Volume 26, Issue 2 (8-2026)
Social Welfare Quarterly 2026, 26(2): 169-198 |
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Hezarjaribi J, Hajmohammadi N. (2026). Social Health in Nurses: A Meta-Synthesis Study. Social Welfare Quarterly. 26(2), 169-198. doi:10.32598/refahj.26.2.4690.1
URL: http://refahj.uswr.ac.ir/article-1-4483-en.html
URL: http://refahj.uswr.ac.ir/article-1-4483-en.html
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Extended Abstract
Introduction
Health is a fundamental concept that extends beyond the mere absence of disease. According to the World Health Organization (WHO, 1948), health is defined as “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.” Among these three core dimensions, social health has historically received less attention than physical and mental health, yet it plays an equally vital role in individuals’ quality of life, professional functioning, and social integration (Keyes, 1998; Larson, 1996). Social health refers to an individual’s perception of the quality of their social relationships, their sense of belonging to a community, their effective participation in social roles, and their evaluation of the society in which they live (Keyes & Shapiro, 2004).
Nurses constitute the largest and most essential workforce in any health system. Their work is characterized by long shifts, high workload, continuous contact with patients and their families, exposure to suffering and death, and often inadequate organizational support (Wang et al., 2018). These challenging conditions can negatively affect nurses’ social health, which in turn may compromise the quality of patient care, job satisfaction, organizational commitment, and the overall sustainability of the health system. In Iran, despite the growing number of studies on nurses’ social health, the findings remain fragmented, and a comprehensive conceptual framework that integrates individual, organizational, interpersonal, and cultural factors is lacking.
Therefore, this study was designed with two complementary aims: (1) to extract, integrate, and interpret the findings of research conducted on the social health of Iranian nurses between 2017 and 2023, and (2) to present an integrated conceptual model that explains the dimensions of nurses’ social health and the multiple factors influencing it.
Method
This study employed a metasynthesis approach based on the sevenstep model proposed by Sandelowski and Barroso (2007). Although most primary studies in this field were quantitative, the metasynthesis method, through a process known as “qualitizing,” can convert numerical findings into meaningful qualitative statements and themes (Sandelowski and et al, 2009).
A systematic search was conducted in six Persianlanguage databases: SID, Magiran, IranDoc, Noormags, Civilica, and the Comprehensive Portal of Humanities (Ensani.ir) from 2017 to 2023. Keywords were combined using Boolean operators and included: “social health,” “nurses,” “social wellbeing,” “dimensions of social health,” “social participation,” “social cohesion,” “social acceptance,” “psychological capital,” “selfefficacy,” “cultural intelligence,” “religious values,” “social skills,” and “physical activity.” The initial search yielded 160 articles.
Inclusion criteria were: (a) focus on social health of nurses, (b) conducted in Iran, (c) published in scientificresearch journals, (d) quantitative, qualitative, or mixedmethods design, (e) fulltext availability, and (f) publication between 2017 and 2023. Exclusion criteria were: irrelevant topic, review or systematic review studies, nonnurse populations, duplicates, incomplete text or insufficient data, and publication outside the time frame. After removing duplicates (n=31) and screening titles and abstracts (removing 74 irrelevant articles), 55 articles remained. Fulltext screening excluded another 41 articles (22 reviews or theoretical studies, 13 with insufficient extractable data, and 6 outside the time frame). Ultimately, 14 articles met all inclusion criteria and were selected for final analysis.
Quality appraisal was conducted independently by two reviewers using the STROBE checklist for crosssectional studies (12 articles) and the CASP checklist for intervention studies (2 articles). Disagreements were resolved by a third reviewer. All selected studies received a “moderate to high” quality rating. Intercoder reliability for data extraction was established with Cohen’s kappa = 0.82.
Findings
The 14 included articles were published in 12 scientificresearch journals over seven years (2017–2023). Nursing and medicine accounted for 42.5% of the content production, followed by management and sports sciences (21.5%) and psychology (14%). Sociology, social work, and curriculum planning each contributed approximately 7%. The articles were authored by 48 researchers, of whom 46% were female and 54% male. In terms of methodology, 85.7% used crosssectional survey designs, and 14.3% used experimental or quasiexperimental designs. More than 78.5% were conducted at the city level, two (14%) at the provincial level, and one (7%) at the national level. The unit of analysis in all studies was the individual.
