EMHJ • Vol. 19
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
No. 4 • 2013
Factors influencing women’s willingness to volunteer
in the healthcare system: evidence from the Islamic
Republic of Iran
A. Alami,1,2 S. Nedjat,2,3 R. Majdzadeh,2,3 A. Rahimi Foroushani,2 S.J. Hoseini 4 and H. Malekafzali 2
ب ِينات من مهورية إيران اإسامية:العوامل التي تؤثر عى رغبة النساء للتطوع ي النظام الصحي
حسن ملک افضلی، سيد جواد حسيني، عباس رحيمي فروشاي، رضا جدزاده، سحرناز نجات،علی عامی
، تقدم هذه الدراسة للحاات والشواهد تقيي ًا للعوامل التي تؤثر عى تطوع النساء ي برنامج التطوع الصحي النسائي ي مهورية إيران اإسامية:اخاصـة
ومع الباحثون. شاهدة) من تلك امراكز146 متطوعة و145( إمرأة291 وقد شملت الدراسة. مركز ًا ي واية خراسان – ي رضوي150 وهو برنامج ين َفذ ي
) بن ميل
( التحوف اللوجيستي الوحيد امتغرات وامتعدد؛ ووجدوا ترابط ًا ُي ْعتَدُ به إحصائي ًا
وقام الباحثون بتحليل.البيانات باستخدام استبيان
ُ
والدعم، وتكوين الشبكة ااجتاعية، والعاقة الوثيقة مع اجران، ووجود طفل دون السنتن من العمر ي اأرة،النساء للتطوع وبن حجم اأرة
ويمكن إنشاء بعض. وا ُبدّ من تأسيس البنى التحتية ذات الصلة بالرغبة بالتطوع بن أفراد امجتمع إذا أردنا تعزيز ذلك. والدعم بامشورة،العاطفي
ِ اأماكن امناسبة من قبيل "منازل
. أن تساهم ي زيادة الرغبة ي اانضام إى هذه الرامج التشاركية،"اج َوار
ABSTRACT This case–control study evaluated the factors influencing volunteering in the Islamic Republic of Iran’s
Women’s Health Volunteer (WHV) programme, which is implemented in 150 centres in Khorasan-e-Razavi Province.
We recruited 145 cases (volunteers) and 146 controls (non-volunteers) from the centres. Data were collected by
questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings,
husband’s age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy,
child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of
acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory
support, monetary support, physical support, time support. There were significant associations (P < 0.05) between
women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood
intimacy, social network composition, and emotional and advisory support.
Facteurs influençant l'intention des femmes à devenir volontaires dans le système de soins de santé : données
provenant de la République islamique d'Iran
RÉSUMÉ La présente étude cas-témoin a évalué les facteurs influençant le volontariat dans le programme Femmes
volontaires de la santé en République islamique d'Iran, mis en œuvre dans 150 centres de la province du KhorassanRazavi. Nous avons recruté 145 cas (participation volontaire) et 146 témoins (participation sollicitée) dans ces centres.
Des données ont été recueillies par questionnaire. Les variables sociodémographiques prises en compte étaient les
suivantes : la durée de résidence dans le voisinage, le nombre de frères et sœurs, l'âge du mari, son niveau d'études et
son emploi, la taille de la famille, la qualité de vie, l'état de santé auto-évalué, le degré de connaissance du voisinage,
la présence ou non d'un enfant de moins de deux ans dans la famille, le fait d'être propriétaire de son logement
et l'indice de richesse. Les variables des réseaux sociaux prises en compte étaient les suivantes : la taille du réseau
égocentré, le type de connaissance, le degré d'intimité avec les autres, la communication relationnelle, la durée
des relations, le soutien psychologique, l'appui consultatif, le soutien financier, le soutien physique et le soutien à
la personne. Des corrélations significatives (P < 0,05) ont été trouvées entre la propension des femmes à devenir
volontaires et la taille de la famille, la présence ou non d'un enfant de moins de deux ans, le degré de connaissance
du voisinage, la composition du réseau social, et le soutien psychologique et consultatif.
1
School of Public Health, Social Development and Health Promotion Research Centre, Gonabad University of Medical Sciences, Gonabad,
Khorasan Razavi, Islamic Republic of Iran. 2Department of Epidemiology and Biostatistics, School of Public Health; 3Knowledge Utilization
Research Centre, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (Correspondence to S. Nedjat: nejatsan@tums.ac.ir).
4
Health Centre of Khorasan-e-Razavi Province, Mashad University of Medical Sciences, Mashad, Islamic Republic of Iran.
Received: 28/08/11; accepted: 2/12/11
348
امجلد التاسع عر
العدد الرابع
Introduction
Participation and volunteering
Since the World Health Organization’s
“Health for All” Strategy was devised
in 1979, participation has been considered a subject central to health. he
important role of participation in health
promotion strategies was re-emphasized in the “Otawa Charter for Health
Promotion” in 1986 [1]. Participation
may be deined as “a process by which
people are enabled to become actively
and genuinely involved in deining the
issues of concern to them, in making
decisions about factors that afect their
lives, in formulating and implementing
policies, in planning, developing and
delivering services and in taking action
to achieve change” [2].
Volunteering would also be one of
the important components of social
capital at the level of community [3].
Jenner [4] deines a volunteer as “a
person who, out of free will and without wages, works for a not-for-proit
organization which is formally organized and has as its purpose service to
someone or something other than its
membership”.
The Women’s Health
Volunteer programme
Although most volunteers give their
eforts to non-proit organizations, a
noticeable proportion of all volunteer
activity is directed to the public sector
[5]. he Women’s Health Volunteer
(WHV) programme, as governmentbased voluntary action, is a national
plan which was launched in some urban
parts of the Islamic Republic of Iran in
1990–1991. his community-based
health programme has gradually been
expanded to all the urban parts of
the country [6]. he WHVs (rabetine-behdashti in Farsi) are women who
voluntarily participate in community
health-based programmes. here is evidence that WHV activities could have
positive efects on community health
[6,7]. herefore, we selected this
امجلة الصحية لرق امتوسط
programme to study, as a successful
programme in the context of people’s
engagement with community healthbased programmes.
Influencing factors on
individuals’ willingness to
volunteer
here are various factors, such as personal, family, and local characteristics,
that could inluence individuals’ willingness to volunteer. Recently, researchers
have paid particular atention to the
inluence of social network characteristics on personal decisions. Indeed,
it is believed that social networks are
central to various social processes affecting health-related behaviours [8]. A
social network is a set of actors who may
have relationships with one another [9].
Tindall and Wellman also deine social
network as “the study of social structure
and its efects” [10].
Social network characteristics may
be stratiied in 3 dimensions. he irst
dimension is structural characteristics (size, density and network composition). he second is interaction
characteristics (relation type, contact
frequency, relation permanency, and intimacy with network members which is
evaluated by closeness sensation of subject with network members). he third
dimension is functional characteristics
(various types of support consisting of
emotional, advisory, monetary, physical,
and time support) [11,12]. Individuals
can obtain diferent types of support
from their network members. Relatives,
friends, and neighbours as well as colleagues can be important resources to
ofer help and support. It is believed
that diverse connections could create
various types of social support for each
person. It is also supposed that the more
diverse connections in one’s personal
social network, the beter one’s access
to a widespread range of diferent types
of support [12].
In the Islamic Republic of Iran,
although a number of studies have
been carried out concerning the
sociodemographic factors of WHVs as
well as the inluence of their activities on
community health [7,13], less atention
has been paid to the efect of contextual
factors on volunteering. he impact of
sociodemographic and social network
characteristics on individuals’ decisions
to volunteer would still be a fruitful ield
for exploration.
his study was conducted to
assess the relationship between sociodemographic and social network
characteristics, and women’s willingness to participate with Iran's WHV
programme.
