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Der Artikel untersucht das subjektive Wohlbefinden älterer Erwachsener über 60 im ländlichen Norden Ghanas und offenbart ein multidimensionales Verständnis dessen, was ein gutes Leben in dieser demografischen Situation ausmacht. Die Studie identifiziert fünf Schlüsselthemen, die ihre Wahrnehmung von Wohlbefinden prägen: materielle Sicherheit, physische und kulturelle Arbeitsfähigkeit, Gesundheit und psychisches Wohlbefinden, Religiosität / Spiritualität und der Beitrag zu anderen. Jedes Thema ist eng miteinander verknüpft, wobei sich innerer Frieden als zentrales Konzept herauskristallisiert, das diese Dimensionen vereint. Die Studie unterstreicht die Bedeutung des kulturellen Kontexts für die Definition von Wohlbefinden und zeigt, wie soziokulturelle Faktoren die Prioritäten und Erfahrungen älterer Erwachsener beeinflussen. Die Ergebnisse unterstreichen die Bedeutung materieller Ressourcen, körperlicher Unabhängigkeit, Gesundheit, spiritueller Praktiken und sozialer Beiträge für das Erreichen eines Gefühls inneren Friedens und allgemeinen Wohlbefindens. Diese umfassende Untersuchung bietet wertvolle Einblicke in die einzigartigen Herausforderungen und Stärken älterer Erwachsener im ländlichen Ghana und bildet eine Grundlage für die Entwicklung kulturell sensibler Interventionen und Strategien zur Verbesserung ihrer Lebensqualität.
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Abstract
Improving well-being has increasingly become an important policy outcome for governments globally, prompting a focus on its conception and measurement. Existing studies on conceptions of well-being in Ghana have mainly focused on adolescents and adults. Given that Ghana’s population is ageing, exploring conceptions of well-being among older adults is important for improving their well-being. This study explores how older adults aged 60 and above conceptualize well-being and how the socio-cultural context shapes these conceptions in rural northern Ghana, West Africa. We undertook 17 in-depth interviews in a low resource setting in Ghana focusing on community-dwelling older adults from three socioeconomically diverse backgrounds. Interviews were analysed thematically. Overall, older adults conceptualized well-being as multidimensional, largely shaped by their socio-cultural context consisting of: (1) material security, (2) physical and cultural work capacity, (3) health, affect and psychological well-being, (4) religiosity/spirituality, and (5) contributing to others. In this context, a low-arousal positive affect, inner peace, was central to a ‘good life’ in older adulthood. Given the multidimensional conceptualization of well-being and how inner peace was central to the good life, a multi-faceted approach that addresses the different dimensions to ensure emotional stability, resilience and security is required for improving well-being among older adults in Ghana.
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1 Introduction
As projections indicate that the number of older adults aged 60 and over in Ghana will increase from 2.1 million in 2024 to 5.7 million by 2050, the well-being of older adults in Ghana has become a public health concern (Ashirifi et al., 2022; United Nations Department Economic and Social Affairs [UNDESA], 2024). Global commitment to improve health and well-being of older people is expressed in Sustainable Development Goal 3: ensure healthy lives and promote well-being for all at all ages (United Nations [UN], 2015). The Madrid International Plan of Action on Ageing (MIPAA) considered advancing health and well-being into old age a priority for ageing populations in the twenty-first century (UN, 2002). Given that conceptions of well-being have implications for experienced well-being, increasing understanding on well-being conceptions among older adults in Ghana becomes crucial for holistically improving their well-being.
Conceptions of well-being among older adults have been studied predominantly in Western settings (Douma et al., 2017; McMahan & Estes, 2011). It is understood as a multidimensional concept comprising dimensions such as health and functioning, social life, activities, space and place, independence, happiness, and contribution to others (Douma et al., 2017; McMahan & Estes, 2011; Ward et al., 2012). Well-being has also been defined among older adults in Western countries as life satisfaction and contentment with life; varying according to age, gender, culture, socio-economic status, residence, chronic conditions, and functional limitations (Bedi & Case, 2014; Douma et al., 2017; McMahan & Estes, 2011). However, a few studies found no differences in well-being conceptions by age, gender, or culture (e.g., Jopp et al., 2014). Inner peace or peace of mind as a conception of well-being has been less prominent in the subjective well-being literature until recently. It is considered a Low-Arousal Positive (LAP) affect such as calm, harmony, or tranquility, mostly valued and shaped in East Asian (e.g., Chinese, Korean) cultural settings (McManus et al., 2024; Tsai, 2017). Nonetheless, recent evidence suggests it contributes to well-being in Western settings too (McManus et al., 2024). For instance, Sophie et al. (2022) found that peace of mind was an important contributor to subjective well-being (i.e., life satisfaction, positive and negative affect) among Belgians aged 15–87 years. Notably, the importance of inner peace as a psychological well-being state was confirmed by Delle Fave et al. (2016) when inner peace constituted 37% of well-being conceptions among lay people relative to 14% of High-Arousal Positive (HAP) affect such as joy, vitality, and elation across 12 nations on five continents. Unlike in the Western settings, existing studies on well-being conceptions in sub–Saharan Africa (SSA) have mostly focused on adolescents and adults (Adedeji et al., 2023; Agbo & Ome, 2017; Dzokoto et al., 2019; White & Jha, 2018). For instance, Zambian and Tanzanian adults identified material, moral, and relational dimensions of well-being conceptions (Kaufman et al., 2022; Sambuo, 2024; White & Jha, 2018). Exploring cultural variation in well-being conceptualization in South Africa, Adedeji et al. (2023) named 11 sub constructs of well-being conceptions including social