Today, with the development of societies and the improvement of living standards, the issue of Quality of Life (QoL) has gained considerable importance because the ultimate goal of development is to achieve the desired life (Abbasnia et al. 2019; Catré et al. 2019). Obtaining information about the status of QoL of different populations can be considered as basic information for planning and policy-making (Ko and Choi 2015). QoL can be considered on two aspects, objective and subjective, which in the objective aspect, indicators such as economic production (Sofer and Saada 2017), literacy rate, life expectancy at birth, or other data, without any valuing, will be used (Boncinelli 2015; McCrea et al. 2006; von Wirth et al. 2015). In other words, to assess respondents' experiences of their lives in terms of satisfaction, the subjective view of the quality of life is based on survey and interview tools (Singh et al. 2016; Shahraki et al. 2020), happiness (Senasu and Singhapakdi 2018), well-being (Sandhu et al. 2012; Proverbs et al. 2020), or things like that (Rastegar et al. 2017). However, at first, the emphasis of the researches was on examining the objective aspect of QoL, but since the 1970s, subjective indicators have also been used for it. Traditionally, various indices for instance death rate and life expectancy were used to calculate QoL, while these factors alone cannot estimate the QoL. “QoL” is a complicated, multidimensional, and qualitative term in association with the condition of a population at a particular geographical scale (Raphael et al. 1996). QoL is a broad notion that embraces concepts such as good, valuable, satisfying, and happy life.Therefore, the discussion of QoL has been the subject of many studies in various fields and disciplines such as health and medicine, environmental studies, psychology, economic studies, human geography, sociology, development studies, and other fields.It has not been possible to provide a comprehensive and uniform definition for it. One of the main reasons for this failure is the multifaceted nature of the concept (Darbanastaneh and Mahmoudi 2016; Tavares et al. 2014).Campbell et al. (1976) first looked at the subjective and psychological characteristics of QoL. The importance of the issue of QoL has caused different perspectives, among which, from the perspective of health researchers, the concept of "Health-related QoL” has been proposed as a vital and practical issue (Hays et al. 1993). This was achieved at a time when odd diseases like COVID-19 had not yet emerged, and in the current context of coping with different diseases, a health-related QoL is becoming more important.
Dimensions of QoL
However, most experts and scholars in this field have an opinion that QoL has different dimensions including ecological, spiritual, communal, and physical ones. For example, Rahiminia et al. (2017), in a study entitled "Evaluation of Physical, Mental, Social, and Environmental Quality of Life in Female Students Living in Dormitories of Qom University of Medical Sciences," examined the quality of life in four aspects: physical, social, psychological, and ecological ones, and the psychological dimension was the lowest. In another research entitled “Health-Related QoL in Iranian Patients with Type 2 Diabetes: An Updated Meta-Analysis,” they found that among patients, physical health had the lowest status (Mokhtari et al. 2019), and in another research, Kazemi Karyani et al. (2019) found that among the 4 dimensions of health-related QoL, poor QoL in Iran was approved.
In general, questions related to the physical dimensions of humans, including self-care and the ability to perform daily activities, strength, as well as symptoms of disease such as pain, are interpreted and measured. The feeling of well-being and the quality of people's relationships with colleagues, family, friends, and the community are explained in the social dimension (Olsen and Misajon 2020). This is especially true when measuring the psychological dimensions of psychological signs, including fear, depression, anxiety, and deprivation (Xie et al. 2018). The quality of the environment around human life is assessed for biology and components such as salary satisfaction, type of job, or job satisfaction in the environmental dimension (Sharbatiyan and Imani2018; Qaderi et al. 2019).
In General, within the former few eras, there has been a rising focus on understanding and measuring people's health beyond traditional health indicators. One of these indicatorsis the World Health Organization's QoL Index.Health is one of the sets and components of QoL, but it is not equivalent because health is well-defined by the WHO as “lacking any physical, psychological, or communal defects,” while QoL is a sense of life satisfaction, and this life may or may not be associated with health, so QoL has a wide-range meaning that includes all features of life. Health is the center and gravity of QoL (Skevington and Epton 2018).Meanwhile, the World Health Organization has provided one of the best definitions of QoL which is: value systems, a person's understanding of their life situation, in the context of culture and in relation to their standards, expectations, concerns, and goals )Hawthorne et al. 2006).
QoL in rural areas
Along with the significant increase in relocation from the countryside to urban areas in the last century, some villages have accepted immigrants. Therefore, immigrants who cannot afford to live in cities, due to the availability of cheap land and housing, as well as the relative expansion of the intercity transportation network and ease of access, settle in the villages around the cities. This overflow of the population will have consequences, one of which is the transformation on the outskirts of cities. Villages around these cities are not left without these changes and changes occur in their socio-economic, environmental, and physical structure and sometimes cause the formation of settlements. RURBAN or rural urbanization is the integration of urban and rural social structures on the outskirts of metropolitan areas. Suburban villages, economically and politically, are dependent on cities and are usually considered dormitory cities because immigrants who have come to big cities and towns for work, etc., due to their inability to provide housing, inevitably choose to live around cities, which are cheaper. This overflow of the population has consequences, one of which is the transformation of villages to RURBANs. In fact, these settlements, on the one hand, enjoy some benefits and services due to their proximity to the city, and on the other hand, because of this proximity, face problems that affect their QoL, health, and overall life gratification.