Methods
Sampling and study population
We conducted this case–control study
in 2010 in Korasan-e-Razavi Province,
one of the largest and most populous
provinces in the country. It has roughly
5.5 million inhabitants (about 7% of the
Iranian population). To select the samples, we restricted the selection process
by some potential confounding variables: age, education level, marital status
and job. Our research population was
married women who were housewives,
aged 15–49 years, with an education of
between 6 and 12 years, living in urban
parts of the province.
To calculate the required sample
size, we irst conducted a pilot study
on 20 individuals from the population.
From this we identiied the potential
problems of the data collection phase
and to determine P1 and P2. We then
used the equation below to estimate the
sample size for each group:
n = [2(Z1 – α/2 + Z1 – β)2 P(1 – P)]/(P1 – P2)
Where P = (P1 + P2)/2 and considering Z1 – α/2 = 1.96 and Z1 – β = 0.84
(i.e. a power of 0.80), we calculated different sample sizes ranging from 62 to
96 samples in each group. As we applied a 2-stage cluster sampling method
to select the samples, we considered
349
EMHJ • Vol. 19
the design efect equal to 1.5. So, our
sample size was estimated at 145 samples in each of the case and the control
groups. To control potential problems
during data gathering, the researchers
increased the sample size to 150 participants for each group.
here are nearly 175 urban health
centres in Khorasan-e-Razavi province. he WHV programme is actively
implemented among 150 centres. To
select the participants, we randomly
selected 50 of these centres as clusters
and administered questionnaires to
3 women as cases in each cluster. All
the respondents were women who
had recently volunteered for participation in the WHV programme in the
selected centres during the research
period, 1 May 2010 to 1 September
2010.
In the Islamic Republic of Iran nearly all family members, including women,
are registered in family health dossiers
which are kept in the urban health centres. Ater data gathering for the cases,
we randomly selected 3 controls in each
of the centres among women who did
not participate in the WHV programme
and had not previously had any cooperation with similar programmes. he
questionnaires then were administered
via face-to-face interview.
here were 50 interviewers in our
study. To assure quality and eliminate
potential interviewer bias, a 1-day
workshop was held for the interviewers.
Additionally, an interview guide was
made to use in the process of interviewing. he researchers also used a coding
system for the questionnaires to control
potential bias in both data entry and
analysis and to ensure anonymity for the
participants.
Data collection tool
We used a 2-section questionnaire to
collect data. Internal consistency was
assessed using Cronbach’s alpha (0.73
in the social network characteristics domain). Reliability of the questionnaire
was assessed via test–retest with a mean
350
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
No. 4 • 2013
intra-class correlation coeicient of 0.82
(0.74–1.00).
he irst section of the questionnaire
covered sociodemographic characteristics including length of residence in her
neighbourhood, the age and education
level of the respondent and her husband, husband’s job, and family size. We
also collected data on other factors including presence of a child under 2years
old in the family, and home ownership.
To evaluate the family wealth index,
we used a list of assets such as vacuum
cleaner, washing machine, dishwasher,
telephone line, motor car, computer,
refrigerator, colour television, and CD
or DVD player. We then measured
family wealth index via principle component analysis. In the inal part of this
section, we used a 5-point Likert-range
question to assess quality of life and selfrated health status as well as a 7-point
Likert-range question to evaluate neighbourhood intimacy as perceived by the
respondent.
he second section of the questionnaire was allocated to individual social
network factors comprising the structural, interactional and functional characteristics. he structural factors were
size, density and network composition.
Interactional characteristics consisted
of relation type, contact frequency, relation permanency, and intimacy with
network members. In this study, 5 types
of support—emotional, advisory, monetary, physical, and time support—were
considered social network functional
characteristics.
Data analysis
We entered the data into Stata, version 10. We evaluated diferences
between case and control groups via
the Mann–Whitney U-test, χ2 and
Fisher exact test. Using univariate
and multiple logistic regression with
odds ratio (OR), P-value and 95%
conidence interval. We assessed
the association between volunteering and sociodemographic as well
as social network characteristics. All
independent variables were entered
separately in the univariate logistic
regression model. hen, as Jewell indicated, those variables with P < 0.2
were selected for entering in multiple
logistic regression [14]. In the inal
model, variables with P < 0.05 were
reported as statistically signiicant.
Ethical considerations
he researchers obtained the approval
of the institutional review board of
Tehran University of Medical Sciences. Before conducting the research,
the research team obtained the authority of managers in regard to the
research project. Agreement of all
participants to participate the research
was obtained before the interviews.
As the interviews were prolonged
(roughly 1 hour), respondents were
ofered rest breaks. he respondents
were informed of their rights to cease
their participation at any time during
the interview.
Results
For the data analysis, we used 291 (out
of 300) completed questionnaires
(cases = 145, controls = 146), a refusal
rate of 3%. he mean age in the case
group was 28.84 (SD 8.26) years and
the duration of education was 10.06
(SD 2.08) years; in the control group
the corresponding values were 29.59
(SD 6.9) years and 9.91 (SD 2.07)
years, respectively.
Table 1 shows the respondents’
sociodemographic characteristics and
their associations with participation
in the WHV programme. Some sociodemographic factors, including the
presence of a child under 2 years (P =
0.020), quality of life (P = 0.018) and
neighbourhood intimacy (P = 0.002),
had P < 0.05 in univariate logistic regression.
Table 2 shows the social network
characteristics and their associations
with volunteering. Social network
امجلد التاسع عر
العدد الرابع
امجلة الصحية لرق امتوسط
Table 1 Binary logistic regression analysis of sociodemographic characteristics in association with participation in the
Women’s Health Volunteer programme
Variable
Length of residence in neighbourhood
(months)
No. of siblings
Case
(n = 145)
Control
(n = 146)
Crude
OR
P-value
95% CI
Mean (SD)
Mean (SD)
99.57 (92.61)
86.10 (93.52)
1.00
0.342
0.99–1.00
5.02 (2.34)
4.92 (2.06)
1.07
0.277
0.95–1.20
33.54 (8.74)
34.17 (7.73)
0.99
0.870
0.97–1.03
Husband's education (years)
9.76 (3.02)
9.31 (3.58)
1.02
0.767
0.94–1.11
Family size
3.37* (1.20)
3.62* (1.13)
0.83
a
0.100
0.66–1.04
Quality of life
3.88* (0.67)
3.66* (0.69)
1.60a
0.018
1.09–2.37
Husband's age (years)
Self-rated health status
3.91 (0.64)
3.84 (0.70)
1.17
0.389
0.82–1.68
Neighbourhood intimacy
4.30* (1.34)
3.68* (1.39)
1.40a
0.002
1.14–1.72
1.00
0.902
0.50–2.20
No.
%
No.
%
Governmental
22
16
23
16
Free market
84
61
92
63
1.05
0.779
0.27–5.63
4
34
5
3
1.24
0.655
0.18–2.96
6
4
0.73
0.663
0.48–3.21
20
14
18
12
1.24
0.840
0.16–9.90
2
2
2
2
1.24
Yes
20
14
47
32
1.00a
0.020
0.21–0.88
No
125
86*
99
68*
0.43a
Owner
63
44
55
38
1.00
0.689
0.50–1.58
Tenant
57
39
72 (
49
0.89
0.492
0.60–2.87
Other
25
17
19
13
1.31
Husband's job
Retired
Private office
Worker
Unemployed
6
Child under 2 years
House ownership
Wealth index
1 (poorest)
34
23
27
19
1.00
0.509
0.29–1.85
2
30
21
27
19
0.73 a
0.844
0.45–1.91
3
28
19
27
19
0.93 a
0.089
0.20–1.12
4
27
19
30
21
0.47 a
0.181
0.29–1.27
5 (richest)
26
18
31
22
0.60 a
*P < 0.05 (Mann–Whitney U-test, χ2 test, Fisher’s exact test).
a
Variables with P < 0.2 and considered for multiple logistic regression.
OR = odds ratio; CI = confidence interval.
density (P = 0.012) and heterogeneity
(P < 0.001), women’s intimacy with
their network members (P < 0.001)
and emotional (P < 0.001) as well
as advisory (P < 0.001) support obtained from network members also
had P < 0.05 in the univariate model.
