Explaining Social Well-being in the Perspective of Retired Men of the Armed Forces: A Qualitative Content Analysis
2 Department of Intensive Care Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran, Email: email@example.com
Citation: Afshar PF, et al. Explaining Social Well-being in the Perspective of Retired Men of the Armed Forces: A Qualitative Content Analysis. Ann Med Health Sci Res. 2018;8:209-214
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Introduction: The social well-being is a dimension of individual health which is neglected in medical sciences. It has a significant effect on the quality of life and health. Thus, this study was conducted aiming at explaining social well-being from the perspective of the retired men of the armed forces. Method: This is a qualitative content analysis. The nine retired men of the armed forces participated in this study. The sampling started and proceeded purposefully until the saturation of the data. The data were collected through a semi-structured interview. The data analysis was conducted using the directed content analysis approach of Hsieh and Shannon (2005) using MAXQDA v.11 software. Results: Data analysis led to the extraction of 400 initial codes in six generic categories, including social integration, social acceptance, social contribution, social actualization and social coherence and financial well-being. Conclusion: This study showed that the dimensions of Keyes social well-being theory were confirmed in the Iranian retired men of the armed forces. Considering the socio-economic changes, the financial well-being dimension can be justified which was added to the present study.
Aged; Military Personnel; Health; Social well-being
The world faces a phenomenon called the rising population of older adults, due to factors such as medical progress and the reduction of mortality and birth rates. It is estimated that by 2020, the world’s older adult population touch 1 billion.  In Iran, based on censuses the old population is also on the rise.  Paying special attention to the needs of older adults is crucial in the community.
Health is one of the important needs of the older adults. [3,4] Based on the Health definition provided by the World Health Organization in 1948, health is “The state of complete physical, mental and social well-being, and not merely the absence of illness and disability”, It was the first time that social wellbeing was placed along with physical and mental well-being.  The well-being was generally studied with two hedonism and eudaimonism well-being. In the hedonic approach, the purpose of life is happiness and avoidance of suffering; however, in the eudaimonic approach, the purpose is to achieve good traits. 
The cognitive well-being is one of the most important components of individual well-being.  The social well-being is one of the newest concepts raised in the field of sociopsychological theories.  Dimensions of the social well-being are determined based on a research approach (hedonism and eudaimonism well-being) and the research level.  Social wellbeing falls into three levels: personal, interpersonal and social. The researchers study in a hedonic approach, at the personal level (e.g. alienation and abnormality), at the interpersonal level (e.g. violence) and at the social level (e.g. poverty and crimes); and in the eudaimonic approach, at the personal level (e.g. social contribution) at the interpersonal level (e.g. social support) and at social level (e.g. social capital). [9,11]
The Keyes theory is one of the latest theories on social wellbeing, which deals with this concept at the individual level and eudaimonic approach. Based on this theory, social wellbeing at the individual level includes five possible components (social integration, social acceptance, social contribution, social actualization and social cohesion), these dimensions each reflect the challenges that human beings face it as a social being. 
The core of social well-being is the dynamic nature of life; the experience of life is the product of the interaction of the social structure and the individual, which helps the individual to assess his or her social well-being; therefore, we must focus on the internal and subjective reports of older adults in the studies on the experiences of life of them, to gain a deep and comprehensive understanding of the concept of social well-being.  The older adults live in a world with their own specific psychosocial dimensions; until now, there has been little attention paid to the type and importance of social well-being dimensions for the older adults. 
The concept of health and its dimensions in each society returns to the common sense of the people of that society from their health and culture.  Iran is a country in the Middle East that has recently undergone rapid social and economic changes.  Therefore, this research was conducted aiming at explaining Social Well-being in the Perspective of Retired Men of the Armed Forces at a personal level and eudaimonic approach.
Materials and Methods
This is a directed content analysis. Nine retired men of the armed forces in Tehran participated in this study. The inclusion criteria consisted of willingness to participate in research, age range 60- 75, and being male. There are no criteria for determining the number of samples in the qualitative research, and sampling will continue until no other information is received from participants.  Sampling started as of November 22, 2017, and continued until saturation on May 22, 2018, such that in the last two interviews no new code was extracted pertaining to the research purpose.
