Journal of American College Health

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/vach20

Quality of life and life satisfaction among

university students: Exploring, subjective norms,
general health, optimism, and attitude as
potential mediators

Seyedeh Belin Tavakoly Sany, Najmeh Aman, Fatemeh Jangi, Elaheh Lael-
Monfared, Hadi Tehrani & Alireza Jafari

To cite this article: Seyedeh Belin Tavakoly Sany, Najmeh Aman, Fatemeh Jangi, Elaheh
Lael-Monfared, Hadi Tehrani & Alireza Jafari (2021): Quality of life and life satisfaction among
university students: Exploring, subjective norms, general health, optimism, and attitude as potential
mediators, Journal of American College Health, DOI: 10.1080/07448481.2021.1920597

To link to this article: https://doi.org/10.1080/07448481.2021.1920597

Published online: 09 Jul 2021.

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Journal of American College Health
https://doi.org/10.1080/07448481.2021.1920597

MAJOR ARTICLE

Quality of life and life satisfaction among university students: Exploring,

subjective norms, general health, optimism, and attitude as potential
mediators
Seyedeh Belin Tavakoly Sany, phda,b , Najmeh Aman, bscc, Fatemeh Jangi, bscc, Elaheh
Lael-Monfared, phdd , Hadi Tehrani, phde and Alireza Jafari, phdf*
a
Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran;
b
Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; cStudent Research
Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; dStudent Research Committee, School of Public
Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; eDepartment of Health Education and Health
Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; fHealth Sciences
Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran

ABSTRACT ARTICLE HISTORY

Objective: This study aims to examine the association of quality of life (QOL) with life Received 26 April 2020
satisfaction, subjective norms, general health, optimism, and attitude among university Revised 23 February 2021
students. Participants: Respondents include 632 university students (Mage=21.36, SD = 2.86). Accepted 18 April 2021
Methods: This cross-sectional study was conducted on university students in Torbat
Heydariyeh, Iran. Several statistical models were tested, including hierarchical regression and KEYWORDS
path analysis, to examine the direct or indirect association between a set of important Health promotion;
variables. Results: According to the results of path analysis, constructs of subjective norms, mental health;
general health, positive attitude, optimism, and life satisfaction were significant predictors path analysis;
of students’ QOL. Compared with other constructs, general health status (p < 0.001, R2 = 0.548) positive thinking;
and life satisfaction (p < 0.001, R2 = 0.253) showed the strongest association with QOL. psychology
Conclusions: The results indicate that efforts to improve life satisfaction by targeting general
health, subjective norms, optimism, and attitudes may provide promising ways to improve
QOL.

Abbreviations: QOL: Quality of life; SWLS: Satisfaction with Life Scale; GH: General health

Introduction In the fields of psychology and general medicine,

QOL is usually equal to life satisfaction. For example,
Health state was defined by the World Health Organization in the American Psychiatric Association’s Handbook, all
(WHO) as “a state of complete mental, social, and phys- three general targets of QOL measures in psychiatric
ical well-being not merely the absence of disease”.1,2 The patients are equated with life satisfaction measures.4 Life
World Health Organization emphasizes that health esti- satisfaction is the important subjective component of
mation methods should not only include symptoms of QOL that suggests a cognitive-judgmental process, in
disease severity and frequency changes but also evaluate which people evaluate their QOL according to set their
new measures of wellbeing to improve the quality of life own criteria.8 Recent studies have shown that factors
(QOL).1 The QOL is defined as a people’s perception of such as career adaptability, optimism, and hope are asso-
their situation in life in the context of the culture and ciated with higher life satisfaction among young people
social system in which they live.1,3 Likewise, the concept because they can help people think positively about their
of ‘‘quality’’ is related to human values (e.g., health, sat- lives and make people more satisfied.8–10
isfaction, and happiness), and the concept of ‘‘life’’ is Optimism, defined as the attitude or tendency to inter-
related to the main dimension of human existence (e.g., pret events and different situations positively, is consid-
family, work, and health).3–5 In general, a broad-ranging ered as a human virtue and strength.8,9,11 Studies have
concept influences subjective QOL, such as psychological shown that there is a positive correlation between opti-
well-being, social relationships, salient features of envi- mism and several important factors in young people’s
ronment, life satisfaction, general health, and beliefs.4,6,7 lives, such as lower psychological maladjustment, life

