ± 16.3
70.4 ± 15.8
54.3 ± 14.5
63.8 ± 21.1
P value (F statistic)
0.034
< 0.001
0.195
0.047
< 0.001
Socioeconomic status
 High
68.9 ± 13.7
72.3 ± 14.4
74.3 ± 15.6
60.4 ± 14.3
74.4 ± 15.5
 Intermediate
65.3 ± 14.9
69.0 ± 13.1
74.1 ± 14.9
55.8 ± 13.6
68.7 ± 15.6
 Low
61.5 ± 15.8
61.6 ± 16.0
67.4 ± 16.4
48.8 ± 15.0
60.4 ± 19.9
P value (F statistic)
< 0.001
< 0.001
< 0.001
< 0.001
< 0.001
Social capital
 High SC
66.2 ± 14.4
68.1 ± 13.4
73.3 ± 15.2
57.9 ± 13.6
68.9 ± 18.3
 Moderate SC
65.2 ± 15.1
67.6 ± 15.2
71.8 ± 15.7
54.6 ± 14.7
67.7 ± 18.3
 Low SC
60.7 ± 16.2
62.0 ± 17.6
67.1 ± 18.5
48.6 ± 17.7
60.8 ± 19.3
P value (F statistic)
0.006
< 0.001
0.004
< 0.001
< 0.001
*Using the 0–100 scoring method

Multivariate linear regression model for nuclear family system

Table 5 presents the results of the multivariate linear regression model for nuclear family syste. In multivariate model, rural residence was negatively associated with physical − 2.55 units [95% CI: − 5.42 to − 0.33], psychological − 1.90 units [95% CI: − 4.9 to − 1.13] and environmental domains − 3.69 units [95% CI: − 7.27 to − 0.09]. Female gender was also negatively associated with QOL scores in physical, psychological and social relationship domains − 2.64 units [95% CI: − 4.59 to − 0.68], − 3.56 units [95% CI: − 5.5 to − 1.65] and − 1.92 units [95% CI: − 3.91 to − 0.07] respectively, no significant association was observed in environmental health domain. Increasing age was negatively associated with QOL scores. One-decade increase in age lead to 0.27 units [95% CI: − 0.35 to − 0.20], 0.15 units [95% CI: − 0.2 to − 0.06] and 0.12 units [95% CI: − 0.05 to − 0.12] reduction in scores of physical, psychological and relationship domains respectively. Presence of disease or disability led to significant decline in the QOL in physical domains. However, there was no significant association of disease and disability with QOL scores in other domains. QOL scores significantly declined with changing socio-economic status from high to low in all four domains. Social capital was also positively associated with QOL scores in all the domains.
Table 5
Multivariate linear regression analysis for physical, psychological, social and environmental health domains of nuclear family in Abbottabad, Pakistan (n = 1010)*
 
