Quality of life

In general, one must point out that there are numerous approaches to explain the phenomenon of quality of life. This chapter provides an overview of central concepts and measurements in QOL research but does not attempt to cover the entire range of models in this field. Instead, the chapter focuses on QOL concepts that have proven themselves in the tourism context and whose strength is an investigation of tourism conditions in terms of the research question of the present thesis.

Following the WHO definitions of both health and quality of life, it is evident that QOL research needs a multidimensional approach. According to the World Health Organization, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 2020, p. 1). The definition of quality of life is even broader. It is seen “… as an individual's perception of their position in life in the context of the culture and value systems in which they live and concerning their goals, expectations, standards, and concerns” (WHO, 1998).

Before QOL aspects are discussed in relation to tourism impacts, it is vital to focus on the characteristics of QOL itself. Understanding the influencing factors on someone’s quality of life is essential to gain more profound knowledge about its impacts and interrelations. As the WHO definition of quality of life mentioned at the beginning of this chapter shows, this

approach can be seen as a synthesis of diverse research efforts. Moreover, Andereck and Nyaupane (2011, p. 248) note that there are over 100 definitions of the term “quality of life”.

To analyze the complex interrelationships of the factors influencing the quality of life, it is advisable to divide the concept or the influencing factors into different dimensions, as shown in the following table.

Table 23: Domains for quality of life, defined by WHOQOL Physical Psychological Level of

independence

Social relationships Environment Spirituality Pain

Source: Based on Naude-Potgieter, R.‑A., & Kruger, S. (2018). The bet is on: A case study of the Naudé-Potgieter model of casino employees's happiness in the workplace. In M. Uysal, M. J. Sirgy, & S. Kruger (Eds.), Managing quality of life in tourism and hospitality (pp. 138–151). Wallingford, Boston, MA: CABI.

From the above table, it can be deduced that quality of life cannot be equated with the term

“health”, but requires a much broader approach (Irtelli & Durbano, 2020, p. 2). Depending on the perspective and research focus, it becomes clear why researching quality of life issues is a multifaceted endeavor. Each of the dimensions mentioned by the WHO can be studied with great care and offers numerous different questions. Combining different elements allows for an unmanageable number of approaches to explain individuals' quality of life phenomena or entire societies. Schalock et al. (2008, p. 182) developed an action-oriented approach to classify and further investigate the quality of life of population strata:

Table 24: Framework of dimensions of quality of life

Factor Domain Exemplary indicators

Independence Personal development

Education status, personal skills, adaptive behavior

Self-determination Choices/decisions, autonomy, personal control, personal goals Social

participation

Interpersonal relations

Social networks, friendships, social activities, interactions, relationships

Social inclusion Community integration/participation, community roles, support Rights Human (respect, dignity, equality)

Legal (legal access, due process)

Well-being Emotional well-being Safety & security, positive experiences, contentment, self-concept, lack of stress

Physical well-being Health & nutrition status, recreation, leisure

Material well-being Financial status, employment status, housing status, possessions Source: Schalock, R. L., Bonham, G. S., & Verdugo, M. A. (2008). The conceptualization and measurement of quality of life: Implications for program planning and evaluation in the field of intellectual disabilities.

Evaluation and Program Planning, 31(2), 181–190. https://doi.org/10.1016/j.evalprogplan.2008.02.001

In principle, people's quality of life can be researched based on objectifiable data and subjectively collected attitudes. Naturally, this results in disadvantages either on the one hand (objective data) or on the other hand (subjective data). By combining data from measurements or observations with information obtained from personal interviews or surveys, the above disadvantages can be largely circumvented (Schalock et al., 2008, p. 183).

Vennhoven (2012) shows another approach of classifying factors influencing the quality of life and demonstrates the concept of the “Four qualities of life”.

Table 25: Four qualities of life

Outer qualities Inner qualities

Life chances Livability of environment Life ability of the person Life results Utility of life Satisfaction with life

Source: Veenhoven, R. (2012). Happiness, also known as “Life Satisfaction” and “Subjective Well-Being”. In K.

C. Land, A. C. Michalos, & M. J. Sirgy (Eds.), Handbook of Social Indicators and Quality of Life Research (pp. 63–78). Dordrecht: Springer.

Regarding the above table, Vennhoven points out that quality of life depends on “opportunities for a good life and the good life itself”. Whereby the so-called “outer qualities” can be equated with the quality of the environment, and the “inner quality“ is connected with the personal attitude (Veenhoven, 2012, p. 63).

