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SECTION 1: A LITERATURE REVIEW
CHAPTER 1.1. INTRODUCTION
"Adding life to years, and not just more years to life!" 1
"Money can't buy happiness" (proverb)
"Quality of life must be in the eye of the beholder" 2
Aims and objectives
1.1 In March 2005 the Scottish Executive commissioned Centre for Cultural Policy Research ( CCPR) to undertake research to define "quality of life" ( QOL) in the context of culture, arts and sport and explore ways in which the impact on QOL and sense of well-being through participation in cultural or sport interventions can be identified and measured, both in social and economic terms. This was to be achieved through both a literature review and a "think-piece".
1.2 The detailed objectives of the research were:
- To examine the "bigger picture" of QOL and the definitions already established by previous research;
- To then "draw in" and focus on the definition of QOL and well-being in the context of culture, arts and sport;
- To provide a clear understanding of the social and economic benefits flowing from culture and sport projects that enhance QOL and well-being; and
- To identify social and economic indicators that can be used to measure QOL and sense of well-being impact in relation to culture and sport for possible "piloting" in a follow-up piece of research in the context of a culture or sports "case-study" to be identified by the Executive.
1.3 A literature review was required to inform the Executive's thinking on the social and economic measurement of QOL and well-being, and to provide the basis for an exploratory "think-piece". The remit was to review the literature published since 1995. The specific aims of the literature review were to:
- draw from the range of social research and economics literature;
- summarise the various definitions of the concepts of QOL and well-being in general;
- drawing from the literature, focus on definitions of QOL and well-being in the context of culture and sport impacts on the individual and community;
- establish a standardised working definition for the purpose of this study;
- explore the difficulties faced in measuring QOL and well-being; and
- and cite standard methods and results, and critique methodologies.
1.4 CCPR reviewed the social research literature. Nicola Birkin undertook the scoping, with advice from Dr Mark Petticrew of the Medical Research Unit, University of Glasgow, and Christine Hamilton of CCPR reviewed the literature on sport and QOL. CCPR commissioned Professor David Bell, University of Stirling, to review the economics literature. This review, which also looks in more detail at the concept of well-being, is included as Annex 1 of this document.
1.5 The review does not deal with the wider literature on arts and health, with which there is some overlap. This was the subject of a recent literature review commissioned by Arts Council England. 3 For the purposes of this review, arts, culture and sport are defined in terms of participatory activities, in other words, what we are concerned with is the effect of participation in cultural and sporting activities on QOL and/or well-being.
Overview of the literature
1.6 Discussion of QOL dates back to Plato and Aristotle 4. Although neither the philosophical origins nor historiography of the term can be dealt with here, discussion of these themes may be found in the literature. 5
1.7 In terms of the volume of articles, discussion of QOL and well-being within the academic literature centres on the health care field, including nursing, medicine and health promotion. 6 A large body of literature exists on learning disabilities and other types of disability, including mental health. Psychology literature on QOL forms a large subset of the health literature.
1.8 QOL is also the subject of academic debate in economics, particularly in the related field of happiness studies, a research area shared with psychologists and sociologists. Most of this literature considers the effect of medical interventions on the QOL, or subjective well-being of individuals or groups of individuals with shared characteristics.
1.9 QOL and well-being are also a concern of the social indicators movement, which developed in both Scandinavia and the US in the 1960s and 1970s out of a feeling that economic indicators alone could not reflect the QOL of populations. 7 Over the past 30 years this has become a fast growing discipline now fully embraced by governments and public sector agencies worldwide, seeking to measure and compare changes in QOL within and between communities, cities, regions and nation states. Major studies of QOL, for example, have been sponsored by organisations such as UNESCO, the OECD, and the World Health Organization ( WHO). 8
1.10 QOL emerged as an academic discipline in its own right in the 1970s, with the establishment in 1974 of the peer reviewed scientific journal Social Indicators Research, founded and edited by Alex Michalos. Since then the volume of academic articles concerned with QOL and well-being issues has steadily increased. Schalock reports that since 1985 alone over 20,900 academic articles have appeared in the international literature containing the term "quality of life" in their title. 9 A second key academic publication is The Journal of Happiness Studies, a multi-disciplinary journal which provides a forum for discussion of what it describes as the two main traditions in happiness research (1) speculative reflection on the good life and (2) empirical investigation of subjective well being. The International Society for Quality-of-Life Studies ( ISQOLS) serves as a forum for academic researchers working in this field, encouraging inter-disciplinary research and methodological debate and development.
1.11 Our literature search produced a final selection of 244 articles, the majority academic but with a significant minority drawn from commissioned consultancy work and reports by public sector agencies. Full details of the search criteria and strategies are included in Annex 5.
Structure of the Literature Review
1.12 The literature review takes the following form. Chapters 2 and 3 consider QOL as a concept. The first of these looks at definitional issues and defining attributes of QOL. The second sets out the main debates at the heart of QOL definitions. Definitions of well-being and its relationship with QOL are considered in Chapter 4. Well-being is also considered further in Annex 1 by Professor David Bell. Chapter 5 reviews the ways in which QOL has been measured. Studies exploring the contribution of culture to QOL and well-being, at both an individual and community level, are reviewed in Chapter 6, while Chapter 7 reviews the equivalent literature relating to exercise and sport. Overall conclusions, indicating the options for future research in this area are provided in Chapter 8.
1.13 As far as possible in this literature review we have attempted to maintain a consistency in our own use of terms. However in quoting the work of others we will inevitably reflect the confusion that exists in the literature over the usage and meaning of terms. A key part of this is the inter-changeable use of different concepts, discussed below.
1.14 Professor David Bell's Review into Subjective Well-being and its Relation to Sport and Culture is included in Annex One.
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