Assessment of the Quality of Life, Health, and Social Wellness in Upper Elementary School Students: Cross-Cultural and Gender Specificity

Ružena Popović1, Evdokia Samouilidou2, Jasna Popović3, Milan Dolga 1University of Niš, Faculty of Sport and Physical Education, Niš, Serbia 2School Supervisor for Physical Culture Northern Aegean Region, Athens, Greece 3University of Pristine/Kos.Mitrovica, Faculty of Sport and PE, Leposavić (Kosovo)*, Serbia 4Agency for Multivariate Data Analysis, “Smart Line” Novi Sad, Serbia Email: ruzenapop@mail.com


The subject, problem, aim and tasks of research
The purpose of this pilot study was a comparative analysis of the quality of life of the elementary school students in terms of the possibilities of physical activity application for children with health problems, and the presentation of the current status in the samples of respondents of different groups of ethnic origin (home and foreign country elementary school children).
The key aim, and the problem orientation of this study is related to the analysis of eleven thematic segments (C1-C11), and 37 items/study questions, within the questionnaire (Q), used for the assessment of the Quality of life, regarding Health and Social Wellness (QLHSW) components. The Convention on Children Rights, adopted by the UN (1989), points out that children have a right to health and well-being.
For this reason, the objective of this study is to assess all mentioned components, using a comprehensive (Q). Of the special interest is to assess emotional, and physical components of health, regarding the student's health situation, which may affect their ability to engage in activities of physical education (PE), as well as the perception of social wellbeing. For that reason are set the following tasks, regarding the comparative analysis of the gender differences in home country (HC) sub-samples (boys/girls), as well as different "group's" of ethnic origins (EO) analysis. 1) To present the basic characteristics of items, within eleven segments of Q, regarding the opinions of two "groups" of respondents, of different EO, with a presentation of possible gender differences in HC sub-samples. 2) To determine the differences in the statements modalities, between two "groups" of different EO, concerning the applied items within particular segments of the Q, with a presentation of possible gender differences in HC sub-samples. 3) To define the characteristics of each "groups" of respondents of different EO, regarding the applied items within the particular segments of Q (C1-C11). 4) To determine the contribution of the wholes (C) to the characteristics of the "groups" of different EO: Greece (GRE-1), Serbian (SER-2), on total samples of respondents.

Research hypothesis
Taking into account the previous experience, the basic aim, and the presented problem orientation, objective, and goals of the research, as well as the methodological approach to this study, there was set up a Global hypothesis as null (H0), and alternative (A0): H0 -There will be no established between "groups" difference of the respondents of different EO, concerning the applied items within 11 segments of the Q, defined as (C1-C11).

Britain International of Humanties and Social Sciences (BIoHS) Journal
ISSN: 2685-3868(Online), 2685-1989(Print) Vol. 2, No. 1, February 2020 A0 -There will be established a significant between "groups" difference of the respondents of different EO, concerning the tested items within 11 segments of the Q.
When it is about gender differences within HC sub-samples (Boys/Girls), the research results will be provided only in form of relative values, in tables, within 11 scales of the Q, and 37 items (study questions), with 4-levels of Likert-type scale statements modalities.

II. Review of Literature
Considering a small number of researches, elaborated in this field in home country, and region-wide, dealing with the estimation of the quality of life in children and youth, this study is partly based on the model, which was implemented by Kvrgić, S, (2001), and published as a monograph Quality of life of school children and youth. The next important research in this area was conducted by Samouilidou, E. (2004), and published as a monograph Stimulation of the motor development in pupils with mental retardation.

III. Research Method
This comparative analysis provides the evaluation of the research results, collected during the physical education (PE) classes, with upper Elementary school students in Nis (as HC), and with the foreign country students of Greece.
Unlike the model, implemented in the above mentioned research, with two version of the Q (children and parental), in this pilot study was applied only Q, concerning to the components of the QLHSW, in school children (without the consideration of parental situation, only in Introductory part, Table A).
The observed variables are items. The characteristics concerning the divided sample of HC students to the sub-samples by gender is a criterion. More items, which are connected to each other meaningfully, and make a logical order are called simply "whole" (C). All observed thematic sections make a field of examination, regarding the criterion difference, as stated in Global hypothesis as "groups" of different EO.