CONTACT Alireza Jafari [email protected]  Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences,
Torbat Heydariyeh, Iran; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
*
Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
© 2021 Taylor & Francis Group, LLC
2 S. B. TAVAKOLY SANY ET AL.

satisfaction, more engagement in their educational and Torbat Heydariyeh from January 2018 to November
career planning, and a positive attitude.8,12,13 Optimism 2018. There are several public higher education insti-
and a positive attitude are two related constructs that tutions in this city, which are recognized by the Iranian
focus on motivation and the way to achieve desired goals Ministry of Science and Technology.
in the future. These constructs can be implemented as The students were included if they (a) study at one
dual indicators or single-dimensional internal structures of the universities of Torbat Heydariyeh; (b) able to
to reflect possible positive health outcomes and orienta- complete all relevant questionnaires; (c) hadn’t suffered
tion toward future.12–14 Optimism and attitude about life mental illness, (d) didn’t use depression drugs, and (e)
satisfaction also could be affected by subjective norms, were willing to participate in this study. The required
which can influence an individual’s ability and motivation sample size was estimated by the following formula.
to be proactive.15 In turn, all these cognitive structures Where, Z is the standard normal value that is considered
may independently affect the QOL related to health, to be a 5% type 1 error (p < 0.05), and S is the expected
which is the main indicator of mental, physical, and standard deviation (SD) in population according to the
social well-being, particularly among young people.4,15,16 previous study.23 After adjusting the 20% non-response,
In the recent century, phenomena such as interna- 632 students were enrolled as a sample size.
tionalization, rapid technological, and fast-moving global There are five public universities in Torbat Heydariyeh
economy influence health state and people’s QOL, par- city. We provided different lists of universities in the
ticularly in developing and Middle East countries.4 In Torbat Heydariyeh based on the stratification of student
these countries, the economic recession has reduced populations in each department and study group, and
insurance, employment, and pension securities.4 In Iran, all departments and study groups were assigned num-
more studies have shown that the QOL and life satis- bers. We used the multi-stage sampling design because
faction of college students are lower than other students it is a cost-efficient sampling method and requires less
in developed countries.17,18 Therefore, the problem of time to implement. Each university was considered as
poor QOL among Iranian college students is still an a class (or cluster). The first stage of sampling used
open issue. Several studies have shown that many con- probability sampling to select three departments. These
founding factors related to life satisfaction may also probability samples were weighted by the number of
affect the QOL of Iranian students. According to the students in each of these universities (the total number
literature, QOL and life satisfaction of Iranian students of 15 departments from 5 universities). The second-stage
are positively related to postmodern values and identity sampling included a simple random sampling to select
status, health literacy, perceived self-efficacy and self-es- two study groups from each department.
teem, individualism, emotional intelligence, 6,19,20 and Then, a simple random sampling was used to select
negatively related to emotional loneliness and hopeless- students from each study group who were willing to par-
ness.18,19,21 Although, as documented, the relation between ticipate in this study. In total, 660 students were willing
QOL and other variables in university students has been to participate in the study, and their physical and mental
well studied, the potential link between QOL, the seem- health has been checked through the electronic health
ingly important subjective norms, and the situation of records (EHRs) system. This national system allows us to
general health, optimism, and positive attitude seem access students’ health history based on information from
essential to investigate. As far as we know, the associa- various sources, including doctors, hospitals, clinics, phar-
tion between these variables has not been estimated with macies, and laboratories.
Iranian students before. Finally, 632 students met the inclusion criteria and
Therefore, it seems important to better understand completed the consent form. Likewise, they completed
the role of key variables, which deserve more attention study instruments in a written format based on a self-re-
in predicting QOL among university students. With this port method. Data were gathered through the question-
awareness, education and psychological intervention pro- naires of attitude and subjective norms in connection
grams could be designed to promote students’ personal with Optimism, Orientation to Life scale (optimism),
adaptation and academic achievements.4,22 In this context, Satisfaction with Life Scale, General Health, and QOL.
the aim of this study was to examine the association of After obtaining permission and a code of ethics (IR.
QOL with life satisfaction, subjective norms, general THUMS.REC.1396.35), researchers described the purpose
health, optimism, and positive attitude among university of the study to all university students in the selected
students. study groups.

