Volume 25, Issue 97 (7-2025)
refahj 2025, 25(97): 77-106 |
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Omidnia S, Rezaei Jamalouei H, Abachzadeh K, Rafiei H. (2025). The Conceptualizing of social health from the perspective of children and adolescents: Results of an Iranian qualitative study. refahj. 25(97), : 3 doi:10.32598/refahj.25.97.3027.1
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URL: http://refahj.uswr.ac.ir/article-1-4412-en.html
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Extended Abstract
Introduction
The concept of health has been defined as “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 dimension of health besids of physical and mental aspects, providing a comprehensive and three-dimensional concept of health (Doyle & Link, 2024).
In the 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 cases have been presented in this field. In the first health, social health is considered as one of mental health, along with cognitive and psychological. Keyes examines social health from an individual perspective and evaluates it and recognizes how an individual perceives his or her performance in society and the quality of relationships with other individuals, families, and social groups (Niyazi et al., 2023). At the same time, Russell pays attention to the social community (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 are asfollows: rule of law, fair distribution of wealth, public participation in decision-making, and a high level of social capital (Samiee et al., 2011).
Considering the need for children and adolescents to participate in conceptualizing social health, this study answers the following questions:
1. What is the view of children and adolescents on the concept of social health?
2. Is the view of children and adolescents close to the individual and social characteristics of 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 group discussions (8 to 10 people per each group). The total number of participants was 154 female (77) and male (77) students, divided into two age groups: children (6 to 12 years) and adolescents (12 to 18 years) by gender, place of residence (urban/rural), and socioeconomic status (high, medium, and low) residing in the cities and villages of Tehran, Karaj, Isfahan, Kerman, Sanandaj, Semnan, Zabol, and Gonabad. The group discussions were conducted by eight facilitators with a Master’s degree in clinical psychology and five to 25 years of work experience. The sessions were organized according to a single guideline. The discussions were held from March 2, 2013 to April 2, 2014 in the classrooms. A review of studies conducted by the research team showed that no significant study has been conducted in recent years on the conceptualization of social health of children and adolescents in Iranian society. Therefore, the raw data from the group discussions in 2023 were analyzed using content analysis to develop social health indicators for children and adolescents.
In this method, responses to questions posed in the form of co-coded themes, repetitive themes, and themes with the lowest number of respondents were removed from the long list. Then, the initial list of themes was reviewed by two external observers for relevance of the responses to the topic in question.
Findings
In response to the question, what do you think social health is? Environmental facilities (educational, health, sports and recreation), 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.
Access to environmental facilities (educational, welfare, sports, and recreational) is the dominant theme of male adolescents in medium urban areas, with themes such as “the existence of green spaces, playgrounds, gyms”, “reasonable ticket prices for playgrounds” and “screenings of social comedy films in cinemas”, “creating bicycle paths on the streets”, “healthy entertainment for children in the city”.
A healthy society, which is repeated in almost all groups, is the dominant theme of adolescent boys in underprivileged urban areas, characterized by items such as “no price increases”, “positive media influence”, “social and economic security”, “decent employment”, “no poverty in communities”.
Social acceptance is the dominant theme of adolescent girls in medium and high urban areas, characterized by the themes of “ability to live comfortably in society”, “not suppressing adolescent behavior”, “understanding adolescents”, “respecting adolescents”, “not imposing adult opinions on adolescents” and “free expression of opinions”.
Communication skills with the themes of “respecting elders”, “being polite”, “not being aggressive towards others”, “not having bad friends”, “being good with people”, “healthy interactions”, “competition”, “not violating the rights of others”, “unethical relationships between boys and girls” are the dominant themes of adolescent boys in rural areas.
Prosocial behaviors with items such as “helping friends, family and people”, “helping/visiting the sick/needy people”, “helping parents when sick”, “helping friends” as well as physical and mental health with items such as “not being hurt”, “not having anxiety”, “healthy heart”, “healthy body and soul”, “not being addicted”, “not getting tuberculosis” are the dominant themes of adolescent girls in rural areas.
Also, personal hygiene (prevention of disease, brushing teeth, covering mouth when sneezing, etc.), environmental hygiene (neighborhood cleanliness, nature, healthy air, dust, etc.) and healthy lifestyle (eating enough food, exercise, healthy nutrition, etc.) are the dominant themes of rural children and adolescents and children in underprivileged urban areas.