We therefore entered these variables,
together with those which had P <
0.20 (i.e. wealth index and family size),
in the multiple logistic regression
analysis.
The results of the multiple logistic
regression analysis are shown in Table
3. here were signiicant associations
between volunteering and some sociodemographic factors including
presence of a child under 2 years [adjusted OR (AOR) = 0.46], family size
(AOR = 0.76) and neighbourhood
intimacy (AOR = 1.31) and some
social network characteristics including type of acquaintance (which implies social network heterogeneity)
(AOR = 0.60) and emotional support
obtained. We compared no support
(level 1) with a litle support (level 2)
conditions (AOR = 1.80), no support
with enough support (level 3) conditions (AOR = 1.82) for emotional
support obtained, as well as advisory
support obtained in comparison with
no support to a litle support conditions (AOR = 1.48) and no support
to enough support conditions (AOR
= 2.13).
351
EMHJ • Vol. 19
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
No. 4 • 2013
Table 2 Binary logistic regression of social network characteristics of Women's Health Volunteer programme volunteers and
controls
Variable
Volunteers
(n = 145)
Controls
(n = 146)
Crude
OR
P-value
95% CI
Social network domain: structural
Ego network size [mean (SD)]
12.79(7.43)
12.99 (5.62)
1.02
0.294
0.99–1.05
Density [mean (SD)]
0.64 (0.18)
0.70 (0.18)
0.13a
0.012
0.03–0.64
457 (27)
264(15)
1.00
1257 (73)*
1499 (85) *
0.48a
< 0.001
0.38–0.62
< 0.001
1.06–1.34
Type of acquaintance [No. (%)]
Non-relative
Relative
Social network domain: interactional
3.99*(1.21)
3.70*(1.34)
1.19a
> once a week
898 (53)
921 (53)
1.00
once a week
342 (20)*
372 (21)*
0.94
0.646
0.73–1.21
once in 2 weeks
157 (9)*
87 (11)*
0.86
0.487
0.57–1.31
306 (18)*
273 (15)*
1.15
0.414
0.82–1.61
Visual
1246(75)
1374 (79)
1.00
By telephone
396 (24)*
365 (21)*
1.20
0.244
0.89–1.62
7 (0)*
4 (0)*
1.93
0.424
0.39–9.67
10 (1)*
6(0)*
1.84
0.345
0.52–6.49
1.00
0.505
0.99–1.00
Intimacy with others [mean (SD)]
No. of contacts [No. (%)]
< once in 2 weeks
Relationship [No. (%)]
By mail
Other
Relationship duration (months) [mean (SD)]
203.94 (143.49)
196.87 (134.52)
Social network domain: functional
Emotional support [No. (%)]
None
170 (10)
401 (23)
1.00
A little
631 (37)*
680 (38)*
2.19a
< 0.001
1.58–3.03
Enough
913 (53)*
680 (39)*
3.17a
< 0.001
2.20–4-56
Advisory support [No. (%)]
None
294 (17)
562 (32)
1.00
A little
656 (38)*
678 (39)*
1.85a
< 0.001
1.45–2.36
Enough
762 (45)*
518 (29)*
2.81a
< 0.001
2.09–3.78
None
931 (54)
962 (55)
1.00
A little
399 (23)
359 (20)
1.15
0.409
0.83–1.60
Enough
379 (22)
431 (25)
0.91
0.550
0.66–1.24
583 (34)
639 (37)
1.00
A little
614 (36)
606 (35)
1.11
0.504
0.81–1.52
Enough
493 (30)
496 (28)
1.09
0.599
0.79–1.51
None
542 (32)
614 (35)
1.00
A little
644 (38)
638 (36)
1.14
0.344
0.87–1.51
Enough
515 (30)
496 (29)
1.18
0.316
0.86–1.62
Monetary support [No. (%)]
Physical support [No. (%)]
None
Time support [No. (%)]
*P < 0.05 ((Mann–Whitney U test, χ2 test, Fisher’s exact test).
a
P < 0.2 and considered for multiple logistic regression,
OR = odds ratio; CI = confidence interval.
SD = standard deviation.
352
امجلد التاسع عر
العدد الرابع
امجلة الصحية لرق امتوسط
Table 3 Multiple logistic regression of sociodemographic and social network characteristics associated with participation in
the Women's Health Volunteer programme
Variable
Adjusted OR
P-value
95% CI
0.76
0.027
0.60–0.97
Quality of life
1.41
0.108
0.93–2.14
Neighbourhood intimacy
1.31
0.018
1.05–1.64
0.17
0.075
0.026–1.19
0.037
0.22–0.96
0.382
0.26–1.68
Family size
Density
Child under 2 years
No
1.00
Yes
0.46
Wealth index quintile
1 (poorest)
1.00
2
0.66
3
0.94
0.884
0.41–2.15
4
0.44
0.123
0.16–1.25
5 (richest)
0.79
0.588
0.34–1.84
0.60
< 0.001
0.47–0.77
1.01
0.875
0.90–1.13
Type of acquaintance
Non-relative
Relative
Intimacy with others
1.00
Emotional support
None
1.00
A little
1.80
< 0.001
1.31–2.46
Enough
1.82
0.003
1.22–2.72
1.11–1.96
Advisory support
None
1.00
A little
1.48
0.007
Enough
2.13
< 0.001
1.52–2.99
OR = odds ratio; CI = confidence interval.
Discussion
To the best of our knowledge, this is the
irst study conducted in Iran that deals
with the association between sociodemographic and social network factors
and willingness to participate in a voluntary programme. By recognizing these
potential associations, a new view could
be created to improve such programmes.
Multiple logistic regression analysis
indicated that neighbourhood intimacy
and the emotional and advisory support obtained from network members
may have a direct association with
willingness to volunteer in the WHV
programme, while presence of a child
under 2 years in the family, family size
and network homogeneity may have
an inverse association. We found no
signiicant associations between certain
sociodemographic variables and social
network characteristics and participation in the WHV programme.
Arguments and
counterarguments
Family size was an inluencing variable
on volunteering. he smaller the family
size, the more likely respondents were
to participate in the WHV programme.
As these women may have more time
to participate in social activities, this
would be logical. Nesbit also suggested
that middle-aged women with larger
family size have less time to engage in
voluntary activities [15].
here was a signiicant association
between presence in the family of a child
under 2 years and volunteering. his is
similar to the indings of Gomez and
Gunderson who reported an association between the existence of a dependent child in the family and volunteering
[16]. here was also a signiicant association between neighbourhood intimacy
and volunteering in our research. Poley
and Stephenson indicated strategies
which develop common interests in
their neighbourhood could have positive efects on neighbourhood members’ civic engagement [17].
We found the number of non-relative members (friends and neighbours)
in the social networks of volunteers was
statistically signiicantly greater than
in the social networks of the control
group. In fact, the social networks in the
volunteers were more heterogeneous
than those of the controls. Diversity in
353
EMHJ • Vol. 19
their personal social network may imply
that an individual is more communicative, and this may be a predictor of willingness to volunteer. Our inding was
similar to those of Wilson and Musick,
which showed a direct association between number of friends and voluntary
activity [18].
Our results showed a signiicant association between the emotional and
advisory support, as personal social
network resources, and willingness to
volunteer in the WHV programme. It
was comparable with the results of the
study of Tong, Hung and Yeun in Macao, which was conducted to recognize
the determinants and efects of social
network characteristics on pro-social
behaviours such as volunteering and
helping others [19]. hey emphasized
those individuals who have resourceful
social networks have more willingness to
participate in such pro-social activities.
In contrast, in our study, there was
no signiicant association between
social network size and willingness to
volunteer. In the study carried out by
Tong, Hung and Yeun, social network
size may have had a direct association
with personal willingness to help others
and volunteering. As their study could
not investigate temporality between
exposure (social network size) and outcome (volunteering), the network size
may itself be inluenced by volunteering.