Physical Domain
Psychological Domain
Relationship Domain
Environmental Domain
β (95% CI)
β (95% CI)
β (95% CI)
β (95% CI)
Fixed effects
Residence
  Urban
Ref.
Ref.
Ref.
Ref.
  Rural
−2.55(−5.42 to 0.33)
−1.90(−4.9 to − 1.13)
−3.69(− 7.27 to −0.09)
Gender
 Male
Ref.
Ref.
Ref.
Ref.
 Female
−2.64(−4.59 to − 0.68)
−3.56(− 5.5 to − 1.65)
− 1.92(− 3.91 to 0.07)
 Age (Decades)
−0.27(− 0.35 to − 0.20)
−0.15(− 0.2 to) -0.06
−0.12(− 0.05 to 0.12)
Disease
 None
Ref.
Ref.
Ref.
Ref.
 Physical disability
−8.78(− 16.1 to − 1.50)
 Hypertension
− 3.58(−7.4 to 0.24)
 Diabetes
− 13.0(− 19.0 to − 7.0)
 Others
−4.75(− 7.02 to − 2.47)
Socio-economic status
 High
Ref.
Ref.
Ref.
Ref.
 Intermediate
−3.86(−6.2 to − 1.54)
− 3.47(− 5.8 to − 1.15)
−0.58(− 3.10 to 1.95)
− 4.20(− 6.37 to − 2.02)
 Low
−7.37(−9.73 to − 5.01)
−9.91(− 12.3 to − 7.5)
−6.54(− 9.89 to − 4.05)
− 9.89(− 12.1 to − 7.66)
Social capital
0.07(0.01 to 0.12)
0.12(0.07 to 0.18)
0.11(0.05 to 0.16)
0.18(0.13 to 0.23)
Random-effects
Level 1: Union Council
  Gender
0.91(0.03 to 6.57)
0.99(0.30 to 3.99)
0.43(0.21 to 4.53)
2.36(1.31 to 4.22)
  Age
0.02(0.00 to 6.64)
0.08(0.08 to 0.65)
0.06(0.02 to 0.18)
0.09(0.04 to 0.17)
  Social capital
0.03(0.00 to 0.26)
0.08(0.06 to 0.17)
0.02(0.00 to 1.22)
0.01(0.00 to 1.39)
  Constant
1.39(0.02 to 11.49)
0.04(0.00 to 0.90)
0.01(0.00 to 0.20)
0.00(0.00 to 0.03)
Level 2: Cluster number
 Constant
4.44(3.15 to 6.26)
4.45(4.07 to 5.86)
5.20(4.15 to 7.31)
5.26(4.04 to 6.84)
 Residual
13.32(12.6 to 13.9)
10.14(11.8 to 12.9)
14.6(13.97 to 15.34)
12.1(11.51 to 12.8)
*Explanations: Β Beta coefficient, CI Confidence interval, Ref Reference group; The linear regression multivariate model adjusted for residence ownership, marital status, education and employment status in Physical domain and Psychological domain. Type of residence, residence ownership, marital status, education, employment status and disease for Social domain; Residence ownership, marital status, age, sex, education, employment status, and disease in Environmental domain; The short dashes (−) mean that the variable was removed by the stepwise deletion process in regression analysis

Discussion

Our study is one of its kinds to assess the predictors of QOL domains in joint and nuclear families in Pakistan. We found that male gender, urban residence, younger age, higher socio-economic status and social capital were positive predictors in both types of family systems. Increasing age and presence of illness were associated with lower QOL scores in joint and nuclear families. Predictors were similar in for all domains of QOL across two types of families with few exceptions.
Family type has been reported to affect the mental and social wellbeing. A study from India reported that adolescents from joint family have better mental health compared to nuclear family [31]. Another study from India found no difference in the QOL scores between joint and nuclear family types except for social relationship domain where scores were significantly high for those living in nuclear families [18]. One study from Pakistan reported that elderly living in joint families had better social support and quality of life than those in nuclear families [32]. Another study from Japan reported that couples living as couples did not have any significant difference in the perceived physical and mental health while they were more likely to have severe hypertension compared to those in extended families [33].
Our study found higher scores for males in all four domains of QOL. This finding is similar to a study from India where females had lower scores [18]. A study from Kuwait also reported negative association of female gender with QOL scores [19]. A study from Iran also found that there were significant association between QOL and greatly varied by socio-demographic variables including gender [34]. These findings indicate that family members even within same family have different views about the family environment which could affect their QOL [35] and that of female members.
Ageing is associated with physical and mental changes in the body which affects the health and QOL. We found that increasing age was associated with decrease in the QOL scores in all domains except environmental domain in both types of families. Other studies have also reported similar association of age with QOL scores [18, 36]. With the increasing life expectancy countries will experience increasing proportion of elderly population. This calls for reorientations of systems and services to ensure healthy elderly.
Our study found significant association of socio-economic status with QOL scores in both types of families. Socio-economic status is associated with availability of resources and access to services which ultimately affect QOL. Studies on different populations have shown positive association of higher socio-economic status with higher scores in different domains of QOL [18, 34, 36]. Likewise, social capital was also associated with higher QOL scores in all domains a finding similar to studies from China and Malaysia [37, 38].
We found that presence of diseases was associated with lower scores in physical and psychological domains in joint families and with physical domain in nuclear families. Presence of any physical deformity or illness affect the physical and psychological health. Studies have consistently shown negative association of QOL with presence of diseases [19, 36, 39]. A study reported that people with mental and physical illness had significantly lower scores than healthy people in all three domains of QOL life except environmental domain [40].
We did not find any significant difference in the predictors of QOL among both family types. Our findings are interesting in a way that it is considered that QOL differs in both family systems and their predictors would also be different. There is a need to do further studies to explore this finding.
Our study is one of its kinds from Pakistan to assess the levels and predictors of QOL in joint and nuclear families from the randomly selected general population. We used robust statistical procedures and performed multi-level analysis to draw conclusions. However certain limitations need to be considered while interpreting the results of this study. First our sample was drawn from a single city which may limit the generalizability of our results. Second, questionnaire was administered by the interviewer which could introduce social desirability bias in the response. To minimize this, we ensured privacy during interviews and no other household member was allowed in the interview room. Thirdly, this was a cross-sectional study and temporal associations could not be ascertained with certainty and we cannot say surely whether the predictors of our study preceded the quality of life.

