Quality of Life Analysis Regarding Resources
for Different Income Levels

Baomei Zhao
University of Akron

Introduction

     The improvement in living conditions and quality of life1 is among the main goals of government at all levels. In recent years, efforts to monitor and systematically describe and analyze the current state of quality of life have been given new priority.
     The purpose of this study was to analyze the factors that affect quality of life among different income levels, adjusted for the use of community-based human services in the form of social services and income supports2 .  
     Two realities are obvious.  First, the research to date has been relatively limited with regard to quality of life and the use of household internal3 and external resources4.  Second, many community-based human services are provided according to the profit principle, funding source preference, or resources availability. There is little evidence to support a perception that those who make the decisions about what community human services to provide have used research-based findings when choosing the services to provide because the research on the effect of those services on quality of life is so sparse.  So a gap between theoretical approaches and actions taken by social service providers to improve quality of life exists. Thus, state government and public and private agencies are trying many different ways to improve quality of life through community services without truly understanding what services actually impact upon perceptions of quality of life. 
     The present research accepts the challenge to investigate quality of life and the detailed effects of urgent needs of individual/family and use of community human services in order to address this gap. Urgent needs were in six perspectives, whether worry that food will run out before getting money to buy more, whether worry about paying mortgage or rent, whether worry about being able to pay utility bills, whether the respondent has enough income to pay for prescription drugs the family needs, whether the respondent has enough income to pay for the family’s medical needs, and whether the respondent has enough income to pay for family housing.  With regard to the correlation between urgent needs and the community-based human services in the form of income support, the research reveals the aspects of individual, family or community-based human services have an effect on perceived quality of life.

Literature Review

     “Quality of life” denotes a set of wants, the satisfaction for which makes people happy. It reflects a combination of the subjective feelings and objective status of the “well-being” of people and the environment in which they live at a particular point in time (Cooley, 1998).   
     The status of the quality of life for any individual is interdependent in the following three mechanisms: “the intrapersonal capability of the individual, the interpersonal aspects with other individuals, and the political system or society in which they all live as members, namely, the self, the other, and the societal system” (Scott, 1971).  These three aspects are the self, the other and the societal system.  This paradigm is also in accordance with family resource theory that classifies resources/services as internal or external. 
So we can interpret quality of life regarding the family resources availability, where the quality of life that each individual (i) attempts to maximize may be expressed as an output function with two factor inputs--the Internal (IN) and the External (EX) – a portion of which one owns and a portion of which one shares with other people in the community at any given point of time (t):

QoL_it = F (IN_it, EX_it)                 (1)     
Where “i” stands for any individual, 1, 2, 3 …n;
            “t” stands for a point of time, 1, 2, 3…n;

     It should be noted that the input factors are not completely independent; they can be employed in varying proportions in the production of quality of life. As for resources, we assume the more the better, but because of some welfare regulations or scarcity of resources, we classify resources into internal or external. 
     It is possible that the internal inputs can be used as substitutes to a certain extent for the external inputs and likewise external inputs as substitutes for internal inputs. In fact, both IN and EX play an important role in determining the quality of life in the family system. In many cases, IN and EX can not be substituted fully for each other, for example, Medicare, as an external resource, can substitute for internal resources at certain level, but a further increase in Medicare would not increase a person’s education level or marital situation. So in this model, IN and EX are generally not perfect substitutes.
     Equation (1) is also represented in Figure 1— iso-quality curves, that are representations of combinations of factor inputs (IN) and (EX) so that the level of quality of life produced is the same for all combinations of the two input factors. Along this iso-quality curve, the availability of additional input from one category while holding the amount of the other input constant, beyond a certain level, will not enable an individual to acquire a better quality of life. For example, an input of OI” of (IN) and OE” of (EX) will produce the same level of quality of life, Q1, as does the combination of OI and OE, or OI’ and OE’ of (IN) and (EX), respectively. However, given (IN) input of OI,” any additional input of (EX) in excess of OE” units will not produce a greater level of quality of life than Q1. In the same way, neither will any additional (IN) in excess of OI with a given OE of (EX) increase the level of quality of life to Q2. There is a saturation level with both the inputs beyond both points of b and b’. The higher levels of quality of life are represented by iso-quality curves Q2 and Q3, which lie uniformly above Q1. Improvements in quality of life can be achieved by greater amounts of both inputs IN and EX. 
     In conclusion, IN and EX are generally not perfect substitutes. Convexity is assumed in the sense that the marginal rate of substitution between these two inputs is diminishing. For a given iso-quality curve, d (QoL) = 0.