Sample
Total sample of 45 respondents, divided into two samples, according to different EO: Greek students (from Northern Aegean Region), not very balanced in terms of gender (13 male/2 female), up 10-11 to 16-17 years of age, and HC students of a Serbian citizenship (of Niš), good balanced in terms of gender (15 male/15 female), up 10-11 to 14-15 years of age.

Instrument of Research
Applied Q is designed to assess the Quality of Life, Health and Social Wellness. Introductory part contain seven sections, dealing with some socio demographic indicators concerning the parental situation of the respondents. The following segments of the Q refers to the eleven applied scales (C1-C11), and offered four levels of statements modalities, on Likert-type scale up 1-4 points of intensity. Names and description of certain scale are provided according to Kvrgić, S. (2001): pp. 22-24, by Source: The CHQ Britain International of Humanties and Social Sciences (BIoHS) Journal ISSN: 2685-3868(Online), 2685-1989(Print) Vol. 2, No. 1, February 2020 User's Manual. Landgraf, Ware, Abetz, 1996.

Area of research
The introductory part of the Q (Table "A") and assessed with seven parts (1-7), regarding some demographic, and social status variables of upper elementary school students, and their parents. All obtained data were analyzed only based on the absolute and relative frequencies of statements modalities, within provided items on gender, age, level of education and professional position of children (when applicable), and parents.
The main area of this research consists of eleven thematic scales, which are analyzed concerning different "groups" of EO, related to ethnic specificity, and gender differences comparison: C1-Scale of physical functioning; C2-Scale of social roles implementations; C3-Scale of Global health; C4-Scale of Bodily pain; C5-Scale of Psychological impact on parents; C6-Scale of Social roles implementation; C7-Scale of Self-assessment; C8-Scale of Mental health; C9-Scale of Behavior; C10-Scale of Family activities and relationships; C1 1-Scale of Health changes.

Mathematical-Statistical model of data processing a. Applied processes
Data was processed with the appropriate mathematical-statistical procedures (M-S). The analysis was conducted in three steps as follows: hypothesis testing about the similarities or differences, specifying measures of the differences, and defining characteristics.
The 1st level are items, given in the form of a statements. At the 2nd level, item-like particles are observed in the sub-scales that cover different dimensions of QLHSW. The raw scores of each scale are transformed into standardized, with an appropriate statements modalities, which facilitates the interpretation of the results. The 3rd level represents total physical and psycho-social health. Up to this level, there are certain statistical procedures, based on the individual scale scores.
Eleven segments of Q, (C1-C11) with applied 37 items, have non-parametric properties, and they are analyzed with non-parametric methods, regarding the frequency of statements modalities.
For data analysis was used multivariate procedures: Multivariate Analysis of Variance (MANOVA) and Discriminate Analysis (DISCRA). The purpose of the application of M-S analysis is to determine the characteristics of the samples homogeneity, and the distance between them in relation to the estimated criterion characteristics, and for the reason of reliable and accurately prediction and prognosis with positive significance.

b. Testing of the hypothesis
The methods used for proving the existence of similarities or differences, between sub-samples, confirm the hypothesis or reject it, or indicate the existence of differences. When testing the hypothesis it is used critical value p, which means the risk of conclusion. If p>0.1 there is no reason not to accept the initial hypothesis. For the rejection of the initial hypotheses are used two levels of significance. In the case where 0.1 >p>0.05 the alternative hypothesis is accepted with an increased risk of conclusion, when p< 0.05 the alternative hypothesis is accepted, and points out on significant differences.