The findings revealed that nurses’ social health is not a unidimensional phenomenon but rather the result of dynamic interactions among organizational, individual, interpersonal, and sociocultural factors. The five dimensions of social health—social participation, social cohesion, social acceptance, social coherence, and social flourishing—operate as an interactive network. Interactionoriented dimensions, particularly social participation and social cohesion, were more frequently reported and more favorable compared with perceptual/valueoriented dimensions, such as social acceptance and social flourishing. Weaknesses in the latter were associated with workplace conditions, economic pressures, and structural constraints.
Among the influencing factors, organizational factors (e.g., managerial support, organizational justice, work pressure, staffing shortages, type of employment) were reported in eight studies. Individual factors (e.g., age, work experience, selfefficacy, psychological capital, psychological hardiness, religious coping) appeared in six studies. Interpersonal factors (e.g., relationships with colleagues, social support, teamwork) were reported in five studies. Sociocultural factors (e.g., religious values, cultural intelligence, physical activity) appeared in three studies. Psychological capital and positive religious coping played reinforcing (mediating) roles, enhancing the effects of individual and organizational factors on social health.
Discussion
The findings indicate that interactionoriented dimensions of nurses’ social health (social participation and cohesion) have received greater attention and appear to be more favorable than perceptual/valueoriented dimensions (social acceptance and flourishing). This pattern suggests that although nurses are continuously engaged in professional interactions and organizational activities, their sense of belonging, social acceptance, and opportunities for professional growth may be hindered by workplace pressures and structural limitations.
Social acceptance and flourishing are more strongly influenced by job pressures, structural constraints, and organizational conditions. Therefore, improving nurses’ social health requires interventions that go beyond individual training and education. Policymakers and health system managers should focus on reforming organizational structures, welfare policies, enhancing managerial support, and facilitating nurses’ participation in decisionmaking processes. The integrated conceptual framework presented in this study—which combines structural (Durkheimian) and perceptual (Keyes’ model) approaches—can serve as a basis for practical planning, human resource health policymaking, and the development of evidencebased interventions.
Limitations
This study has several limitations. First, the predominant reliance on quantitative, crosssectional designs limited the depth of qualitative understanding of nurses’ lived experiences. Second, the lack of access to some unpublished theses may have introduced publication bias. Third, differences in operational definitions and measurement tools of social health across studies made data harmonization challenging. Fourth, the focus on Iranian studies restricts generalizability to other cultural and health system contexts. Fifth, the absence of longitudinal studies precludes definitive conclusions about trends in nurses’ social health over time.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles, including proper citation, scientific integrity, and respect for authors’ rights, have been observed throughout the research process. Given the metasynthesis nature of this study and the use of published data, obtaining an ethics code was not required.
Authors’ contributions
The authors contributed to the study design, systematic search, quality assessment of articles, data analysis and synthesis, and drafting of the initial manuscript. All authors have reviewed and approved the final version of the article.
Funding
This research received no specific grant from any funding agency. It was conducted with the internal support of Allameh Tabataba’i University.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to express their sincere gratitude to all researchers whose articles were utilized in this metasynthesis, and to all individuals who assisted us in conducting this research.
World Health Organization. (1948). Constitution of the World Health Organization. Geneva: WHO.
Larson, J. S. (1996). The measurement of social well-being. Social Indicators Research, 38(3), 285-296.
Keyes, C. L. M. (1998). Social well-being. Social Psychology Quarterly, 61 (2), 121-140.
Keyes, C. L. M., & Shapiro, A. D. (2004). Social well-being in the United States: A descriptive epidemiology. In O. G. Brim, C. D. Ryff, & R. C. Kessler (Eds.), How healthy are we? A national study of well-being at midlife (pp. 350-372). University of Chicago Press.
Wang, H., Zhang, D., Yan, F., & Hou, Z. (2018). Association between social health insurance and choice of hospitals among internal migrants in China: A national cross-sectional study. BMJ Open, 8(2), e018440.
