Our study aimed to investigate the association between social capital and SRH among the married women in four western provinces of Iran. Finding of our study could fill gaps in our knowledge of social capital and SRH among married women in the context of Iran as a developing country. Our finding showed that mean of SRH among the married women was relatively high. It was inconsistent to those reported in Khawaja and Mowaf study [18] and was similar to Brown et al.[19]. Also, our finding indicated that considering the attainable range of social capital score, the mean of the social capital in the married women was relatively high.
According to our findings, higher social capital was associated with increase in SRH in the married women. This finding was consistent with the results of previous studies [20–22]. Kim et al. (2007) in the United States found that people with higher levels of social capital experienced few days with poor physical and mental health (boredom and ill-health) and activity restriction [23]. Result of a study in Japan showed that women who actively participated in the social group were more socially empowered compared to women with lower social participation, which is conceptually consistent with the present study [24]. Herzong et al.'s (2002) also showed that lower social participation and social support (as indicators of social capital) have negative effects on people's health [25]. However, a study conducted in Iran showed that there was no significant association between participation in social or local activities, being active in the social context, and quality of neighborhood communications with perceived health [26].
Also, our finding showed a correlation between the relational dimension of social capital and SRH among the participants. This dimension was more strongly correlated with SRH than others. Also, among the subscales of communication, trust had the highest correlation with SRH. Most theories of social capital emphasize two key elements including trust among social members and participation in social organizations [27]. Social trust is a positive ethical orientation among individuals in a community with essence of community-based moral expectations [28]. Girdano et al. (2010) in a study showed that an inability to trust others was significantly associated with poor health, while social participation was significantly associated with improved health over time [29]. Meng et al. (2014) also assessed the association between social capital and health among urban and rural population in China and found that among the components of social capital, only trust had a significant effect on health [30]. The findings of our study showed that cognitive social capital had a positive and significant association with participants’ SRH. This finding is consistent with the past study by Rajabi et al. (2013) among Iranian teachers [12]. Cognitive social capital addresses qualitative dimensions of social capital and encompasses variables such as values, reciprocal norms, and collaboration. It can affect overall health by creating health-related behavioral norms, controlling risky behaviors, social support, and creating unofficial information exchange tools. While the cognitive dimension of social capital is considered as a key factor in moving individuals to health action, the structural dimension is also effective as facilitator. Social support as a component of cognitive social capital promotes health through highlighting the sense of belonging and solidarity in individuals as well as enhancing the performance and self-esteem [12].
Our findings also showed that the structural dimension of social capital was correlated with the women's SRH. The growth of voluntary service associations and participation of women in those as a structural dimension of social capital can enhance the vertical and horizontal relationships between people and improve their health. The associations can build trust and partnership at the macro, middle and micro levels of community through warm and symmetrical relationships and creating material and emotional opportunities, and subsequently strengthening the social relations network [31].
According to our finding, education and employment were associated with SRH among the participants. These findings are consistent with those in Yousefi et al. study (2010) [32]. Previous studies showed that the mental health status of employees is better than non-employed, which is consistent with the results of the present study [33, 34]. According to Keyes and Shapiro (2004), attention to the effect of social context in health is an important issue which should be considered in healthcare and medical interventions [35]. Although Field (2006) has emphasized that the psychological approach to trust and control are apart from social environment and government policies [11], however, the general pattern of evidence such as the findings of our study and similar studies illustrate the positive association between social capital and health. Putnam discussed that social capital through social networks is related to health in four ways: first; social networks reduce anxiety through tangible benefits, second; networks reinforce the health measures, third; networks can better address the demand for health services, and fourth, social interaction and activation make the body's immune system more active [36].
Our study has two limitations that have to be considered when interpreting the findings. First; using a large sample size from four provinces resulting in more precise estimates. Second; a very high response rate (94%) along with a randomly selected sample decreased the possibility of selection bias. However, there would be a possibility of measurement bias, because of the self-reported nature of data gathering.