Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. Feelings of abandonment among elderly people in rural Northeast Thailand A thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy In Health Sciences At Massey University, Palmerston North, New Zealand Supaporn Sudnongbua 2011 ii i ABSTRACT The study was focused on feelings of abandonment among elderly people whose children had left their home villages in rural Northeast Thailand. Sequential mixed methods were employed. A cross-sectional survey (Study A) was used to determine (1) the extent and degree to which older persons living in a rural area of Northeast Thailand felt abandoned by the migration of their children from their home province; (2) the factors which affect feelings of abandonment; (3) the impact that feelings of abandonment had on their quality of life. Ethnographic methods (Study B) were then used to gain an in-depth understanding of the experiences and meaning of abandonment from the perspectives of those who identified as feeling abandoned or not feeling abandoned. Furthermore, data were obtained and analysed that highlighted the way in which the two groups solved problems when facing difficult circumstances. A cross sectional survey, consisting of 113 questions including the 26-item WHOQOL-BREF and the 24-item WHOQOL-OLD was administered to 212 participants who ranged in age from 60 to 107 with a mean age of 71. While only 9% were found to live alone, 20% stated that they felt abandoned to some degree. To identify the factors which may impact on feelings of abandonment, participants were assigned to groups based on their stated feelings of abandonment (i.e., abandoned / not abandoned) and compared on 21 variables. They were found to differ on 7 of those (i.e., age, level of education, whether they lived alone or with others, satisfaction with living arrangements, frequency of contact with any of their children, degree of economic hardship, and family support). A standard multiple regression was performed to predict variance of feelings of abandonment using those 7 variables. These variables predicted 23% of variance in feelings of abandonment in this sample. Only 4 variables (i.e, frequency of contact with any of their children, living alone or with others, degree of economic hardship and family support) were found to make a unique and significant contribution to this prediction. A one-way between groups MANOVA was conducted to determine if those who felt abandoned differed from those who did not on a single-item question of overall quality of life and the total scores for the WHOQOL-BREF and WHOQOL-OLD. Significant differences were found ii between groups on the total scores for the WHOQOL-BREF and the WHOQOL- OLD only. Participants in Study B were initially selected from those in Study A and supplemented by purposive sampling in the study setting. Twenty-five participants, 14 who felt abandoned and 11 who did not feel abandoned were recruited. Data collection involved participant observation and in-depth interviews. Thematic analysis was employed for data analysis. The findings from Study B were that the reasons for feeling abandoned (as perceived by elderly parents) are constructed from children’s actions perceived as negative by parents, economic hardship, illness/spouse’s sickness, and hopelessness. Of these reasons, only two were also identified in the cross-sectional survey the frequency of negative contacts with children and degree of economic hardship showed as quantitative measures of abandonment. Problem solving by participants is formulated from several bases: using Buddha’s teachings, acting positively towards their children, focusing on life’s satisfaction, finding financial solutions, seeking support and dealing with sorrow. Recommendations made as a result of this study draw attention mainly to the minimization of the negative effects of labour migration on elders. In addition, the government, health care workers, and community should play an active role in taking care of those old persons left behind, especially aging people who live alone, by providing community bases and home health care services rather than increasing institutional services. This could substantially change the implications of migration on the well-being of the parents, especially when illness or frailty occurs and daily personal assistance is needed. iii DEDICATION (Golden ‘first Buddha’ of Thasung temple in Uthaithani province, Thailand) I dedicate this thesis to my father (Pol.Lt.Col. Surb Sudnongbua) who was a senior policeman and helped the people in remote areas all his life. In addition, I devote the knowledge from this research to all elderly in Thailand. iv v ACKNOWLEDGEMENTS There is no tension for those Who have completed the journey And have become free from The distress of bondage. Dhammapada v.90 Firstly, I have to acknowledge Buddha’s teachings that I have learned since I was young. This knowledge has enabled me