Measuring Subjective Wellbeing in Developing Countries.

The paper explores the conceptual and methodological issues entailed in using subjective measures of well-being in developing countries. In the first part I define, situate and contrast subjective quality of life (QoL), subjective well-being (SWB), and well-being. I also look at the conceptual and methodological shortcomings of subjective measures of well-being and suggest ways of overcoming these by combining different approaches. I then explore how an expanded concept of subjective quality of life fits into the theoretical framework of the UK-based Well-being in Developing Countries study (or WeD), specifically how it plans to produce a new, “development-related” profile of quality of life, drawing on the methodology of the WHOQOL group (1995; 1998)

Universal coverage but unequal access? Factors affecting the use of health services in Northeast & South Thailand.

Abstract Thailand’s rapid economic growth has brought health challenges as well as benefits, namely a rise in life expectancy to 6.5 years above the global average, and an ‘epidemiological transition’ from infectious and deficiency diseases, to chronic non-communicable diseases such as diabetes. Previous research in Northeast and South Thailand by the Wellbeing in Developing Countries ESRC Research Group demonstrates the importance of health to people’s subjective quality of life and wellbeing, and suggests that ill health is a significant problem - nearly a fifth of households in WeD sites experienced severe health-related ‘shocks’ during the past five years, and a third of household heads defined themselves as chronically ill. In 2001 the Government of Thailand introduced the Universal Health Coverage scheme to offer near-universal health care coverage. However, while this has reduced ‘out of pocket’ expenditures for healthcare and impoverishment through ‘catastrophic expenditures’, the perceived quality of its services mean it is in danger of becoming little more than a safety net and failing to ameliorate existing inequalities. This proposition is explored using the results of large-scale qualitative health study carried out by WeD with 245 men and women from different age groups and socio-economic statuses in Northeast and South Thailand, supplemented by WeD household survey data. The paper is divided into three parts; the first briefly introduces Thailand and the WeD sites, and describes the sampling and methodology. It also reviews current discourses about health and health issues in Thailand, and outlines the context to health and health services. The second presents data from the qualitative health research covering health risks, and the incidence and impacts of chronic illness and disability. The final section looks at the health seeking behaviour of people in the WeD sites (illustrated with case studies), focusing particularly on use of the UHC and traditional medicine

Outcomes of Orphanhood in Ethiopia: A Mixed Methods Study

The paper addresses the question of whether parental death always has a strongly negative effect on children’s outcomes using quantitative and qualitative data from Young Lives, a longitudinal study of childhood poverty in Ethiopia. It investigates the validity of potential mediating factors identified by other studies in Sub-Saharan Africa using data from the whole sample (n = 973) and explores these processes in-depth through the experiences of three orphans in one community in Addis Ababa. The paper concludes that the outcomes of orphans and non-orphans in poor communities are not significantly different, supporting the need to address vulnerability at a societal level. Nonetheless, specific groups, for example, older female children who have lost their mothers, may face particular risks that should be addressed with targeted interventions

What role for qualitative methods in randomised experiments?

The vibrant debate on randomized experiments within international development has been slow to accept a role for qualitative methods within research designs. Whilst there are examples of how „field visits? or descriptive analyses of context can play a complementary, but secondary, role to quantitative methods, little attention has been paid to the possibility of randomized experiments that allow a primary role to qualitative methods. This paper assesses whether a range of qualitative methods compromise the internal and external validity criteria of randomized experiments. It suggests that life history interviews have advantages over other qualitative methods, and offers one alternative to the conventional survey tool

Household trajectories in rural Ethiopia – what can a mixed method approach tell us about the impact of poverty on children?

The paper explores the dynamics of child and household poverty in rural Ethiopia using three rounds of household survey and qualitative data collected by Young Lives, a longitudinal study of child poverty. It uses a mixed-method taxonomy of poverty (Roelen and Camfield 2011) to classify children and their households into four groups: ultra-poor, poor, near-poor and non-poor. Survey and qualitative data are then used to analyse the movements in and out of poverty and explore the factors that underpin these movements. The use of mixed methods in both the identification of the poor and analysis of their mobility illustrates that the combined use of qualitative and quantitative information can lead to deeper insights and understandings. The paper reports a reduction in the percentage of poor households from 50 to 20 percent between rounds 1 and 3 (2002-9), following the ‘stages of progress’ posited in Roelen and Camfield (2011). However, these changes were not unequivocally beneficial to children (for example, the acquisition of livestock might mean dropping out of school to herd them). Ultra-poverty proved persistent with little change in the circumstances of the one in ten households classified as ultra-poor, who were vulnerable to illness, lending or ‘sharecropping-out’ land on unfavourable terms and exclusion from the government’s food-for-work scheme

What role for qualitative methods in randomized experiments?