Conclusion

Our study determined the levels and predictors of QOL scores of individuals in joint and nuclear families using validated WHO QOL BREF. Predictors were similar across both types of families. Male gender, urban residence, younger age, higher socio-economic status and social capital were positive predictors of QOL score while increasing age and presence of illness were associated with lower QOL scores among both family systems. These findings call for policy actions such as women empowerment, improvement in facilities in rural areas and poverty alleviation to improve quality of life. We also recommend further studies in different segments of population to further characterize the predictors of QOL.

Acknowledgements

This study was originated from the Ph.D. thesis of the first investigator at Department of Epidemiology and Biostatistics of Tehran University of Medical Sciences, Iran. We also acknowledge the efforts and collaboration of Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
This study was approved by the Ethics Committee of Tehran University of Medical Sciences and by health and political administrative bodies of Abbottabad District, Pakistan. All participants provided written consent prior to the interview.
Not applicable.

Competing interests

The authors declare that they have no competing interests.
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Literatur
1.
Zurück zum Zitat Bahadur A, Dhawan N. Social value of parents and children in joint and nuclear families. J Indian Acad Appl Psychol. 2008;34:74–80. Bahadur A, Dhawan N. Social value of parents and children in joint and nuclear families. J Indian Acad Appl Psychol. 2008;34:74–80.
2.
Zurück zum Zitat Itrat A, Taqui AM, Qazi F, Qidwai W. Family systems: perceptions of elderly patients and their attendents presenting at a university hospital in Karachi. Pak J Pak Med Assoc. 2007;57(2):106–10.PubMed Itrat A, Taqui AM, Qazi F, Qidwai W. Family systems: perceptions of elderly patients and their attendents presenting at a university hospital in Karachi. Pak J Pak Med Assoc. 2007;57(2):106–10.PubMed
3.
Zurück zum Zitat McGill D. Cultural concepts for family therapy. Cult Perspect Fam Ther. 1983:108–21. McGill D. Cultural concepts for family therapy. Cult Perspect Fam Ther. 1983:108–21.
4.
Zurück zum Zitat McGoldrick M, Giordano J, Garcia PN. Ethnicity and family therapy. 3rd ed. New York: Guilford Press; 2005. McGoldrick M, Giordano J, Garcia PN. Ethnicity and family therapy. 3rd ed. New York: Guilford Press; 2005.
5.
Zurück zum Zitat McGill DW. The cultural story in multicultural family therapy. Fam Soc. 1992;73(6):339–49.CrossRef McGill DW. The cultural story in multicultural family therapy. Fam Soc. 1992;73(6):339–49.CrossRef
6.
7.
Zurück zum Zitat Falicov CJ, Brudner-White L. The shifting family triangle: the issue of cultural and contextual relativity. In: Falicov CJ, editor. Cultural perspectives in family therapy. Rockville: Aspen Corporation; 1983. p. 51–67. Falicov CJ, Brudner-White L. The shifting family triangle: the issue of cultural and contextual relativity. In: Falicov CJ, editor. Cultural perspectives in family therapy. Rockville: Aspen Corporation; 1983. p. 51–67.
8.
Zurück zum Zitat Kapadia KM. Marriage and family in India. 3rd ed. Bombay: Oxford University Press; 1966. Kapadia KM. Marriage and family in India. 3rd ed. Bombay: Oxford University Press; 1966.
9.
Zurück zum Zitat Caldwell JC, Reddy PH, Caldwell P. The causes of demographic change: experimental research in South India. Madison: Madison University Press; 1988. Caldwell JC, Reddy PH, Caldwell P. The causes of demographic change: experimental research in South India. Madison: Madison University Press; 1988.
