Background
It is well documented that poverty has a negative impact on children’s physical and psychological well-being [
1‐
3]. There is also growing concern over the influence of income disparity on the psychological well-being of children, particularly for those living in low-income families [
4,
5]. Research suggests that income disparity can actually aggravate the negative effects of poverty on children’s well-being, severely affecting their quality of life [
4,
6,
7]. Nevertheless, despite the belief that income disparity is becoming a global problem, its relationship to the psychological well-being of children and their quality of life remains relatively underexplored.
Hong Kong has experienced an upward trend of poverty among its child population [
8] and a serious income disparity with a Gini coefficient of 0.475 [
9], the highest among the world’s developed economies. Results from a recent study by Ho and colleagues [
5] examining the effects of poverty and income disparity on the psychological well-being of 1725 Hong Kong Chinese children reported that children from low-income families have statistically significant lower levels of self-esteem and quality of life, and higher levels of depressive symptoms than those from high-income families. Additionally, the results of this previous study also revealed that housing type and parent marital status were major factors contributing to children’s self-esteem, depressive symptoms, and quality of life [
5].
The research of Ho and colleagues [
5] provides some evidence that poverty and income disparity have a negative impact on the psychological well-being of children. However, their study is limited by a lack of qualitative information that might enable researchers to understand the problem more thoroughly. Specifically, they fail to address the reasons for children living in low-income families reporting lower levels of self-esteem and depression in the first place, subsequently leading to a diminished quality of life. Therefore, they pointed out the importance of collecting qualitative information to explore how poverty and income disparity affect children’s psychological well-being. Scientific evidence indicates the significance of examining the daily lives in reflecting and understanding ones’ psychological well-being [
10]. In particular, it is recommended to review descriptions on the daily lives [
11,
12], thus delineating the impact of poverty on children’s psychological well-being. More importantly, studying daily lives in relation to poverty and income disparity is essential prerequisites for the design of an effective and appropriate intervention that can help children living in low-income families to bolster their self-esteem, alleviate their depressive symptoms and improve their quality of life.
Given the foregoing issues, this follow-up study aimed to conduct qualitative interviews to enhance our understanding of how poverty and income disparity negatively affect the psychological well-being of Hong Kong Chinese children. It was anticipated that some underlying factors contributing to the psychological well-being of children from low-income families could be identified through comparing their daily lives with those from high-income families.
Methods
Design
A qualitative study using a phenomenological approach was conducted from May 2012 to January 2013. A random sample of 42 children aged 10–13, with 17 from families in the three highest monthly household income districts (high-income families) and 15 from the three lowest monthly household income districts (low-income families) were chosen from the previous study conducted by Ho and colleagues [
5].
Subjects
Hong Kong Chinese children who met the inclusion criteria were eligible for the interviews. The inclusion criteria were (1) able to speak and read Chinese, and (2) studying at grade five or six in elementary school. Also, they had to live in the same district where their elementary schools were located. This ensured that the informants were selected according to the study protocol, i.e., from families in the three highest and three lowest monthly household income districts. Those with identified behavioral or learning problems were excluded.
Data collection procedures
Approval for the study was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference UW 12-237). Written consent was then obtained from all parents after they were told the purpose of the study. They were given the option of allowing or refusing their child’s involvement in the study. The children were also invited to put their names on a special assent form and told that their participation was voluntary. The recruitment of informants was carried out in 12 elementary schools that were previously chosen from the three highest and three lowest monthly household income districts [
5]. A name list of all eligible students was obtained from each school, and every student was assigned for a serial code. A computer programme would then use the serial codes for selection of students at random. All of the randomly selected students were asked to undergo individual semi-structured interviews conducted in a counseling room after school. All of the interviews were tape-recorded and lasted 25 to 30 min.
A semi-structured interview guide was developed. It covered seven areas of children’s life experience, including family background, living environment, usual diet, clothing, leisure activities, learning opportunities and personal feelings.
Two trained research nurses conducted all interviews. The informants were asked to respond to a broad question, “Can you share with me your everyday life other than going to school?” This was followed by more specific questions, such as, “How do you feel about your living environment?” During the interviews, the research nurses adopted different probing techniques to help elicit more comprehensive information.
Analytic strategy
After the interviews, the recordings were immediately transcribed, verbatim, in Cantonese to capture nuances of expression unique to the dialect. Quotations relevant to the themes were then translated into English. In the coding process, two researchers who were not involved with data collection helped to analyze the narratives. They started with an extensive review of the transcripts, with the aim of searching for general constructs and themes. Special attention was paid to constructs and themes related to the major topics covered in the interview guide.
The technique of open coding was employed to code the transcriptions, followed by selective coding in which some categories were identified as core variables and used to code transcripts that were closely related to them. Regular meetings were held among the research team members to resolve any ambiguity or disagreement of coding.
Discussion
Although Ho and colleagues [
5] investigated into the negative effects of poverty and income disparity on children’s psychological well-being, the main reasons behind remained unclear. To the best of our knowledge, this is the follow-up study is the first study that addresses the literature gap by demonstrating the possible underlying factors contributing to the psychological well-being of children from low-income families through comparing their daily lives with those from high-income families.
