EXERCISE AND QUALITY OF LIFE
Research article
Volume 3, No. 2, 2011, 31-42
UDC
613.99:616-058
PHYSICAL FUNCTIONING AND GENERAL HEALTH OF
WOMEN FROM URBAN AND RURAL AREAS
Sara Szakal*
Master degree student
Faculty of Sport and Physical Education
University of Novi Sad, Serbia
Abstract
Women generally live longer than men because of both biological and behavioural advantages;
still womenís longer lives are not necessarily healthy lives. Considering that women from rural
areas are often recognized as particularly vulnerable social groups concerning quality of life and
physical activity, the study was conducted aiming to determine physical functioning and general
health of women from urban and rural areas, as well as to examine differences between them in
these health domains. Sample comprises of females aged 30 to 60 yrs, totally 146 participants
(73 from urban areas, 73 from rural areas). For the purposes of this study two scales, Physical
functioning and General health perceptions, from the SF-36 Health Survey. The results obtained
show that significant differences between two groups of participant exist in both domains, with
more positive self-perceptions of physical functioning in urban females and more positive global
health perceptions in rural females. These results confirm that personal satisfaction and
perception of oneís global health are affected not merely by the physical functioning, but by
other health components as well.
Keywords: women, health, physical functioning, rural areas, urban areas
Introduction
According to a traditional definition, health means the absence of diseases. The
Constitution of the World Health Organization defines health as "A state of complete physical,
mental, and social well-being not merely the absence of disease or infirmity". The examination
of health and the effects of health care must also include the evaluation of well-being, which can
be estimated by measuring the improvements of the quality of life. WHO defines the Quality of
Life as an individual's perception of their position in life in the context of the culture and value
systems in which they live and in relation to their goals, expectations, standards and concerns. ÑIt
* Corresponding author. Faculty of Sport and Physical Education, University of Novi Sad, Lov„enska 16, 21000
Novi Sad, Serbia, e-mail: mipele@freemail.hu
© 2010 Faculty of Sport and Physical Education, University of Novi Sad, Serbia
S. Szakal
is a broad ranging concept affected in a complex way by the person's physical health,
psychological state, personal beliefs, social relationships and their relationship to salient features
of their environmentì (WHOQOL, 1997) .
Women generally live longer than men because of both biological and behavioural
advantages, still womenís longer life is not necessarily a healthy one (WHO, 2009). They lack
basic health care, especially in the teenage and elderly period of life, in spite of the fact that they
live on average six to eight years longer than men, warns WHO.
The problem of womenís quality of life and health acquires an additional dimension
when observed from the aspect of how urban the area they live in is. The women in the rural
areas represent a specific subpopulation and not often do they stay out of sight of the scientist
working in the field of physical education and sport. The efforts which, on the global level, are
put in achieving the equality of women in society have brought about an ancreased interest in
womenís health and quality of life.Women from the rural areas constitute a specially vulnerable
and marginalized social group .
The survey conducted on the sample of women from the rural areas and the women who
live in the remote parts of Australia showed that there are some differences in the health state,
health habits and health services (Byles, Mishra & Brookes, 2005). This study was conducted
with the purpose of examining the changes in health of the older Australian female population by
comparing the abundant key indicators of health and health care in three time points. The factors
which were the subject of comparison were: health state (quality of life in comparison to health,
symptoms, sight, hearing, help with everyday activities, falling down); healthy way of life
(smoking, physical activity); and using health services. Since it can be expected that the women
from the rural and remote parts of Australia are different from the ones who live in the urban
areas, there was a comparison of these variables for urban and rural populations, or the
population living in the remote parts of Australia.