As we used incident cases, there was no
similar problem in our study.
here was no signiicant association
between wealth status of the participants and volunteering in our study. In
contrast, Goss implied that wealthy
people are more willing to donate their
time in voluntary eforts [20].
Although several studies have reported an association between home
ownership and volunteering [21,22] we
did not ind such an association. Insuficient sample size may be a cause of
the failure to ind this association in our
study. Neither did we ind a signiicant
association between social network
354
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
No. 4 • 2013
density and volunteering, which was
comparable to the results of Rotolo
[23], but contrary to those of Kane [24].
Study limitations
Case–control studies are known to
have more of a tendency to confounding, information bias and selection bias
than other types of study. To control the
problem, we restricted the selection of
subjects on some variables such as age
(15–49 years), duration of education
(6–12 years), marital status (married)
and job (housewife). We also conducted some activities to improve quality
assurance, such as holding a workshop
for interviewers and preparing an interview guide. To avoid the efect of
volunteering on the factors under study,
especially social network characteristics,
all the selected cases were new volunteers (incident cases).
We would particularly refer to 2 issues. Although many studies have demonstrated a potential relation between
education level and volunteering [25],
we could not investigate the association
between the variables. his was because
of the restriction on this factor in the
selection process. Similarly, associations
between volunteering and the respondents' age, marital status, and job could
not be evaluated in this study. Besides,
a woman who is willing to participate in
the WHV programme must obtain written agreement from her husband. his
behaviour may be a proxy for a more
democratic family. So it seems women
living in such families may have more
chance to participate in social activities
such as the WHV programme. herefore, our results might be inluenced by
this discrepancy between the volunteer
group and the control group. Of course,
this association should be investigated
through a separate study.
Policy implications
As mentioned, there has been no previous research to identify the characteristic factors of women who have a
propensity to participate in the Iranian
WHV programme, as a voluntary plan.
Our indings can be used by policymakers who work on community-based
voluntary programmes, especially in
the Islamic Republic of Iran and other
countries with similar cultures. According to our indings in regard to the
relationship between volunteering and
family size as well as the presence of a
child under 2 years in the family, we
suggest that managers should probably
target their atempts at women who
have small families, with no dependent
children so that they may be able to
select appropriate individuals for their
voluntary programmes.
We found that the greater the intimacy in the neighbourhood, the greater
the chance of a woman being willing
to volunteer. To promote a volunteering culture in the community, places
such as “neighbourhood houses” (c.f.
community centres) or “neighbourhood councils” could be established.
hrough such places, neighbours could
design and generally run public activities, including educational and health/
exercise activities. he likelihood of
more-communicative persons, i.e. those
with a propensity for volunteering, attending such places would be quite
high. So, we suggest establishing places
such a “neighbourhood house”, because
of these multi-dimensional efects.
In conclusion, family size, neighbourhood intimacy, individual social
network heterogeneity and received
emotional and advisory supports from
network members may be important
determinants of participation in community-based voluntary programmes
such as the WHV programme.
Acknowledgement
his paper is based on the irst author's
PhD dissertation, supervised by the second author and submited to the Epidemiology and Biostatistics Department,
Tehran University of Medical Sciences,
2010 and granted by the University.
امجلد التاسع عر
العدد الرابع
امجلة الصحية لرق امتوسط
References
1.
Baum FE, Ziersch AM. Social Capital. Journal of Epidemiology
and Community Health, 2003, 57:320–323.
14.
Jewell NP. Statistics for epidemiology. California, Chapman &
Hall/CRC, 2004.
2.
Community participation in local health and sustainable development: approaches and techniques. Geneva, World Health
Organization, 2002 (European Sustainable Development
and Health Series 4) (https://www.utexas.edu/nursing/norr/
docs/commparticipation.pdf, accessed 15 February 2013).
15.
Nesbit B. A comparison of volunteering data in the panel
study of income dynamics and the current population survey.
Nonprofit and Voluntary Sector Quarterly, 2010, 39(4):753–761.
16.
Gomez R, Gunderson M. Volunteer activity and the demands
of work and family. Industrial Relations/Relations Industrielles,
2003, 58(4):573–589.
17.
Poley L, Stephenson M. Community, trust and the habits of
democracy: an investigation into social capital and civic engagement in U.S. cohousing neighborhoods (paper presented at the
Annual Meeting of the American Political Science Association, Chicago, 30 August–2 September 2007). 2007 (http://
citation.allacademic.com//meta/p_mla_apa_research_citation/2/0/9/9/8/pages209987/p209987-1.php, accessed 15
February 2013).
18.
Wilson J, Musick MA. Social resources and volunteering. Social
Science Quarterly, 1998, 79:799–814.
19.
Tong KK, Hung EPW, Yeun SM. The quality of social networks:
Its determinants and impacts on helping and volunteering in
Macao. Social Indicators Research, 2011, 102(2):351–361.
3.
Cox E. Building social capital. Health Promotion Matters, 1997,
4:1–4.
4.
Jenner JR. Participation, leadership, and the role of volunteerism among selected women volunteers. Journal of Voluntary
Action Research, 1982, 11(4):27–38.
5.
Brudney JL, Kellough JE. Volunteers in state government:
involvement, management, and benefits. Nonprofit and Voluntary Sector Quarterly, 2000, 29(1):111–130.
6.
Vahidnia F. Case study: fertility decline in Iran. Population and
Environment, 2007, 28(4–5):259–266.
7.
Ramazani AA, Miri MR, Shayegan F. [Effect of health education
on health coordinating volunteers of Birjand health center
to promote healthy life styles in the community]. Journal of
Birjand University of Medical Sciences, 2008, 14(4):9–15 [in Farsi].
8.
Marsden PV. Network methods in social epidemiology. In:
Oakes JM, Kaufman JS, eds. Methods in social epidemiology. San
Francisco, Jossey-Bass, 2006:267–286.
9.
Hannemann RA, Riddle M. Introduction to social network methods. Riverside, California, University of California, Riverside,
2005 (ch 2) (http://faculty.ucr.edu/~hanneman/nettext/, accessed 15 February 2013).
10.
Tindall D, Wellman B. Canada as social structure: social network analysis and Canadian sociology. Canadian Journal of
Sociology, 2001, 26(2):265–308.
11.
Israel BA, Antonucci TC. Social network characteristics and
psychological well-being: A replication and extension. Health
Education Quarterly, 1987, 14(4):461–481.
12.
Bastani S, Salehi M. [Network social capital and gender: Investigation of structural, interactional and functional characteristics of social network of men and women in Tehran]. Social
Science Letter, 2007, 30:63–93 [in Farsi].
13.
Ganji F et al. [Evaluation of the impact of participatory intervention in the reduction of unnecessary caesarian (deliveries)
in Shahrekord, Iran]. Shahrekord University of Medical Sciences
Journal, 2006, 8(1(29)):14–18 [in Farsi].
20. Goss KA. Volunteering and the long civic generation. Nonprofit
and Voluntary Sector Quarterly, 1999, 28(4):378–415.
21.
Rohe W, McCarthy G, Van Zandt S. The social benefits and
costs of homeownership: a critical assessment of the research.
Washington DC, Harvard University, Joint Center for Housing Studies, 2001 (Low Income Home Ownership Working
Paper Series LIHO-01.12) (http://www.jchs.harvard.edu/
sites/jchs.harvard.edu/files/liho01-12.pdf, accessed 15 February 2013).
22. Volunteering in America 2010: national, state, and city information. Washington DC, Corporation for National and Community Service, Office of Research and Policy Development, 2010
(http://www.theartofcivicengagement.org/files/IssueBriefFINALJune15.pdf, accessed 15 February 2013).
23. Rotolo T. Town heterogeneity and affiliation: a multilevel
analysis of voluntary association membership. Sociological
Perspectives, 2000, 43(2):271–289.
24. Kane DA. Network approach to the puzzle of women’s cultural
participation. Poetics, 2004, 32:105–127.