to understand elderly people, and has allowed me to cope with issues that arose in the research. In addition, my experiences from Buddha’s teachings helped me understand the aging people’s feelings clearly while I interviewed them. A sincere thank you must go to the aging parents who willingly participated and shared their useful views and experiences in this research. Without their participation, my research could not have been accomplished and even I, a child who has an aging mother and who has left home to work in a big city, have had the opportunity to learn deeply about myself and about the feelings of abandonment of elderly parents whose children have left the home village. The outcomes of this study will benefit not only me but also the Thai government that may provide the various programs for the elderly in rural remote areas in Thailand. In the field in the remote rural area in Northeast Thailand, my special thanks go to the director of Nong Khai Provincial Health Office, Bung Khla hospital, District Health Office, Bung Khla District Office, and Bung Khla Subdistrict Administration Organization. Also, for joining the activities with the people in the field, my thanks go to the teachers, and students at Bung Khla high school and Bung Khla primary school who welcomed me to teach them English at available times. Furthermore, I would like to express my sincere thanks to the villagers who welcomed me sincerely to join their activities such as digging cassava, and the Song-Kran festival. My special thanks go to Wijitra Meerat, who was a senior vi nurse at BungKhla hospital and my old friend, and Tim Kotrat, who was a village health volunteer and accompanied me in the remote area. I will not forget Assist.Prof.Dr. Piyapan Siripan who gave me suggestions about ethnographic methods when I had questions about the methods in the field. During the cross-sectional survey, I would like to thank Assoc.Prof.Dr. Wongsa Kongdee who gave me some suggestions and recommended me to the people whom I consulted statistics (Wallop, Day, and Nan). Without these three statisticians, I might have been in trouble with quantitative data. For the translation of a questionnaire, special thanks go to three translators who have experience over five years in using English; Assist.Prof. Sripanya Chaiyai, Mr. Sittiporn Songsataya, and Dr. Pattama Surit. Also, special thanks go to Dr. Somjai Puttapitukpol and Assist.Prof. Jiamjit Sangsuwan who are experts for validity of a questionnaire. My thank go to Assist.Prof.Dr. Suwanna Boonyaleepan who provided me emotional support during data collection. To my beloved family – Mrs. Chalad Sudnongbua, my mother who gave birth to me, and encouraged me during studying PhD. Also, my older sister (Mrs. Tanida Tanyakasempong), my younger brother (Mr. Kajohnsak Sudnongbua), my younger sister (Mrs. Supak Panyasiri), my nephew (Moo-orn), my nieces (Namo and Putto), and all my relatives whose I do not show names. Without them I would never have been gone this far in achieving success. For people in New Zealand, I express my gratitude to Professor Julie Boddy and Professor Steve LaGrow, my supervisors, for their wisdom and support all along this journey of my dissertation. From the time and guidance which they devoted to me, I have gained a lot of experiences from them. Also, I thank all staff of the School of Health and Social Services who provided me with encouragement, especially Dr. Martin Woods whom I consulted about philosophy and who willingly shared many ideas with me. A thank you goes to Mrs. Lois Wilkinson and Mr. Stephen Wrathall for their guidance in improving my English grammar in this thesis. I would like to thank Mr. Dean Richard and Mr. Colin Leong who helped me when I had computer problems. vii For emotional support and encouragement, my special thanks go to Mr. Peter and Mrs. Jocelyn Carver whom I stayed with and provided me emotional support when I lost heart. Also, all Thai housewives and their families provided me Thai food when I studied hard and took me around North Island, especially Mrs. Tanya and Mr. Jack Hope, Mrs. Peng and Mr. Carl Huges, Mrs. Booranee Roskruge, Mrs. Boonsita Harrowfield, and Mrs. Tewaporn Anwar. I would like to thank the Thai Students Association which gave me opportunity to participate activities with all Thai students in Palmerston North. I felt relaxed and enjoyed my leisure time with it. For all Thai students, I would like to thank them for sharing ideas and consulting with each other about study. Also, I will not forget all other friends who made friendship with me and encouraged me for study. Special thanks go to my Fijian friend – Mrs. Alisi Vudiniabola who accompanied and dropped me home when I studied late at night. Finally, I need to acknowledge the Royal Thai Government for the Royal Thai Scholarship, and Massey University for providing me with the opportunity to learn, which assisted in the completion of this thesis. Thank you.