10.
Zurück zum Zitat Richard J, Banumati K, Rajakumar E. Family type and the aged. J Fam Welf. 1985;31(4):31–8. Richard J, Banumati K, Rajakumar E. Family type and the aged. J Fam Welf. 1985;31(4):31–8.
11.
Zurück zum Zitat Elliott S, Gray A. Family structures: a report for the New Zealand immigration service. Wellington: New Zealand Immigration Service; 2000. Elliott S, Gray A. Family structures: a report for the New Zealand immigration service. Wellington: New Zealand Immigration Service; 2000.
12.
Zurück zum Zitat Nighat A. Evaluation of the joint family system as a major cause of depression among married women of Sindh. Interdiscip J Contemp Res Bus. 2013;4(10):113–32. Nighat A. Evaluation of the joint family system as a major cause of depression among married women of Sindh. Interdiscip J Contemp Res Bus. 2013;4(10):113–32.
13.
Zurück zum Zitat Farooq A, Kayani AK, Ahmad K. Marriage and family structures in the rural Punjab a shift from conservative to contemporary patterns. Int J Sociol Soc Policy. 2015;35(5–6):306–24. Farooq A, Kayani AK, Ahmad K. Marriage and family structures in the rural Punjab a shift from conservative to contemporary patterns. Int J Sociol Soc Policy. 2015;35(5–6):306–24.
14.
Zurück zum Zitat Bongaarts J. Household size and composition in the developing world in the 1990s. Popul Stud. 2001;55(3):263–79.CrossRef Bongaarts J. Household size and composition in the developing world in the 1990s. Popul Stud. 2001;55(3):263–79.CrossRef
15.
Zurück zum Zitat Mason KO. Family change and support of the elderly in Asia: what do we know? Asia-Pac Popul J. 1992;7(3):13–32.PubMed Mason KO. Family change and support of the elderly in Asia: what do we know? Asia-Pac Popul J. 1992;7(3):13–32.PubMed
16.
Zurück zum Zitat Knodel J, Debavalya N. Social and economic support systems for the elderly in Asia: an introduction. Asia-Pac Popul J. 1992;7(3):5–12.PubMed Knodel J, Debavalya N. Social and economic support systems for the elderly in Asia: an introduction. Asia-Pac Popul J. 1992;7(3):5–12.PubMed
17.
Zurück zum Zitat Hermalin AI, Chang M-C, Lin H-S, Lee M-L, Ofstedal MB. Patterns of support among the elderly in Taiwan and their policy implications. Research Report No. 90–4, Comparative Study of the Elderly in Asia. Population Studies Center. Ann Arbor: University of Michigan; 1990. Hermalin AI, Chang M-C, Lin H-S, Lee M-L, Ofstedal MB. Patterns of support among the elderly in Taiwan and their policy implications. Research Report No. 90–4, Comparative Study of the Elderly in Asia. Population Studies Center. Ann Arbor: University of Michigan; 1990.
18.
Zurück zum Zitat Thadathil S, Jose R, Varghese S. Assessment of domain wise quality of life among elderly population using WHO-BREF scale and its determinants in a rural setting of Kerala. Int J Curr Med Appl Sci. 2015;7(1):43–6. Thadathil S, Jose R, Varghese S. Assessment of domain wise quality of life among elderly population using WHO-BREF scale and its determinants in a rural setting of Kerala. Int J Curr Med Appl Sci. 2015;7(1):43–6.
19.
Zurück zum Zitat Ohaeri JU, Awadalla AW, Gado OM. Subjective quality of life in a nationwide sample of Kuwaiti subjects using the short version of the WHO quality of life instrument. Soc Psychiatry Psychiatr Epidemiol. 2009;44(8):693–701.CrossRef Ohaeri JU, Awadalla AW, Gado OM. Subjective quality of life in a nationwide sample of Kuwaiti subjects using the short version of the WHO quality of life instrument. Soc Psychiatry Psychiatr Epidemiol. 2009;44(8):693–701.CrossRef
20.
