Health Education and Health Promotion

Relationship between Social Exclusion and Post-Divorce Adjustment in Iranian Women

Document Type : Descriptive & Survey

Authors

R. Ghadimi Azad 1
A. Emami Sigaroudi 2
Z. Bostani Khalesi 3
E. Kazemnezhad Leiili 3

1 Social Determinants of Health Research Center,Guilan University of Medical Sciences, Rasht, Iran

2 “Cardiovascular Disease Research Center” and “Department of Cardiology, School of Medicine”, Guilan University of Medical Sciences, Rasht, Iran

3 Social Determinants of health Research Center, Guilan University of Medical Sciences, Rasht, Iran

Abstract
Aims: The increasing rate of divorce has turned it into an important social dilemma, and this necessitates the need to pay attention to the factors related to adjustment after divorce. This study was conducted to determine the relationship between social exclusion and post-divorce adjustment in women.

Instrument & Methods: In this cross-sectional study, 474 divorced women in Rasht City participated. Sampling was performed in a convenience and Snow Ball method. Data collection tools were a three-part questionnaire including demographic information form, social exclusion questionnaire, and post-divorce adjustment questionnaire. Data analysis was performed by descriptive and inferential statistical tests at a significant level (p<0.05).

Findings: The highest and lowest scores of social exclusion were related to exclusionary marital status (3.50±0.66) and discriminative marital state (3.9±0.6), respectively. The highest and lowest adjustment scores were related to the areas of self-worth (3.34±0.40) and anger (2.90±0.43), respectively. The areas of horror (β=-0.067; p=0.008) and discriminative marital state (p=<0.001; β=-0.188) were predictors of adjustment. Also, lack of history of physical illness (p=0.024; β=0.145) and increased number of children (p=0.07; β=0.053) had a positive and direct effect on the adjustment.

Conclusion: There is a statistically significant inverse correlation between social exclusion and post-divorce adjustment of women, and therefore the study and development of educational-counseling intervention programs to increase social support can increase women’s adjustment after divorce.

Keywords

Social Exclusion
Divorce
Post-Divorce Adjustment
women
Subjects
Introduction
Divorce is one of the most critical events in women's lives [1], a complicated process with short and long-term psychological, social, economic, and cultural outcomes [2]. Iran is the 22nd country in the world in terms of divorce [3], and the marriage and divorce rate index was 127318 and 34659 cases, respectively, from March to May 2020; in the same period, the marriage and divorce rate index of Gilan Province, Iran, was 3936 and 1482 cases, respectively. In general, the marriage/divorce ratio is 3.6 in the whole country and 2.6 in Gilan, a relatively high figure [4]. From March to September 2019, the total number of marriages in Gilan was 9449, 3228 of which were related to Rasht, and in the same period, 3469 cases of divorce were recorded in the province, 1531 of which were related to the city of Rasht. Thus, the marriage/divorce ratio in Rasht is 2.1, which is worrying [5].
On the one hand, the increasing rate of divorce and its negative outcomes, on the other hand, has made divorce an important social dilemma [6, 7]. The concepts of woman, sexuality, and divorce are conceptualized differently in various societies [8]. As divorce increases, the effects of its outcomes threaten the life and health of the people more than ever [2]. Divorced women face far more challenges and obstacles than divorced men and experience more problems threatening their well-being [1] that divorce might put a woman into a risky situation [8].
Women experience social dysfunction after divorce, loss of independent living, reduced contact with the outside environment, reduced social influence, weakening of social positions, and social exclusion [9]. The ongoing economic crises in Iran have worsened the employment situation for women and men alike. However, women face even greater vulnerabilities in the labor market due to their gender. There is a relationship between quality of life and equality. Unequal financial support affects a divorced woman's quality of life. However, discrimination based on gender and marital status is a hidden social outcome of divorce built up in a sociocultural context [8]. Divorce also leads to discrimination, unemployment, marginalization, loneliness, and social exclusion in many cases [10]. In some Iranian research, it has been argued that a divorcee can destroy her social dignity, even though one might think that divorce is the beginning of freedom. The ignominy assigned to a divorcee is the basis of women's exclusion from society [8].
Social exclusion as one of the determinants of health and social welfare affects the health of individuals [11]. Post-divorce social exclusion in women is higher than in men [12]. Social exclusion in divorced women is viewed as social exclusion, lack of equal employment opportunities, lack of support from society, financial problems and needs, economic dependence, exposure to high-risk behaviors, and distance from married women [13]. This exclusion is imposed not only by members of the community but by the divorced women themselves [9]. The majority of women were concerned about the attitudes held by members of their community. They had seen themselves as a divorced woman who differs from married women [8].
Divorced women are among the most excluded groups in society, and not paying attention to the needs and eliminating the existing exclusions reduces the post-divorce adjustment and intensifies their vulnerability [14]. Divorcees in Iran are not supported by other women by any means; however, the majority of men would pursue and support them if they seek a free "sexual appliance [8].
According to the results of studies, people who better adjust to the post-divorce conditions experience less negative outcomes and have more physical and mental health. Incompatibility with post-divorce conditions leads to the incidence of depression, anger, anxiety, stress [15], physical and psychological outcomes, and decreased activity [13]. Adjustment is a psychological process in which a person meets or controls the desires and challenges of life [16]. Post-Divorce adjustment is a situation in which a divorced person has positive self-worth and a sense of self-management [17]. Divorced people need the support of friends, relatives, and society to be more adjustable to the post-divorce condition [18]. Post-Divorce Adjustments the adjustment to the process that a person faces after divorce [15]. In a general sense, post-divorce adjustment shows a person's degree of success in transitioning from shared life experiences to individual life [17].
Despite individual differences, post-divorce adjustment is usually a difficult process associated with depression, anger, anxiety, and stress in the divorced person [13]. Severe pain and suffering, which usually exerts the individual after separation, can significantly affect the activities and performance of the individuals [19]. Many people struggle with divorce and find themselves in a situation where adjustment is impossible or very difficult and exhausting. Therefore, adjusting to the new post-divorce situation is necessary.
 