In the last three decades, developing countries have seen increasing urban population growth. Most of this urban population growth has occurred on the outskirts of metropolises and large cities. Demographic changes in the metropolitan area of Tehran also show that in the last three decades, the urban population has tripled and the surrounding areas of the metropolis of Tehran have increased eightfold. Therefore, most of the population of Tehran metropolis has settled on the outskirts of the city. Tehran province in the 2011-2016 period had more than 20% of the country's immigrant population (951248 people) and the figure in the period of 2006-2011 was equal to 17.7% (equivalent to 979636 people), which has been the most immigrant-friendly province in the country (DSITP, 2016). Tehran, as a metropolis, is facing an increasing influx of immigrants, and such rural areas around it, as a complementary arena for its functions, accept part of its residential role as a dormitory. The formation and expansion of these villages around Tehran have been a spontaneous phenomenon without any planning. Attracting the population to these villages has not been done by decentralizing the metropolis of Tehran, but by attracting rural immigrants from other parts of the country, who are not able to live in Tehran, at least for a short time. Therefore, the formation and expansion of these villages around Tehran did not reduce the population pressure on Tehran. By contrast, they have increased it indirectly.
Among all QoL studies, the QoL in rural areas around metropolitan areas has not been addressed. The poor cannot live in metropolitan areas because of the high cost of living; therefore, they are forced to live in rural areas around these areas.The real gap in relation to the rural areas of the metropolitan areas, which has led to the formation of several challenges in these villages, in addition to the lack of integrated management in the metropolitan areas, is a lack of rural development programs and a lack of attention to QoL in these areas.Failure to concentrate on the QoL in these rural zones will lead to a change in the functioning of the villages from the productive, economic, and residential functions to urban labor dormitories. However, by carefully examining the QoL situation in these rural areas, careful planning can be done to develop these areas in accordance with their main function. Development of rural regions is in line with the expansion and enhancement of the QoL of the villagers, and the villages will achieve development when the QoL has undergone a fundamental change, and these changes in QoL begin with the implementation of rural development steps in an infrastructural manner (Gholami et al. 2016) (Spellerberg et al. 2007) (D’Agostini and Fantini 2008) (Yang et al. 2017).
Bernard et al. (2016) identified the causes of deficiency in rural regions. The results of these researchers revealed that the absence of decent quality is more common in rural districts. In rural areas, factors such as transportation options, employment, infrastructure, housing, etc. are limited in terms of viability. These restrictions reduce the QoL in these areas and provide fewer living conditions compared to cities, and therefore reduce population. (Bernard 2018). The goal of QoL in rural spaces is to stabilize the population of rural households and their fair access to resources in rural areas (Pourtaheri et al. 2011). The role and position of villages at different regional scales in political, social, and economic development processes are obvious. Outcomes of not concentrating on QoL in rural spaces can be growing inequality, poverty, rapid expansion of residents’ in urban areas, job loss, urban marginalization, migration, etc., which show the need for essential attention to rural development and its importance to urban development, especially in the metropolises of Tehran province, the center of Iran. The outcomes of this study can be considered as primary information and statistical documents in rural development policies and programs.