25. Erlinghagen M, Karsten H. The participation of older Europeans
in volunteer work. Ageing and Society, 2006, 26(4):567–584.
355
EMHJ • Vol. 19
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
No. 4 • 2013
Factors influencing women’s willingness to volunteer
in the healthcare system: evidence from the Islamic
Republic of Iran
A. Alami,1,2 S. Nedjat,2,3 R. Majdzadeh,2,3 A. Rahimi Foroushani,2 S.J. Hoseini 4 and H. Malekafzali 2
ب ِينات من مهورية إيران اإسامية:العوامل التي تؤثر عى رغبة النساء للتطوع ي النظام الصحي
حسن ملک افضلی، سيد جواد حسيني، عباس رحيمي فروشاي، رضا جدزاده، سحرناز نجات،علی عامی
، تقدم هذه الدراسة للحاات والشواهد تقيي ًا للعوامل التي تؤثر عى تطوع النساء ي برنامج التطوع الصحي النسائي ي مهورية إيران اإسامية:اخاصـة
ومع الباحثون. شاهدة) من تلك امراكز146 متطوعة و145( إمرأة291 وقد شملت الدراسة. مركز ًا ي واية خراسان – ي رضوي150 وهو برنامج ين َفذ ي
) بن ميل
( التحوف اللوجيستي الوحيد امتغرات وامتعدد؛ ووجدوا ترابط ًا ُي ْعتَدُ به إحصائي ًا
وقام الباحثون بتحليل.البيانات باستخدام استبيان
ُ
والدعم، وتكوين الشبكة ااجتاعية، والعاقة الوثيقة مع اجران، ووجود طفل دون السنتن من العمر ي اأرة،النساء للتطوع وبن حجم اأرة
ويمكن إنشاء بعض. وا ُبدّ من تأسيس البنى التحتية ذات الصلة بالرغبة بالتطوع بن أفراد امجتمع إذا أردنا تعزيز ذلك. والدعم بامشورة،العاطفي
ِ اأماكن امناسبة من قبيل "منازل
. أن تساهم ي زيادة الرغبة ي اانضام إى هذه الرامج التشاركية،"اج َوار
ABSTRACT This case–control study evaluated the factors influencing volunteering in the Islamic Republic of Iran’s
Women’s Health Volunteer (WHV) programme, which is implemented in 150 centres in Khorasan-e-Razavi Province.
We recruited 145 cases (volunteers) and 146 controls (non-volunteers) from the centres. Data were collected by
questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings,
husband’s age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy,
child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of
acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory
support, monetary support, physical support, time support. There were significant associations (P < 0.05) between
women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood
intimacy, social network composition, and emotional and advisory support.
Facteurs influençant l'intention des femmes à devenir volontaires dans le système de soins de santé : données
provenant de la République islamique d'Iran
RÉSUMÉ La présente étude cas-témoin a évalué les facteurs influençant le volontariat dans le programme Femmes
volontaires de la santé en République islamique d'Iran, mis en œuvre dans 150 centres de la province du KhorassanRazavi. Nous avons recruté 145 cas (participation volontaire) et 146 témoins (participation sollicitée) dans ces centres.
Des données ont été recueillies par questionnaire. Les variables sociodémographiques prises en compte étaient les
suivantes : la durée de résidence dans le voisinage, le nombre de frères et sœurs, l'âge du mari, son niveau d'études et
son emploi, la taille de la famille, la qualité de vie, l'état de santé auto-évalué, le degré de connaissance du voisinage,
la présence ou non d'un enfant de moins de deux ans dans la famille, le fait d'être propriétaire de son logement
et l'indice de richesse. Les variables des réseaux sociaux prises en compte étaient les suivantes : la taille du réseau
égocentré, le type de connaissance, le degré d'intimité avec les autres, la communication relationnelle, la durée
des relations, le soutien psychologique, l'appui consultatif, le soutien financier, le soutien physique et le soutien à
la personne. Des corrélations significatives (P < 0,05) ont été trouvées entre la propension des femmes à devenir
volontaires et la taille de la famille, la présence ou non d'un enfant de moins de deux ans, le degré de connaissance
du voisinage, la composition du réseau social, et le soutien psychologique et consultatif.
1
School of Public Health, Social Development and Health Promotion Research Centre, Gonabad University of Medical Sciences, Gonabad,
Khorasan Razavi, Islamic Republic of Iran. 2Department of Epidemiology and Biostatistics, School of Public Health; 3Knowledge Utilization
Research Centre, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (Correspondence to S. Nedjat: nejatsan@tums.ac.ir).
4
Health Centre of Khorasan-e-Razavi Province, Mashad University of Medical Sciences, Mashad, Islamic Republic of Iran.
Received: 28/08/11; accepted: 2/12/11
348
امجلد التاسع عر
العدد الرابع
Introduction
Participation and volunteering
Since the World Health Organization’s
“Health for All” Strategy was devised
in 1979, participation has been considered a subject central to health. he
important role of participation in health
promotion strategies was re-emphasized in the “Otawa Charter for Health
Promotion” in 1986 [1]. Participation
may be deined as “a process by which
people are enabled to become actively
and genuinely involved in deining the
issues of concern to them, in making
decisions about factors that afect their
lives, in formulating and implementing
policies, in planning, developing and
delivering services and in taking action
to achieve change” [2].
Volunteering would also be one of
the important components of social
capital at the level of community [3].
Jenner [4] deines a volunteer as “a
person who, out of free will and without wages, works for a not-for-proit
organization which is formally organized and has as its purpose service to
someone or something other than its
membership”.
The Women’s Health
Volunteer programme
Although most volunteers give their
eforts to non-proit organizations, a
noticeable proportion of all volunteer
activity is directed to the public sector
[5]. he Women’s Health Volunteer
(WHV) programme, as governmentbased voluntary action, is a national
plan which was launched in some urban
parts of the Islamic Republic of Iran in
1990–1991. his community-based
health programme has gradually been
expanded to all the urban parts of
the country [6]. he WHVs (rabetine-behdashti in Farsi) are women who
voluntarily participate in community
health-based programmes. here is evidence that WHV activities could have
positive efects on community health
[6,7]. herefore, we selected this
امجلة الصحية لرق امتوسط
programme to study, as a successful
programme in the context of people’s
engagement with community healthbased programmes.
Influencing factors on
individuals’ willingness to
volunteer
here are various factors, such as personal, family, and local characteristics,
that could inluence individuals’ willingness to volunteer. Recently, researchers
have paid particular atention to the
inluence of social network characteristics on personal decisions. Indeed,
it is believed that social networks are
central to various social processes affecting health-related behaviours [8]. A
social network is a set of actors who may
have relationships with one another [9].
Tindall and Wellman also deine social
network as “the study of social structure
and its efects” [10].
Social network characteristics may
be stratiied in 3 dimensions. he irst
dimension is structural characteristics (size, density and network composition). he second is interaction
characteristics (relation type, contact
frequency, relation permanency, and intimacy with network members which is
evaluated by closeness sensation of subject with network members). he third
dimension is functional characteristics
(various types of support consisting of
emotional, advisory, monetary, physical,
and time support) [11,12]. Individuals
can obtain diferent types of support
from their network members. Relatives,
friends, and neighbours as well as colleagues can be important resources to
ofer help and support. It is believed
that diverse connections could create
various types of social support for each
person. It is also supposed that the more
diverse connections in one’s personal
social network, the beter one’s access
to a widespread range of diferent types
of support [12].
In the Islamic Republic of Iran,
although a number of studies have
been carried out concerning the
sociodemographic factors of WHVs as
well as the inluence of their activities on
community health [7,13], less atention
has been paid to the efect of contextual
factors on volunteering. he impact of
sociodemographic and social network
characteristics on individuals’ decisions
to volunteer would still be a fruitful ield
for exploration.
his study was conducted to
assess the relationship between sociodemographic and social network
characteristics, and women’s willingness to participate with Iran's WHV
programme.