In other words, a divorced woman, regardless of the level of her self-efficacy, is widely marginalized. To be a woman and also a divorcee amplifies exclusion [8]. Because determining the factors associated with post-divorce adjustment prepares individuals to deal with problems, reinforces positive behaviors, and reduces negative outcomes [9], paying attention to determining these factors is an undeniable necessity [17]. Therefore, this study was conducted to determine the relationship between social exclusion post-divorce adjustments in women. Some scholars argue that research on sensitive topics cannot be free of political, ethical, and societal influences and
values. Challenges of the study, such as the language of silence and privacy concerns, were presented. In order to overcome the language of silence and privacy concerns in individual interviews, we controlled our speaking style, look, gesture, and posture, consulted participants on their sexual life [20].
This study was conducted to investigate the relationship between social deprivation and adjustment after divorce in women of Rasht City, Iran.
 
Instrument and Methods
This descriptive-analytical cross-sectional study was conducted in 2020 on divorced women of Rasht City, Iran, who were either covered by the Welfare or Relief Committee or not covered by anywhere. The sample size was determined 474 with 95% confidence and 90% test strength based on a preliminary study in 33 people. Based on a pilot study with a volume of 33 people, based on the results with 95% confidence and 90% test power, the sample size was 474 people. These people were divided into 3 groups of 158 people. The group of divorced women covered by welfare was covered by the relief committee and those not covered anywhere. Since in the women's community under the auspices of the Welfare and Relief Committee, a questionnaire is provided to the research units and delivered at another time, so in these two communities, taking into account the 10% sampling loss, the sample size of 176 people was determined. Sampling method for divorced women covered by welfare and relief committee as available method and Snowball sampling method was used for divorced women who were not covered.
After obtaining the permission of the Ethics Committee and after obtaining written permission from Guilan University of Medical Sciences, Welfare and Relief Committee and by justifying the participants about the objectives of the study and assuring the confidentiality of the information and obtaining informed written consent from divorced women, To collect data, place of completing the questionnaire, welfare organization and relief committee, which was done through liaisons and in the case of uncovered women, the questionnaire by the student in person at the community level and in the form of snowballs in the presence of women, including offices, clubs, parks, and beauty salons were completed.
The face validity method was used to determine the validity of the demographic questionnaire. In this way, it was adjusted based on the research objectives and using scientific sources and studies of others, and after approval by the research group, it was provided to the judges. At the judges' suggestion, the minimum stages of validity and reliability of the social exclusion questionnaire, including the validity of quantitative content based on two CVR-CVI indices and the reliability of the test-retest, were performed. CVR index was used to assess the validity of quantitative content. The range of changes obtained was between 0.78 to 1, which is acceptable based on the Lavasheh table for a 10-person panel. In determining the CVI index, the minimum value was 89%, and the maximum value was 100%. The required corrections were made. Post-divorce social exclusion questions were valid in terms of relevance, simplicity, and clarity
The reliability coefficient of peer questionnaires was used for the reliability of the social exclusion questionnaire, and the Icc agreement coefficient was used to agree on the scores of the two peer questionnaires. Questionnaires were distributed among 10 samples and collected after answering; then the homogeneous questionnaire with similar questions and sometimes repetitive with the questions of the main questionnaire was distributed and collected among the same 10 people. The reliability coefficient of the questionnaire was 99%; the ICC agreement coefficient of the questionnaire was equal to 0.999 and was statistically significant (p<0.01).
