Role of political factors in wellbeing and quality of life during long-term constraints and conflict: an initial study

Background Although much is known about wellbeing and quality of life generally, there is insufficient understanding and measurement of human functioning during chronic constraint. This difficulty is especially true for populations whose constraints extend beyond economic disadvantage to include persistent political conflict and its associated constraints, as is the case for Palestinians living in the occupied Palestinian territory (oPt). In this study, the first phase of a project designed to assess the wellbeing of adult Palestinians, we sought to answer some fundamental questions about wellbeing and quality of life. This population cohort is of particular interest in terms of wellbeing because of its high political activism during the first intifada, and because it has endured a steady economic decline, increasing political constraints, and protracted political violence since then. Methods In February, 2010, trained local fieldworkers from the Palestinian Center for Policy and Survey Research, Ramallah, West Bank, interviewed in Arabic 68 adults (33 men, mean age 34·8 years, range 21–53; 35 women, mean age 32·2 years, range 20–49) in the West Bank, East Jerusalem, and the Gaza Strip in 14 groups of five same-sex individuals (apart from two absentees). Participants were selected with purposive sampling to represent sex, region, refugee or non-refugee status, and (in the Gaza Strip) the main political factions of Fateh and Hamas. The focus of the interviews was on participants' perceptions of what constitutes quality of life and wellbeing in their society. Various methods were used to elicit this information during the interview, including the description of close associates who were doing fairly and less well, and ad-hoc listing and prioritisation of domains of wellbeing. The interviews of the 14 groups (including 68 individuals), each one lasting 60–90 min, were transcribed in Arabic and translated into and transcribed in English. Content analyses of the English transcripts were done with Atlas.ti (version 6.2.27) by three project staff, with several Palestinian key informants checking the coding of the transcripts. The study was approved by the institutional review boards of the University of Tennessee, Knoxville, TN, USA, and the Palestinian Centre for Policy and Survey Research. Interviewees provided written informed consent. Findings In the analyses, we identified expected domains of wellbeing and quality of life—ie, economics, education, employment, family relations, personal characteristics, social relations, health, and religion. Examples of the prevalence of some of these conventional domains of wellbeing and quality of life include economic issues (n=65 [96%]), family relations (62 [91%]), and education (52 [76%]). Additionally, however, consistent with hypotheses about the central role of the political domain in the lives of Palestinians, most participants (27 [82%] men, 29 [83%] women) also mentioned political factors. Types of issues coded as being in the political domain included experience of occupation, perceived effects of occupation, political conflict, solidarity between political factions, freedom of expression, mobility constraints, safety or security, stability, and expectations of government provisions. Of these, safety or security and solidarity between political factions were more frequently discussed by the Gazan participants (n=40) than by the non-Gazan participants (n=28). 31 (78%) Gazans mentioned safety or security as an element of wellbeing compared with six (21%) non-Gazans. Similarly, 24 (60%) Gazans mentioned solidarity in the factions as an element of wellbeing compared with seven (25%) non-Gazans. Interpretation The findings of this study contribute valuable and detailed insights into how wellbeing and quality of life are viewed under lifelong political conflict and constraints. The findings reinforce and expand the increasing recognition of the important role of the political domain in the definition of wellbeing in populations such as the Palestinians in the oPt. The substantial, refined elaboration of this domain by the participants we interviewed is especially valuable for the creation of methods for measuring political wellbeing and quality of life. Funding Jacobs Foundation.