Britain International of Humanties and Social Sciences (BIoHS) Journal
ISSN: 2685-3868(Online), 2685-1989(Print) Vol. 2, No. 1, February 2020 The procedure of (MANOVA) was used to test the hypothesis H1: H1 -There are no significant differences between sub-samples for the given thematic unit. A1 -There are significant differences between sub-samples for the given thematic unit.
The procedure of (DISCRA) to test the hypothesis H2 : H2 -There is no clearly defined border between sub-samples for the given thematic unit. A2 -There is a clearly defined border between sub-samples for the given thematic unit.

IV. Discussion
To avoid losing of information, finding the finest links and information's, on nonparametric values, data scaling is performed on the tables of contingency. This procedure, based on the unit frequency, for each part is given a real number, which reflects the intensity of item modalities, within certain scales of the Q.

Survey of the Introductory part "A" of (Q) within 7 segments (43 items) of the Student's Social Status, different "Groups" of EO, and HC Gender Comparison
In the Introductory part of Q (Table-A), are provided the basic social-status components, within the SSS (1-7) of the upper elementary school students, and some demographic data on home (SRB-2), and foreign country (GRE-1) examinees, and their parents.  estimated on 4-points scale, up "very limited" to "no limit". A low score indicates that health problems significantly limit the children in performing all physical activities (PA), whereas a high score means that a children perform (PA), without restrictions.

Scale of the Physical Functioning -SPF (8-10).
Based on comparative analysis of results, provided by HC sub-samples (Boys-2; Girls-2), there were no estimated significant gender differences, while the majority respondents opted for the statement "no limit" or "no restrictions" on the provided items within SPF (8-10) in Table 1.
Conducted MANOVA (F=6.74, p=0.001); and DISCRA (F=6.57, p=.001) analysis indicates that there is a significant between «groups» difference, considering students of different EO. The established coefficients of discrimination (c.dsc) are in following items: C2 -Scale Of The Social Roles Implementation. Accomplishing, and the realization of social role, previously mainly estimated on absences from the school, and now is considered being of great importance as for the ability to socialize, and get along with others. Accordingly, these 4-point scales assesses to what extent physical health interfere with children everyday school activities and social contact with their friends. The low score point out on high degree of restrictions, while high score means that there is no restrictions.

C3 -The Scale Of The Global Health.
In this part of the questionnaire respondents subjectively evaluate past, present and future health status, as well as susceptibility to diseases, by expressing its agreement with the statements on the 4-point scale. A low score means that the children's health is assessed as poor (very bad), with a worsening trend, whereas a high score comes to evaluating health as excellent and the belief that it will remain so. C4 -The Scale Of The Bodily Pain, designed to measure the intensity and frequency of pain, as one of the indicators of physical health. The pain or discomfort is assessed through responses ranging up "no pain" to "presence of a strong pain" (within a period of the last 4 weeks, from the day of survey assessment). A low score means that the child fills extremely strong, frequent and restrictive pain, whereas a high score speaks of the absence of pain.

C5 -The Scale Of The Emotional Impact On The Parents.
The Scale is 4-point, and the responses are in range from "very limited" to "not limit". A low score point out on high degree of limitation in the time available for personal needs, due to child physical, and/or psycho-social health. A high score means that a parent do not experiencing such a limitations.

C6 -The Scale Of The Emotional State And Bahavior.
For the realization of the social role, which includes daily activities, such are school activities, and social activities with friends, in addition to the physical health of the great importance are the emotional state and behavior. The Scales, which measures this effect have been constructed as a 4-points and can be separated, but also can be a unique-form scale that talks about the combined impact of emotions and behaviors for the realization of social role. A low score means that the child is, because of his behavior or emotional problems, substantially limited in performing school or other daily activities with friends, while a high score means that there are no restrictions.

