The general health status and its relationship with life skills among service recipients of comprehensive health service centers in Iranian setting: a descriptive-analytical study

Abstract

Objective

Enhancing a community’s health is essential for societal growth and development. Life skills and a healthy lifestyle can improve mental health and overall well-being. This study investigates the relationship between life skills and general health status among service recipients of comprehensive health service centers in Khalkhal County, northwest Iran.

Results

A total of 365 participants were included in the study. The mean life skills score was 123.63 (SD = 29.32) and the mean general health score was 30.52 (SD = 15.43). A significant negative correlation was found between life skills and general health (r = -0.55, P < 0.001). Factors such as marital status, age, economic status, type of basic insurance, supplementary insurance, and underlying diseases were identified as predictors of general health. The relationship between life skills and all dimensions of general health was statistically significant (P < 0.001).

Introduction

The World Health Organization (WHO) defines health as complete physical, mental, and social well-being, rather than merely the absence of disease or infirmity [1, 2]. In the past, health professionals primarily focused on treating diseases; however, they now emphasize disease prevention and health promotion through improved lifestyles. Individuals who possess these skills take greater responsibility for their health [3, 4]. Studies have shown that many psychological and social problems, such as addiction to smoking, alcohol, and drugs, reliance on psychiatric medications, antisocial behaviors, and various mental health disorders, are the result of weak life skills, requiring timely attention and intervention [5].

Acquiring essential life skills enables individuals to respond to significant life events effectively [6]. “Life skills” refers to a broad set of psychological, social, and interpersonal skills to help individuals make informed decisions, communicate effectively, develop coping and personal management skills, and lead healthy, fulfilling lives [7]. A person’s lifestyle is closely linked to their health. WHO has stated that 60% of a person’s quality of life and health status is determined by their behaviors and lifestyle choices [8]. Research indicates that life skills education plays a significant role in improving overall health and quality of life [9].

Quality of life indicators in Iran are on the rise. The central provinces have experienced the highest growth in terms of environmental and social indicators [10]. A comprehensive study carried out in Iran found that socioeconomic status, social capital, and gender are the most significant factors influencing improvements in health-related quality of life [11]. Research among students indicates that their health is at risk, particularly concerning anxiety, depression, and both social and physical well-being [12]. Studies involving patients reveal that this group experiences higher levels of depression and anxiety [13]. Additionally, more than half of workers reported experiencing social dysfunction, and approximately 40% reported the prevalence of social disorders [14].

It can be argued that the presence of healthy individuals is one of the essential conditions for the growth of a community. Improving life skills contributes to better health, as the enhancement of these skills fosters a healthy lifestyle and reduces health risks. Numerous studies have focused on promoting health-related life skills education, particularly among students and patients [15, 16]. However, the life skills training package developed by the Iranian Ministry of Health and Medical Education has shortcomings regarding prioritization, relevance, and cultural considerations [17]. The levels of health-promoting behaviors vary across different regions of Iran [18], suggesting we can expect variations in general health as well. So, this study aimed to explore the relationship between life skills and general health status among patients attending comprehensive health service centers in Khalkhal County.

Methods

Study design

This descriptive-analytical study was conducted from July to October 2024 in the northwest region of Iran (Khalkhal County).

Study setting¹

Khalkhal County is situated in the southern part of Ardabil Province, covering an area of 3,980 square kilometers. As of 1402 (according to the Iranian calendar), the population of the county was 84,149, consisting of 43,021 men and 41,128 women. The population breakdown reveals that 18.54% are under the age of 15, 68.64% are between the ages of 15 and 64, and 12.82% are aged 65 and older. Khalkhal County has a total of 26,779 households, with 14,042 located in urban areas and 12,717 in rural areas. The crude birth rate is 7.78, the crude death rate is 7.02, and the general fertility rate stands at 1.3. Additionally, the population growth rate is 6.4%.

Study population, sampling method, and sample size

The study population for this research consisted of individuals aged 18 and over who referred to urban and rural comprehensive health service centers (Centers 1, 2, and 3) in Khalkhal city.