The results suggest that, in general, the daily lives of children from low-income families differ from those of children from high-income families in terms of their living environment, physical health, social lives and ability to function at school. Among them, living environment was the greatest concern reported by children from low-income families. This supports that housing type plays a significant role in children’s psychological outcomes [
5]. Consistent with previous research [
13,
14], informants from low-income families in our study generally considered their living environment to be unsatisfactory due to insufficient space for daily activities. Indeed, some evidence has suggested that a chaotic environment is a stressor contributing to distress [
15,
16] by increasing the probability of family conflict [
17] and household injuries [
18]. Since this is uncontrollable, children living in such environments may perceive themselves as not having any ability to change things, thereby feeling depressed [
19].
Another possible explanation for poor psychological outcomes in underprivileged children is limited access to material resources and social activities. Many informants from low-income families in our study reported being unable to afford material goods and were also discouraged from participating in various kinds of social activities to cut down on unnecessary expenses. Indeed, this lack of access may have a greater than expected negative impact on children’s psychological well-being [
20]. According to Festinger [
21], humans are motivated to make comparisons with other society members in terms of their financial condition. Those considering themselves in a better position obtain a sense of superiority, which helps build up their self-esteem; whereas exclusion from services may create a sense of inadequacy, thereby lowering a child’s self-esteem [
22,
23]. This state of mind was observed in the semi-structured interviews, as those having difficulty accessing material resources and social services reported avoiding making friends with children from high-income families and feeling inferior due to their financial situation.
This study also provides further insight into how a parent’s marital status may affect a child’s psychological outcome [
5]. As indicated by the demographic data, 40 % of informants from low-income families compared with only 11.8 % from high-income families had divorced or separated parents. According to Thomas and Sawhill [
24], family structure can directly affect household income, with single-parent families reporting less income. It is therefore understandable that children from these families may be more deprived of material resources and social services compared with those from married-parent families, resulting in feelings of inferiority and susceptibility to the psychological effects of poverty and income disparity.
One of the interesting findings was that many children from low-income families had unhealthy eating habits and also adopted a sedentary lifestyle. As observed in the interviews, it was common for these children to consume high-sugar foods and spend their leisure time watching television. Indeed, it has been well-documented that physical inactivity is associated with depressive symptoms [
25] and low self-esteem [
26]. Although the reason is unknown, engaging in regular physical exercise has been recognized as an effective way to reduce stress [
27] by stimulating the secretion of endorphins, which leads to feelings of happiness [
28]. Additionally, there is some evidence that healthy eating is linked to higher self-esteem as it can reduce the risk of obesity, thereby improving self-image [
29]. Given the above issues, adopting a sedentary lifestyle and unhealthy eating habits are possible factors mediating the effects of poverty and income disparity on the psychological well-being of children from low-income families.
Another finding warranting special attention is that quite a large number of informants from low-income families complained about their difficulty accessing educational resources. Indeed, scholars have suggested that such disadvantages may deprive children of opportunities to move up the social ladder, rendering them much more susceptible to intergenerational poverty [
30]. This provides further justification for supporting a greater allocation of resources by the government to children from low-income families, thereby helping them to break the cycle of poverty.
Limitations
This study has several limitations. First, the interviews were only conducted with children. Because of their immature cognitive development, they might have been unable to provide a detailed explanation of how poverty and income disparity affected their psychological well-being. We recommend that parents and social workers be included in future studies to obtain a better understanding of their effects on children. Another limitation is that all of the informants were from families in the three highest and three lowest monthly household income districts. The daily lives of children from the middle range thus remain unknown. Future studies could consider recruiting them as informants to show how poverty and income disparity impact on the daily lives and psychological well-being of children from a wider range of socioeconomic backgrounds.
Implications for research and clinical practice
An important implication of this research is that it adds to the literature by showing that a sedentary lifestyle and unhealthy eating habits are possible factors mediating the effects of poverty and income disparity on the psychological outcomes of children from low-income families. Future research can integrate them as new variables for evaluating this segment of the population.
Understanding how poverty and income disparity affect the daily lives of children from low-income families should also be a prerequisite for designing an appropriate intervention to promote their psychological well-being. As physical inactivity and unhealthy eating habits are two possible reasons for poor psychological outcomes, developing a protocol advocating regular physical exercise and healthy eating is of paramount importance.
More importantly, nurses should make themselves aware of the effect of poverty and income disparity on children’s psychological health, forming multi-disciplinary partnerships with different stakeholders to promote children’s psychological well-being.
One more important implication relates to highlight the significance in improving the material circumstances of low-income families especially in terms of living environment, social and educational resources. Children’s rich descriptions on these areas guide the development of suitable measures to address their particular concerns. Considerations should also be given to the study results when planning services and policies in the long run.
Authors’ contributions
KYH, WHCL and KKWL conceived and designed the study, developed the semi-structured interview guide and monitored the whole research process. KYH searched the literature, reviewed the literature and extracted data. KYH, WHCL, KKWL and SSCC analyzed and interpreted the data. KYH and WHCL drafted the manuscript. JOKC, KKWL, SSCC and XW critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript. We all agree to be accountable for all aspects of the work. All authors read and approved the final manuscript.