Social exclusion and well-being in older adults in rural and urban communities

Abstract

Background: Social exclusion (SE) is a framework for understanding how social factors - often neglected in health psychology research - influence individual well-being and health. This paper describes a study on the association between SE and well-being in urban and rural communities. Methods: The study had a cross-sectional survey design with a stratified sampling frame. Participants (≥65 years old, N=1255) were recruited from rural (n=628) and urban (n=627) metropolitan areas of Barnsley, U.K. and completed a questionnaire measuring indicators of four SE domains: civic activity, material resources, social relationships and services; plus an additional domain, neighbourhood, regarded as of particular importance for older adults. Hierarchical linear regression models were developed for 1) total sample; 2) rural areas; and 3) urban areas, in which well-being was regressed on SE indicators after controlling for self-reported health. Findings: SE indicators accounted for 12.1% of the variance in well-being in the total sample (neighbourhood 2.3%); the corresponding figures for the rural model were 13.3% (4.3%) and for the urban model 17% (2.1%); all models and model increments p<.05. Four SE indicators were significant in the rural model, compared with six in the urban model, with only two common to both. Discussion: After controlling for self-reported health, SE indicators explained significant variance in well-being. Of the SE domains, neighbourhood exclusion explained more variance in well-being in rural areas compared to urban, whereas exclusion from services explained more variance in urban than rural areas. This suggests that SE processes operate differently in urban and rural communities.