Exploring the capability approach to quality of life in disadvantaged population groups

The capability approach argues that having effective choices and fair opportunities are essential to maintain and promote one’s own health and quality of life (QoL). This study examines the determinants of QoL in four disadvantaged population groups (young people not in education, employment, or training; long-term unemployed; refugees; older people living alone) within the framework of the capabilities by tracking the direct and indirect effects of individual and structural factors and capabilities on their QoL. Cross-sectional data (N = 866) with validated scales of quality of life (physical, social, psychological, and environmental QoL) and self-reported capabilities were utilized. Individual factors included age and gender and structural factors education and income. Descriptive statistics and structural equation modelling with latent variables were used for statistical analyses. Our results suggest that capabilities have crucial direct and mediating roles in achieving good QoL in the disadvantaged population groups. Individual factors had only small effects whereas especially the structural factors affected QoL through capabilities. Our results suggest that to reduce health inequalities and to promote wellbeing, policies should focus on improving both the structural factors and the individual capabilities of people in disadvantaged positions.publishedVersionPeer reviewe

Varhaisessa kotoutumisen vaiheessa olevien pakolaistaustaisten aikuisten elämänlaatua selittävät tekijät

ENGLISH SUMMARY Reeta Kankaanpää & Niko Eskelinen & Csilla Veszteg & Janet Anand & Tomi Mäki-Opas & Marja Vaarama & Samuli Neuvonen: Factors explaining quality of life among adult refugees in the early stages of resettlement (Varhaisessa kotoutumisen vaiheessa olevien pakolaistaustaisten aikuisten elämänlaatua selittävät tekijät)Refugees are exposed to harmful living conditions, trauma and various stress factors and to changing social relations before, during and after migration. These circumstances and factors can influence their perceived quality of life (QoL). However, the pathways of these circumstances and factors are still largely unknown.The aim of this study was to examine the pathways from socioeconomic factors, trauma experiences, posttraumatic stress symptoms and loneliness to perceived quality of life. The data consisted of 210 adult refugees recently resettled in Eastern Finland. Data on health and well-being and several background factors were collected using a self-administered questionnaire, which was professionally translated into Arabic and Farsi-Dari. QoL was measured using 24 items of the WHOQOLBREF scale that covers physical, psychological, social and environmental QoL. Structural equation modelling with suitable model fit indexes were applied using MPLUS 8.Loneliness and post-traumatic stress symptoms were negatively associated with physical, psychological, social and environmental QoL. Female refugees had lower physical and psychological QoL, and increased age decreased their physical QoL. Living in a relationship and good education increased QoL, downplaying the negative effects of loneliness and post-traumatic stress symptoms. The negative association of trauma experience was mediated to QoL through loneliness and post-traumatic stress symptoms. Sufficient income was positively associated with psychological, social and environmental QoL. All the previous factors explained 19 to 35 per cent of the variance in the four dimensions of QoL among refugees. To promote QoL among adult refugees, social, financial and psychological help and support should be offered to those suffering from posttraumatic stress and loneliness. It is also necessary to offer refugees appropriate support for the use of their many skills and other positive resources, for their own benefit and for the benefit of society as a whole.Keywords: refugees, quality of life, loneliness, post-traumatic stress symptoms, structural equation modelling.</p

SOTE-uudistuksen vaikutusten ennakkoarviointi

Tämä raportti on Terveyden ja hyvinvoinnin laitoksen laatima asiantuntija-arvio hallituksen esitysluonnoksesta laiksi sosiaali- ja terveydenhuollon järjestämisestä. Arvio on tehty sosiaali- ja terveysministeriön toimeksiannosta, ja sen alustava versio julkaistiin joulukuussa 2013. Sote-lakiehdotuksen vaikutusten ennakkoarvioinnissa haetaan vastausta kysymykseen, miten hyvin ehdotus vastaa sille asetettuun tavoitteeseen muuttaa sosiaali- ja terveydenhuollon järjestämisen kansallista rakennetta nykyistä vahvemmaksi ja kestävämmäksi. Asiaa tarkastellaan erityisesti peruspalvelujen vahvistamisen ja palvelujen integroinnin sekä palvelujen saatavuuden, saavutettavuuden, laadun ja yhdenvertaisuuden näkökulmista. Lakiehdotusta käsitellään myös sosiaali- ja terveydenhuollon IT-kehityksen ja tietohallinnon näkökulmasta. THL:n arviointi perustuu julkaistuun tutkimustietoon tai muutoin dokumentoituun kokemukseen kansallisista kokeiluista ja kansainvälisistä uudistuksista, asiantuntija-arviointeihin ja saatavilla oleviin kustannustietoihin