CHAPTER 3

METHODOLOGY

3.1 RESEARCH DESIGN

The present research was a cross-sectional non-experimental mixed design. The study
was divided into two parts i.e. quantitative and qualitative.

3.2 RESEARCH QUESTION

The study aimed to examine resilience, meaning in life and mental health of urban
elderly with regard to different living arrangements.

3.3 OBJECTIVES

The specific objectives of the study were-

1. To assess resilience, meaning in life and mental health of the urban elderly.
2. To study the inter relationship between resilience, meaning in life and mental
health in the urban elderly.
3. To study the effect of resilience and meaning in life on mental health among
the urban elderly.
4. To study the difference in resilience, meaning in life and mental health
between the urban elderly with regard to their living arrangement.
5. To study gender difference on resilience, meaning in life and mental health of
the urban elderly.
6. To study resilience, meaning in life and mental health of urban elderly in
depth using a qualitative approach.

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3.4 HYPOTHESES

1. There will be a significant relationship between resilience, meaning in life and

mental health of urban elderly.
2. There will be a significant effect of resilience & meaning in life on the mental
health of urban elderly.
3. There will be a significant difference in resilience, meaning in life and mental
health of the urban elderly with regard to their living arrangement.
4. There will be a significant gender difference in resilience, meaning in life and
mental health of urban elderly.

3.5 OPERATIONAL DEFINITIONS

 Elderly - Individuals who are 65 to 85 years of age are taken as elderly in the
present study.

 Living Arrangements - Living arrangement is explained in terms of the type

of family in which the elderly live, the headship they enjoy, the place they stay
in and the people they stay with, the kind of relationship they maintain with
their kith and kin, and on the whole, the extent to which they adjust to the
changing environment (Irudaya Rajan et al 1995a). In the present study two
different types of living arrangements have been taken, i.e. elderly living in
their homes on their own (with or without a spouse) (Group-1) and elderly
living with their adult married child/children (Group-2).

 Resilience - The concept of resilience can be defined as the personal qualities

that enable one to thrive in the face of adversities. Resilience may also be
viewed as a measure of successful stress coping ability (Connor-Davidson
2003).

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 Meaning in Life - The concept of meaning in life has been defined as the
sense made of, and significance felt regarding, the nature of one’s being and
existence (Steger 2006).

 Mental Health- Is the optimal functioning as the combination of emotional

wellbeing (presence of positive affect and satisfaction with life and the
absence of negative affect), social wellbeing (incorporating acceptance,
actualization, contribution, coherence, and integration), and Psychological
wellbeing (combining self-acceptance, personal growth, purpose in life,
environmental mastery, autonomy, positive relations with others) (Keyes,
2005).

3.6 QUANTITATIVE APPROACH

3.6.1 Sample

In the present study, the total sample consisted of 164 older participants (92 males and
72 females) between 65 to 85 years. These participants were selected from two
metropolitan cities i.e., Delhi (NCR) and Ahmedabad (Gujarat) using snowball and
purposive sampling techniques. The sample was divided into two groups based on
their living arrangements: 1) Elderly living in their homes on their own and 2) Elderly
living with their adult married child/children. An attempt was made to include an
equal number of participants in each group. Written informed consent was obtained
after a detailed explanation about the study. The demographic characteristic with
regard to living arrangement and gender is given below in table 3.1.

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Table 3.1
Demographic characteristics (gender and living arrangements) of the sample for the
quantitative study (N=164)
Male Female Total

Group 1 30 30 60

Group 2 62 42 104

Total 92 72 164

Group 1= Elderly living on their own, Group 2=Elderly living with their adult married
child/children.
 Inclusion criteria
1. Elderly between 65-85 years of age.
2. Who can read and write English/Hindi/Gujarati.
3. Elderly who are married but maybe with or without their spouse at present.
4. Elderly independent in their activities of daily life.
5. Elderly with adequate communication and comprehension ability.

 Exclusion criteria
1. Presence of any chronic disabling illness in the elderly or spouse.
[According to WHO Disabilities is an umbrella term, covering impairments,
activity limitations, and participation restrictions. An impairment is a problem
in body function or structure; an activity limitation is a difficulty encountered
by an individual in executing a task or action; while a participation restriction
is a problem experienced by an individual in involvement in life situations].
2. Presence or history of major Psychiatric, neurological illness in elderly
participant or his/her spouse.
3. Individuals with sensorimotor/language deficits render them not amenable for
testing.
4. Elderly who never married.

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3.6.2 Tools

3.6.2.1 Semi-Structured Interview Schedule- A Semi-structured interview schedule

was prepared by the researcher to collect socio-demographic details such as
age, education, gender, occupation, source of Income, spouse status (this
includes availability and non-availability. Availability where the spouse is
living with the participant and non-availability where either spouse is expired
or separated), family members living with elderly, place of residence, number
of family members, children details, available support system (people elderly
look upon or seek help when in need or crisis), active social and leisure
activities, presence or absence of known physical, neurological or psychiatric
illness and medication history (Appendix II).