relationships, spirituality, physical health, and community solidarity among a multicultural adult sample. Also, in a study among young college students in Eastern Nigeria and South Africa, participants’ conceptions of happiness included positive affect, social relationships, and cognitive evaluation of life (Agbo & Ome, 2017; Pflug, 2009).In Ghana, Wilson Fadiji et al. (2019) explored well-being conceptualizations among employed urban adults in Ghana. They found a multidimensional conceptualization of well-being encompassing health, material, psychological, relational, and spiritual aspects. Well-being has been construed as cultural identity, social capital, and meeting basic needs among adults in Ghana (Kangmennang & Elliot, 2019). Similarly, adolescents identified good physical health and the absence of malaria as well-being (Glozah, 2015). Dzokoto et al. (2019) found happiness and work-related meaning predominant in the conceptualization of the good life among Ghanaian college students. Recently, instead of high-arousal well-being, researchers in Ghana found low-arousal themes including peace of mind, materiality, and relationality as conceptions and experience of well-being among a community and student sample in Ghana (Affram et al., 2024; Osei-Tutu et al., 2022). Overall, conceptions of well-being among older adults and how these conceptions are shaped by the African socio-cultural context has received little scholarly attention in rural Ghana.This study seeks to explore how older adults aged 60 and above conceptualize subjective well-being and how the socio-cultural context shapes these conceptions in rural northern Ghana. We apply a qualitative research approach to explore culturally relevant well-being conceptions for potentially informing well-being measurement tools in SSA as suggested by Wilson Fadiji et al. (2022). This study broadens the understanding on how conceptions of well-being among older adults are shaped by the socio-cultural context in Ghana.
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1.1 Cultural Influence on Well-Being Conceptions
Although well-being is considered universal, conceptions or perceptions of well-being and of how it is achieved are embedded in meanings and values shaped by culture (Joshanloo et al., 2021; Oishie & Gilbert, 2016; Uchida & Oishie, 2016). A major cultural difference with consequences for well-being conceptualization is that between individualistic and collectivistic cultures (Joshanloo et al., 2021). Euro-American societies that emphasize individual independence regarding the conceptualization of well-being are considered individualistic, while non-Western (e.g., Africa, East Asia) societies that stress social interdependence are collectivistic (Joshanloo et al., 2021). Researchers have examined conceptions of well-being among individuals from these two cultural backgrounds (e.g., Bedi & Case, 2014; Uchida & Ogihara, 2012). For example, Uchida and Ogihara (2012) found that while happiness is individualistic, embodying personal achievement, self-esteem, agency, and autonomy in Euro-American cultural contexts; it is collectivistic, based on social relationships, ordinariness, and interdependence in Eastern culture. Similarly, Bedi and Case (2014) found cultural differences in British and Indian older adults’ experiences of happiness and life satisfaction that reflect individualist and collectivist societal norms respectively. Indian older adults believed that religion was central to their culture and improves happiness and well-being, whereas this was not the case for British older adults (Bedi & Case, 2014).
Among the cultural variations in well-being conceptualization between individualistic and collectivistic cultures are: the value placed on HAP and LAP states and the importance of context (Joshanloo et al., 2021; McManus et al., 2024; Tsai, 2017). Euro-Americans typically prefer HAP feelings such as excitement, joy, and enthusiasm more than East Asians, who prefer LAP feelings such as inner peace, calm, and serenity (Tsai, 2017; Tsai et al., 2007), even though recent evidence suggests a global preference for calmness (McManus et al., 2024). In terms of the importance of context, individualistic cultures emphasize personal feelings, choices, and behaviour in well-being conceptualization over the influence of contextual determinants (Joshanloo et al., 2021). They prioritize the internal and one’s ability to control what happens in their lives with regards to well-being. However, collectivistic cultures emphasize the importance of contextual determinants, acknowledge the influence and interdependence between the material and spiritual worlds, social/community norms and values, social networks in well-being conceptualization and outcomes (Bains, 2015; Ortiz, 2020; White & Jha, 2018). Therefore, we expected cultural embeddedness of well-being conceptualization in our study, potentially extending the literature on the understanding of well-being. As Laube (2015), to explain how well-being conceptions were embedded in or shaped by the socio-cultural context of our study, we turned to literature on cultural schema theory (D’Andrade, 1992). Cultural schema theory is appropriate for explaining local indigenous conceptions of well-being as it focuses on how culture influences people’s beliefs, perceptions, attitudes, and actions (D’Andrade, 1984). According to D’Andrade (1984), cultural schemas in a community are made up of shared knowledge structures of objects and events. These cultural schemas constitute the reality-determining system of humans, and inform what states of the world can and should be pursued (D’Andrade, 1992). Schemas may include personal or shared perceptions, beliefs, goals, values, discourses, and emotions (D’Andrade, 1992). It has been argued that for every social phenomenon, schemas exist that are embedded in the cultural meaning system (Strauss & Quin, 1997). When schemas become internalized through socialization and previous experiences, they take the form of beliefs, engaging the mind and emotions (Straus & Quin, 1997). Quinn (2005) argued that an individual’s perceptions and behaviours are the result of cultural schemas, or shared experiences, from which cultural meaning is derived and used to interpret, perceive, and relate to the world or environment.