Discussion
According to the research questions, it can be said that the responses of adolescent girls in high and medium urban areas are closer to the individual approach and the responses of adolescent boys in low and medium urban areas are closer to the social approach (healthy society) of social health.
Also, the variables of gender, age group (12-18 years), place of residence (urban areas) and socio-economic status (high, medium and low) have the highest share, and age group (under 12 years), place of residence (rural) and especially male adolescents in privillaged urban areas have the lowest share of the diversity of responses.
This study shows that a kind of evolution is observed in the responses of children and adolescents, so that as we move from younger to older ages, from rural areas to urban areas and from underprivileged areas to more prosperous urban areas, the responses become closer to academic approaches to social health (individual and social approach).
Undoubtedly, attracting early participation of research target groups and assessing the needs of population layers can help improve policymaking, planning and implementation measures and align decision-making and policymaking in the field of social health with the principles of equity and the participatory policymaking model.
Ethical considerations
The authors declare that there are no conflicts of interest in this article.
refrence:
Doyle, D. M., & Link, B. G. (2024). On social health: history, conceptualization, and population patterning. Health Psychology Review, 1-30. https://doi.org/10.1080/17437199.2024.2314506
Land, K. C. (2012). The well-being of America’s children: developing and improving the child and youth well-being index (Vol. 6). Springer Science & Business Media.
Niazi, M., Zolfaghari, A., Abshirin, S., & Rezaei, E. (2023). Meta-Synthesis of Compiling and Designing a New Model of Factors Affecting the Social Health of Iranians. Strategic Studies of Culture, 2(4), 111-136 [In Persian]. https://doi.org/10.22083/scsj.2023.381872.1084
Rezadoost, K., Hosseinzadeh, A., & Rostami, A. (2019). The study of sociological factors affecting social health among students of Shahid Chamran University of Ahwaz. Quarterly Journal of Social Development (Previously Human Development), 14(1), 1-30 [In Persian]. doi: doi.org/10.22055/qjsd.2019.15264
Samiee, M., Rafiee, H., Amini, R. M., & Akbarian, M. (2011). Social health of Iran: from a consensus-based definition to an evidence-based index [In Persian]. https://sid.ir/paper/173470/en
Schramme, T. (2023). Health as complete well-being: The WHO definition and beyond. Public Health Ethics, 16(3), 210-218. https://doi.org/10.1093/phe/phad017
Introduction
The concept of health has been defined as “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 dimension of health besids of physical and mental aspects, providing a comprehensive and three-dimensional concept of health (Doyle & Link, 2024).
In the 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 cases have been presented in this field. In the first health, social health is considered as one of mental health, along with cognitive and psychological. Keyes examines social health from an individual perspective and evaluates it and recognizes how an individual perceives his or her performance in society and the quality of relationships with other individuals, families, and social groups (Niyazi et al., 2023). At the same time, Russell pays attention to the social community (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 are asfollows: rule of law, fair distribution of wealth, public participation in decision-making, and a high level of social capital (Samiee et al., 2011).
Considering the need for children and adolescents to participate in conceptualizing social health, this study answers the following questions:
1. What is the view of children and adolescents on the concept of social health?
2. Is the view of children and adolescents close to the individual and social characteristics of 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 group discussions (8 to 10 people per each group). The total number of participants was 154 female (77) and male (77) students, divided into two age groups: children (6 to 12 years) and adolescents (12 to 18 years) by gender, place of residence (urban/rural), and socioeconomic status (high, medium, and low) residing in the cities and villages of Tehran, Karaj, Isfahan, Kerman, Sanandaj, Semnan, Zabol, and Gonabad. The group discussions were conducted by eight facilitators with a Master’s degree in clinical psychology and five to 25 years of work experience. The sessions were organized according to a single guideline. The discussions were held from March 2, 2013 to April 2, 2014 in the classrooms. A review of studies conducted by the research team showed that no significant study has been conducted in recent years on the conceptualization of social health of children and adolescents in Iranian society. Therefore, the raw data from the group discussions in 2023 were analyzed using content analysis to develop social health indicators for children and adolescents.
In this method, responses to questions posed in the form of co-coded themes, repetitive themes, and themes with the lowest number of respondents were removed from the long list. Then, the initial list of themes was reviewed by two external observers for relevance of the responses to the topic in question.
Findings
In response to the question, what do you think social health is? Environmental facilities (educational, health, sports and recreation), 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.