Methods Instruments

Study design and sampling Attitude and subjective norms questionnaire

This questionnaire consists of 11 questions measured by
This study has been carried out through a cross-sec- a 5-points Likert scale from “totally agree” to “totally
tional design on 632 students, from all universities in disagree”. The score of this scale was ranged from 11 to
 Journal of American College Health 3

55. The attitude section consists of 8 questions (for satisfaction (e.g., how satisfied are you with your life?
example, I feel that my life is meaningful and purposeful Or how much life is close to your ideal life?). This
when I think positive) and the subjective norm contains questionnaire is rated using a seven-point Likert scale
3 questions (for example, my friends expect me to have ranging from 1 (completely disagree) to 7 (completely
positive thoughts when I’m with them). The content agree). The range of scores for SWLS is from 5 to 35.
validity ratio (CVR) and content validity index (CVI) It should be noted that in this tool, the higher score
for attitude and subjective norms questionnaire were 0.84 shows more satisfaction. Bayani et al. investigated the
and 0.67, which were acceptable in Jafari et al. study.24 reliability and validity of the questionnaire, and
Cronbach’s alpha coefficient was 0.887.30

Life orientation Test-Revised (LOT-R) questionnaire

Statistical analyses
(optimism)
This questionnaire consists of 11 validated short questions Statistical Package for Social Sciences software (SPSS 22,
on the optimistic mode and pessimistic mode. These Chicago, Illinois) and R version 3.0.2 were used to pro-
questions rated using a five-point Likert scale ranging duce accurate estimates. In the present study, descriptive
from 1 (completely agree) to 5 (completely disagree). The statistics (mean, standard deviation) and inferential sta-
range of scores for LOT-R is from 6 to 30.25 The validity tistics (Independent samples t-Test, One-way ANOVA,
and reliability of this questionnaire have been investigated Pearson correlation) were used to compare clinical and
and approved in Iran (Cronbach’s alpha= 0.94).26 socio-demographic characteristics. The level of statistical
significance was considered as p < 0.05. The path analysis
General health questionnaire (GHQ-12) fit criteria were tested by Chi-square (x2), the root mean
The GHQ-12 is one of the most useful and commonly square error of approximation (RMSEA), adjusted good-
used self-report tools for evaluating health and QOL. ness of fit index (AGFI), goodness of fit index (GFI),
Factor analysis studies have found that GHQ-12 is a incremental fit index (IFI), relative fit index (RFI), normed
multi-dimensional tool for evaluating depression and fit index (NFI), and comparative fit index (CFI). The Path
anxiety symptoms, perceived stress, and loss of confi- model is considered as an acceptable and a good fit if
dence. This questionnaire contains 12 questions, which Chi-square (x2) <5, RMSEA < 0.08, AGFI >0.8, GFI, NFI,
are rated using a five-point Likert scale ranging from 1 IFI, RFI and CFI > 0.9.31–33
(never) to 4 (more than usual). The range of score for
GHQ-12 is from 12 to 48. The psychomotricity of GHQ-
12 has been carried out in Iran. The study indicated Results
that the Iranian version of the GHQ-12 has a suitable
structural design and is a valid and reliable questionnaire Descriptive statistics and correlation analysis
to examine self-rated health. The test-retest correlation This study was conducted on 632 students. In this study,
for the whole sample was ranged from 0.84 to 0.93.27 34.1% of the participants were male (n = 214) and 65.9%
were female (n = 413). The mean (± SD) age of eligible
Quality of life questionnaire (SF-12) students was 21.36 (± 2.86) years old. The majority of
The SF-12, a shorter form of the SF-36, is a reliable, students were single (n = 456, 73.5%), less than a diploma
brief, and well-tested questionnaire for clinical practice or high school diploma, and satisfied with their field of
or research purposes when studying health related QOL.28 study (n = 434, 91.6%), and their mothers and father
Most participants completed the SF-12 in less than a third were the housekeeper and employee, respectively
of the usual time needed to complete the SF-36. The (Table 1).
SF-12 is commonly used to assess the QOL, overall health Based on the correlation analysis, there was a sig-
status, physical health status, and psychological problems. nificant relationship between gender and student’s
The range of score for SF-12 is from 12 to 47. The SF-12 attitude, subjective norms, and optimism. There was
has also been tested for reliability and validity in Iran. also a significant relationship between marital status
The study indicated that the Iranian version of SF-12 was and life satisfaction (p = 0.022), and fathers’ education
a psychometrically sound questionnaire, and it is suitable level and students’ QOL (p = 0.032) were significantly
for use in the Iranian population, both in rehabilitation correlated together. The correlation analysis showed
and clinical settings. Face validity and Content Validity an insignificant relationship between the mother’s edu-
Index for SF-12 were acceptable (85.6%).29 cation level, parents’ job, number of friends, attitude,
subjective norms, optimism, life satisfaction, general
health, and students’ QOL. There was a significant
Satisfaction with life scale (SWLS) questionnaire relationship between students’ interest in their field
This scale consists of 5 sections on subjective well-being of study and their attitude, life satisfaction, general
sense that assess individual’ opinions about life health, and QOL (p < 0.05) (Table 1).
4 S. B. TAVAKOLY SANY ET AL.