2 Methodology
2.1 Study Design
A qualitative study was conducted. An exploratory approach which allowed for understanding participants’ perceptions, beliefs, views, and experiences of well-being from the emic perspective was utilized (Hennink et al., 2020). This paper is part of a larger qualitative study on intergenerational solidarity (support) and subjective well-being in rural northern Ghana.
2.2 Study Setting
We conducted the study in the Kassena-Nankana Municipal of the Upper East Region, Northern Ghana. This municipality covers an area of 865 km2 and has a total population of 99,895 (Ghana Statistical Service [GSS], 2021). The share of older adults aged 60 and above in the municipality is higher (8.5%) than the national average (6.5) (GSS, 2021). The municipality is mainly rural (GSS, 2021). Population sizes of rural communities in this municipality ranges between 300–4500 people. According to the GSS (2023), almost 34% (i.e., 33,765 people) of the population live in multidimensional poverty. Socio-cultural factors including religion plays an important role in the lives of the people in the study area (Akweongo et al., 2021). Belief in God or a supernatural being is widespread and influences people’s worldviews. The three main religions among the people includes: Christianity (dominant), Islam, and African Traditional Religions (ATR). As in many Ghanaian communities, social status is valued in the municipality, and it often related to material wealth (Laube, 2015). Life in the study area is further influenced by seasonality. The youth in the area often migrate in the dry season to southern Ghana for work and return in the farming season. Services and subsistence agriculture, mainly crop cultivation (e.g., millet) and livestock rearing (e.g., goats) are the main livelihood activities (GSS, 2023). There are two main ethnic groups in the study communities: Kassena and the Nankana. Despite speaking different languages, the cultural norms, social, and economic institutions of these main ethnic groups are similar. Traditionally, the patrilineal system of inheritance is practiced and funerals are major customary practices. Majority of the people in the municipality live in compounds with houses built with mud brick/earth walls, often roofed with metal iron sheets. Our study communities (i.e., Korania and Pungu-Bawio) though mostly similar to communities in the municipality, were selected mainly due to their prior experience with participatory approaches (e.g., PWR).
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2.3 Participatory Wealth Ranking (PWR)
For the purpose of selecting participants across a range of socio-economic backgrounds, PWR was first conducted with key informants (selected through community leaders) in study communities to determine the wealth status of older adults for participation in In-Depth Interviews (IDIs). PWR is considered an appropriate proxy measure and proven to accurately determine the socio-economic backgrounds of community members in rural settings, where community members use local, subjective poverty indicators to rank the wealth of households, as most people do not have stable source of income (Aryeetey et al., 2013; Simanowitz et al., 2000; Van Campenhout, 2007). The reason for using PWR for selecting participants instead of standard quantitative socio-economic indicators was to ensure the results reflect the emic perspective (i.e., subjective measures) of study communities regarding one’s socio-economic background. In this context there are social or cultural values that may determine how one is viewed in terms of their socio-economic background. Standard quantitative socio-economic indices that capture living standards such as household ownership of durable assets (e.g., television, bicycle) and infrastructure and housing characteristics (e.g., sanitation facility, roofing material) may misrepresent a household (Vyas & Kumaranayake, 2006) that does not meet these criteria but relies on support from well-off relatives such as adult children residing outside the household to meet their needs (e.g., basic, health, etc.). Also, the scarcity, abundance, or value of a resource such as land determines the weight ascribed to these resources in the ranking of individuals and households by community members (Vyas & Kumaranayake, 2006).
The lead author, assisted by 2 research assistants (who mainly took notes) conducted two focus group meetings with a group from each study community (2 × 2 = 4 focus groups) during which mapping, ranking, and analysis were conducted (Aryeetey et al., 2013). In total, 11 informants were involved—six (4 men; 2 women) were aged 60–76 years whilst five (2 men; 3 women) were aged 22–55 years. In the first meeting, a community map was drawn on the floor and all households with older adults aged 60 and older within the boundaries of the community identified by informants. Next, ranking, which involved informants identifying local subjective indicators of poverty was conducted. Informants were facilitated to answer the question: what differentiates a poor household from a wealthy household? Informants were guided to come up with a list of indicators for poor and wealthy households. Informants discussed in detail the indicators and characteristics that closely resembled poor and wealthy households and subsequently a third category: better (see Fig. 1). Generally, households who were deemed as wealthy were those who were able to afford three nutritious meals daily; had members who were experiencing peace of mind, good health, and happiness; and were able to solve their problems without external help. The opposite was the case for poor households, whilst better households may only be able to feed twice daily and slipped into poverty during crisis such as crop failure. Afterwards, key informants were paired up and given coloured notepads (i.e., green, yellow, and red) to represent wealthy, better, and poor respectively. They were then assigned older adult households in the community and asked to independently rank these households and bring their results to the next meeting. At the second meeting, results of the ranking were analysed. Names of households with older adults were mentioned and informants who ranked them lifted their coloured papers. We tallied the number of each colour assigned to a household by informants. The decision on the households’ wealth status was based on a simple majority of the number of same colour paper assigned. Disagreements in assigning wealth status were resolved through discussion among informants. In total, 62 households of older adults were ranked (14 wealthy, 19 better, 29 poor). Refer to supplementary material for further details of PWR. PWR results were then used to recruit participants for IDIs.