Methods
Sampling and study population
We conducted this case–control study
in 2010 in Korasan-e-Razavi Province,
one of the largest and most populous
provinces in the country. It has roughly
5.5 million inhabitants (about 7% of the
Iranian population). To select the samples, we restricted the selection process
by some potential confounding variables: age, education level, marital status
and job. Our research population was
married women who were housewives,
aged 15–49 years, with an education of
between 6 and 12 years, living in urban
parts of the province.
To calculate the required sample
size, we irst conducted a pilot study
on 20 individuals from the population.
From this we identiied the potential
problems of the data collection phase
and to determine P1 and P2. We then
used the equation below to estimate the
sample size for each group:
n = [2(Z1 – α/2 + Z1 – β)2 P(1 – P)]/(P1 – P2)
Where P = (P1 + P2)/2 and considering Z1 – α/2 = 1.96 and Z1 – β = 0.84
(i.e. a power of 0.80), we calculated different sample sizes ranging from 62 to
96 samples in each group. As we applied a 2-stage cluster sampling method
to select the samples, we considered
349
EMHJ • Vol. 19
the design efect equal to 1.5. So, our
sample size was estimated at 145 samples in each of the case and the control
groups. To control potential problems
during data gathering, the researchers
increased the sample size to 150 participants for each group.
here are nearly 175 urban health
centres in Khorasan-e-Razavi province. he WHV programme is actively
implemented among 150 centres. To
select the participants, we randomly
selected 50 of these centres as clusters
and administered questionnaires to
3 women as cases in each cluster. All
the respondents were women who
had recently volunteered for participation in the WHV programme in the
selected centres during the research
period, 1 May 2010 to 1 September
2010.
In the Islamic Republic of Iran nearly all family members, including women,
are registered in family health dossiers
which are kept in the urban health centres. Ater data gathering for the cases,
we randomly selected 3 controls in each
of the centres among women who did
not participate in the WHV programme
and had not previously had any cooperation with similar programmes. he
questionnaires then were administered
via face-to-face interview.
here were 50 interviewers in our
study. To assure quality and eliminate
potential interviewer bias, a 1-day
workshop was held for the interviewers.
Additionally, an interview guide was
made to use in the process of interviewing. he researchers also used a coding
system for the questionnaires to control
potential bias in both data entry and
analysis and to ensure anonymity for the
participants.
Data collection tool
We used a 2-section questionnaire to
collect data. Internal consistency was
assessed using Cronbach’s alpha (0.73
in the social network characteristics domain). Reliability of the questionnaire
was assessed via test–retest with a mean
350
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
No. 4 • 2013
intra-class correlation coeicient of 0.82
(0.74–1.00).
he irst section of the questionnaire
covered sociodemographic characteristics including length of residence in her
neighbourhood, the age and education
level of the respondent and her husband, husband’s job, and family size. We
also collected data on other factors including presence of a child under 2years
old in the family, and home ownership.
To evaluate the family wealth index,
we used a list of assets such as vacuum
cleaner, washing machine, dishwasher,
telephone line, motor car, computer,
refrigerator, colour television, and CD
or DVD player. We then measured
family wealth index via principle component analysis. In the inal part of this
section, we used a 5-point Likert-range
question to assess quality of life and selfrated health status as well as a 7-point
Likert-range question to evaluate neighbourhood intimacy as perceived by the
respondent.
he second section of the questionnaire was allocated to individual social
network factors comprising the structural, interactional and functional characteristics. he structural factors were
size, density and network composition.
Interactional characteristics consisted
of relation type, contact frequency, relation permanency, and intimacy with
network members. In this study, 5 types
of support—emotional, advisory, monetary, physical, and time support—were
considered social network functional
characteristics.
Data analysis
We entered the data into Stata, version 10. We evaluated diferences
between case and control groups via
the Mann–Whitney U-test, χ2 and
Fisher exact test. Using univariate
and multiple logistic regression with
odds ratio (OR), P-value and 95%
conidence interval. We assessed
the association between volunteering and sociodemographic as well
as social network characteristics. All
independent variables were entered
separately in the univariate logistic
regression model. hen, as Jewell indicated, those variables with P < 0.2
were selected for entering in multiple
logistic regression [14]. In the inal
model, variables with P < 0.05 were
reported as statistically signiicant.
Ethical considerations
he researchers obtained the approval
of the institutional review board of
Tehran University of Medical Sciences. Before conducting the research,
the research team obtained the authority of managers in regard to the
research project. Agreement of all
participants to participate the research
was obtained before the interviews.
As the interviews were prolonged
(roughly 1 hour), respondents were
ofered rest breaks. he respondents
were informed of their rights to cease
their participation at any time during
the interview.
Results
For the data analysis, we used 291 (out
of 300) completed questionnaires
(cases = 145, controls = 146), a refusal
rate of 3%. he mean age in the case
group was 28.84 (SD 8.26) years and
the duration of education was 10.06
(SD 2.08) years; in the control group
the corresponding values were 29.59
(SD 6.9) years and 9.91 (SD 2.07)
years, respectively.
Table 1 shows the respondents’
sociodemographic characteristics and
their associations with participation
in the WHV programme. Some sociodemographic factors, including the
presence of a child under 2 years (P =
0.020), quality of life (P = 0.018) and
neighbourhood intimacy (P = 0.002),
had P < 0.05 in univariate logistic regression.
Table 2 shows the social network
characteristics and their associations
with volunteering. Social network
امجلد التاسع عر
العدد الرابع
امجلة الصحية لرق امتوسط
Table 1 Binary logistic regression analysis of sociodemographic characteristics in association with participation in the
Women’s Health Volunteer programme
Variable
Length of residence in neighbourhood
(months)
No. of siblings
Case
(n = 145)
Control
(n = 146)
Crude
OR
P-value
95% CI
Mean (SD)
Mean (SD)
99.57 (92.61)
86.10 (93.52)
1.00
0.342
0.99–1.00
5.02 (2.34)
4.92 (2.06)
1.07
0.277
0.95–1.20
33.54 (8.74)
34.17 (7.73)
0.99
0.870
0.97–1.03
Husband's education (years)
9.76 (3.02)
9.31 (3.58)
1.02
0.767
0.94–1.11
Family size
3.37* (1.20)
3.62* (1.13)
0.83
a
0.100
0.66–1.04
Quality of life
3.88* (0.67)
3.66* (0.69)
1.60a
0.018
1.09–2.37
Husband's age (years)
Self-rated health status
3.91 (0.64)
3.84 (0.70)
1.17
0.389
0.82–1.68
Neighbourhood intimacy
4.30* (1.34)
3.68* (1.39)
1.40a
0.002
1.14–1.72
1.00
0.902
0.50–2.20
No.
%
No.
%
Governmental
22
16
23
16
Free market
84
61
92
63
1.05
0.779
0.27–5.63
4
34
5
3
1.24
0.655
0.18–2.96
6
4
0.73
0.663
0.48–3.21
20
14
18
12
1.24
0.840
0.16–9.90
2
2
2
2
1.24
Yes
20
14
47
32
1.00a
0.020
0.21–0.88
No
125
86*
99
68*
0.43a
Owner
63
44
55
38
1.00
0.689
0.50–1.58
Tenant
57
39
72 (
49
0.89
0.492
0.60–2.87
Other
25
17
19
13
1.31
Husband's job
Retired
Private office
Worker
Unemployed
6
Child under 2 years
House ownership
Wealth index
1 (poorest)
34
23
27
19
1.00
0.509
0.29–1.85
2
30
21
27
19
0.73 a
0.844
0.45–1.91
3
28
19
27
19
0.93 a
0.089
0.20–1.12
4
27
19
30
21
0.47 a
0.181
0.29–1.27
5 (richest)
26
18
31
22
0.60 a
*P < 0.05 (Mann–Whitney U-test, χ2 test, Fisher’s exact test).
a
Variables with P < 0.2 and considered for multiple logistic regression.
