Journal of health research in community

Introduction
Several studies have highlighted the importance of enhancing older people's capabilities, as population aging has become a widespread phenomenon in many countries. Currently, about 800 million people aged 65 and older live worldwide, and it is estimated that this number will reach 1.5 billion by 2050. In Iran, the increasing trend of the population ageing also indicates a major demographic transformation, which consequently leads to changes in Iran’s social structure—particularly in the field of health. 
Despite the growing number of the aged population, social planning does not adequately account for the needs of this group. The present study aims to examine the relationship between socioeconomic status (SES), health-related quality of life (HRQOL), and health-oriented culture among the elderly in Iran.

Methods
This is a cross-sectional survey conducted among 375 elderly residents of Abadeh City, selected via cluster random sampling. Data were collected using the World Health Organization Quality of Life (WHOQOL) questionnaire with three dimensions: social-environmental health, psychological health, and physical health. The SES was theoretically determined by three factors: educational level, occupation, and income. The health-oriented culture variable was measured using a researcher-developed questionnaire, whose construct validity was verified using factor analysis, and its reliability using Cronbach’s alpha was 0.705. Statistical analyses were performed in SPSS software using Pearson’s correlation test, independent t-test, and multiple regression analysis. The significance level was set at 0.05.

Results:
The majority of participants had a moderate level of HRQOL; only 24.8% reported high HRQOL. The SES data based on the educational level revealed that most of the older men were illiterate (22.4%), while most of the older women had an elementary school education (16%). Regarding occupation, the high status jobs had the least frequency (n=17, 4.5%). Regarding gender, no significant difference was observed between men and women in terms of HRQOL (P=0.055). 
There was a relatively weak but significant positive correlation between SES and HRQOL (r=0.295, P<0.001). Therefore, a higher SES is associated with better HRQOL in older adults. There was also a weak but significant positive relationship between SES and health-oriented culture (r=0.16, P=0.002); therefore, a higher SES is associated with better health-oriented culture. Moreover, there was a relatively weak but significant positive between health-oriented culture and HRQOL (r=0.247, P<0.001). Finally, it was found that  SES could significantly affect HRQOL indirectly through health-oriented culture. Overall, SES and health-oriented culture explained 13.8% of the variance in HRQOL.

Conclusion
Findings demonstrated that the HRQOL of the elderly in Abadeh city is at a moderate level. Those with higher SES had better HRQOL. Moreover, the findings indicated a mediating role for health-oriented culture in the relationship between SES and HRQOL. SES and health-oriented culture are the predictors of HRQOL in the elderly. This implies that improving the HRQOL of elderly populations requires simultaneous attention to their SES and reinforcement of their health-oriented culture. 

Ethical Considerations
Compliance with ethical guidelines
The participants were informed of the study objectives and provided written and verbal informed consent. The confidentiality of their information was also observed. This study has ethical approval from Yasuj University of Medical Sciences (IR.YUMS.REC.1404.003).

Funding
This article was extracted from the master's thesis of Farjam Nazari at the Department of Sociology, Faculty of Literature and Humanities, Yasuj University. The research has not received any financial support from government, private, or non-profit organizations.

Authors contributions
Supervision, editing & review: Maryam Mokhtari; Writing, data collection, and data analysis:Farjam Nazari; Supervision: Seyed Samad Beheshti.

Conflicts of interest
The authors declare no conflicts of interest.

Acknowledgments
The authors would like to thank the seniors who participated in this study for their time and cooperation.

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