In Australian longitudinal study of womenís health- better known as Australian
Womenís Health (ALSWH) - the participants were aged between 70 and 75 at the time of the
first examination in 1996. After that they were asked to fill in the questionnaire twice and the
third survey was conducted in 2005. In the survey the women had to answer a large number of
closed-type questions about their health and the way of life. 12.432 women aged between 70 and
75 took part in the first survey (in 1996), 8647 women took part in the survey 3 (69% of the
sample), while 8397 women took part in all surveys. All in all, there were few differences in the
health state between the women who live in urban areas, big rural, small rural and other rural and
remote areas and regions in every of the given surveys. Even though the changes in womenís
healt status were relatively small, they started occurring more often in the second survey. Even
though the need for the formal health protection was not singnificanlty higher, it has significantly
increased during the period of six years of observation. The main difference between women
from different surroundings lay in the fact that the ones from the urban surroundings used,
generally, a higher level of health protection. The data from ALSWH also indicated that the
women who moved to a more urban area suffered from more symptoms of a bad health state,
weaker mental health, a greater desire to have an approach to the system of health care, but at the
same time they used health services less than those who never moved. These data indicate the
fact that the women who moved from rural to urban areas are more susceptible to diseases and
they potentially represent a group of endangered elderly women who require a special treatment
by politics and planning, as well as the analysis of the problem in comparison to the spatial
distribution of inequality.
Cleary and Howell (2006) conducted a research with the purpose of examining the
experience that people from the rural area of the state of Idaho, aged 65 and over, had about a
high quality of life. SF-36 questionnaire was filled in by 95 people in total. The obtained results
were compared to the normative values of general American adult population and the specific
32
Physical functioning and general health of women
normative values for the people aged 65 and over. Women aged 75 and over had a lower level of
the physical health component. The results showed that the participants in the survey aged 75
and over had a higher quality of life in comparison to the expected values. That also shows that
living in rural areas is not an indicator of a lower quality of life for elderly people (Cleary &
Howell, 2006).
Taking into account that the women from the rural areas were often recognized as a
specially vulnerable group when it comes to the quality of life and taking part in physical activity
and sport, the goal of this study was to establish the physical functioning and general health of
women from urban and rural areas, as well as to examine the differences between them in the
two observed aspects of health.
Method
The research was conducted within the frameworks of a project at the Faculty of Sport
and Physical Education in Novi Sad called ìImprove your health by exercisingî, aimed at
women and directed at following the influence of physical activity on their health. The
participants from cities were surveyed at the beginning of the project, while the ones from the
rural area were surveyed separately in the field.
Participants
The sample of participants consisted of women aged between 30 and 60, in total 146
participants. The sample of participants was divided in two subsamples: 1) participants from
urban area (in total 73 participants) and 2) participants from rural area (in total 73 participants).
The sample of the women from the rural area was convenient; it consisted of the women who
voluntarily applied for the project ìImprove your health by exercisingî at the Faculty of Sport
and Physical Education in Novi Sad. The participants from the rural area were recruited in the
village Svilojevo.
Measuring instruments
In this research the general health questionnaire SF-36 (Short Form Health Survey) was
used. The past experience with this questionnaire has been recorded in 4000 publications. It
covers eight aspects of health (eight subscales) or 36 items (questions). What is obtained is an
eight-dimensional profile of functional data about health conditions and the level of well-being,
as well as the summary of measures of physical and mental health based on psychometric data
and the index of general health conditions. There are eight health concepts chosen out of forty
covered by the Medical Outcomes Study or MOS (Stewart & Ware, 1992). The chosen concepts
are the ones which are widely used for health examinations and at the same time those which
have the strongest influence on diseases and their treatment (Ware, Snow, Kosinski, & Gandek,
1993; Ware, 1995). It is assumed that eight subscales form two separate sets on a higher level
because of the variance of physical and mental health which is mutual for them. Physical
components are: physical functioning, physical role, physical pain and general health. Mental
components are: mental health, emotional role, social functioning and vitality. This research
included two aspects of the physical component of health, or two subscales with the appropriate
items: Physical functioning and General health.
Three subscales (Physical Functioning, Physical Role and Physical Pain) mostly correlate
with the physical component and add to the result of Physical Component Summary or PCS
(Ware, Kosinski, & Keller, 1994). The mental component mostly correlates with the scales
mental health, emotional role and social function, which also add to the Mental Component
Summary or MCS. There are three subscales (Vitality, General Health and Social Functioning)
33
S. Szakal
which show noticeable correlations with both components. Scoring in the subscales is done in
accordance with the original key, so for the items with three possible items an participant can get
0,25 or 50 points, depending on the chosen answer, while for the items with five possible
answers an participant can score 0, 25, 50, 75 or 100 points. The direction of scoring depends on
the orientation of the item; higher score always indicates a more positive aspect of health. The
total result on a subscale represents an average score on items which form that scale. The internal
consistency of Physical Functioning and General Health subscales is relatively high (0.824 and
0.834 respectivelly).