Magnini, Ford & LaTour (2012, p. 52) conclude that there are three basic ways of looking at the quality of life: (1) when our lives conform to the moral code of accepted systems such as religion or philosophy, (2) when people use their limited resources to satisfy their preferred desires, and (3) when a person perceives his or her own life as a good life.

This qualitative approach is contrasted with the collection of standardized data over a certain period. These so-called social indicators include key figures such as “unemployment rates, crime rates, estimates of life expectancy, health status indices, school enrollment rates, average achievement scores, election voting rates“ (Kenneth, Michalos, & Sirgy, 2012, p. 1). However, not only objectively measurable data play an essential role. The measurement of subjective data concerning the personally experienced quality of life is also included in the research of social indicators (Piedmont & Friedmann, 2012, p. 313). It is precisely the collection of these “well-being“-related data that has received considerable scientific attention in recent decades (Noll, 2004, p. 7).

After this first attempt to describe the factors influencing the quality of life, it is now appropriate to examine how to measure the QOL of residents. According to Irtelli & Durbano (2020, p. 6), research instruments investigating quality of life should consist of the following dimensions:

(1) physical, (2) psychological, (3) level of independence, (4) social relationships, and (5) environmental dimension.

Over the past decades, numerous indicators are reliable in terms of what they say about the quality of life research.

WHOQOL-100 / WHOQOL-BREF / WHO-5

“The instrument is organized into six broad domains of quality of life. These are: physical domain; psychological domain; levels of independence; social relationships; environment; and spiritual domain. Within each domain, a series of sub-domains (facets) of quality of life summarize that particular domain of quality of life” (WHO, 1998).

WHOQOL-100 consists of 100 items and is used for profound analyses of life circumstances, whereas WHOQOL-BREF consists of 26 items (Angermeyer, Kilian, & Matschinger, 2000).

However, both instruments show reliable evidence, to gain more profound knowledge about social aspects of QOL WHQOL-100 should be the choice (O'Carroll, Smith, Couston, Cossar,

& Hayes, 2000). WHO-5 is an even shorter questionnaire, primarily aimed at the rapid survey of mental well-being (Topp, Østergaard, Søndergaard, & Bech, 2015).

UNDP Human Development Index (HDI)

The HDI is based on the premise that it takes more than just economic indicators to measure the prosperity of a country's population and make it internationally comparable. As shown in the following figure, the HDI is based on three dimensions: (1) health dimension (e.g., life expectancy), (2) education dimension (e.g., education index), and (3) standard of living dimension (e.g., GNI¹³) (UNDP, 2020).

Figure 16: UNDP Human Development Index (HDI)

UNDP (2020). Human Development Index (HDI). Retrieved from http://hdr.undp.org/en/content/human-development-index-hdi

DIMENSIONS INDICATORS

DIMENSION INDEX

Long and healthy life Life expectancy at birth

Life expectancy index

Knowledge Expected years

of schooling

Mean years of schooling Education index

A decent standard of living GNI per capita (PPP $)

GNI index

Human Development Index (HDI)

The HDI is characterized by the necessary level of complexity and detail to provide a profound assessment of the quality of life of a population (Crouch & Ritchie, 2012, pp. 493–494).

SF 36 / SF 12 Short Form Health Survey

According to Ware & Sherbourne (1992), a 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) “limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems;

4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions” (Ware & Sherbourne, 1992). The SF-12 is a shorter version of the SF-36, which can provide results similar to those of the SF-36, although there are some limitations to be considered (Jenkinson et al., 1997).

In addition, there are a large number of setting-related questionnaires, which are based on specific clinical pictures, for example (Kohlmann, 2013; Schalock et al., 2008; Thieme, 2021;

Weiling, 2015), target specific groups of the population (Borrmann, Hofer, Rehb, Pechstädt, &

Wulz, 2018; Marans & Stimson, 2011; Nunkoo & Ramkissoon, 2011; Zobeltitz, 2016) or survey the quality of life of the population in a particular region or neighborhood (Amt der Steirischen Landesregierung, 2019; Bonaiuto, Fornara, Ariccio, Ganucci Cancellieri, &

Rahimi, 2015; Dębek & Janda-Dębek, 2015; Holmes, Galik, & Resnick, 2019). Thus, in the research of the relationships between the development of tourist regions, numerous survey instruments have also been developed in recent decades.