A semi-structured interview was conducted after explaining the research purpose, and obtaining a written consent from participants for data collection. The interview with the older adults was in-person and in a quiet place, preferably in the retirement center. Keyes theory was used to prepare interview questions. Interview began with greetings and demographic questions. Then, a few questions were used as the interview guidance (e.g. can you explain about the Iranian community? How do you consider your community? Can you explain about well-being? Explain your feelings about well-being in the society? What factors make you feel well-being in the society? What factors reduce your well-being in the community? Can you elaborate on it?). In total, 9 interviews were conducted with each participant for 20-60 minutes. The interview was recorded by a digital voice recorder and transcribed and analyzed at the first opportunity.
The data with the directed content analysis method was used in order to achieve the purpose of the research. When there is a theory or research about a concept this approach is used. Such type of analysis aims to develop or credit a conceptual framework or previous framework.  Considering the wide concept of social well-being, the theory selected in this type of study can contribute to the focus of the research purpose and will also be useful in the initial encodings and relationships between the codes. The present study used the social well-being theory presented by Keyes.
The content analysis was done by Hsieh and Shannon method.  Three stages of preparation, organization and, reporting were proposed for data analysis in this method. In the preparation stage, after transcribing the interviews to text, each text was read several times for data immersion and thus obtaining a comprehensive perception of the interviews. Then, in the organization process, using MAXQDA v.11 software, the codes were assigned to semantic units during reading the text. The codes were compared in terms of difference and similarity, and those that imply on one meaning were placed in the categories corresponding to the theory. Then, on the basis of conceptual and logical relationship, the possibility to place these categories in the main categories of the matrix, or the formation of the new main categories were investigated. At the end of this stage, the researcher achieved a general description of the social wellbeing concept.
We have allocated enough time to collect and analyze data (more than five months). The Member Check, permanent and ongoing involvement approach with the research subject was used in order to ensure the validity of the findings. For providing confirmability, peer check method was used.  This study was approved by the Ethics Committee of the AJA University of Medical Sciences.
Nine retired men of the armed forces participated in this study, consisting of two 2nd Lieutenants, two 1st Lieutenants, two captains, one Major, one lieutenant colonel, and one Colonel. The mean age of participants was 67.44 ± 4.33 (range 60-75). All participants were married and had a work experience of 30 years. The level of education was from elementary to an academic degree (elementary degree: 2, diploma degree: 5, and an academic degree: 2). Based on data analysis, six categories were formed pertaining to social well-being: social integration, social acceptance, social contribution, social actualization and social coherence, financial well-being. Table 1 shows summary of categories, sub-categories and initial code.
|Sense of value
|Family and Work relationship
|The attention of society to the older adults
|Having high military experience
|Unemployment and vanity
|Changing the society
|Changing the behavior of the people in society
|Use of communication networks
|Keeping track of the day's issues
|The imbalance between income and expenses
|Feeling financial security
|Concern about the future financial situation
Table 1: Categories and sub-categories of social well-being in the perspective of retired men of the armed forces.
The first category formed pertaining to the main purpose of the research was social integration. Participants in this category referred to the following sub-categories: a sense of value and good relationships. Social integration was the most important factor of social well-being to the opinion of older adults participating in the study.
A sense of value: A sense of being valuable and important was the feeling that somehow expressed by all participants. The a-68-year-old participant said: “My rank was Major, I used to control a large part of the office, and I still can be useful for my country.” Another older adult aged 64 with the 2nd lieutenant rank stated: “People are valued with their job when retired, all will leave you.” Another participant said: “I was a captain and quite active in the housing co-operative office, now that I am retired, I am busy with construction, it’s going well thank God”. A Colonel aged 65 expressed that “I used to be much more important, but I still work now, and I do not want to be useless”.
Relationship: Sub-category relationships played a highlighted role in the neighborhood, in the family, among friends and society. An older adult said: “Before retirement, I used to see my colleague every day and we were happy, I controlled many soldiers, now I am more in contact with the family, and sometimes I see colleagues in the retirement center.” Or another one said: “Previously, my relationship with my wife and children was limited, but now I spend more time with them.”
Individuals with desirable social acceptance accept others’ weaknesses and deficiencies and have a positive attitude toward the society (1). Social acceptance was another category formed in regard to the main research purpose. Trust and dignity were sub-categories extracted from interviewing participants.