Methods of data processing
The data were processed by using the descriptive statistics and the differences in the
observed aspects of health between the subsamples of the women from urban and rural areas
were examined by applying t-tests for two independent samples. The statistical package SPSS
was used for data processing. In the chapter Results first of all the differences between two
groups of participant on Physical functioning subscale are presented, followed by the results of
analyzing the differences in individual items of this subscale. After showing the differences
between two groups of females on the subscale General health, the differences in individual
items of this subscale are presented.
Results
Physical functioning
Table 1 contains basic descriptive indicators of the participants from urban and rural ares
on the subscale Physical functioning. Figure 1 shows mean values of the participants from the
observed groups on the subscale Physical functioning. As the table 4 shows, the participants
from urban areas expressed numerically higher mean values on the subscale Physical functioning
in comparison to the participants from rural areas (93.56 to 89.79). At the same time, the range
of the results is higher in the rural subsample, which, together with higher values of the
coefficient of variation, indicates a greater homogeneity of the subsample.
Table 1
Physical functioning: basic descriptive indicators
N M SD MIN MAX CV%
Rural areas
73
89,79
13,73
45
100
15,29
Town
73
93,56
8,27
70
100
8.84
N ñ number of participants; M ñ arithmetic mean; SD ñ standard deviation; MIN ñ minimal result; MAX ñ
maksimum result; KV% - coefficient of variation
34
Physical functioning and general health of women
Figure 1. Participantsí average scores on the subscale Physical Functioning
1 - Participants from rural area
2 - Participants from urban area
The significance of the differences between two arithmetic means was tested by the t-test
for small independent tests. The results are shown in the table 2. From the table 2 it can be
concluded that the differences between the participants from urban and rural areas are
significantly different according to their mean values on the subscale Physical functioning (t=-
2,008; p= 0.046). Women from a urban area usually give significantly higher scores for their
physical functioning in comparison to the women from the rural area.
Table 2
Testing the significance of differences between the subsamples on the subscale Physical
Functioning
SUBSCALE
Subsample N M t-test p
Physical functioning Rural area
73
89,79
-2,01
0,05
Urban area
73
93,56
N ñ number of participants; M ñ arithmetic mean; p ñ level of significance
The analysis of the answers to individual questions (items) which belong to the subscale
Physical functioning gives a full insight in the specific nature of the subsamples. Mean values for
the individual items are shown in the table 3.
35
S. Szakal
Table 3
Testing the significance of differences between the subsamples on individual items of the
subscale Physical functioning
Number
Rural areas
Urban areas
of the
Item
t-test
p
item
M SD M SD
2
Vigorous activities, such as
running, lifting heavy objects,
71,23
35,28
73,29
32,36
-0,37
0,71
participating in strenuous
sports
3
Moderate activities, such as
moving a table, pushing a
94,52
15,73
93,84
18,53
0,24
0,81
vacuum cleaner, moderate
sports
4
Lifting or carrying groceries
91,78
20,44
95,21
14,82
-1,16
0,25
5
Climbing several flights of
81,51
29,47
89,04
20,83
-1,78
0,08
stairs
6
Climbing onf flight of stairs
97,26
11,46
99,32
5,85
-1,36
0,18
7
Bending, kneeling, stooping
79,45
32,10
87,67
21,70
-1,81
0,07
8
Walking for several
86,99
28,90
97,95
9,99
-3,06
0,00
kilometres
9
Walking several blocks
96,58
12,72
99,32
5,85
-1,67
0,10
10
Walking one block
98,63
8,22
100,00
0,00
-1,42
0,16
11
Bathing or dressing yourself
100,00
0,00
100,00
0,00
N ñ number of participants; M ñ arithmetic mean; p ñ level of significance
From the table 3 it can be concluded that the statistically significant differences on the
level of individual items exist only for the item number 8 (ìWalking for several kilometersî) in
favour of the participants from a urban areas, who are very close to the maximum results with
their average score 97.95. The participants from both subsamples are completely independent in
taking care of theur personal hygiene and putting on clothes (item 11). The lowest average scores
are obtained on the item number 2 which refers to physically demanding activities, where the
participants from the rural areas achieved a score 71.23 and the participants from a urban
areas73.39. Figure 2 shows regularity in the item which refers to walking as the most frequent
exercise: the longer it is, the lower their scores are (they see their physical functioning in more
negative light). Even though there are no statistically significant differences, except for walking
for several kilometers, it can be concluded that the participants from a urban areas achieved
numerically higher values in
9 out of
10 items which belong to the subscale Physical
functioning, which affected a significantly higher average score on this subscale in comparison
to the participants from the rural areas.