Zurück zum Zitat Sabbah I, Drouby N, Sabbah S, Retel-Rude N, Mercier M. Quality of life in rural and urban populations in Lebanon using SF-36 health survey. Health Qual Life Outcomes. 2003;1(1):30.CrossRef Sabbah I, Drouby N, Sabbah S, Retel-Rude N, Mercier M. Quality of life in rural and urban populations in Lebanon using SF-36 health survey. Health Qual Life Outcomes. 2003;1(1):30.CrossRef
21.
Zurück zum Zitat Government of Pakistan. District Profile: Abbottabad. Earthquake Reconstruction and Rehabilitation. Islamabad: Earthquake Reconstruction and Rehabilitation Authority and Affiliates; 2007. Government of Pakistan. District Profile: Abbottabad. Earthquake Reconstruction and Rehabilitation. Islamabad: Earthquake Reconstruction and Rehabilitation Authority and Affiliates; 2007.
23.
Zurück zum Zitat Haq M, Mustafa U, Ahmad I. Household's willingness to pay for safe drinking water: a case study of Abbottabad district. Pak Dev Rev. 2007;46(4):1137–53.CrossRef Haq M, Mustafa U, Ahmad I. Household's willingness to pay for safe drinking water: a case study of Abbottabad district. Pak Dev Rev. 2007;46(4):1137–53.CrossRef
24.
Zurück zum Zitat Group TW. The World Health Organization quality of life assessment (WHOQOL): development and general psychometric properties. Soc Sci Med. 1998;46(12):1569–85.CrossRef Group TW. The World Health Organization quality of life assessment (WHOQOL): development and general psychometric properties. Soc Sci Med. 1998;46(12):1569–85.CrossRef
25.
Zurück zum Zitat Organization WH. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. 1996. Organization WH. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. 1996.
26.
Zurück zum Zitat Lodhi FS, Raza O, Montazeri A, Nedjat S, Yaseri M, Holakouie-Naieni K. Psychometric properties of she Urdu version of the World Health Organization's quality of life questionnaire (WHOQOL-BREF). Med J Islam Repub Iran. 2017;31:129. Lodhi FS, Raza O, Montazeri A, Nedjat S, Yaseri M, Holakouie-Naieni K. Psychometric properties of she Urdu version of the World Health Organization's quality of life questionnaire (WHOQOL-BREF). Med J Islam Repub Iran. 2017;31:129.
28.
Zurück zum Zitat Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.CrossRef Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.CrossRef
29.
Zurück zum Zitat Grootaert G, Narayan D, Nyhan Jones V, Woolcock M. Measuring Social Capital: An Integrated Questionnaire. World Bank Publications; 2004. Grootaert G, Narayan D, Nyhan Jones V, Woolcock M. Measuring Social Capital: An Integrated Questionnaire. World Bank Publications; 2004.
30.
Zurück zum Zitat Khan A. Lady health workers and social change in Pakistan. Econ Political Wkly. 2011:28–31. Khan A. Lady health workers and social change in Pakistan. Econ Political Wkly. 2011:28–31.
31.
Zurück zum Zitat Panchal DR. Mental health and psychological well-being among adolescents of joint and nuclear family. Int J Technol Res Eng. 2013;7(4):431–4. Panchal DR. Mental health and psychological well-being among adolescents of joint and nuclear family. Int J Technol Res Eng. 2013;7(4):431–4.
32.
Zurück zum Zitat Naz S, Naz S, Gul S. Relationship between economic independence, social support and quality of life among elderly people. J Ind Acad Appl Psychol. 2014;40(2):255. Naz S, Naz S, Gul S. Relationship between economic independence, social support and quality of life among elderly people. J Ind Acad Appl Psychol. 2014;40(2):255.
33.
Zurück zum Zitat Turagabeci AR, Nakamura K, Kizuki M, Takano T. Family structure and health, how companionship acts as a buffer against ill health. Health Qual Life Outcomes. 2007;5(1):61.CrossRef Turagabeci AR, Nakamura K, Kizuki M, Takano T. Family structure and health, how companionship acts as a buffer against ill health. Health Qual Life Outcomes. 2007;5(1):61.CrossRef
