| چکیده انگلیسی مقاله |
Conceptualizing Social Health from the Perspective of Children and Adolescents: Results of an Iranian Qualitative Study
Introduction
The concept of social health was first proposed by the World Health Organization in 1948. This definition states that health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (Schramm, 2023). In this definition, social health is a vital dimension of overall health alongside physical and mental health dimensions that provide a comprehensive and three-dimensional concept of health (Doyle and Link, 2024).
In the late 1960s, the concept of social health expanded with the beginning of the social indicators monitoring movement (Land, 2012). Since then, at least two individual and social approaches have been presented in this field. In the first approach, social health is considered as a dimension of mental health, along with cognitive and psychological dimensions. Keyes considers social health from an individual perspective and considers it as an individual's assessment and understanding of how they function interpersonally in society and the quality of relationships with other individuals, relatives, and social groups (Niyazi et al., 2023). At the same time, Russell pays attention to the social approach (healthy society) of social health (Rezadoust et al., 2019) and considers a healthy society to be a society in which there is opportunity and universal access to basic services and goods. Some of the indicators of a healthy society according to Russell include: rule of law, fair distribution of wealth, public participation in the decision-making process, and a high level of social capital (Samiee et al., 2011). This study, focusing on the need for children and adolescents to participate in the process of conceptualizing social health, answers the following questions:
1 What is the perspective of children and adolescents regarding the concept of social health?
2 Is the perspective of children and adolescents close to the individual and social approaches to social health?
3 To what extent do children and adolescents’ perspectives differ based on age group, gender, place of residence (urban or rural), and socioeconomic status?
Method
This study was conducted using a qualitative method and 16 focus group discussions (each group consisting of 8 to 10 people). The total number of participants was 154 female (77) and male (77) students, who were divided into two age groups: children (under 12 years) and adolescents (12 to 18 years), as well as based on gender (girls and boys), place of residence (urban/rural), and socioeconomic status (high, medium, and low) , living in the cities and villages of Tehran, Karaj, Isfahan, Kerman, Sanandaj, Semnan, Zabol, and Gonabad. The group discussions were conducted by 8 facilitators with a master’s degree in clinical psychology and a minimum of 5 and a maximum of 25 years of work experience. The sessions were organized according to a single guideline. These discussions were held from March 2, 2013 to April 2, 2014 in the classrooms of students in urban and rural areas of 8 cities in Iran. A review of the studies conducted by the research team showed that no significant study has been conducted in the field of conceptualizing the social health of children and adolescents in Iranian society in recent years. Therefore, the raw data from the group discussions in 2021 were analyzed using thematic analysis to develop indicators of the social health of children and adolescents.
In this method, the answers to the questions raised in the form of common coding themes, repetitive themes, and themes that had the lowest number of respondents were removed from the long list. Then, the initial list of themes was reviewed by two external observers in terms of the relevance of the answers to the topic in question.
Findings
According to the research questions, it can be said that the responses of adolescent girls in upper and middle urban areas are close to the individual approach to social health, and the responses of adolescent boys in middle and lower urban areas are close to the societal approach (healthy society) to social health.
Also, the demographic variables of gender, age group (12-18 years), place of residence (urban areas) and socioeconomic status (high, medium and low) have the highest contribution and the demographic characteristics of age group (under 12 years), place of residence (rural) have the lowest contribution to health related to the diversity of social responses.
In the meantime, the responses of male adolescents from high urban areas also had the lowest contribution to the diversity of responses.
In response to the question, what do you think social health is? Environmental facilities (in terms of educational, welfare, sports and recreational), healthy society, social acceptance, communication skills, pro-social behavior, physical and mental health, hygiene (personal and environmental), and healthy lifestyle were the most important main themes expressed.
Environmental facilities (educational, welfare, sports and recreational) and the possibility of accessing and using them is the dominant theme of male adolescents in medium privileged urban areas. Which is characterized by items such as availability of "green space, playground, gym", "affordable ticket prices for playground and screening of social comedy films in cinemas", creating bike lanes on the streets", "having fun for children", "healthy entertainment facilities" and "educational facilities". A healthy society, which is repeated in almost all groups, is the dominant theme of male adolescents in low privileged urban areas, which is characterized by items such as "no price increases", "positive impact of the media", "social and economic security", "appropriate employment", "societies are not in poverty".
Social acceptance is the dominant theme of adolescent girls in medium and high privileged urban areas, which is characterized by items such as "being able to live comfortably in community", "not suppressing adolescent behavior", "understanding adolescents", "respecting adolescents", "not imposing adult opinions on adolescents" and "free expression of opinions".
Communication skills with items such as "respecting elders", "being polite", "not being aggressive towards others", "not having bad friends", "being nice to people", "healthy interactions", "useful competition", "not violating the rights of others", "wrong relationships between boys and girls" are the dominant themes of adolescent boys in rural areas, while pro-social behaviors with items such as "helping friends, family and people", "helping/visiting the sick/needy people", "helping parents when they are sick", "helping friends" and also physical and mental health with items such as "not being easily offended", "not having anxiety", "healthy heart", "healthy body and soul", "not having addiction", "not having tuberculosis" are the dominant themes of adolescent girls in rural areas.
Also, personal hygiene (disease prevention, brushing teeth, covering your mouth when sneezing, etc.) , environmental hygiene (neighborhood cleanliness, nature, healthy air, dust, etc.) , and a healthy lifestyle (eating enough food, exercising, healthy nutrition, etc.) are the dominant themes for rural children and adolescents and children of low privileged urban areas.
Discussion
This study shows that a kind of evolution is observed in the responses of children and adolescents, in such a way that as we move from younger to older ages, rural to urban areas, and low privileged areas to high urban areas, the responses of respondents become closer to academic approaches to social health (individual and social approach).
Undoubtedly, paying attention to attracting early participation of the target groups of the research, which in this case are children and adolescents, as well as assessing the needs of different demographic layers can help improve policymaking, planning, and executive actions in line with the needs of different groups in society and align decision-making and policymaking in the field of social health with the principles of justice and equity and the participatory policymaking model.
Ethical consideration
The authors declare that there are no conflicts of interest in this article.
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