3.6.2.2 Connor-Davidson Resilience Scale (CD-RISC) – This scale was developed by

Connor and Davidson, 2003). The Connor-Davidson Resilience Scale (CD-
RISC) comprises 25 items each rated on a 5-point scale (0–4), with higher
scores reflecting greater resilience. The scale demonstrated good psychometric
properties and factor analysis yielded five factors namely. The 25 item scale
can be completed in about 5-10 minutes. The scale has been developed and
tested as (i) a measure of the degree of resilience, (ii) as a predictor of
outcome to treatment with medication or psychotherapy, stress management,
and resilience-building; (iii) as a marker of progress during treatment; (iv) as a
marker of biological (i.e. physical) changes in the brain. The scale also has
promise as a method to screen people for high, intermediate, or low resilience.
Cronbach’s alpha was calculated as .91 for the study population. The tool
Connor-Davidson Resilience scale (CD-RISC) was not available in the open
domain therefore the author (s) was contacted and permission to use the same
was sought. The tool was purchased from the author. The purchased tool was
available in English and Hindi language (Appendix III & IV).

3.6.2.3 The Meaning in Life Questionnaire- The Meaning in Life Questionnaire

(MLQ) was developed by Steger et al (2006). This tool (MLQ) assesses two

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dimensions of meaning in life 1) the Presence of Meaning (MLQ-Presence)
and 2) the Search for Meaning (MLQ-Search). It consists of 10 items that are
rated on a 7-point scale from 1 (absolutely untrue) to 7 (absolutely true). The
Presence of Meaning subscale measures how much life is considered
meaningful. The Search for Meaning subscale measures how engaged and
motivated respondents are in efforts to find meaning or deepen their
understanding of meaning in their lives. It is intended to measure meaning in
life across the complete range of human functioning. Cronbach’s alpha was
calculated as .52 for the study population. The MLQ takes about 3-5 minutes
to complete. The Meaning in Life Questionnaire (MLQ) was available in the
open domain in both English and Hindi (Appendix V & VI).

3.6.2.4 The Mental Health Continuum-Short Form (MHC-SF) – The MHC-SF was
developed by Keyes (2005) as a brief self-rating assessment tool that
combined the three components of well-being: emotional, social, and
psychological. The scale consists of 14 items that were chosen as the most
prototypical items representing the construct definition for the three facets of
well-being. The emotional well-being subscale-EWB (three items), is defined
in terms of positive affect/satisfaction with life. Social well-being-SWB is
assessed with five items that represent social contribution, social integration,
social actualization, social acceptance, and social coherence. Finally, six items
belonged to psychological well-being representing self-acceptance,
environmental mastery, positive relations with others, personal growth,
autonomy, and purpose in life. Participants were required to respond to items
on a 6-point Likert-type scale based on the experiences they had over the last
month (never, once or twice, about once a week, 2 or 3 times a week, almost
every day). The MHC-SF is based upon Keyes’s two continua model that
holds mental illness and mental health on one continuum and flourishing and
languishing on the other dimension. The absence of one doesn’t imply the
presence of another. To be diagnosed with flourishing mental health,
individuals must experience ‘every day’ or ‘almost every day at least one of

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the three signs of hedonic well–being and at least six of the eleven signs of
positive functioning during the past month. Individuals who exhibit low levels
(i.e., ‘never’ or ‘once or twice’ during the past month) on at least one measure
of hedonic well–being and low levels on at least six measures of positive
functioning are diagnosed with languishing mental health. Individuals who are
neither flourishing nor languishing are diagnosed with moderate mental health.
Cronbach’s alpha was calculated as .86 for the study population. (Appendix
VII &VIII).
The Mental Health Continuum-Short Form (MHC-SF) was available in
English in the open domain but the Hindi version was not available. Therefore
MHC-SF was translated into Hindi. Since the subjects in the present study
were primarily Hindi and English speaking, therefore, it was translated into
the Hindi language as well.
3.6.3 Procedure

Resident Welfare Association (RWA) in both Delhi NCR region and Ahmedabad
were approached. The Purpose of the study was explained to the head/authorities and
permission to interview elderly living in that particular society was sought. A total of
7 RWAs were contacted out of which 5 permitted the researcher to conduct the
present study.

A list of elderly persons both male and female living in these societies was prepared.
Elderly persons were approached through telephone or personal visits and the purpose
of the research was explained. Written consent was taken from all the participants
(Appendix I). Each Participant was explained the purpose of the study. In the present
study, tests were administered individually. Research tools were administered after
ensuring that the participant was not tired and inattentive. Each participant was
screened using a semi-structured interview schedule followed by the administration of
the CD-RISC Resilience scale, Meaning in Life and Mental Health Continuum- Short
Form.