OR = odds ratio; CI = confidence interval.
density (P = 0.012) and heterogeneity
(P < 0.001), women’s intimacy with
their network members (P < 0.001)
and emotional (P < 0.001) as well
as advisory (P < 0.001) support obtained from network members also
had P < 0.05 in the univariate model.
We therefore entered these variables,
together with those which had P <
0.20 (i.e. wealth index and family size),
in the multiple logistic regression
analysis.
The results of the multiple logistic
regression analysis are shown in Table
3. here were signiicant associations
between volunteering and some sociodemographic factors including
presence of a child under 2 years [adjusted OR (AOR) = 0.46], family size
(AOR = 0.76) and neighbourhood
intimacy (AOR = 1.31) and some
social network characteristics including type of acquaintance (which implies social network heterogeneity)
(AOR = 0.60) and emotional support
obtained. We compared no support
(level 1) with a litle support (level 2)
conditions (AOR = 1.80), no support
with enough support (level 3) conditions (AOR = 1.82) for emotional
support obtained, as well as advisory
support obtained in comparison with
no support to a litle support conditions (AOR = 1.48) and no support
to enough support conditions (AOR
= 2.13).
351
EMHJ • Vol. 19
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
No. 4 • 2013
Table 2 Binary logistic regression of social network characteristics of Women's Health Volunteer programme volunteers and
controls
Variable
Volunteers
(n = 145)
Controls
(n = 146)
Crude
OR
P-value
95% CI
Social network domain: structural
Ego network size [mean (SD)]
12.79(7.43)
12.99 (5.62)
1.02
0.294
0.99–1.05
Density [mean (SD)]
0.64 (0.18)
0.70 (0.18)
0.13a
0.012
0.03–0.64
457 (27)
264(15)
1.00
1257 (73)*
1499 (85) *
0.48a
< 0.001
0.38–0.62
< 0.001
1.06–1.34
Type of acquaintance [No. (%)]
Non-relative
Relative
Social network domain: interactional
3.99*(1.21)
3.70*(1.34)
1.19a
> once a week
898 (53)
921 (53)
1.00
once a week
342 (20)*
372 (21)*
0.94
0.646
0.73–1.21
once in 2 weeks
157 (9)*
87 (11)*
0.86
0.487
0.57–1.31
306 (18)*
273 (15)*
1.15
0.414
0.82–1.61
Visual
1246(75)
1374 (79)
1.00
By telephone
396 (24)*
365 (21)*
1.20
0.244
0.89–1.62
7 (0)*
4 (0)*
1.93
0.424
0.39–9.67
10 (1)*
6(0)*
1.84
0.345
0.52–6.49
1.00
0.505
0.99–1.00
Intimacy with others [mean (SD)]
No. of contacts [No. (%)]
< once in 2 weeks
Relationship [No. (%)]
By mail
Other
Relationship duration (months) [mean (SD)]
203.94 (143.49)
196.87 (134.52)
Social network domain: functional
Emotional support [No. (%)]
None
170 (10)
401 (23)
1.00
A little
631 (37)*
680 (38)*
2.19a
< 0.001
1.58–3.03
Enough
913 (53)*
680 (39)*
3.17a
< 0.001
2.20–4-56
Advisory support [No. (%)]
None
294 (17)
562 (32)
1.00
A little
656 (38)*
678 (39)*
1.85a
< 0.001
1.45–2.36
Enough
762 (45)*
518 (29)*
2.81a
< 0.001
2.09–3.78
None
931 (54)
962 (55)
1.00
A little
399 (23)
359 (20)
1.15
0.409
0.83–1.60
Enough
379 (22)
431 (25)
0.91
0.550
0.66–1.24
583 (34)
639 (37)
1.00
A little
614 (36)
606 (35)
1.11
0.504
0.81–1.52
Enough
493 (30)
496 (28)
1.09
0.599
0.79–1.51
None
542 (32)
614 (35)
1.00
A little
644 (38)
638 (36)
1.14
0.344
0.87–1.51
Enough
515 (30)
496 (29)
1.18
0.316
0.86–1.62
Monetary support [No. (%)]
Physical support [No. (%)]
None
Time support [No. (%)]
*P < 0.05 ((Mann–Whitney U test, χ2 test, Fisher’s exact test).
a
P < 0.2 and considered for multiple logistic regression,
OR = odds ratio; CI = confidence interval.
SD = standard deviation.
352
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Table 3 Multiple logistic regression of sociodemographic and social network characteristics associated with participation in
the Women's Health Volunteer programme
Variable
Adjusted OR
P-value
95% CI
0.76
0.027
0.60–0.97
Quality of life
1.41
0.108
0.93–2.14
Neighbourhood intimacy
1.31
0.018
1.05–1.64
0.17
0.075
0.026–1.19
0.037
0.22–0.96
0.382
0.26–1.68
Family size
Density
Child under 2 years
No
1.00
Yes
0.46
Wealth index quintile
1 (poorest)
1.00
2
0.66
3
0.94
0.884
0.41–2.15
4
0.44
0.123
0.16–1.25
5 (richest)
0.79
0.588
0.34–1.84
0.60
< 0.001
0.47–0.77
1.01
0.875
0.90–1.13
Type of acquaintance
Non-relative
Relative
Intimacy with others
1.00
Emotional support
None
1.00
A little
1.80
< 0.001
1.31–2.46
Enough
1.82
0.003
1.22–2.72
1.11–1.96
Advisory support
None
1.00
A little
1.48
0.007
Enough
2.13
< 0.001
1.52–2.99
OR = odds ratio; CI = confidence interval.
Discussion
To the best of our knowledge, this is the
irst study conducted in Iran that deals
with the association between sociodemographic and social network factors
and willingness to participate in a voluntary programme. By recognizing these
potential associations, a new view could
be created to improve such programmes.
Multiple logistic regression analysis
indicated that neighbourhood intimacy
and the emotional and advisory support obtained from network members
may have a direct association with
willingness to volunteer in the WHV
programme, while presence of a child
under 2 years in the family, family size
and network homogeneity may have
an inverse association. We found no
signiicant associations between certain
sociodemographic variables and social
network characteristics and participation in the WHV programme.
Arguments and
counterarguments
Family size was an inluencing variable
on volunteering. he smaller the family
size, the more likely respondents were
to participate in the WHV programme.
As these women may have more time
to participate in social activities, this
would be logical. Nesbit also suggested
that middle-aged women with larger
family size have less time to engage in
voluntary activities [15].
here was a signiicant association
between presence in the family of a child
under 2 years and volunteering. his is
similar to the indings of Gomez and
Gunderson who reported an association between the existence of a dependent child in the family and volunteering
[16]. here was also a signiicant association between neighbourhood intimacy
and volunteering in our research. Poley
and Stephenson indicated strategies
which develop common interests in
their neighbourhood could have positive efects on neighbourhood members’ civic engagement [17].
We found the number of non-relative members (friends and neighbours)
in the social networks of volunteers was
statistically signiicantly greater than
in the social networks of the control
group. In fact, the social networks in the
volunteers were more heterogeneous
than those of the controls. Diversity in
353
EMHJ • Vol. 19
their personal social network may imply
that an individual is more communicative, and this may be a predictor of willingness to volunteer. Our inding was
similar to those of Wilson and Musick,
which showed a direct association between number of friends and voluntary
activity [18].
Our results showed a signiicant association between the emotional and
advisory support, as personal social
network resources, and willingness to
volunteer in the WHV programme. It
was comparable with the results of the
study of Tong, Hung and Yeun in Macao, which was conducted to recognize
the determinants and efects of social
network characteristics on pro-social
behaviours such as volunteering and
helping others [19]. hey emphasized
those individuals who have resourceful
social networks have more willingness to
participate in such pro-social activities.
In contrast, in our study, there was
no signiicant association between
social network size and willingness to
volunteer. In the study carried out by
Tong, Hung and Yeun, social network
size may have had a direct association
with personal willingness to help others
and volunteering. As their study could
not investigate temporality between
exposure (social network size) and outcome (volunteering), the network size
may itself be inluenced by volunteering.