The vibrant debate on randomized experiments within international development has been slow to accept a role for qualitative methods within research designs. Whilst there are examples of how „field visits? or descriptive analyses of context can play a complementary, but secondary, role to quantitative methods, little attention has been paid to the possibility of randomized experiments that allow a primary role to qualitative methods. This paper assesses whether a range of qualitative methods compromise the internal and external validity criteria of randomized experiments. It suggests that life history interviews have advantages over other qualitative methods, and offers one alternative to the conventional survey tool.

Why and How of Understanding ‘Subjective’ Well-being: Exploratory work by the WeD group in four developing countries.

The paper reviews participatory studies carried out in developing countries during the past decade and contrasts their findings with qualitative data from the initial phase of the Wellbeing in Developing Countries ESRC Research Group’s exploration of quality of life. This used primarily qualitative methods to establish the categories and components of subjective quality of life or wellbeing in four developing countries: Bangladesh, Ethiopia, Peru and Thailand. The comparison supports the proposition that a more open-ended approach provides insight into how people understand, pursue, and preserve their wellbeing. Subjective quality of life was not simply equated with happiness, but related to the aspects of life people regarded as important. For example, observing religion was part of both living well and being a model person, but not a source of happy memories, which suggests that treating happiness as the ‘universal goal’ is not sufficient to capture people’s motivations. People’s values and aspirations were ascertained via three questions: ‘When were you happiest?’ ‘What are the characteristics of a woman or man who lives well?’ ‘Who are the people you most admire/ respect or the best/ model persons of this community?’ The answers revealed many commonalities across sites and countries; for example, having good relationships with immediate and natal family was universally important (‘relatedness’). It also revealed cultural differences; for example, ‘not being materialistic’ was only characteristic of a ‘model’ person in Northeast Thailand, possibly because of its link to the Buddhist ideal of the ‘world renouncer’. Framing the enquiry in terms of wellbeing rather than poverty enables researchers to explore what poor people have and are able to do, rather than focusing on their deficits, which should produce more credible and respectful representations of people’s lives to inform development policy and practice. The desired outcome is development that creates the conditions for people to experience wellbeing, rather than undermining their existing strategies

What are the determinants of quality of life in people with cervical dystonia?

Background: Little is known about the quality of life in patients with cervical dystonia, although pain and depression are relatively common. Objective: To test the hypothesis that an individual’s ability to cope with the disease will modify the association of intrinsic, extrinsic, and disease related factors with quality of life. Methods: Patients with cervical dystonia diagnosed by a movement disorder specialist were recruited from seven European countries. Data on quality of life (SF-36), measures of coping, and intrinsic, extrinsic, and disease related factors were collected by a self completed postal questionnaire. Results: 289 patients (101 men and 188 women), mean age 55 years, completed the questionnaire. Both physical and mental quality of life scores were predicted by self esteem and self deprecation, educational level, employment status, social support, response to botulinum toxin, disease severity, social participation, stigma, acceptance of illness, anxiety, and depression. In multivariable analyses, the strongest predictors were anxiety and depression. Severe depression was associated with a 19.1 point decrement in the physical summary score (95% confidence interval, -31.7 to -6.6; p = 0.003); however, disease duration and severity remained predictors. Conclusions: Care for patients with cervical dystonia must not only focus on reducing the severity of the dystonia but also on the psychological wellbeing of the patient. Interventions aimed at treating depression or anxiety, especially of a cognitive nature, may have a large impact on improving quality of life

Cultures of of Aspiration and Poverty? Aspirational Inequalities in Northeast and Southern Thailand

The paper provides micro-level evidence of rising inequality in Thailand, using data from an intensive study of seven communities in Northeast and Southern Thailand. This inequality affects participants’ material and subjective wellbeing, their aspirations, and the extent to which they feel these are realised. The paper argues that adaptation, expressed as reduced aspirations, could explain why the effect of material poverty on people’s satisfaction with their lives is small. The reduction in attainment of aspirations linked to socio-economic status suggests that a small, but constant group of people are being excluded from a shift in the societal consensus over what constitutes a good life