The sample size was determined based on a study by Mousavi et al., which estimated a sample size of 362 participants [19]. The parameters used for the sample size calculation were p = 0.62, which relates to the outcome and the variable for the sample size determination, and q = 0.38. A maximum allowable error of 0.05 and a 95% confidence interval were established:

$$\:n=\frac{{\left({Z}_{1-\raisebox{1ex}{$\alpha\:$}\!\left/\:\!\raisebox{-1ex}{$2$}\right.}\right)}^{2}*p*(1-p)}{{d}^{2}}$$

Convenience sampling was employed as the sampling method. The inclusion criteria for participants were: willingness to participate in the study, attendance at healthcare centers affiliated with Khalkhal Faculty of Medical Sciences as either a patient or a patient companion at the time of the study, and being over 18 years of age. Participants who did not complete the questionnaire were excluded from the study.

Data collection method

Once the proposal received final approval and we obtained permission from the Ethics Committee, we secured a letter of introduction from the Research Department of Khalkhal University of Medical Sciences to distribute the questionnaires. Participants were informed about the study’s objectives, and the questionnaires were provided for them to complete.

Study tools

This study employed three questionnaires. The first questionnaire was a demographic survey, which included items on age, gender, marital status, residence, education level, economic status, underlying medical conditions, type of insurance, and supplementary insurance coverage.

To assess the life skills of participants, the Life Skills Questionnaire, designed by Saatchi colleagues in 2010 [20], was used. This questionnaire consists of 40 questions and 10 components. In this questionnaire, participants indicated their opinions on the components based on a Likert scale (5-point) ranging from very low (1) to very high (5). The highest possible score for an individual in this questionnaire is 200, and the lowest is 40. In Jamali’s study (2013), the reliability of the questionnaire was evaluated using Cronbach’s alpha coefficient, which yielded a reliability coefficient of 0.92, indicating an acceptable level of reliability for the tool [21].

The third questionnaire used in this study is the General Health Questionnaire (GHQ-28). This questionnaire was designed by Goldberg and Hillier in 1979 [22] and contains 28 questions. It asks respondents to indicate, using a 4-point Likert scale, the extent to which they experience general health. The scoring method is based on the Likert scale, where responses are scored as 0, 1, 2, or 3. The maximum score for a respondent using this scoring system is 84. A lower score indicates better mental health. Goldberg suggests that participants with total scores of 23 or below should be classified as non-psychiatric, while participants with scores > 24 may be classified as psychiatric or not healthy [23]. Goldberg and Hillier reported the reliability of this questionnaire using Cronbach’s alpha as 0.84 [22]. In a study conducted in Iran by Taghavi, the reliability of the questionnaire was confirmed (Cronbach’s alpha = 0.9) [24].

Data analysis

For data analysis, SPSS version 26 software was used. In the analysis of the results of this study, descriptive statistics were applied to report the variables. Pearson correlation coefficient independent t-tests and analysis of variance (ANOVA) were used for comparisons. General linear regression analysis was employed to investigate the relationship between life skills scores and general health scores, while adjusting for some demographic variables. It should be noted that to adjust for confounders, some of them were eliminated as a result of determining the inclusion and exclusion criteria, and the rest were included in the data analysis stage using the regression method.

Results

Out of 380 distributed questionnaires, 365 questionnaires were collected from participants, resulting in a response rate of 96.05%. The average age of participants in this study was 40.39 years (SD = 16.85). Participant characteristics are presented in Table 1.

Table 1 The scores of life skills and general health based on participants characteristics (N = 365)

The mean total score for life skills (Mean = 123.63, SD = 29.32) was obtained, indicating a high level of life skills.The mean total score for general health (Mean = 30.59, SD = 15.43) was above the average level. But, 33.9% of participants classified as non-psychiatric, while 66.1% of participants with scores > 24 classified as psychiatric or not healthy. The scores for the study variables, broken down by dimension, are presented in Table 2. The mean score for single participants (Mean = 129.03, SD = 27.58) was higher than that for married participants (Mean = 120.46, SD = 29.9), and this difference was statistically significant (P = 0.007).

Table 2 The scores of life skills and general health

Based on the Pearson correlation test, a statistically significant correlation was found between the total life skills score and the general health score (r=-0.55, P < 0.001). The correlations between the ten dimensions of life skills (except for the interpersonal skills dimension), and the four dimensions of general health were statistically significant (P < 0.05 or P < 0.001).