Cronbach's alpha coefficient was used for internal consistency of the questions of the social exclusion questionnaire, and the total Cronbach's alpha coefficient was 0.96, which indicates the high internal consistency of the questions. Due to the study's cross-sectional nature and the possibility of selection bias (some people do not want to complete the questionnaire), based on the preliminary study, 30 out of 37 distributed questionnaires responded, so Rate Response=81.1 was determined. Based on the obtained results, the questionnaire of social exclusion of divorced women is a valid and reliable tool.
Demographic information collection form included (age, age at divorce, time of divorce, duration of martial life, level of education, occupation, economic status, place of residence, number of household members, number of children, child custody, insurance status, etc.), social exclusion standard questionnaire and Fisher Divorce Adjustment Scale.
The social exclusion questionnaire includes 28 items in 5 areas: Frighteningmarital status (2 items), traumatic marital status (4 items), exclusionary marital status (7 items), economic dependence on marital status (7 items), and discriminative marital state (8 items). The method of scoring the social exclusion questionnaire is a 5-point Likert (strongly agree: score 5, agree: score 4, have no opinion: score 3, disagree: score 2, strongly disagree: score 1); the score of each dimension is calculated as a sum of scores of the items of that subscale and the total score of the scale as the sum of the scores of the subscales. Scores between 28 and 65 indicate the lack of understanding, scores between 66 and 103
indicate relative understanding, and scores between 104 and 140 indicate social exclusion after divorce. In fact, higher scores indicate more social exclusion after divorce [21].
Fisher Divorce AdjustmentScale with 100 questions includes six subscales: social self-worth (9 items), social trust (8 items), grief (24 items), anger (12 items), disentanglement(22 items), and self-worth (25 items). The scoring method of this scale is based on a 5-point Likert of almost always (score 1), usually (score 2), sometimes (score 3), rarely (score 4), and almost never (score 5). Out of 100 questions of the questionnaire, 69 questions are scored as 5-4-3-2-1 (direct) and 31 questions as 1-2-3-4-5 (reverse). The total scores of the subscales indicate the final adjustment score, and the higher score indicates higher post-divorce adjustment, and the lower score indicates poor adjustment after divorce [22]. After collecting the data, the information was entered into SPSS software version 21, and the statistical indicators of mean, standard deviation, mean, minimum, maximum were used, and the confidence interval is 95%. The score was obtained in dimensions and in general. Pearson correlation coefficient and Spearman correlation coefficient, and canyon correlation coefficient were used to investigate the correlation between the main variables and the normal distribution. Independent t-test and analysis of variance (ANOVA and MANOVA) were used to determine the adjustment score and social exclusion score in terms of individual-social variables. Non-parametric Mann-Whitney and Kruskal-Wallis tests were used due to a lack of assumptions. The significance level of the tests in this study was considered p<0.05. The analysis of covariance was performed to control confounder variables, and MANOVA and MANCOVA statistical methods were used.
 
Findings
The minimum and maximum ages of the studied units were 19 and 63 years, with the mean of 36.0±9.5 years. The educational degree of the majority of participants was diploma (41.9%), and 75.3% had a temporary job. The minimum and maximum ages at divorce were 18 and 52 years, and the mean was 32.9±7.5 years. Also, most participants (36.7%) had 1 to 3 years passed after their divorce. The majority of the participants (72.5%) had a child, and in 78.5% of cases, the child was under the mother's custody. 51.5% of the participants lived independently.
The mean score of participants' social exclusion was 3.17±0.51 (Table 1).
The mean score of divorce adjustment was 3.21±0.35 (Table 2).
The total adjustment score had a significant inverse correlation with the score of all social exclusion areas and the total score of social exclusion. This correlation with the areas was in the range (r=-0.282 to r=-395), indicating that the correlation coefficient of the total adjustment score with the social exclusion score was (p<0.001; r=-0.448), which indicates an inverse and significant moderate relationship. A significant relationship was seen in examining the canonical correlation between the areas of social exclusion and adjustment to divorce. 30% of adjustment changes were related to the areas of social exclusion (r=0.549; p<0.001; canonical correlation of R=0.302). In general, with the increase in the score of social exclusion, the score of divorce adjustment decreased by 0.36.
 