Methodology

     This section explains the methodology applied to this research in two subjects: (a) sampling and data collection, and (b) operationalizing variables and analysis.
Sampling and Data Collection
     Heath (2003) at the University of Kentucky Research Center for Families and Children (RCFC) conducted a study to assess knowledge and use of human services in the Lexington-Fayette County area.  The Self-Assessment Study (Heath, 2003) was conducted by the Research Center for Families and Children with survey assistance by the University of Kentucky Survey Research Center. Both centers are located at the University of Kentucky. The study was funded by LexLinc--a nonprofit organization in Lexington, Kentucky.
     The sample was initially drawn using the Info Time Polk Directory distributed by Equifax (2002). This directory has listed information for all households in Lexington-Fayette County, Kentucky. A simple random sample of 11,500 households was drawn across all census tracts in Lexington-Fayette County to ensure that there would be enough households in the sample pool to complete both the telephone and mailed phases of the study. After the matching and cleaning process to obtain telephone numbers where none were originally listed, a smaller random sample of 4,700 was drawn resulting in 3,606 households for the telephone survey sample and the remaining 1,094 for the mailed survey sample. Calls were conducted by the University of Kentucky Survey Research Center from March 22-April 18, 2002. Up to 22 attempts were made by telephone per sample household at various times during the day and evening (Heath, 2003).
     Mailed surveys were used to reach households drawn in the sample who did not have telephone service or for which no number was found. Statements in Spanish inviting participation in the survey through either a phone interview in Spanish or a mailed survey in Spanish were included in a cover letter. The mailed portion of the study began May 10, 2002 and was completed June 25, 2002.
     The number of completed surveys was 1561 (1237 telephone surveys and 324 mailed surveys). “The margin-of-error for the survey is less than ± 2.5% at the 95% confidence level” (Heath, 2003). Individuals must have been 18 years old of age or older to participate in the interview. Randomly selected Lexington residents answered questions regarding their financial needs, income support, needs of the elderly, employment, childcare needs, physical and mental health needs, and characteristics such as ethnicity, last grade of school completed, martial status, and number of people in their household.
     The dependent variable was assessed at the end of the overall assessment of needs questionnaire, the key question is “Thinking about the needs of you and your household and thinking about the issues in this survey, overall, how do you perceive your situation in life? Would you say you are: (1) thriving, (2) safe, (3) stable, (4) at-risk, or (5) in-crisis?”  This question with resulting response options was derived for use based on the development and use of this same scale by Community Action Council as the basis on which to judge clients’ needs.  The scale has also been adopted by the local Salvation Army for use in their assessment of clients.
Sample Description
     This section reports the sample and characteristics using descriptive statistics in the order of the individual, household, and community. When the respondent was asked to think, overall, about himself or herself, their household, and the issues of the survey, respondents report their perceived quality of life (n=1547): 6.0 percent reported in-crisis or at risk, 64.5 percent stable or safe, and 29.5 percent thriving (see Table 1).
Characteristics of Respondents’ Individual Characteristics
     Of the respondents, 61.5 percent were female. Respondents’ average age is within the range of 35-44 years, with a mode of 55 years old or above; 88.4 percent identified themselves as white.  Almost three out of five (58.4%) were currently married. About three quarters of respondents (77.1%) own their residence. Regarding education, 21.2 percent had a high school diploma, GED or less, 27.4 percent had some college but no degree/Vocational-technical degree; 51.4 percent had bachelor degree or more (see Table 2).
Characteristics of Respondents’ Household