As we used incident cases, there was no
similar problem in our study.
here was no signiicant association
between wealth status of the participants and volunteering in our study. In
contrast, Goss implied that wealthy
people are more willing to donate their
time in voluntary eforts [20].
Although several studies have reported an association between home
ownership and volunteering [21,22] we
did not ind such an association. Insuficient sample size may be a cause of
the failure to ind this association in our
study. Neither did we ind a signiicant
association between social network
354
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
No. 4 • 2013
density and volunteering, which was
comparable to the results of Rotolo
[23], but contrary to those of Kane [24].
Study limitations
Case–control studies are known to
have more of a tendency to confounding, information bias and selection bias
than other types of study. To control the
problem, we restricted the selection of
subjects on some variables such as age
(15–49 years), duration of education
(6–12 years), marital status (married)
and job (housewife). We also conducted some activities to improve quality
assurance, such as holding a workshop
for interviewers and preparing an interview guide. To avoid the efect of
volunteering on the factors under study,
especially social network characteristics,
all the selected cases were new volunteers (incident cases).
We would particularly refer to 2 issues. Although many studies have demonstrated a potential relation between
education level and volunteering [25],
we could not investigate the association
between the variables. his was because
of the restriction on this factor in the
selection process. Similarly, associations
between volunteering and the respondents' age, marital status, and job could
not be evaluated in this study. Besides,
a woman who is willing to participate in
the WHV programme must obtain written agreement from her husband. his
behaviour may be a proxy for a more
democratic family. So it seems women
living in such families may have more
chance to participate in social activities
such as the WHV programme. herefore, our results might be inluenced by
this discrepancy between the volunteer
group and the control group. Of course,
this association should be investigated
through a separate study.
Policy implications
As mentioned, there has been no previous research to identify the characteristic factors of women who have a
propensity to participate in the Iranian
WHV programme, as a voluntary plan.
Our indings can be used by policymakers who work on community-based
voluntary programmes, especially in
the Islamic Republic of Iran and other
countries with similar cultures. According to our indings in regard to the
relationship between volunteering and
family size as well as the presence of a
child under 2 years in the family, we
suggest that managers should probably
target their atempts at women who
have small families, with no dependent
children so that they may be able to
select appropriate individuals for their
voluntary programmes.
We found that the greater the intimacy in the neighbourhood, the greater
the chance of a woman being willing
to volunteer. To promote a volunteering culture in the community, places
such as “neighbourhood houses” (c.f.
community centres) or “neighbourhood councils” could be established.
hrough such places, neighbours could
design and generally run public activities, including educational and health/
exercise activities. he likelihood of
more-communicative persons, i.e. those
with a propensity for volunteering, attending such places would be quite
high. So, we suggest establishing places
such a “neighbourhood house”, because
of these multi-dimensional efects.
In conclusion, family size, neighbourhood intimacy, individual social
network heterogeneity and received
emotional and advisory supports from
network members may be important
determinants of participation in community-based voluntary programmes
such as the WHV programme.
Acknowledgement
his paper is based on the irst author's
PhD dissertation, supervised by the second author and submited to the Epidemiology and Biostatistics Department,
Tehran University of Medical Sciences,
2010 and granted by the University.
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References
1.
Baum FE, Ziersch AM. Social Capital. Journal of Epidemiology
and Community Health, 2003, 57:320–323.
14.
Jewell NP. Statistics for epidemiology. California, Chapman &
Hall/CRC, 2004.
2.
Community participation in local health and sustainable development: approaches and techniques. Geneva, World Health
Organization, 2002 (European Sustainable Development
and Health Series 4) (https://www.utexas.edu/nursing/norr/
docs/commparticipation.pdf, accessed 15 February 2013).
15.
Nesbit B. A comparison of volunteering data in the panel
study of income dynamics and the current population survey.
Nonprofit and Voluntary Sector Quarterly, 2010, 39(4):753–761.
16.
Gomez R, Gunderson M. Volunteer activity and the demands
of work and family. Industrial Relations/Relations Industrielles,
2003, 58(4):573–589.
17.
Poley L, Stephenson M. Community, trust and the habits of
democracy: an investigation into social capital and civic engagement in U.S. cohousing neighborhoods (paper presented at the
Annual Meeting of the American Political Science Association, Chicago, 30 August–2 September 2007). 2007 (http://
citation.allacademic.com//meta/p_mla_apa_research_citation/2/0/9/9/8/pages209987/p209987-1.php, accessed 15
February 2013).
18.
Wilson J, Musick MA. Social resources and volunteering. Social
Science Quarterly, 1998, 79:799–814.
19.
Tong KK, Hung EPW, Yeun SM. The quality of social networks:
Its determinants and impacts on helping and volunteering in
Macao. Social Indicators Research, 2011, 102(2):351–361.
3.
Cox E. Building social capital. Health Promotion Matters, 1997,
4:1–4.
4.
Jenner JR. Participation, leadership, and the role of volunteerism among selected women volunteers. Journal of Voluntary
Action Research, 1982, 11(4):27–38.
5.
Brudney JL, Kellough JE. Volunteers in state government:
involvement, management, and benefits. Nonprofit and Voluntary Sector Quarterly, 2000, 29(1):111–130.
6.
Vahidnia F. Case study: fertility decline in Iran. Population and
Environment, 2007, 28(4–5):259–266.
7.
Ramazani AA, Miri MR, Shayegan F. [Effect of health education
on health coordinating volunteers of Birjand health center
to promote healthy life styles in the community]. Journal of
Birjand University of Medical Sciences, 2008, 14(4):9–15 [in Farsi].
8.
Marsden PV. Network methods in social epidemiology. In:
Oakes JM, Kaufman JS, eds. Methods in social epidemiology. San
Francisco, Jossey-Bass, 2006:267–286.
9.
Hannemann RA, Riddle M. Introduction to social network methods. Riverside, California, University of California, Riverside,
2005 (ch 2) (http://faculty.ucr.edu/~hanneman/nettext/, accessed 15 February 2013).
10.
Tindall D, Wellman B. Canada as social structure: social network analysis and Canadian sociology. Canadian Journal of
Sociology, 2001, 26(2):265–308.
11.
Israel BA, Antonucci TC. Social network characteristics and
psychological well-being: A replication and extension. Health
Education Quarterly, 1987, 14(4):461–481.
12.
Bastani S, Salehi M. [Network social capital and gender: Investigation of structural, interactional and functional characteristics of social network of men and women in Tehran]. Social
Science Letter, 2007, 30:63–93 [in Farsi].
13.
Ganji F et al. [Evaluation of the impact of participatory intervention in the reduction of unnecessary caesarian (deliveries)
in Shahrekord, Iran]. Shahrekord University of Medical Sciences
Journal, 2006, 8(1(29)):14–18 [in Farsi].
20. Goss KA. Volunteering and the long civic generation. Nonprofit
and Voluntary Sector Quarterly, 1999, 28(4):378–415.
21.
Rohe W, McCarthy G, Van Zandt S. The social benefits and
costs of homeownership: a critical assessment of the research.
Washington DC, Harvard University, Joint Center for Housing Studies, 2001 (Low Income Home Ownership Working
Paper Series LIHO-01.12) (http://www.jchs.harvard.edu/
sites/jchs.harvard.edu/files/liho01-12.pdf, accessed 15 February 2013).
22. Volunteering in America 2010: national, state, and city information. Washington DC, Corporation for National and Community Service, Office of Research and Policy Development, 2010
(http://www.theartofcivicengagement.org/files/IssueBriefFINALJune15.pdf, accessed 15 February 2013).
23. Rotolo T. Town heterogeneity and affiliation: a multilevel
analysis of voluntary association membership. Sociological
Perspectives, 2000, 43(2):271–289.
24. Kane DA. Network approach to the puzzle of women’s cultural
participation. Poetics, 2004, 32:105–127.
25. Erlinghagen M, Karsten H. The participation of older Europeans
in volunteer work. Ageing and Society, 2006, 26(4):567–584.
355