Fig. 1
Examples of subjective indicators of wealthy, better, and poor households
Guided by PWR results, prospective participants were approached in their homes to take part in IDIs. Research assistants, who were native speakers, were engaged to assist with participant recruitment and translation. Community-dwelling adults aged 60 years and above, who were able to understand and respond appropriately to questions, and consented to participate, were recruited. Participants were recruited in three rounds according to age range (60–64, 65–74, 75 +), sex, and socio-economic background (wealthy, better, poor) for sample representativeness and because age, sex, and socioeconomic background can influence perceptions, attitudes, and experiences of well-being (Abe et al., 2023; Miles & Huberman, 1994). This ensured that varied perspectives were elicited at any given time during the interview process.
2.5 Data Collection
The lead author (researcher), a native speaker, conducted IDIs between August and December 2021. Research assistants and the researcher translated the IDI guide from English to Kasem and Nankam and identified terms that needed colloquial connotation. Hence, the IDI guide was contextualized for more appropriate terms used in the study area. For instance, ŋwe-laao [good life or living well] or ŋwe-ywoŋa [sweet or good life] and wo-pwolo were identified as prompt words for well-being and happiness respectively in Kasem. In Nankam, we identified Vonsumɔ [good life or living well] and pupeelum for well-being and happiness respectively. The researcher piloted the IDI guide with three older people to check for comprehensibility and flow of questions, probes, and timing of the interview questions. After the pilot, a few questions were rephrased and reordered to improve comprehension and flow (Hennink et al., 2020). The researcher conducted IDIs with participants in their homes in the local languages (Kasem and Nankam) and audio-recorded it. The purpose of IDIs was to delve deeper into personal perceptions, beliefs, and experiences of participants to ensure a holistic understanding of well-being from their perspective. Using prompt words for well-being in the local language, we explored participants’ understanding of well-being. We asked participants how they felt about their life in general and what in their opinion contributed to the good life. Sample questions are presented in Box 1. Probes in the guide were used for thorough exploration of issues during interviews but attention was also paid to emerging issues. After every interview, audio-tapes were reviewed and field notes and reflections written. Issues such as whether and how inner peace was linked to health and happiness that needed further attention were identified during reflections and subsequently pursued in the next interviews. Also, how material resource was related to health, happiness, or inner peace was pursued in subsequent interviews. On average, IDIs lasted for 62 minutes. Table 1 summarizes characteristics of IDI participants.
All names are pseudonyms. aATR = African Traditional Religions
2.6 Data Analysis
All IDIs were transcribed verbatim in the original language to preserve their authenticity, and within days after they were conducted (Richards & Morse, 2012). Transcripts were checked for accuracy and quality before they were imported into ATLAS.ti 22.2 (ATLAS.ti Scientific Software Development, 2022). Informed by a constructionist approach to uncover how the socio-cultural context shapes older adults’ well-being conceptions, thematic analysis, a method used for identifying, analysing, and reporting patterns of meaning was used (Braun & Clarke, 2021). First, to familiarize with the data, transcripts were read repeatedly, and initial ideas, patterns, and meanings noted. Coding was then done from reading the data (inductive) and from scholarly literature (theory) and/or personal experience (deductive) relevant to the study question. After, all codes and relevant data extracts were collated and sorted into candidate themes. Next, candidate themes were reviewed to ensure they were relevant to the data extracts and entire dataset. Finally, the connections between codes and/or candidate themes were discussed by all authors, leading to further discussions, refining, defining, and naming of final themes. Table 2 shows the coding and final themes developed. Field notes and reflections were used to clarify and to interpret the meaning of quotations by participants.
Table 2
Coding and final themes developed
Inductive codes
Deductive codes
Final themes
Example
Poverty prevents the good life, finances, cash, basic needs, living standard, livestock ownership
Material resource and assets, meeting basic needs, social status
Material security
“It is essential to have a good standard of living … having the means to have a good standard of living helps to experience the good life” (Memunatu, 64 years, better)
Performing household chores, farm work, watering and tethering livestock, poultry rearing, ability to perform activities of “strong or young” years
Independence and self-sufficiency, fulfilling socio-culturally rooted work roles, positive self-worth
Physical and cultural work capacity
“When I wake up in the morning and can work, keep the compound clean, wash, water livestock in the afternoon, I feel active, happy” (Kende, 76 years, poor)
Physical health, absence of worrying or ‘thinking’, healthy family, happiness for health, health for happiness, happiness, joy, anger, sadness, grief, inner peace or peace of mind (i.e., buchongo zuru) for health, inner peace or peace of mind for happiness
Physical health, mental health, social health, affect or emotions, positive psychological state
Health, affect, and psychological well-being
“For me living well, the good life is when you have inner peace, you know, healthy and happy” (Akuka, 71 years, poor)
Religious/spiritual practices and activities, religious beliefs, gratitude, contentment with life
resilience, inner peace, happiness, acceptance
Religiosity/spirituality
“I often pray, as a Moslem, I go to the mosque, it [mosque] is not far from my home, I thank Allah for health, for long life, I am grateful, this [praying] keeps me happy, gives me inner peace” (Memunatu, 64 years, better)
Supporting others (e.g., family, community, orphans), grand parenting, raising ‘successful’ children ‘rich’ in every aspect
An others’ orientation, social relationships, self-fulfilment, self-accomplishment, social status
Contributing to others
“Having my grandchildren around, we talk, play games … when they return from school I look after them until evening when their parents return, it [grandparenting] is a source of happiness” (Mohamed, 76 years, wealthy)
2.7 Ethical Standards
Ethical approval was granted by the Institutional Review Board of the Navrongo Health Research Center, Ghana (NHRC IRB 408) and the Faculty of Spatial Sciences Research Ethics Committee of the University of Groningen (2021-04). All participants signed or thumb printed informed consent forms prior to participation. The confidentiality and anonymity of participants was ensured by using pseudonyms. Identifiers were removed from transcripts. Steps to take to withdraw from the study was explained to participants.