     Regarding household, the average household size is 2.48 with 22.7 percent of the households with only one member, and 38.8 percent of households with two people; 64.9 percent of households reported no child under the age of 18 in the household (see Table 3). In the 35.1 percent of households with a child under the age of 18, the average number of children was 1.76. For 20.1 percent of households with someone 65 years of age or older, the average size of the household is 1.36 persons. 82.3 percent of households report overall physical health as good or excellent compared to 17.7 percent of households report overall physical health as poor or fair.  Regarding income, 17 percent reported income at $25,000 or below, 33 percent reported between the ranges of $25,001 - $50,000; and 50 percent reported $50,001 or above.
Characteristics of Respondents Regarding Community-based Human Services
     Regarding community-based human services, the majority of respondents (92.5%) reported living in a safe neighborhood. At least 93 percent reported not using Lextran -- the public transportation service, 75.9 percent reported not having friends or family pick them up. Regarding financial assistance, approximately 50 percent reported turning to family or friends, 20 percent reported turning to church or clergy, 26 percent reported turning to banks, 5.6 percent reported turning to Lexington Housing Authority, 9 percent reported turning to utility companies, 9.4 percent reported turning to Community Action Council or Department of Community-based Services, 11 percent reported turning to food banks, 11 percent reported turning to the Salvation Army, 8.6 percent reported turning to Catholic Social Services, and about 6 percent report turning to other person or agency.  Regarding income support during the past twelve months, 21.8 percent of households reported support from social security/survivor income, and 19.3 percent reported support from Medicare (see Table 4).
Correlation Analyses of Perception of Quality of Life Regarding Different Income:
Urgent Needs by Use of Community-based Human Services
     In this section, income difference is compared. Crosstabular analysis and Pearson correlations were used to analyze perception of quality of life: urgent needs by use of community human based services. Results are reported in three parts: income levels with Chi-square and Pearson Correlation, Significance (p<.05, p<.01, and p<.001). Differences in each group were to be compared and reported when they are statistically significant.
     Income was categorized into three groups, they are $25,000 or below as Group 1, between $25,001-$50,000 as Group 2 and $50,001 or above as Group 3. In the total of 1561 samples, 265 (17%) are in Group 1, 516 (33%) are in Group 2 and 780 (50%) are in Group 3.
     Table 5 shows the fact that the majority of income groups 1-3 are in “stable and safe” categories. The highest income group has the lowest percentage of feeling “in –crisis or at risk”. And the same pattern shows that at the higher income group, the less worries in the six perspectives investigated. Income is statistically significant in the perception of quality of life and urgent needs.
     With regard to the correlation between perception of quality of life and the community-based human services (see Table 6), for Group 1, one variable is significant, it is transportation: having family or friends to provide transportation (-.16). For Group 2, one variable is significant, it is to turn to Community Action Council or Department of Community-based Services (-.10). For Group 3, five variables are significant, they are neighborhood safety (.08), transportation: having family or friends to provide transportation (-.08), financial assistance: family or friends (-.14),   bank (-.12); during the past 12 months received income from Medicare (-.08).
     Urgent needs were also investigated within income groups (see Table 7).
     Urgent needs were in six perspectives, whether worry that food will run out before getting money
to buy more, whether worry about paying mortgage or rent, whether worry about being able to pay utility bills, whether the respondent has enough income to pay for prescription drugs the family needs, whether the respondent has enough income to pay for the family’s medical needs, and whether the respondent has enough income to pay for family housing.  With regard to the correlation between urgent needs and the community-based human services in the form of income support, results are reported in the order of the six urgent needs perspectives.
     (1) Regarding whether the respondent worries whether food will run out before getting money to buy more, six income support variables are statistically significant with Group 1, they are financial assistance: family or friends (.13), bank (-.13), Lexington Housing Authority (.14), Community Action Council or Department of Community-based Services (. 23), food banks (.24) and other persons or agencies (.12). Five income support variables are statistically significant with Group 2, they are financial assistance: family or friends (.12), utility (.14), food bank (.10), during the past 12 months received income from:  social security/survivor income (-.10) and Medicare (-.13). One income support variable is statistically significant with Group 3, it is during the past 12 months received income from:  Medicare (.08).