36
Physical functioning and general health of women
Figure 2. Participantsí average scores for the items refer to walking: Walking for several
kilometres (A), walking several blocks (B) and walking one block (C)
A
B
C
1 - Participants from rural area
2 - Participants from urban area
1
2
1
2
1
2
General health
Basic statistic indicators of the subsamples of women from urban and rural areas on the
subscale General health are shown in the table 4. Average scores for both subsamples are also
shown in the Figure 3. The participants from the rural areas achieved higher numeric values of
the total scores on the subscale General health (78.92 in comparison to 72.53 for the participants
from a urban areas). At the same time, the subsample of women from the rural area contained
lower minimal result, even though values of the coefficient of variation indicate equal
homogeneity of the subsample.
Table 4
General health: basic descriptive indicators
Sample N M
SD MIN MAX KV%
Rural areas
73
78,92
19,60
10
100
24,83
Urban areas
73
72,53
17,50
30
100
24,13
N ñ Number of participants; M ñ arithmetic mean; SD ñ standard deviation; MIN ñ minimal result; MAX ñ
maximum result; CV% - coefficient of variation
37
S. Szakal
Figure 3. Participantsí average scores on the subscale General Health
1 - Participants from rural area
2 - Participants from urban area
Table
5 shows the results of testing the significance of differences between the
subsamples on the subscale General health. It can be concluded that there are statistically
significant differences in the self-estimation of health in favour of the participants from the rural
area (78,92 to 72,53).
Table 5
Testing the significance of differences between the subsamples on the subscale General health
SUBSCALE Subsample N M t-test p
General health Rural area
73
78.92
2,08
0,04
Urban area
73
72,53
N ñ number of participants; M ñ arithmetic mean; p ñ level of significance
Descriptive indicators and t-test on the level of individual items (indicators) of General
health are shown in the table
6. Out of
5 itemswhich belong to this subscale, there are
statistically significant differences for only 2 items (ìI am as healthy as anybody I knowí and
ìMy health is excellentî). In both cases the participants from the rural areas showed higher
agreement with these claims in comparison to the participants from a urban areas. The highest
scores were achieved for the items number 12 and 14 which refer to suffering from illnesses or
expectations with reference to deteriorations of their health, where the participants from the rural
area denied the claim that they get sick easier than other people (AM= 84.93), while the
participants from a urban areas deny the claim that they expect their health to be deteriorated
(with the same average score). The lowest average score was expressed for the item number 13
(ìI am as healthy as anybody I knowî) in the subsample of the women from the urban area
(AM= 59.93) which shows that the majority of women were hesitant about agreeing with this
statement.
38
Physical functioning and general health of women
Table 6
Testing the significance of differences between the subsamples on individual items of the
subscale General health
Rural areas
Urban areas
Number
Item
t-test
p
of item
M SD M SD
1
Health now
65,48
28,30
67,47
27,22
-0,43
0,67
12
I seem to get sick a little
84,93
29,39
78,77
27,22
1,32
0,19
easier than other people
13
I am as healthy as anybody I
79,79
23,81
59.93
28,18
4,60
0.00
know
14
I expect my health to get
80,14
29,45
84,93
21,94
-1,12
0,26
worse
15
My health is excellent
84,25
20,63
71,58
26,78
3,20
0,00
M ñ arithmetic mean; SD ñ standard deviation; p ñ level of significance
Discussion
The examination of the differences in self-evaluation of physical health and general
health of the participants from the rural and urban surroundings indicated the existence of
statistically significant differences in both domains. When taking physical functioning into
account, women from the urban surroundings, who scored on average 93.56 in comparison to
89.79 (the score of the participants from the rural surroundings), have a significantly better
perception of their own physical capacities
On the other hand, the participants from the rural subsample were significantly better at
the evaluation of their general health (78.92 to 72.53 ).