Access to environmental facilities (educational, welfare, sports, and recreational) is the dominant theme of male adolescents in medium urban areas, with themes such as “the existence of green spaces, playgrounds, gyms”, “reasonable ticket prices for playgrounds” and “screenings of social comedy films in cinemas”, “creating bicycle paths on the streets”, “healthy entertainment for children in the city”.
A healthy society, which is repeated in almost all groups, is the dominant theme of adolescent boys in underprivileged urban areas, characterized by items such as “no price increases”, “positive media influence”, “social and economic security”, “decent employment”, “no poverty in communities”.
Social acceptance is the dominant theme of adolescent girls in medium and high urban areas, characterized by the themes of “ability to live comfortably in society”, “not suppressing adolescent behavior”, “understanding adolescents”, “respecting adolescents”, “not imposing adult opinions on adolescents” and “free expression of opinions”.
Communication skills with the themes of “respecting elders”, “being polite”, “not being aggressive towards others”, “not having bad friends”, “being good with people”, “healthy interactions”, “competition”, “not violating the rights of others”, “unethical relationships between boys and girls” are the dominant themes of adolescent boys in rural areas.
Prosocial behaviors with items such as “helping friends, family and people”, “helping/visiting the sick/needy people”, “helping parents when sick”, “helping friends” as well as physical and mental health with items such as “not being hurt”, “not having anxiety”, “healthy heart”, “healthy body and soul”, “not being addicted”, “not getting tuberculosis” are the dominant themes of adolescent girls in rural areas.
Also, personal hygiene (prevention of disease, brushing teeth, covering mouth when sneezing, etc.), environmental hygiene (neighborhood cleanliness, nature, healthy air, dust, etc.) and healthy lifestyle (eating enough food, exercise, healthy nutrition, etc.) are the dominant themes of rural children and adolescents and children in underprivileged urban areas.
Discussion
According to the research questions, it can be said that the responses of adolescent girls in high and medium urban areas are closer to the individual approach and the responses of adolescent boys in low and medium urban areas are closer to the social approach (healthy society) of social health.
Also, the variables of gender, age group (12-18 years), place of residence (urban areas) and socio-economic status (high, medium and low) have the highest share, and age group (under 12 years), place of residence (rural) and especially male adolescents in privillaged urban areas have the lowest share of the diversity of responses.
This study shows that a kind of evolution is observed in the responses of children and adolescents, so that as we move from younger to older ages, from rural areas to urban areas and from underprivileged areas to more prosperous urban areas, the responses become closer to academic approaches to social health (individual and social approach).
Undoubtedly, attracting early participation of research target groups and assessing the needs of population layers can help improve policymaking, planning and implementation measures and align decision-making and policymaking in the field of social health with the principles of equity and the participatory policymaking model.
Ethical considerations
The authors declare that there are no conflicts of interest in this article.
refrence:
Doyle, D. M., & Link, B. G. (2024). On social health: history, conceptualization, and population patterning. Health Psychology Review, 1-30. https://doi.org/10.1080/17437199.2024.2314506
Land, K. C. (2012). The well-being of America’s children: developing and improving the child and youth well-being index (Vol. 6). Springer Science & Business Media.
Niazi, M., Zolfaghari, A., Abshirin, S., & Rezaei, E. (2023). Meta-Synthesis of Compiling and Designing a New Model of Factors Affecting the Social Health of Iranians. Strategic Studies of Culture, 2(4), 111-136 [In Persian]. https://doi.org/10.22083/scsj.2023.381872.1084
Rezadoost, K., Hosseinzadeh, A., & Rostami, A. (2019). The study of sociological factors affecting social health among students of Shahid Chamran University of Ahwaz. Quarterly Journal of Social Development (Previously Human Development), 14(1), 1-30 [In Persian]. doi: doi.org/10.22055/qjsd.2019.15264
Samiee, M., Rafiee, H., Amini, R. M., & Akbarian, M. (2011). Social health of Iran: from a consensus-based definition to an evidence-based index [In Persian]. https://sid.ir/paper/173470/en
Schramme, T. (2023). Health as complete well-being: The WHO definition and beyond. Public Health Ethics, 16(3), 210-218. https://doi.org/10.1093/phe/phad017
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Received: 2024/11/26 | Accepted: 2025/03/12 | Published: 2025/07/6
Received: 2024/11/26 | Accepted: 2025/03/12 | Published: 2025/07/6
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