      (2) Regarding whether the respondent worries about being able to pay mortgage or rent, six income support variables are statistically significant with Group 1, they are who turn to when need financial assistance: family or friends (.13), Lexington Housing Authority (.14), utility companies (.15), Community Action Council or Department of Community-based Services (.17), food banks (.17), during the past 12 months received income from:  social security/survivor income (-.15). Six income support variables are statistically significant with Group 2, they are financial assistance: family or friends (.13), Lexington Housing Authority (.10), utility companies (.10), Community Action Council or Department of Community-based Services (.11), during the past 12 months received income from:  social security/survivor income (-.10) and Medicare (-.09). One income support variable is statistically significant with Group 3, it is financial assistance: family or friends (.12).  
      (3) Regarding whether the respondent worries about being able to pay utility bills, seven income support variables are statistically significant with Group 1, they are financial assistance: family or friends (.13), utility companies (.18), Community Action Council or Department of Community-based Services (.19), food banks (.18), Catholic Social Services (.12); during the past 12 months received income from:  social security/survivor income (-.13), and Medicare (-.14). Two income support variables are statistically significant with Group 2, they are financial assistance: family or friends (.14), and Community Action Council or Department of Community-based Services (.09). One income support variable is statistically significant with Group 3, it is financial assistance: family or friends (.15).
      (4) Regarding whether the respondent has enough income to pay for prescription drugs the family needs, seven income support variables are statistically significant with Group 1. They are financial assistance: family or friends (-.19), Lexington Housing Authority (-.16), utility companies (-.14), Community Action Council or Department of Community-based Services (-.32), food banks (-.27), the Salvation Army (-.15), Catholic Social Services (-.22). One income support variable is statistically significant with Group 2, it is financial assistance: utility companies (-.14). One income support variable is statistically significant with Group 3, it is during the past 12 months received income from:  social security/survivor income (-.08).
      (5) Regarding whether the respondent has enough income to pay for the family’s medical needs, five income support variables are statistically significant with Group 1, they are financial assistance: family or friends (-.21), Community Action Council or Department of Community-based Services (-.29), food banks (-.17), Catholic Social Services (-.15),   during the past 12 months received income from:  social security/survivor income (.13). One income support variable is statistically significant with Group 2, it is financial assistance: family or friends (-.11). Two income support variables are statistically significant with Group 3, they are financial assistance: family or friends (-.10), and bank (-.08).
      (6) Regarding whether the respondent has enough income to pay for family housing, two income support variables are statistically significant with Group 1. The variables are financial assistance: bank (-.13), and during the past 12 months received income from:  social security/survivor income (.14); none are statistically significant with Groups 2 and 3.
     The above results revealed that there were income differences in perception of quality of life. Regarding urgent needs and the use of community human services, there were also differences among different income groups. Lower income groups had more urgent needs than the highest income group, and depended more on community human services. Those in lower income groups intended to turn to family and friends when financial assistance was needed than the highest income group. Those of the highest income group tended to use services from banks when financial assistance was needed. Community human services were very important resources for lower income groups with urgent needs, especially for those households with income of $25,000 or below.