In this study, the mean (± SD) of the variables of on the QOL. Likewise, based on the results obtained,
attitude, subjective norms, optimism, general health, life direct effects accounted for 65.64% of total effects on
satisfaction, and QOL was 30.45 (± 5.14), 11 (± 2.24), the QOL while indirect effects accounted for 35.35%
20.28 (± 3.29), 21.39 (±7.01), 32.78 (± 6.11), and 34.92 of the estimated total effects (Table 2).
(± 6.03), respectively. The results of the Pearson correla-
tion test showed that there was a direct significant cor- Discussion
relation between students’ attitude (r = 0.345), subjective
norms (r = 0.134), optimism (r = 0.330), life satisfaction This study evaluated the effect of bio-psycho-social fac-
(r = 0.527), and general health (r = 0.674) with QOL tors (subjective norms, general health, positive attitude,
(p < 0.001). There was also a direct correlation between and optimism) on QOL and life satisfaction of college
general health (r = 0.500) and optimism (r = 0.313) with students. Our finding indicated that demographic vari-
life satisfaction (p < 0.001). ables, (excepting father’s education level and marital
status) had no significant effect on QOL and life satis-
faction. There is some evidence that thefather’s education
level is the main factor determining a students’ academic
Path results
achievement and improving their QOL. The National
The results of the path analysis showed that the fitting Bureau of Statistics report stated that, compared with
index of the final model had an acceptable value and students whose fathers had a higher education, students
confirms the model (X2 = 11.23, df = 5, X2/df = 2.225, whose fathers had low education experience the highest
p-value = 0.049, GFI = 0.99, AGFI = 0.97, RMSEA = risk of course failure and the lowest achievement.34
0.044, NFI = 0.99, CFI = 0.99, IFI = 0.99, RFI = 0.96). Likewise, little is known about the impact of having an
The final model is shown in Figure 1. The obtained educated father on students’ QOL compared with the
results showed that variables of attitude, subjective mothers’ impact on students’ QOL, which is the main
norms, optimism, and general health were able to pre- consideration, since father and mothers differ in terms
dict 30% of life satisfaction variance in students. of parental care, parenting styles, and parental involve-
Overall, the variables of attitude, subjective norms, ment.34 This study contributed to fill these gaps in
optimism, life satisfaction, and general health were able knowledge by investigating how fathers’ education and
to predict 50% of QOL variance. The results suggested job in the family are associated with students’ QOL.
that there was a direct effect of general health on QOL, Our research study found a significant association
whereas, there was a significant indirect effect of atti- between students’ life satisfaction and marital status,
tude through enhancing life satisfaction and optimism which suggested that being married may increase life