Table 1) Statistical indicators of the balanced score of social exclusion of divorced women in each area and total (n=474)
 

Table 2) Statistical indicators of divorce adjustment score for divorced women in each area and total (n=474)
 

The results of the non-matched regression model to determine the correlation of the total score of adjustment of divorced women with the areas of social exclusion showed that among the areas of social exclusion, frightening marital score (p=0.008; β=-0.067) and discriminative marital state (p<0.001; β=-0.188) were predictors of the score of Post-Divorce Adjustment in participants.
After matching the relationship between social exclusion areas and adjustment score based on individual-social variables, the score of economic dependence on the ex-spouse (p=0.001, β=0.151) and the score of discriminative marital state area (p=0.002; β=-0.131) was inversely related to the adjustment score in the divorced women studied so that with increasing scores in these areas of social exclusion, the score of divorce adjustment decreased by 0.36.
Lack of history of physical illness (p=0.024; β=0.145) and increase in the number of children (p=0.07; β=0.053) had a positive and direct effect on the adjustment after divorce.
 
Discussion
The highest mean score of social exclusion was in the area of ​​exclusionary marital status, and the lowest was in the area of the discriminative marital state. In this regard, The results of the present study are in line with the studies of Ghotbi et al. [23], Seifuri et al. [24]; in explaining it, it can be said that the similarity of characteristics such as child custody and employment and income status led to similar results.
Participants with low literacy and income levels and child custody had higher social exclusion scores. Participants with permanent jobs and insurance had lower social exclusion scores. In this regard, Regarding the age and duration of cohabitation, the present study was in line with the study of Qutbi et al. [23] but was not in line with the present study in terms of education and occupation. In terms of age, the present study was not in line with Carpenter [25]. In the present study, no significant relationship was observed between age and deprivation and adjustment. To explain this, it can be said that the conditions of women in the two studies were different in terms of place of residence (urban and rural).
The highest balanced mean score of adjustment was in the area of self-worth and the lowest in the area of anger. In this regard, it was seen that In terms of its value, the present study is in line with Asangarani et al. [26].
The mean adjustment score in divorced women whose ex-spouse had a college education was higher than other educational degrees. Also, the mean adjustment score was higher in divorced women with incomes above 2 million and covered by insurance than other participants. These findings were consistent with the results of a study by Balali et al. the results of their study showed a positive relationship between income and post-divorce adjustment [25].
The present study results showed that the adjustment score had a significant inverse correlation with the total score and the score of all areas of social exclusion. In this regard, there is a relationship between social support and post-divorce adjustment that the present study is in line with the study of Nouri et al. [27], Nazarifar et al. [28] and the study of Wilder [29], and the study of Namdari et al. [30]. The results of the non-matched model showed that the areas of frightening marital status and discriminative marital state, and social exclusion are predictors of women's adjustment after divorce.
The results of the matched model showed that the relationship between the areas of social exclusion and adjustment score based on individual-social variables in the area of economic dependence on ex-spouse and discriminative marital state had an inverse relationship with women's adjustment after divorce, in a way that, as the scores of these areas of social exclusion increased, the adjustment score decreased. In addition, a history of physical illness and an increase in the number of children had a positive and direct effect on adjustment. Divorce means double discrimination for women. In other words, a divorcee is seen as a woman rather than a human being. Women are interpreted as "female beings" regardless of their position, social function, and so on. Based on this construction, different societal expectations are formed for men and women in marriage or divorce [8].
Research Limitations:
1. Mental and psychological conditions of the participants when completing the questionnaire, which affected the accuracy of the answers, which was not under the researcher's control.
2. Lack of easy access to divorced women due to embarrassment, fear, etc., which was difficult and time-consuming.
 
Conclusion
Social exclusion is one of the factors related to the reduction of adjustment after divorce, so informing and providing the context for familiarizing health care providers with the topics of social exclusion and its relationship with women's post-divorce adjustment should be considered to increase the social support of divorced women through the development of educational-counseling intervention programs by the authorities. It is also necessary to provide conditions for women's empowerment and custody of children so that women experience less social exclusion after divorce.
 
Acknowledgments: Researchers sincerely thank the cooperation and support of the Vice-Chancellor for Research and Technology of Guilan University of Medical Sciences. We are also extremely grateful for the support and assistance of all women participating in this study.
Ethical Permissions: This article is taken from the master's thesis of nursing students with ethics code IR.GUMS.REC.1398.439. Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.
Conflicts of Interests: The authors declare that there is no conflict of interests.
Authors' Contribution: Ghadimi Azad R. (First author), Introduction author/Original researcher or Assistant/Discussion author (25%); Emami Sigaroudi A. (Second author), Introduction author/Assistant/Statistical analyst/Discussion author (25%); Bostani Khalesi Z. (Third author), Introduction author/Methodologist/Assistant (25%); Kazemnezhad Leili E. (Forth author), Methodologist/Statistical analyst (25%).
Funding/Sources: None declared.
 
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Health Education and Health Promotion
Volume 9, Issue 1
Winter 2021
Pages 73-78