Table 3 showed a statistically significant relationship between total life skills and total general health (p < 0.001). For each unit increase in life skills, general health decreased by 0.29 units (a lower general health score indicates better health status). The relationship between total life skills and all general health dimensions was also statistically significant (p < 0.001).

Table 3 General linear model of life skills and general health and its dimensions adjusted for confounders

Discussion

This study aimed to determine the relationship between life skills and general health status among visitors to comprehensive health service centers in Khalkhal County. The results indicated a significant relationship between these two variables. Previous research has demonstrated that life skills education can effectively improve mental health, social skills, and reduce depression, anxiety, and stress [25].

The study showed a high overall mean score for life skills among participants. Self-awareness training scored the highest, while cooperation and participation skills scored the lowest. A similar study by Abouei et al. found that youth in Yazd province also had life skills above the theoretical average, with the highest in understanding freedom, justice, and equality, and the lowest in cooperation and participation skills [26]. In the study by Ghorbani and Tajik Esmaili, Tehran citizens had a slightly above-average life skills status, with a significant difference between women and men [27]. Similarly, in the present study, life skills were higher in men than women and higher in single individuals than in married ones significantly. We found that life skills were higher in individuals with older age and higher education. Interestingly, those with poorer economic status demonstrated greater effort to improve their life skills.

The overall mean score for general health in this study was above average, with the highest scores in somatic symptoms and general health status, and the lowest in anxiety. Jannati et al. found that many elderly participants had mild to severe general health issues, particularly in anxiety, sleep disorders, and depression, despite better scores in somatic symptoms and social functioning [28]. In Osmani’s study of rehabilitation center staff, general health was slightly below average, showing a positive correlation between social adaptation and mental health, and a negative correlation with COVID-19-related anxiety [29]. A systematic review by Armino et al. showed that the prevalence and incidence of anxiety/depression symptoms among athletes ranged between 21 and 48% and 17–57%, respectively [30]. Madadi Ardekani and Kamkar found that cancer patients reported good general health, though their social functioning was low [31]. In the present study, the general health status among participants was good, considering they shared similar economic, social, and living conditions. However, further research suggests that when the variables studied increase alongside general health, their effects become more apparent.

The results of the study showed a significant correlation between overall life skills and general health, with a 0.29-unit improvement in health for each one-unit increase in life skills. Arshadi et al. highlighted a strong relationship between total life skills and general health, noting that life skills had a greater impact on social functioning than on other health components [32]. A study by Bagheri et al. found that emotional creativity significantly relates to life skills and mental health, explaining 35% of the variance in mental health, with life skills acting as a mediator [33]. Similarly, the study by Salehi and Rasouli found that there was a relationship between communication skills and mental health among elderly individuals covered by the Welfare Organization in Kashmar County [34]. Yousefnejad et al. reported improvement in quality of life and general health for the experimental group, demonstrating the effectiveness of the life skills training program [9]. A study by Amirfaryar et al. found that life skills training positively affected the mental health of mothers with children facing psychological disorders [35].

Studies from various parts of the world have revealed similar findings. For instance, a study by de Oliveira et al. involving older adults in Brazil demonstrated that health-related quality of life (HRQoL) was linked to better physical condition, nutritional status, and self-assessed general health [36]. Additionally, research by Bang et al. highlighted that Southeast Asian Refugees (SEAR) faced worse physical and mental health compared to the general U.S. population. Factors such as trauma, resettlement stress, and a lack of community or religious engagement were associated with mental health issues [37]. Furthermore, Mahajan et al. indicated that Black individuals with low income had the highest estimated prevalence of poor or fair health in U.S [38].

Strengths and limitations

From the results of this study, we can extract skills that are effective and prioritized for improving public health. But this study was conducted in a specific area and on a specific group of the population. To enhance the generalizability of findings, recruiting a larger and more diverse participant is crucial.

Conclusions

This study provided valuable insights for policymakers and planners in the supportive and social sectors, enabling effective interventions to enhance the community’s public health status. The findings indicated that more than 50% of participants were classified as experiencing psychiatric issues. Our results highlight the significant role that life skills can play in influencing general health. Therefore, it is recommended when prioritizing life skills education, across different demographic groups. Teaching these skills can lead to substantial improvements in physical, social, and overall health, while also reducing symptoms of depression and anxiety. Thus, it is advisable to implement comprehensive life skills training at the primary education level in schools.