Table 1. Frequency distribution of students’ demographic factors and their relationship with attitude, subjective norms, optimism, general health,
satisfaction with life scale, and quality of life.
General Satisfaction
Attitude Subjective norms Optimism Health with Life Scale Quality of Life
Variables n (%) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Gender* Male 214(34.1) 29.42(5.19)# 10.63(2.29)^ 19.94(3.60)^ 32.63(6.21) 20.84(7.08) 35.05(6.29)
Female 413(65.9) 30.98(5.06) 11.21(2.19)^# 20.49(3.10)^ 32.86(6.09) 21.70(7.00) 34.86(5.91)
Marital Single 456(73.5) 30.46(4.98) 10.96(2.27) 20.29(3.16) 32.66(6.15) 21.01(6.97)^ 35.00(6.04)
status* Married 164(26.5) 30.40(5.59) 11.10(2.19) 20.30(3.58) 33.24(6.01) 22.48(7.04)^ 34.60(5.92)
Father’s Illiterate 24(3.9) 29.45(5.06) 10.24(2.54) 19.76(3.22) 33.52(4.83) 22.79(7.21) 34.24(5.65)
education ^
level** Diploma and 395(63.6) 30.36(5.05) 11.01(2.17) 20.20(3.18) 32.45(6.04) 20.95(6.85) 34.42(6.01)^
Under diploma
Academic 202(32.5) 30.58(5.37) 11.05(2.34) 20.42(3.52) 33.15(6.40) 21.77(7.24) 35.76(5.99)^
Mother’s Illiterate 49(7.9) 29.94(4.48) 10.48(2.14) 20.43(3.28) 33.09(5.47) 21.35(6.06) 34.28(5.55)
education Diploma and 425(68.4) 30.41(5.12) 11.01(2.16) 20.17(3.23) 32.54(6.08) 21.01(6.96) 34.67(5.99)
level** Under diploma
Academic 147(23.7) 30.71(5.47) 11.17(2.50) 20.56(3.44) 33.48(6.10) 22.36(7.20) 35.92(5.76)
Mother’s Housewife 507(80.7) 30.39(5.03) 10.98(2.20) 20.30(3.19) 32.71(596) 21.13(6.92) 34.69(6.05)
job * Working outside 121(19.3) 30.75(5.60) 11.10(2.42) 20.21(3.68) 32.95(6.74) 22.33(7.34) 35.66(5.86)
the home
Father’s Job* Employee 337(54.4) 30.46(5.13) 10.98(2.220) 20.33(3.08)) 32.61(6.15) 21.35(6.86) 34.59(6.20)
Self-employed 282(45.6) 30.38(5.21) 11.01(2.29) 20.19(3.49) 32.91(6.09) 21.43(7.16) 35.23(5.82)
Interest about Yes 434(91.6) 30.79(4.78)^ 11.02(2.18) 20.46(3.22) 33.12(6.19)# 21.88(6.73) 35.22(5.84)#
filed of No 40(8.4) 28.33(6.95)^ 10.41(2.53) 20.16(3.08) 29.19(6.28) 18.34(8.21)^ 31.66(6.60)#
education* #
Number of ≤3 238(42.7) 30.53(5.05) 11.02(2.37) 20.23(3.21) 32.66(6.15) 21.41(6.86) 34.48(5.84)
friends 4-8 203(36.4) 30.86(4.41) 11.29(2.04) 20.58(3.06) 33.01(6.16) 21.13(6.77) 35.16(6.15)
>8 116(20.8) 30.21(5.92) 10.84(1.97) 20.19(3.79) 32.69(6.78) 21.88(7.36) 35.01(6.89)
*Independent samples- t test, **ANOVA, #p < 0.001, ^p < 0.05.
 Journal of American College Health 5