3 Research Team Positionality
The lead author (researcher) hails from the study area and has a background in public health and gerontology. The lead author’s prior experience conducting PWR and working with older people as a public health specialist delivering health interventions in rural northern Ghana shaped the methods, analysis, and findings of this study. During the fieldwork, the lead author’s insider position was both an advantage and a disadvantage. It was an advantage as it provided a smooth entry into the study communities. Gatekeepers were welcoming and equally excited that a son of the soil was conducting the research. Participants appreciated that the lead author understood both verbal and non-verbal language, shared their knowledge, perspective, and experiences. This reduced tension, increased trust, and encouraged participants to freely express their views and experiences. Most participants were excited someone was researching the well-being of older adults due to limited research focus on older people. This increased participant’s interest in the study. As the interviews progressed, the lead author’s insider position became a disadvantage. The lead author became sympathetic towards some of the participants as they narrate their daily struggles to survive. Two female participants broke down and started crying as they narrated emotional stories about the loss of their children and the non-availability of support to meet basic needs of life. In these instances, the interview was discontinued and a 15–20 minutes break was observed to talk about a less difficult topic to enable participants to relax and to empathize with participants. This ensured that participants re-gained their composure enabling them to continue with the interview. Becoming emotionally involved while at the same time staying focused on conducting the interview proved challenging at times. Moreover, the lead author’s insider status also meant that at times it became challenging to examine the study results without personal biases. Discussing each stage of data analysis with co-authors minimized this bias.
Research assistants were native speakers and also obtained Bachelor linguistic degrees in Kasem and Nankam (local languages). No participant had prior relationship or contact with the lead author, research assistants, or co-authors. The co-authors (HH, FZ, and TV) are the lead author’s supervisors who were involved in designing data collection tools and data analysis (i.e., coding, refining, defining, and naming of final themes). HH is a demographer with expertise in population health, employing qualitative research methods. FZ is public health expert with expertise in nutrition, who has lived in northern Ghana. TV is a demographer with expertise in healthy ageing.
4 Results
Five themes of well-being conceptualizations were uncovered from IDI participants’ narratives: (1) material security, (2) physical and cultural work capacity (3) health, affect, and psychological well-being, (4) religiosity/spirituality and (5) contributing to others. Drawing on relevant quotes, each theme and related aspects are presented below. This is followed by a reflection of how these themes are interrelated.
4.1 Theme 1: Material Security
A theme that characterized participant’s conception of well-being was material security. The availability of material resources for meeting basic needs such as food, clothing, and shelter for survival or a good standard of living was construed as well-being in later life. Thus, the inability to meet basic needs or experiencing yiniga [poverty] defined well-being. Poverty in this context normally refers to individuals or families lacking material resources to obtain food, shelter and healthcare, and to maintain living conditions widely acceptable to society. The capacity to meet basic needs was considered the number one priority to experiencing a positive well-being in later life:
ŋwe-ywoŋa [sweet life], good life, is when you wake up and you have something to eat, the food has to be available always, a nice place to sleep, clothing to wear, and medicine when you are not well, this makes life good, gives wopwolo [happiness] in life (Adua, 65 years, better)
This understanding of well-being resonated with all participants. Poor older participants recognized that poverty prevented them from experiencing the good life. A participant confirms that “being poor, not having the resources to feed, to live well, makes life not sweet [good]” (Kaba, 76 years, poor). Another participant mentions that “life is not good when you are poor” (Kachana, 64 years, poor). Also, participants seemed to perceive that material resources/money fosters well-being or the good life. This conception was expressed by one participant as follows “When there is money, you are able to afford your needs, it brings happiness” (Afia, 75 years, poor).
Furthermore, participants noted that financial difficulties also prevented one from adequately providing for the educational needs of children or the food and healthcare needs of grandchildren. These challenges often led to conflicts, prolonged lwia [worrying] or Boŋem [‘thinking’], and the absence of happiness and buchɔn-zuru [cool heart, peace of mind, or inner peace]. Hence, material resources contributed to well-being in two ways: meeting basic needs and reducing distress or giving peace of mind.