This result, which may seem somewhat illogical at first sight, actually can be interpreted
in many ways. It is asuumed that the subsamples of women included in this research are
significantly different in the way of life, systems of value, roles they play, expectations of the
surroundings they live in and other. It is possible that women who live in cities have a better
coordination of their budget of time in comparison to the ones living in the rural areas, which is
supported by the fact that the participants from the urban subsample chose organized recreational
exercising.
On the other hand, the fact that the women from the rural areas included in this research
achieved significantly higher average scores on our subscale General health can be a proof in
favour of a multidimensional health concept, where physical functioning is just one of
components of good health and subjective feeling of well-being.
As pointed out in the chapter about the measuring instruments, the subscale General
health shows significant correlations with the mental and physical component, which means that
some other factors (apart from physical functioning) could improve the results of the rural
39
S. Szakal
subsample on this scale. To mention just a few, there is a different speed of life, less exposure to
stress, noise, pollution; greater and closer contact with the nature and its rhythms, stronger social
connection inside a family and neighbourhood and similar. All of them are the factors which can
improve the psycho-physical balance of the women from the rural areas. That indicates that
subjectively and/or objectively weaker physical functioning does not necessarily have to have a
negative influence on self-evaluation of general health.
It must be mentioned that the choice of sports and recreational activities of women in the
rural areas is extremely obscure. In a recent study about the position of female sport in
Vojvodina, it has been shown that all local government, except for éitiöte as the most
underdeveloped rural area, give certain amounts of money for financing sports clubs (-orði„,
2011). According to that research, percent of female sports clubs is 9%. Male clubs 47% and
both male and female 44%, which indicates an element of discrimination of women in the field
of taking part in sports clubs. éitiöte as a small rural area has the greatest percent of male sports
clubs (85%), which suggests that the problem is even more expressed in smaller areas. The
presence of the clubs which are available to women (female and mixed clubs) is significantly
smaller than those available to men (male and mixed clubs). Unequal opportunities for taking
part in any sport are the most obvious in éitiöte where one club covers 2618 women or 414 men.
The authors make a conclusion that women, especially in rural areas, have no adequate
possibilities for taking part in sports (-orði„, 2011).
An interesting research which dealt with the problem of rural areas not being present
enough was made by surveying a stratified sample consisting of 1621 village households
(Cveji„, Babovi„, Petrovi„, Bogdanov and Vukovi„, 2010). The existence of differences between
sexes in many aspects of life and work is supported by the finding that in their free time much
more women travelled and did some handicraft, while men chose recreation, hunting and fishing
(Cveji„ et a al., 2010). At the same time the research showed that, inspite of certain losses, there
is a significant social capital of people living in the rural areas. 80% participants confirmed that
they have a close social support in giving advice or emotional help. Observed from the point of
view of sexes, it is noticeable that men somewhat more rely on the closest social surroundings
when it comes to working habits and borrowing money, while women are ahead of them when it
comes to emotional support and the approach to institutions. These results support a possible
explanation of the results obtained in our research.
Women in the rural areas are traditionally tied to house chores socially acceptable ways
of spending free time
(spending time in the neighbourhood, in a ìfemaleî organization,
handicraft, etc). So, on one hand there is no adequate offer of recreational activities, support
from a family or wider community, while on the other it is not in accordance with the traditional
role of a woman to direct her free time towards sports-recreational activities. Women from
Svilojevo, who were members of the rural subsample, have no recreational activities they could
choose, or any professional help they could get in their individual exercising. All that could have
an influence on their negative perception of physical functioning in comparison to the
participants from a urban areas.
It is interesting that average scores of the participants from both subsamples are higher on
the subscale Physical functioning than on the subscale General health, which is also a
confirmation that personal satisfaction and perception of general health influence other aspects
of health as well.
40
Physical functioning and general health of women
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Submitted September 29, 2011
Accepted November 30, 2011
41