Scale of the Emotional State and Behavior (SESB), presents relative values within
items, and provides statements, which do not pointed on significant gender differences between HC sub-samples (Boys-2; Girls-2), while in majority of statements, respondents opted for the highest intensity, which means that there are no limitations, when considering the combined impact of emotions and behaviors for the realization of social role, with some prevalence of higher percentage of statements in boys, except in item U21, with some higher percentage of statements in girls. Conducted MANOVA (F=13.995, p=.000), and DISCRA (F=13.995, p=.000) analysis indicates that there is a significant between «groups» difference, considering school students of different EO. The established (c.dsc) are in following items: C7 -The Self Evaluation Scale. The self-assessment is a multi-dimensional phenomenon that occurs during a pre-adolescence period, and shape and redefines during the life-time, and includes three essential components: social security (confidence), academic skills, and self-esteem. The Scale, used in this survey includes the following dimensions: satisfaction of the school achievement, and physical abilities, satisfaction with appearance, as well the ability of agreement with others, and with family members, and overall satisfaction with life. Answers vary up "very satisfied" to "very dissatisfied", whereas the low score points out that on very dissatisfied child, and the high score points out on very satisfied child with their abilities, appearance, family relationships and overall life satisfaction.

I-C8 -The Scale of the Mental Health.
Measures the frequency of positive and negative states. To analyze the frequency of answers were used a 4-point scale of intensity, on which answers vary from "all the time/continuous" to "never". The low score of mental health talk about feelings of anxiety and depression that are present continuously, while a high score means that the child is calm and happy.  2685-3868(Online), 2685-1989(Print) Vol. 2, No. 1, February 2020 Almost always 25% 15.4% 33.3% 33.3%

C9 -The Scale Of Behaviour.
Frequency of problems related to behavior are assessed on a 4-point scale of intensity, whose responses ranged up-to "always-very often-sometimesnever". The scale includes four dimensions of behavior: aggression, delinquency, hyperactivity (impulsivity), and social rejection. A low score indicates a potentially aggressive, immature and delinquent behavior, while a high score means that the child never manifest such behavior.

C10 -The Scale Of Family Activities And Family Relationships.
The family situation is of great importance for children's health, and also is know that the child health condition can affect family relationships. With this (Q), the authors wanted to assess the level of restrictions that families experience because of their children's health. This 4-point intensity scale is designed to measure the frequency of restrictions in common family activities, which may be conditioned by the physical or emotional problems, as well as with attention disorders, and child behavior. Replies are ranging from "often" to "never", when the low score points out that the child health often has disturb the family activities, or it cause the family tensions, while high score means that child health never produce tensions, nor disturb ordinary activities. For the assessment of family connections has been provided one item, where respondent should answer how well the members their family agree among themselves, whereas the responses vary from "excellent" to "bad". The low score means that the ability to connections is assessed as «bad», whereas the high score points out on positive family connections ability.  2685-3868(Online), 2685-1989(Print) Vol. 2, No. 1, February 2020 C11 -The Scale Of Change In Health -which comprise only one item. This scale registers the health changes over the previous year. Answers range up "much better now" to "much worse now", so that the low score tells of deterioration, and the high score on the improvement of health.

Scale of Health Change (SHC). Provided statements range up "much better now"
as was in Boys sub-sample (76.9%), to "tendency of improvement" in Girls sub-sample (53.3%) of the HC school students. These options point out on some gender differences in this segment of scale, which evaluate the change in health.

V. Conclusion
Based on the conducted mathematical-statistical procedures, and the comparative analysis of the study results and their interpretation, it can be formulated the following conclusions, which indicates on the estimation of the significant differences.
To the between «groups» differences, mostly have contributed the characteristics and homogeneity of the groups of different ethnic origins, concerning the items of particular segments, the frequency of responses, i.e., a different opting for individual statements modalities of items.
Respondents of GRE-1 school students have lower variability of the statements, which were of the moderate intensity of modalities (2*-3*), while the respondents of SRB-2 school students, with one exception (1*), opted for the highest intensity of statements modality (4*) for the most items, within particular segments, which has significantly contributed to the established differences.
Based on the elaborated MANOVA and DISCRA comparative analyses, and the obtained values (F; p), must be rejected the hypothesis H1 and H2 in all segments of the Q, and accepted the alternative hypothesis A1, and A2, which means that there is a difference, and clearly defined border between "groups" of respondents (GRE-1; SRB-2) in all segments of Q, which assesses the Quality of life, Health and Social Wellness in upper elementary school students, when considering "groups" of different ethnic origins.