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The minimum time taken by the participants was around 60 min. However, it was
observed that few participants tended to discuss/share personal life experiences during
the interview which was dealt with gently by the researcher. Sometimes questions
were repeated till the time the participants understand. Responses on every item were
recorded on the response sheet. The tools were administered on one basis with every
participant by the researcher. In cases where both husband and wife were the study
participants, the interview and responses were taken separately from each of them, to
avoid any influences on the spouse response.

3.6.4 Data Analysis

SPSS 21 (Statistical Package for the Social Sciences) was used for the analyses of the
obtained data. Kolmogorov-Smirnov test was used to examine the assumption of
normality of the sample data. The data was found to be normally distributed.
Therefore parametric and non-parametric (where applicable) statistics were used to
analyze the data. The level of significance was taken as a P value <0.05. The obtained
data were analyzed using correlational analysis, t-test, Kruskal Wallis Test, and
analysis of variance.

3.7 QUALITATIVE APPROACH

The aim of the present study was also to explore and develop in depth understanding
of resilience, meaning in life and mental health of the urban elderly. Qualitative
approach was used to gain further insight on this.

3.7.1 Sample

A sample of 25 elderly were taken for the purpose of in depth interview. The
participants who had already participated in the quantitative study were approached
telephonically. Participants were approached randomly and informed consent was
taken from all the participants, who agreed for the detail open-ended interview. The

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interviews were conducted telephonically due to the COVID-19 pandemic situation.
Elderly being high on risk, physical interviews were not possible. The demographic
characteristics of the participants are given in table 2 below.

Table 3.2
Demographic characteristics (gender and living arrangements) of the sample for the
qualitative study (N=25)
Male Female Total

Group 1 4 5 9

Group 2 5 11 16

Total 9 16 25

Group 1= Elderly living on their own, Group 2=Elderly living with their adult married
child/children.

3.7.2 Tools

3.7.2.1 Open ended Questionnaire on Resilience, Meaning in life and Mental Health:
The tool comprised of 5 open ended questions on resilience, 5 on meaning in life and
3 questions on mental health that was constructed by the researcher. The tool was
developed through following stages.
First stage: The questions on resilience (9), meaning in life (8) and mental health (3)
were developed by reviewing relevant literature. A total of 20 questions were made.
These questions were given to the experts for their opinion on the relevance of these
questions.
Second stage: The questions were reviewed by the experts and relevance of the same
was assessed. The final approved questions for resilience were 5, 5 for meaning in
life, and 3 for mental health. The questions were made in both English and Hindi
language. Back translation method was done. The tool was given for translation to
different experts (refer to Appendix IX).

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3.7.3 Procedure

The approved questionnaire was put to final study. Participants who met the inclusion
and the exclusion criteria were taken for the detail interview telephonically (due to
covid situation). A verbal consent was taken and the interviews were recorded after
the consent for the same. After getting the consent for the interview and recording, a
brief rapport was formed, basic demographic details were sought and then the open-
ended questions based interview was carried out.
The open-ended semi-structured interview of some of the participants (N=25,
male=11 and female=14) was taken to understand their resilience, meaning in life, and
mental health in a deeper way. The Open-ended questions were asked to the
participants and their responses were recorded.

3.7.4 Data Analyses

The qualitative analyses was carried out of the responses generated from the semi
structured interview (n=25), comprising of questions related to resilience, meaning in
life and mental health. The data items were read and preliminary codes were written
down, the codes were classified and several key words were identified. After key
words were selected, they were semantically grouped and specific themes were
identified. Thematic Analysis technique given by Braun and Clarke (2006) was used
for analyzing the responses.

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Figure 3.1 Study Flow Chart

Organization contacted --RWAs- 7

Permission received--5

Meeting inclusion and exclusion criteria - No Excluded (16)

Yes

Provided Information for study

No Excluded (3)
Written informed consent

Yes

Included in the Quantitative study Included in the Qualitative

(n=164) study (n=25)

Research tool Open ended

1. SEMI STRUCTURED INTERVIEW SCHEDULE questionnaire on
resilience, meaning in life
2. CD-RISC
and mental health
3. MLQ
(13 Questions)
4. MHC-SF

Data Analysis Thematic Analysis technique

SPSS 21 Package by Braun and Clarke (2006)

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3.8 ETHICAL CONSIDERATIONS

⮚ Written informed consent was obtained from all the participants and the
purpose of the research was explained to each subject.
⮚ Confidentiality was maintained for the information collected for the research.
⮚ Participants were informed about their freedom to exclude themselves at any
point of the time from the study.
⮚ The individuals identified to have any significant psychological issues or
clinical problem was counselled and guided accordingly.

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