Relation of QoL with general health and life satisfaction
Health-related QoL is a multi-aspect notion that comprises social, psychological, physical, and environmental aspects. In this view, these dissimilar aspects of HRQOL structure layers of life satisfaction and general health (Yin et al. 2016). Life satisfaction occurs when basic needs are met and satisfied (Veenhoren 1999). Life satisfaction indicates the degree of satisfaction of basic human desires and needs, and it is why the concept of satisfaction is related to need. Human, as the most complex and complete being in the world of creation, has various and endless needs and motivations that affect his goals and activities. Therefore, life satisfaction can be considered as satisfying human needs, positive perceptions, and pleasant feelings of people towards the realms of life (Di Castro et al. 2018). Michalos (2014) in his research confirmed that there is a noteworthy relation between QoL and life satisfaction. Furthermore, in a study entitled “The Relationship Between Life Satisfaction with QoL and Subjecting Wellbeing in Tehran Teachers,” the results showed that life satisfaction can be predicted through two variables, namely personal well-being and QoL (Farani et al. 2009). According to Maja and Ayano (2021), population and natural resource growth are significantly associated with climate change and the ability of farmers to adapting to climate change, particularly in developing countries with fast changes in resource-dependent demographic and economic changes. One of the important factors in environmental degradation is rapid population growth, which is a fundamental force and threat to the sustainable use of natural resources. These issues reduce the quality of natural resources and their quantity through land fragmentation, intensive agriculture, and over-exploitation. Lack of arable land in areas with increasing population leads to reduced soil fertility and shorter fallow removal and farm incomes due to farmland fragmentation. In addition, landless people or those who work on small farms, settling or cultivating marginal land, reach for natural forests in search of more vacant land, which changes the dynamics of sinking the carbon source in the environment. Food insecurity is exacerbated by low-income farmers working on small farms, limiting their ability to use some of the technologies adapted to climate change. In another research entitled “Relationship Between Life Satisfaction and QoL in Turkish Nursing School Students,” there was an important relationship between life gratification and QoL (Yildirim et al. 2013). Other studies showed that QoL is a predictor of general health (Aguilar et al. 2009) (Aghaei et al. 2013). An individual’s general health is the condition of his/her body and the degree to which it is free from disease or is capable to fight it. The only question “How is your health in general?” is an unpolished and easy measure that has been broadly used, as it grants researchers a brief description of an individual's general state of health (Simon et al. 2005) (Galenkamp et al. 2020). This scale is confirmed to be a strong forecaster for people’s health (Idler and Benyamini 1997), and this general health is strongly affected by the QoL of individuals.
Previous studies (Badiora and Abiola 2017; Nyamathi et al. 2017; Hongthong and Somrongthong 2015) have concluded that the satisfaction of peoples with life may be hemostatic, meaning that their level of satisfaction with life remains constant. This may not be possible in terms of life satisfaction of low-income families in rural communities. The satisfaction of rural communities may have changed with a combination of higher levels of relentless rural poverty and a welfare reform constitution. In fact, understanding the realization of deprivation, which is the perceived difference between people's desire and success, may indicate a level of life satisfaction. Eventually, life satisfaction contributes to QoL, sometimes known as feelings of happiness or mental well-being. QoL may be described as the level to which individuals are able to meet their psychological needs or as a general understanding of the satisfaction of their needs over time. With the use of data from a project such as the current research of rural low-income families, we evaluated the influence of variables representing different forms of capital (public health and satisfaction of life) in low-income villages. This study investigated the perception of life satisfaction and QoL in a highly disadvantaged, yet neglected, group using longitudinal data and four dimensions of QoL in a unique combination. In addition, rural areas are very heterogeneous with urban areas in terms of income level, poverty, and QoL. The significant rate of rural poverty is an important justification for research into its characteristics. Another justification based on these observations is that rural experiences of QoL are often different from those in urban areas and this can affect the QoL, life gratification, and general health of villagers. Improving the QoL in rural communities is recognized as the final aim of development programs in rural regions. However, the primary precondition for achieving the mentioned goal is to provide suitable living situations that can improve the QoL for villagers. In addition, there is a great challenge today for many planners to understand that living conditions can provide a good quality of life for any individual or community.
Now, this research intends to investigate the QoL of the villagers of Tehran metropolisand find out which of the four aspects of QoL has better and which has worse status. In addition, it examines the relationship of QoL with general health and life satisfaction among rural people of Tehran metropolis.
In general, the present study seeks to answer the following two questions:
1) What is the status of QoL in rural spaces of Tehran?
2) What is the relation of QoL with life gratification and general health?
Research Background and conceptual framework
Today, QoL as a key element in policymaking is called one of the basic indicators of development. Numerous studies have been conducted in this field and researches show that the QoL in the medical field is 8 times higher than the study of the QoL in the social sphere. The following are some of these studies. As it is clear in Table )1(, Quang Vo et al. (2018), Kar et al. (2017), Yang et al. (2017), Sreedevi et al. (2016), and Lodhi et al. (2019) used the WHOQOL-BREF questionnaire to calculate the QoL; Yildirim et al. (2013) investigated the “Relationship Between Life Satisfaction and QoL in Turkish Nursing School Students,” and Simon et al. (2005) paid attention to the relation between general health and QoL (Table 1). However, none of the previous studies has examined the effect of QoL on life satisfaction and general health, which is one of the innovations of the present study, and this research intends to fill this knowledge gap.
[Insert Table 1]
Based on the researches and field studies of this research, it intends to calculate the status of QoL in 4 general dimensions in the rural regions of Tehran province and evaluate the impact of these dimensions on life satisfaction and general health (Figure 1).
Fig. 1 is developed in the form of equation modeling structure to show the structural model of the research, which consists of measurement models. The model for measuring the QoL based on the questionnaire of the World Health Organization (WHO) includes a latent variable and a number of observed variables (physical, psychological, and social relations and environmental dimensions). In addition, in this model, feeling good is measured as a latent variable through observed variables (general health and life satisfaction).
[Insert Fig. 1]