Trust: In sentences expressed by older adults, trust refers to the experiences of the individual toward community, for instance, an older adult aged 73 stated: “People are so good, they help me when I need their help in working with ATM”, on the other hand, an older adult aged 63 said: “I don’t like to get out, once I went to bank to get some cash from the bank, when I came home, a youth came to my house, threatened me and stole my money, I knew what to do, if I was young.
Dignity: Decline in the relationship of older adults will put the negligence of other people into the attention of them, for instance, an older adult aged 71, said: “when boarding a bus or subway, the young people give me their seats, I get so happy when I see such behaviors “ an older adult with 1st lieutenant rank stated: “I used to live in the Qasr Firoozeh town, I was accustomed to it, I knew all the neighbors, but since I got retired and came here, I live in a different environment with unfamiliar neighbors. I don’t know anybody and I don’t go out a lot, previously military uniforms highly affected people’s behavior, but after retirement, I could not wear military uniforms.”
Social contribution is closely related to the concept of selfefficacy, i.e., “the individual is able to perform certain behaviors to reach specific purposes”.  The subcategories extracted from the interviewees in the study were experience and efficiency.
Experience: Considering the fact that the older adults retired in the disciplinary force have long been in the organization and are familiar with each and every aspect of their organization, feel that they can share these experiences with their other young colleagues. An older adult aged 68 stated that “I’d been in the army for thirty years, I know the rules and the military issues, and I can be of use in at least some things”.
Efficiency: Efficiency was a problem that was expressed among the older adult participants in a variety of ways, some said: “I still have the strength and ability to work”, whereas others said the opposite: “No, I’m old now. I cannot be of use like before. “Of course, this issue was quite relevant to the age and morale of the individual. By and large, older adults with a more passive morale were reluctant to work. For instance, a Captain said: “I got retired but I work and still I am helpful and I have to work for the family and members, the children are still dependent on me.” Considering that the retirement process in Iran done immediately in government agencies, and people are compulsorily retired after 60, people generally face with this difficulty, for instance, a 65 year old retired man said: “My job is now sitting home, I wander outside and visit friends, but I have no jobs. “ an older adult aged 61, said: “ I could be very helpful, if I was invited to work again” or an adult aged 63 said: “They still call me to repair the airplane.”
Social actualization is identifiable through hope in potential abilities of the social institution and people of the society.  The sub-categories obtained from the interviewees included changes in society and social support.
Social change: Change in society is unpleasant for the Iranian older adults, especially if it affects their financial issues. The 63-year-old man stated: “It’s quite different (society), the country has progressed, works are well-being, and it’s not as hard as the past, for example, when I am sick I go to the hospital and they quickly deal with my illness”. A 1st lieutenant said: “A few days ago, my son came and took me and his mother out, the city has changed so much, and it is not like the past”. Iran’s society is moving from tradition to modernity, and changes are shifting into complexity. The a-68-year-old adult said, “The world has become strange, our time was not like this, people have become strange, it is not clear what is going on”.
Social support: An older adult aged 72 said: “My children pay so much attention to me, when I get sick they quickly arrive and take me to a doctor. When I go to the retirement center, they treat perfectly and have good facilities, and provide me with traveling facilities and loan”. One of the participants stated: “The government does not think about us, we served for thirty years, they do not provide us with facilities, there are all facilities for the employees, there is no raise in our salary, I went to an Etka store yesterday, (the store for the armed forces) and saw that they introduced some items for the workers but nothing for us.”
Understanding the events occurring around a person is logically having a vision of the world.  The interview with the participants in this study obtained the technology sub-category and being updated.
Technology: Using mobile and social networks have become very common in the Iranian community. Younger older adult people are more likely to use new technologies, but older adult people use it less. “Since the advent of mobile, I spend most of my time with it, I constantly search in various networks”, another older adult said. “There has been much medical advancement, I’ve had a heart problem, but I visited a doctor and my problem got fixed quite quickly,” said another 61-year-old aged adult.
Being up-to-date: Following up the day issues was a category extracted from speaking with older adults. An older adult aged 63 said, “I read the news of the day in the mobile phone, looking for what’s happening in the country, it’s interesting to me”. Another participant stated: “I look for health-related material and what can I do to be better.”
Financial well-being is investigated in two objective and subjective approaches, but in this study, the subjective approach was considered. Financial well-being is a person’s perception of his financial condition.  Interview with the participants obtained this category, which included financial satisfaction and financial security feeling.