Summary

Discussion
     Discussion of the use of community-based Human services by types of urgent needs among subpopulations is necessary in this research. Urgent needs were also investigated by receipt of community income support. We can derive the following conclusions regarding different income level sub-groups. 
     Income is highly associated with perception of quality of life and urgent needs. Those of higher income perceive higher quality of life. Regarding urgent needs and the use of community human services, there were also income differences. Lower income groups had more urgent needs than the higher income group, and depended more on community human services.
     Among those three income groups with urgent needs, there were no income differences in using services from church or clergy, the Salvation Army, Catholic Social Services, and social security/survivor income.  But those of lower income groups were more likely to turn to family and friends when financial assistance was needed than the highest income group. Those of the highest income group were more likely to use services from banks. Community human services were very important resources for lower income group with urgent needs, especially for those households with income of $25,000 or below.
Implications
     This research is a contribution to the research on quality of life as it applies a new way of looking at the components of quality of life.  Specifically, the impact of community-based human services and urgent needs on perceptions of quality of life was addressed.  The respondents were broken into sub-groups according to their relative levels of exhibiting urgent needs and by income level. This made it possible to determine what the main variables influencing perception of quality of life, and what community-based human services meet urgent needs. 
     The subpopulation comparison of quality of life with urgent needs and the use of community income support services provided a broader context for interpreting perception of quality of life. This study also provided a useful way of understanding research on perceptions of quality of life and improving community services for the general public and urgent needs at the community level.
Policy makers, educators, and social service providers can benefit from the findings of this study. Specifically, their efforts to improve quality of life should focus on those variables that have been shown to predict enhanced quality of life. 
     There were income differences in perception of quality of life and urgent needs.  Community human services should design some income adjustment programs, especially programs by community housing authority, utility companies, Community Action Council or Department of Community-based Services, food banks, the Salvation Army, Catholic Social Services for low income groups with urgent needs to help deal with their hardships and to assist so they can become independent.  
Future Research
     Although there are limitations in this study, the sample reflected the perception of quality of life with urgent needs of lower income population. As a result these findings do not accurately describe what factors contribute to the perceptions of quality of life and the association of quality of life with urgent needs and the community-based human services. There are several significant conclusions that can be drawn as mentioned above, and the methodology can be applied to future research.   
     Regarding future research, three perspectives are worth considering. (1) Not only the use of community human services, but also the quality of the services should be paid attention. For example, the service may be available, but the satisfaction level for the users of the service may be low, which may even have worse effect on ones perceptions of quality of life than no service. (2) Perceptions of quality of life are highly associated with urgent needs like worry for food, worry for utility bills, etc. Future research can prioritize to urgent needs and investigate the cause of the urgent needs, thus helping to eliminate poverty and improve quality of life.   This study made some initial inroads, however future research may require longitudinal research designs that monitor changes in variables over time. Future research with the above-mentioned factors will build a broader and deeper understanding of the quality of life construct, thus contributing to research and the improvement of quality of life. 

References

Cooley, M. E. (1998). Quality of life in persons with non-small cell lung cancer: a concept analysis. Cancer Nursing,
       21(2), 67-73.  
Heath, C. J. (2003). Our community: an in-depth look at the characteristics and human service needs of Lexington.
       Lexington, Kentucky: Lexington-Fayette County Self-Assessment.                       
Scott, E. and Wright, M. E. (1971). An Arena of Happiness. Springfield, Illinois: Charles C. Thomas, Publisher. 

Endnotes

1. Quality of life is an individual’s subjective feelings about one’s conditions or status of life regarding the needs or wants given limited resources or services available. In regional or community research, it is a term used to indicate a person’s overall perceptions of life quality as affected by personal factors such as income, housing, marital status, gender, and community factors (community human services) one shares with other people in the community at any given point of time.
2. Income supports:In this study, they are specific forms of external resources/services provided by the society or community; they are closely related to both long-term and short-term government welfare policy and community support systems. The most common income supports are social security retirement or survivor income, Medicare, Social Security disability income or insurance, government housing, food stamps, etc. All these income supports have numerical values in finance that differ from other external resources/services as employment service, public safety services, or information services.
3. Internal resources/services: Based on the systems theory model, resources/services are limited and can be classified as within or outside the system. Quality of life is influence by a portion of what one owns and a portion of what one shares with other people in the community at any given point of time, the portion one owns is the portion one exclusively uses and also is termed as internal resources.
4. External resources/services are the resources/services available to someone from outside one’s ability or family to generate at any given point of time.

Figure 1
Quality of Life Levels of Two Different Inputs – Internal and External Resources
of the Household

Note:  Group 1: Income $25,000 or below
            Group 2: Income between $25,001 and $50,000
            Group 3: Income $50,001 or above
             **:  Pearson correlation is significant at the 0.01 level (2-tailed).
             *:     Pearson correlation is significant at the 0.05 level (2-tailed).
             Sample size is in parenthesis.