Related to material security, owning livestock symbolized well-being in this context. A few poor participants noted that owning livestock such as goats and sheep helps people experience the good life. One participant explains:
It [livestock] is something that it’s proper for me to own but I don’t, it’s the reason I said life is not ‘sweet’ [good]… if you don’t own these things [livestock], life is worthless, because owning them [livestock] at this stage shows that you also have something [wealth], you own something that is of value that can be used to help yourself, solve your problems in times of need (Akuka, 71 years, poor)
Besides serving as insurance in times of economic hardship, it appears that participants perceived livestock as indispensable property that individuals of a certain age must possess. People in the study area commonly referred to the livestock an individual owned as if to suggest that it was a measure of what the person’s life was worth. In many parts of Northern Ghana, livestock are customarily valued, and are used in funerals and as dowry. Moreover, in Ghanaian society, cultural value and high social status are associated with material wealth (Laube, 2015). These perspectives add to the perception that owning livestock is essential to better well-being. Despite all aspects of this theme resonating with almost all participants, participants living alone and those aged 75 and above more frequently identified with it.
4.2 Theme 2: Physical and Cultural Work Capacity
Some participants conceptualized well-being as possessing the capacity to perform household chores such as cooking, washing, and cleaning. A participant observes that “well-being means being able to take care of your personal chores like cooking, cleaning, washing … without having to bother anyone” (Afia, 75 years, poor). Also, the capacity to physically perform activities such as farm work, watering, and tethering livestock was construed as better well-being. Difficulties with performing these tasks were associated with poor well-being. One older adult stated that the good life is:
When you are able to do some work, like tethering the animals in the morning, but when you are unable to do anything, it is not a good life. (Kapee, 74 years, wealthy)
Furthermore, some participants believed that being able to undertake activities that they were able to undertake in their youthful days symbolized well-being. This point was clarified by one participant, who noted:
The reason life is difficult [not good] is that you want to do something, and you cannot do it, you do not have the strength to do it, the time you were strong [young], the work that you could do on your own, now you can no longer do it, it is very frustrating paaa because nowadays the young ones do not like being asked to do things all the time. (Alua, 85 years, better)
In this subsistence agricultural context, older people are expected to engage in activities such as poultry rearing, watering, and tethering livestock, since they are often left behind at home because they are physically less able to engage in heavy work. Thus, the capacity of older adults to perform this culturally rooted work appears as contribution towards household upkeep and being unable to accomplish these tasks suggests poor well-being. While the capacity to perform household chores reflects practical independence in managing daily life, the ability to perform culturally rooted work represents fulfilling cultural work roles that can increase self-worth. Moreover, construing well-being as maintaining the physical abilities associated with their youth counters age-related narratives of decline. This theme was noted more among participants aged 65 and over and those living alone, probably due to declining physical abilities with age.
4.3 Theme 3: Health, Affect, and Psychological Well-Being
Well-being was conceptualized as health (physical, mental, and social), affect and psychological. With regards to physical health, a participant observes that “to have a ‘sweet’ [good] life, you must be healthy, strong, you should not be suffering from any disease and health problems (John, 64 years, wealthy). In terms of mental health, a participant indicates that:
There is good life when you are okay with everything in your life [life satisfaction], and you know that ‘thinking’, worrying is also an illness, when I am worried it is normally like I am sick, being worried is an illness. (Kayaga, 76 years, better)
It is widely perceived in the study area that people who are constantly ‘thinking’ or worried are not well mentally and are not ‘themselves’, and therefore are not healthy. Health had a social dimension as well. Participants’ narratives indicate that being physically healthy as an individual is not sufficient for experiencing good health (life). To illustrate, a participant mentioned that “I am happy when my family is healthy” (Martha, 64 years, wealthy). Another participant explained that “life is good when I and my family are in good health” (Mohamed, 76 years, wealthy). This suggests that concern for the health of family members sometimes took precedence over participants’ own physical health, which may be reflective of the belief in many Ghanaian communities that the well-being of one’s family is a moral responsibility. Health was also perceived to be related to happiness. The following statement exemplifies the influence of happiness (as medicine) on a person’s health:
Happiness is medicine not available for sale in the pharmacy, happiness is medicine…if you are happy with yourself, it is better than medicine. (John, 64 years, wealthy)
In terms of affect, most participants construed well-being as comprising the presence of positive emotions such as joy and happiness and absence of negative emotions like sadness or anger. A participant notes that “if you are happy, it helps with having a life that is ‘sweet’ [good], happiness does help at this stage (Alou, 63 years, poor). On the other hand, a few participants mentioned anger/sadness over unfortunate life situations, like the loss of loved ones, that contributes to poor well-being. The following quote illustrates this:
I am not enjoying the good life, I am not happy in life, why? I am angry because of what befell me [death of two well to do sons] (Baaga, 71 years, better).
Reflecting the psychological nature of well-being, most participants conceptualized well-being as buchɔn-zuru, literally translated as ‘cool heart’, which means inner peace, peace of mind, or calm. Throughout participants’ accounts, inner peace occupied a unique position in experiencing the good life (evidenced by the number of times it is mentioned throughout the results) as it was widely perceived that experiencing inner peace indicated better well-being, and its absence indicated otherwise. In quotations like “if you are not at peace [inner peace] with yourself, you do not sleep well, you are worried, then you are sick” (Kende, 76 years, poor), it could be understood that not experiencing inner peace was not being healthy, hence its connection with experiencing better health. Inner peace’s connection with happiness is construed in many quotes such as “happiness is when you have [experience] inner peace” (Martha, 64 years, wealthy) and vice versa, literally and implicitly. Consequently, participants seemed to construe that inner peace encompassed happiness and health, which were inextricably connected, used interchangeably, and mostly interpreted as having the same meaning. The implication is that if one was happy and healthy, one would likely be experiencing inner peace, hence the good life (or well-being). One participant made this point succinctly:
“buchɔn-zuru [‘cool heart’, calm, or inner peace] is the good life, it is everything, when your mind is settled [at peace], you have nothing to worry about, it is well-being” (Kapee, 74 years, wealthy).