Figure 1. Path analysis between Attitude, Subjective norms, optimism, General Health, Satisfaction with Life Scale (SWLS), and Quality of life (R2:
R-Squared, → *p < 0.05, → **p < 0.001).

Table 2.  Direct and indirect effects of constructs.

Causal Effect
Determinants or Predictors Direct Indirect Total effects
Attitude → Quality of Life – 0.265** 0.265
Subjective norms → Quality of Life – 0.139* 0.139
Optimism → Quality of Life – 0.193* 0.193
GH → Quality of Life 0.548** 0.104* 0.652
SWLS → Quality of Life 0.253** – 0.253
Attitude → SWLS 0.122* 0.181* 0.303
Subjective norms → SWLS 0.100* 0.131* 0.231
Optimism → SWLS 0.090* 0.107* 0.197
GH → SWLS 0.409** – 0.409
Subjective norms → Attitude 0.431** – 0.431
Subjective norms → Optimism – 0.196* 0.196
Attitude → Optimism 0.456** – 0.456
Subjective norms → GH – 0.148* 0.148
Attitude → GH 0.224** 0.119* 0.343
Optimism → GH 0.262** – 0.262
Through total causal effect 2.895 1.583 4.478
Percentage of direct and indirect effects 2.895/4.478 =64.65% 1.583/4.478 =35.35%
*p < 0.05, **p < 0.001, SWLS: Satisfaction with Life Scale, GH: General health.

satisfaction. Marital status has a significant effect on life socio-demographic characteristics.36 Therefore, relevant
satisfaction among the adult population because it has evidence is still controversial. The results of path analysis
a protective effect on mental illnesses and depressive showed a good fit between the QOL and the biological
symptoms during adulthood. It is noteworthy that even psychosocial factors. Interestingly, the constructs of sub-
in a community with the highest social violence, such jective norms, general health, positive attitude, optimism,
as Juarez City in the Mexican state of Chihuahua, marital and life satisfaction explained 50% of the total variance
status has been considered as a “protective mechanism” of QOL in university students.
against feelings of despair, social isolation, anxiety, and In this study, among all the constructs, general health
depression.35 Therefore, it is important to include the emerges as the strongest direct path of QOL and life sat-
need to model the impact of the marital status of adults isfaction that mediates the effects of attitude and optimism
in different communities on QOL and life on a student’s QOL. Our finding suggests that university
satisfaction.” students who have a better health status (convenient daily
The results of present study showed that gender dif- lives and physical health, positive emotions, cognitions,
ferences in attitude, subjective norms, and optimism. self-control, and self-steam) showed a greater life satisfac-
However, their findings are contradictory in different tion and QOL within a broader context of mental and
communities because gender differences in psychological physical health, emotional, general well-being, and social
factors could be explained by differences in clinical and functioning performance. This result is consistent with
6 S. B. TAVAKOLY SANY ET AL.