34.
Zurück zum Zitat Nedjat S, Naieni KH, Mohammad K, Majdzadeh R, Montazeri A. Quality of life among an Iranian general population sample using the World Health Organization’s quality of life instrument (WHOQOL-BREF). Int J Public Health. 2011;56(1):55–61.CrossRef Nedjat S, Naieni KH, Mohammad K, Majdzadeh R, Montazeri A. Quality of life among an Iranian general population sample using the World Health Organization’s quality of life instrument (WHOQOL-BREF). Int J Public Health. 2011;56(1):55–61.CrossRef
35.
Zurück zum Zitat Chipuer HM, Villegas T. Comparing the second-order factor structure of the family environment scale across husbands' and wives' perceptions of their family environment. Fam Process. 2001;40(2):187–98.CrossRef Chipuer HM, Villegas T. Comparing the second-order factor structure of the family environment scale across husbands' and wives' perceptions of their family environment. Fam Process. 2001;40(2):187–98.CrossRef
36.
Zurück zum Zitat Keyvanara M, Khasti BY, Zadeh MR, Modaber F. Study of the relationship between quality of life and socioeconomic status in Isfahan at 2011. J Educ Health Promot. 2015;4:92.CrossRef Keyvanara M, Khasti BY, Zadeh MR, Modaber F. Study of the relationship between quality of life and socioeconomic status in Isfahan at 2011. J Educ Health Promot. 2015;4:92.CrossRef
37.
Zurück zum Zitat Gao B, Yang S, Liu X, Ren X, Liu D, Li N. Association between social capital and quality of life among urban residents in less developed cities of western China: a cross-sectional study. Medicine. 2018;97(4):e9656.CrossRef Gao B, Yang S, Liu X, Ren X, Liu D, Li N. Association between social capital and quality of life among urban residents in less developed cities of western China: a cross-sectional study. Medicine. 2018;97(4):e9656.CrossRef
38.
Zurück zum Zitat Hamdan H, Yusof F, Marzukhi MA. Social capital and quality of life in urban neighborhoods high density housing. Procedia Soc Behav Sci. 2014;153:169–79.CrossRef Hamdan H, Yusof F, Marzukhi MA. Social capital and quality of life in urban neighborhoods high density housing. Procedia Soc Behav Sci. 2014;153:169–79.CrossRef
39.
Zurück zum Zitat D’Souza MS, Karkada SN, Somayaji G. Factors associated with health-related quality of life among Indian women in mining and agriculture. Health Qual Life Outcomes. 2013;11(1):9.CrossRef D’Souza MS, Karkada SN, Somayaji G. Factors associated with health-related quality of life among Indian women in mining and agriculture. Health Qual Life Outcomes. 2013;11(1):9.CrossRef
40.
Zurück zum Zitat Ginieri-Coccossis M, Triantafillou E, Tomaras V, Liappas IA, Christodoulou GN, Papadimitriou GN. Quality of life in mentally ill, physically ill and healthy individuals: the validation of the Greek version of the World Health Organization quality of life (WHOQOL-100) questionnaire. Ann General Psychiatry. 2009;8(1):23.CrossRef Ginieri-Coccossis M, Triantafillou E, Tomaras V, Liappas IA, Christodoulou GN, Papadimitriou GN. Quality of life in mentally ill, physically ill and healthy individuals: the validation of the Greek version of the World Health Organization quality of life (WHOQOL-100) questionnaire. Ann General Psychiatry. 2009;8(1):23.CrossRef
Metadaten
Titel
Factors associated with quality of life among joint and nuclear families: a population-based study
verfasst von
Fahad Saqib Lodhi
Unaib Rabbani
Adeel Ahmed Khan
Owais Raza
Kourosh Holakouie-Naieni
Mehdi Yaseri
Umer Farooq
Ali Montazeri
Publikationsdatum
01.12.2021
Verlag
BioMed Central
Erschienen in
BMC Public Health / Ausgabe 1/2021
Elektronische ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-021-10265-2

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