Financial satisfaction: financial satisfaction was a sub-category heard a lot in the older adults’ words about the economic issues of the society. An older adult aged 63 said, “My salary does not meet my livelihood, I have a student son, I can’t afford the expenses, there is so much expensiveness, I work with a taxi, but that doesn’t suffice”. Another participant stated: “I have my pension and I have another job, things are fine, my children are married and gone, I do not have financial issues.”
Financial security feelings: This sub-category was mentioned fewer than others. An older adult aged 65 said “It’s not clear what’s going on, I do not know if I can afford my expenses, things are getting expensive, I got retired seven years ago, well recession is getting higher every day, but my salary has not risen so high, I do not know what to do. “ A participant with the 2nd lieutenant rank stated: “I didn’t let myself to stay unemployed, I quickly found another work, that job is very good so that the recession does not bother me.”
The aim of this study was explaining social well-being in the perspective of retired men of the armed forces. The findings of this study showed that the dimensions of social well-being theory (social integration, social acceptance, social contribution, social actualization, and social coherence) were obtained for the Iranian retired men of the armed forces; but the financial wellbeing dimension was formed in this concept. The retirement is a stressful life event for the militants and it causes loss of their dignity, power, and independence. It is mentioned that the retirement of a military person resembles the conversion of a whale to a fish in a small pond. [21,22]
Keyes states social well-being is an individual’s evaluation of his social function, the quality of his or her relationships with other people and social groups and the place in which he or she lives.  The dimension of social integration is an evaluation of the quality of individual communication with others in society, and it is interpreted as the range in which a person feels to be part of the society and has attachment to the society.  A sense of value and good relationship in society are significant indices of social integration. Based on Erikson’s socio-psychological development theory, the elderly people evaluate their lives;  This evaluation is influenced by the social context in which the individual lives. A sense of value is related to the life satisfaction and the quality of individual’s relationships in society. Social acceptance reflects one’s confidence in others and a sense of peace with them.  Two subcategories of trust and dignity were obtained in this study that was consistent with the above definition. The concept of dignity overlaps with the sense of value, but the social roles are an important source of dignity.  It has been found that not to wear a military uniform would reduce the sense of dignity of military personnel after retirement,  it is also perceived in social communication.  Social contribution refers to the feeling that how much does a person performs is valuable to the community.  In this study, sub-categories of experience, and efficiency were found to which indicated person’s perception on their efficiency in society. Social contribution is especially important for the older adults,  and this can be due to the feeling of being efficient and having experience. A study in 2009, found that 15.5 percent of retired men of armed forces claimed their willingness and efficiency to return to the work.  Social actualization is the evaluation of community development and being hopeful toward the future of society.  According to this definition, the subcategories: social change and social support were the most important classes that came from the older adult content analysis. The social change relates to the perception of the organization of institutions in society. Social coherence is the perception and predictability of the society for individuals.  The use of mobile phone and social networks is common in Iran during recent years, so, subcategory of technology can be justified. Sub-category of “being up-to-date” lead to the perception of what’s happening around an individual.
Financial well-being was the new category that was formed in the concept in this research. Financial well-being in the present study included categories of financial satisfaction and financial security. At first, financial well-being seems to be related to a hedonic approach, but this concept related to sub-categories such as social support and efficiency. Due to the rapid demographic and socio-economic changes that are taking place in Iran, the population is rapidly aging. [2,14] The social support structures of the older adults have not yet been well established in Iran, and the older adults are more vulnerable to economic change than other age groups. Financial well-being is defined by the consent of the current financial situation of the individual.  Financial satisfaction sub-category reflected the financial ability of a person to have a desirable life. The sub-category of financial security feeling related to the economic changes and its effect on the life of individuals.
Social well-being is one of the basic needs of humans. This study showed that the dimensions of the Keyes’ social wellbeing theory, which were obtained at the individual level and with a positive psychological approach, were confirmed in Iran. The only dimension that was obtained in this study was the financial well-being that is justifiable given the socio-economic changes. Dimensions of social integration, social acceptance, social contribution, social actualization, social coherence and financial well-being, together explained the concept of social well-being in the perspective of the retired men of the armed forces.
The research team appreciates the older adults and AJA University of Medical Sciences personnel who helped us in conducting this research.
Conflict of Interest
The authors disclose that they have no conflicts of interest.
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