Sandelowski, M., Voils, C. I., & Knafl, G. (2009). On quantitizing. Journal of Mixed Methods Research, 3(3), 208-222
Introduction
Health is a fundamental concept that extends beyond the mere absence of disease. According to the World Health Organization (WHO, 1948), health is defined as “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.” Among these three core dimensions, social health has historically received less attention than physical and mental health, yet it plays an equally vital role in individuals’ quality of life, professional functioning, and social integration (Keyes, 1998; Larson, 1996). Social health refers to an individual’s perception of the quality of their social relationships, their sense of belonging to a community, their effective participation in social roles, and their evaluation of the society in which they live (Keyes & Shapiro, 2004).
Nurses constitute the largest and most essential workforce in any health system. Their work is characterized by long shifts, high workload, continuous contact with patients and their families, exposure to suffering and death, and often inadequate organizational support (Wang et al., 2018). These challenging conditions can negatively affect nurses’ social health, which in turn may compromise the quality of patient care, job satisfaction, organizational commitment, and the overall sustainability of the health system. In Iran, despite the growing number of studies on nurses’ social health, the findings remain fragmented, and a comprehensive conceptual framework that integrates individual, organizational, interpersonal, and cultural factors is lacking.
Therefore, this study was designed with two complementary aims: (1) to extract, integrate, and interpret the findings of research conducted on the social health of Iranian nurses between 2017 and 2023, and (2) to present an integrated conceptual model that explains the dimensions of nurses’ social health and the multiple factors influencing it.
Method
This study employed a metasynthesis approach based on the sevenstep model proposed by Sandelowski and Barroso (2007). Although most primary studies in this field were quantitative, the metasynthesis method, through a process known as “qualitizing,” can convert numerical findings into meaningful qualitative statements and themes (Sandelowski and et al, 2009).
A systematic search was conducted in six Persianlanguage databases: SID, Magiran, IranDoc, Noormags, Civilica, and the Comprehensive Portal of Humanities (Ensani.ir) from 2017 to 2023. Keywords were combined using Boolean operators and included: “social health,” “nurses,” “social wellbeing,” “dimensions of social health,” “social participation,” “social cohesion,” “social acceptance,” “psychological capital,” “selfefficacy,” “cultural intelligence,” “religious values,” “social skills,” and “physical activity.” The initial search yielded 160 articles.
Inclusion criteria were: (a) focus on social health of nurses, (b) conducted in Iran, (c) published in scientificresearch journals, (d) quantitative, qualitative, or mixedmethods design, (e) fulltext availability, and (f) publication between 2017 and 2023. Exclusion criteria were: irrelevant topic, review or systematic review studies, nonnurse populations, duplicates, incomplete text or insufficient data, and publication outside the time frame. After removing duplicates (n=31) and screening titles and abstracts (removing 74 irrelevant articles), 55 articles remained. Fulltext screening excluded another 41 articles (22 reviews or theoretical studies, 13 with insufficient extractable data, and 6 outside the time frame). Ultimately, 14 articles met all inclusion criteria and were selected for final analysis.
Quality appraisal was conducted independently by two reviewers using the STROBE checklist for crosssectional studies (12 articles) and the CASP checklist for intervention studies (2 articles). Disagreements were resolved by a third reviewer. All selected studies received a “moderate to high” quality rating. Intercoder reliability for data extraction was established with Cohen’s kappa = 0.82.
Findings
The 14 included articles were published in 12 scientificresearch journals over seven years (2017–2023). Nursing and medicine accounted for 42.5% of the content production, followed by management and sports sciences (21.5%) and psychology (14%). Sociology, social work, and curriculum planning each contributed approximately 7%. The articles were authored by 48 researchers, of whom 46% were female and 54% male. In terms of methodology, 85.7% used crosssectional survey designs, and 14.3% used experimental or quasiexperimental designs. More than 78.5% were conducted at the city level, two (14%) at the provincial level, and one (7%) at the national level. The unit of analysis in all studies was the individual.