Based on the above, inner peace was conceptualized as central for well-being by most participants as it reflected experiencing happiness and better health, thus uniquely representing both health and affective nature of well-being. People in the study area expect older people to be wise, calm, and patient, particularly towards younger people. It would appear that this conception of well-being partly emanates from the desire to conform to this societal expectation.
4.4 Theme 4: Religiosity/Spirituality
Under this conceptualization, well-being was experienced from engaging in or adherence to religious/spiritual beliefs or practices. In other words, commitment to shared religious values, goals, and aspirations was important for well-being. In the study setting, belief or faith in God (or the existence of a supernatural being) as the author of the destiny of humans is pervasive, and is mentioned in everyday conversations, such as greetings. For a few Christian participants, adhering to the teachings and messages of the gospel made life good. One participant expressed her beliefs in this way “As I follow the teachings of the gospel, it brings me happiness, it makes life good for me”. (Martha, 64 years, wealthy).
Similarly, other participants explained that involvement in religious activities such as attending services enabled them to persevere and cope in difficult times, hope for better times ahead, and thus fostered well-being. For example, a participant made this observation:
Often when we go to church and they preach about life and how people in the Bible encountered problems, and how in the end they emerged victorious…knowing that others passed through same and survived, gives you peace and happiness. (Adua, 65 years, better)
From the above quotations, it can be interpreted that while involvement in religious activities was expected behaviour, it also helped participants become resilient, experience inner peace and happiness. Relatedly, while talking about what made them happy in life, some older participants talked about how grateful they were to God (or a supernatural being) for having good health, long life, and other blessings in life. Gratitude was seen as a virtue that was positively related to experiencing the good life. The following quote illustrate this:
I am grateful to God for being alive, in good health, I am thankful for long life, there are many who are not alive right now, therefore I am happy about that, to be happy in this life, you have to be grateful to God for everything. (Afia, 75 years, poor)
Some participants also conceptualized well-being in terms of being content with life. For instance, a participant stated that “for me life is good when you are satisfied with life, accept what life gives you, and give everything to God” (Baaga, 71 years, better).
4.5 Theme 5: Contributing to Others
According to some participants, making a positive impact in the lives of others contributes to well-being. Supporting orphans and helping to pay school fees of children and grandchildren were noted as contributing to the good life. This can be inferred from the following response:
Looking after these children [orphans], in terms of their schooling, health care when they are sick, when I support others, when I am able to help another person, it gives me joy, happiness (Memunatu, 64 years, better)
Grand parenting, an aspect of contributing to others, was considered a duty and a privilege that brought happiness and fulfilment. As one participant observed “taking care of my grandchildren, playing with them, paying their school fees, money for feeding, makes me happy, it is fulfilling” (Iddrisu, 69 years, wealthy). Grandparenting is behaviour aligned with social and cultural norms. Thus, one feels proud, socially included when performing this role. It seems maintaining social relationships through providing support (i.e., sharing resources with others, grandparenting) that positively impacts lives as prescribed by shared social and cultural norms was related to fulfilment in later life. Other aspects of this dimension of well-being included having a sense of accomplishment and fulfilment through haven raised children who were ‘successful’ or ‘rich’ (i.e., mostly referring to children who were gainfully employed, were married, and had children). This point is illustrated in this response:
Life is good for me because at least my children are doing well in life, I feel I have done my best, accomplished something…my eldest son is an Agric officer, he lives with his wife and children in town, my other son is a senior nurse at Korle-bu [teaching hospital in Ghana’s capital, Accra] (John, 64 years, wealthy)
In the study context, taking care of the family and educating/training one’s children to take responsible positions in society was a source of pride and high social status for older adults. Not being able to do so was a source of worry and had a negative impact on older adults’ well-being as such individuals are often perceived by society as having failed in life. As one participant put it:
What keeps me up at night [worried] is not being able to see to the education of my children, because of this they were not able to progress and have not become anything [successful] … it has made life not good for me, it has made life meaningless. (Akuka, 71 years, poor)
It appears that having fulfilled familial obligations in the past (i.e., caring for family and educating one’s children to be ‘successful’) was equated with having lived a ‘worthy’ life that contributed to well-being. Consequently, having ‘successful’ children ensured material support for older adults (i.e., material security) by adult children, which contributes to positive well-being. Under this theme, participants seem to conceptualize the good life largely as having an other’s orientation.