other similar studies that showed a higher QOL, positive individual’s QOL in adhering to healthy behaviors.40,41
attitudes, and emotions may significantly influence physical Likewise, several studies have shown that family mem-
and mental well-being by the promotion of optimism and bers should be considered as positive role models when
a healthy lifestyle.3,4 designing health education programs to promote QOL.
Life satisfaction was a second strong direct pathway. Furthermore, our results showed that student’s QOL is
This construct mediates the effects of subjective norms, significantly associated with fathers ‘education level.4,42
attitude, general health, and optimism on the student’s According to the literature, parents’ education level is
QOL, which was consistent with the previous literature.9 associated with life satisfaction in children and young
In this study, most of the students (around 60%) either people, because parents with high education have easy
agreed or strongly agreed with the specific life satisfac- access to financial and social resources.4 There is evi-
tion statements include “I am satisfied with my life or dence that students with strong financial and social con-
so far, I’ve gained whatever I wanted in life”. ditions will benefit from a higher QOL due to easy
Consequently, these students showed a high degree of access to socio-economic support structures. In general,
positivity and optimism toward their QOL. Several stud- these subjective norms could be considered as important
ies have reported that a positive feeling and sense mediators in changing the QOL. 4,41 There is a gap
toward life conditions are more likely to promote an between the identification of the role of subjective norms
individual’s life satisfaction.4,9 The Path analysis showed and their implementation in skill-based operationaliza-
that attitude significantly affected students’ QOL via tion. Therefore, more research is needed to evaluate the
significant indirect pathways that mediate the effects of impact of subjective norms on the QOL through cultural
subjective norms. Also, the significant indirect pathway and socio-economic practices.
that was strongly mediated by attitude causes the overall
impact of optimism on the QOL.
Notably, most of the participants either agreed or Implication
strongly agreed with the specific attitude statements include
“I feel that when I think positively, my life is meaningful Our research is one of the first to use life satisfaction,
and purposeful or I feel that when I think positively, I subjective norms, general health, optimism, and attitude
think better”. Likewise, nearly half of the students believed constructs to provide a database related to identifying
that optimism will lead to better health and communica- potential determinants of QOL among Iranian students.
tion. However, some students (38%) believed that optimism Testing the application of these potential constructs in
does not contribute to the QOL in difficult situations in different populations and cultures is essential to better
life. According to the previous studies, a high positive understand the mechanisms that promote the underlying
attitude and belief toward the benefits of optimism are determinants of QOL. Understanding the theory of QOL
more likely to improve an individual’s QOL. Also, has become an important issue in health promotion
Sosnowski et al. pointed out that attitudes in difficult programs. Indeed, potential determinants that influence
situations may cause specific emotional and behavioral QOL allow public health policy educators and health
responses, which in turn have a significant impact on the promoters to conduct a better study on individual’s needs
QOL and physical function.4 and intentions in different populations.
There is evidence that attitudes constitute two psy-
chological adaptation strategies when life is difficult. The Limitation
first strategy is the constructive (more active, optimistic,
and highly self-sufficient fight with the problem), which Our study is subject to limitations. Although self-reported
is often associated with a better QOL and with better questionnaires are commonly used in a cross-sectional
mental, emotional, social functioning, and physical over- study, it may lead to biased results and the possibility of
all.4,9,37 Second is the destruction (dominated by feelings representativeness. Likewise, the contribution of female
of anxiety, hopelessness, helplessness, low self-sufficiency, students in this study was higher than that of male stu-
a fatalistic attitude, and less active), which is associated dents. This study was designed based on the cross-sec-
with a poorer QOL and with worse functioning in all tional method without any restrictions on gender
aspects of life.4,15,38,39 selection. Gender differences are beyond the design and
Our finding showed that subjective norms positively scope of this study, indicating that there is potential for
affected student’s QOL via significant indirect pathways; future research on this issue. However, our findings indi-
accounting for 14–16% of the explained variance. This cate that the relationship between gender differences,
finding highlights the role of friends, parents, and uni- overall health status, satisfaction with the scale of life,
versity lecturers as influential people on the student’s and QOL is negligible. Since gender differences in psy-
QOL by giving social support and encouraging them to chological factors can be explained by differences in
be optimistic. This result was consistent with other clinical and socio-demographic characteristics, relevant
health promotion studies that indicated subjective norms issues in different countries are contradictory. In future
could potentially lead to long-term changes in an research, we aim to examine gender differences in
 Journal of American College Health 7

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