The findings revealed that nurses’ social health is not a unidimensional phenomenon but rather the result of dynamic interactions among organizational, individual, interpersonal, and sociocultural factors. The five dimensions of social health—social participation, social cohesion, social acceptance, social coherence, and social flourishing—operate as an interactive network. Interactionoriented dimensions, particularly social participation and social cohesion, were more frequently reported and more favorable compared with perceptual/valueoriented dimensions, such as social acceptance and social flourishing. Weaknesses in the latter were associated with workplace conditions, economic pressures, and structural constraints.
Among the influencing factors, organizational factors (e.g., managerial support, organizational justice, work pressure, staffing shortages, type of employment) were reported in eight studies. Individual factors (e.g., age, work experience, selfefficacy, psychological capital, psychological hardiness, religious coping) appeared in six studies. Interpersonal factors (e.g., relationships with colleagues, social support, teamwork) were reported in five studies. Sociocultural factors (e.g., religious values, cultural intelligence, physical activity) appeared in three studies. Psychological capital and positive religious coping played reinforcing (mediating) roles, enhancing the effects of individual and organizational factors on social health.
Discussion
The findings indicate that interactionoriented dimensions of nurses’ social health (social participation and cohesion) have received greater attention and appear to be more favorable than perceptual/valueoriented dimensions (social acceptance and flourishing). This pattern suggests that although nurses are continuously engaged in professional interactions and organizational activities, their sense of belonging, social acceptance, and opportunities for professional growth may be hindered by workplace pressures and structural limitations.
Social acceptance and flourishing are more strongly influenced by job pressures, structural constraints, and organizational conditions. Therefore, improving nurses’ social health requires interventions that go beyond individual training and education. Policymakers and health system managers should focus on reforming organizational structures, welfare policies, enhancing managerial support, and facilitating nurses’ participation in decisionmaking processes. The integrated conceptual framework presented in this study—which combines structural (Durkheimian) and perceptual (Keyes’ model) approaches—can serve as a basis for practical planning, human resource health policymaking, and the development of evidencebased interventions.
Limitations
This study has several limitations. First, the predominant reliance on quantitative, crosssectional designs limited the depth of qualitative understanding of nurses’ lived experiences. Second, the lack of access to some unpublished theses may have introduced publication bias. Third, differences in operational definitions and measurement tools of social health across studies made data harmonization challenging. Fourth, the focus on Iranian studies restricts generalizability to other cultural and health system contexts. Fifth, the absence of longitudinal studies precludes definitive conclusions about trends in nurses’ social health over time.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles, including proper citation, scientific integrity, and respect for authors’ rights, have been observed throughout the research process. Given the metasynthesis nature of this study and the use of published data, obtaining an ethics code was not required.
Authors’ contributions
The authors contributed to the study design, systematic search, quality assessment of articles, data analysis and synthesis, and drafting of the initial manuscript. All authors have reviewed and approved the final version of the article.
Funding
This research received no specific grant from any funding agency. It was conducted with the internal support of Allameh Tabataba’i University.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to express their sincere gratitude to all researchers whose articles were utilized in this metasynthesis, and to all individuals who assisted us in conducting this research.
World Health Organization. (1948). Constitution of the World Health Organization. Geneva: WHO.
Larson, J. S. (1996). The measurement of social well-being. Social Indicators Research, 38(3), 285-296.
Keyes, C. L. M. (1998). Social well-being. Social Psychology Quarterly, 61 (2), 121-140.
Keyes, C. L. M., & Shapiro, A. D. (2004). Social well-being in the United States: A descriptive epidemiology. In O. G. Brim, C. D. Ryff, & R. C. Kessler (Eds.), How healthy are we? A national study of well-being at midlife (pp. 350-372). University of Chicago Press.
Wang, H., Zhang, D., Yan, F., & Hou, Z. (2018). Association between social health insurance and choice of hospitals among internal migrants in China: A national cross-sectional study. BMJ Open, 8(2), e018440.
Sandelowski, M., Voils, C. I., & Knafl, G. (2009). On quantitizing. Journal of Mixed Methods Research, 3(3), 208-222
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Received: 2025/06/10 | Accepted: 2026/06/29 | Published: 2026/08/31
Received: 2025/06/10 | Accepted: 2026/06/29 | Published: 2026/08/31
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