4.6 Interrelations Between Themes: Inner Peace as a Central Conception
The five themes of well-being conceptions presented—material security, physical and cultural work capacity, health, affect, and psychological well-being, religiosity/spirituality, and contributing to others—are uniquely intertwined, with inner peace serving as the central well-being conception. Material security is fundamental as it ensures the fulfilment of basic needs such as food and shelter for survival, reducing anxiety, and enabling older adults to experience health, happiness, and inner peace. Experiencing health, happiness, and inner peace (i.e., health, affect, and psychological theme) seem to act as unifiers, binding together all themes. This can potentially be essential for a balanced emotional state, reducing anxiety. Health ensures physical and cultural work capacity, which enables older adults to maintain physical independence and sustain self-worth. Spirituality appears to serve as a coping mechanism in the face of life’s challenges, thus reducing distress. Spiritual practices may amplify gratitude, acceptance, contentment, and subsequently happiness and inner peace. Finally, contributing to family and others in society through sharing resources, grand parenting, and raising ‘successful’ children could strengthen relational bonds, reduce loneliness, and generate feelings of pride, accomplishment, and self-fulfilment, reinforcing inner peace. Collectively, these themes reflect a holistic conception of the good life in older adulthood in rural Ghana, where inner peace is the outcome of a balanced individual and contextual life circumstances.
5 Discussion
Our study explored older adults’ well-being conceptions and how these conceptions were shaped by their socio-cultural context in rural northern Ghana. We found that older adults conceptualized well-being as multidimensional largely shaped by their socio-cultural context comprising: (1) material security, (2) physical and cultural work capacity, (3) health, affect, and psychological well-being, (4) religiosity/spirituality, and (5) contributing to others. Our study’s contribution lies in showing how inner peace, a low-arousal positive affect, was central to the good life in older adulthood in rural Ghana as it appears to act as a unifying well-being concept around which all interrelated well-being conceptions (themes) revolved.
The multidimensionality of well-being reported in this study has been reported in studies among adolescents and adults in Ghana and other African settings (Agbo & Ome, 2017; Dzokoto et al., 2019; Pflug, 2009; Wilson Fadiji et al., 2019). For instance, Wilson Fadiji et al. (2019) found a conceptualization of well-being among employed urban Ghanaian adults consisting of material, health, relational, and psychological aspects. In terms of material security, material conception of well-being, where meeting basic needs and ownership of material wealth is important for well-being has been identified among adults and adolescents in Ghana and other African settings (Kaufman et al., 2022; Osei-Tutu et al., 2022; White & Jha, 2018; Wilson Fadiji et al., 2019). Material resources have been found to significantly impact the well-being of older adults in resource-scarce contexts (Domfe & Aryeetey, 2016; Huang et al., 2020). Ghana’s slow economic growth, poverty in northern Ghana, and the absence of a welfare system means that many people in rural northern Ghana lack sufficient material resources to meet their basic needs such as food, clothing, and shelter (Abdulai et al., 2018). Correspondingly, the cultural value and high social status associated with material wealth in many Ghanaian communities might negatively affect the self-worth of poor individuals, and hence their well-being (Kasayira & Cherishe, 2010; Laube, 2015). Similarly, conceptualizing well-being as physical and cultural work capacity reflects older adults’ desire for physical independence, fulfilment of culturally prescribed work roles, which may improve self-worth, and consequently well-being. Moreover, in a rural area with subsistence agriculture as the main occupation, possessing physical and cultural work capacity also ensured the fulfilment of basic needs.
Older adults in our study conceptualized well-being as health, affect, and psychological. Unlike most prior studies that found health, happiness, and inner peace as separate well-being concepts, our study suggests these are inextricably connected with inner peace as central for experiencing the good life (Adedeji et al., 2023; Osei-Tutu et al., 2022; Pflug, 2009). This finding uniquely contributes to the literature on well-being conceptualizations by showing how inner peace is central to the good life among older adults in rural Ghana as it reflects both health and affective (happiness) nature of well-being. Rather than high-arousal positive affect, inner peace, a low-arousal positive affect, was central for experiencing well-being, typical in socially-oriented societies (Affram et al., 2024; Osei-Tutu et al., 2022; Tsai, 2017). Health comprised physical, social, and mental aspects as essential complementary dimensions of health, without which well-being might not be totally achieved. Hierarchically, there appeared to be no distinction in terms of importance in these aspects of health. It also appears conceptualizing well-being as social and mental health helps to fulfil societal expectations as worrying or ‘thinking’ was perceived as poor mental health while concern for one’s family’s health is a moral responsibility in many Ghanaian communities (Salm & Falola, 2002). Aspects of this finding is consistent with previous studies among adults and adolescents in Ghana and South Africa, where well-being was defined as good physical and mental health, and the absence of malaria (Adedeji et al., 2023; Glozah, 2015; Wilson Fadiji et al., 2019). Given that being in good health enables one to be independent and participating in society, thus fulfilling societal expectations, this finding may be seen in this light. Also, deteriorating health with age and the challenges associated with accessing healthcare in the study context might explain the attention the older adults gave to health as a conception of well-being (Debpuur et al., 2010). Affect comprised the presence of high-arousal positive (joy, happiness) and absence of negative (sadness, anger) affect. This finding is in line with previous works in Ghana and other African contexts that found positive affect as a well-being conception among adolescents and adults (Agbo & Ome, 2017; Dzokoto et al., 2019; Osei-Tutu et al., 2022; Pflug, 2009). Contributing to others (i.e., family and society) was construed as important for experiencing positive well-being in later life. Fulfilling this societal expectation, also considered a moral responsibility seemed to contribute to older adults’ well-being. This finding is in line with research in Zambia, where well-being consists of fulfilling moral or societal obligations and expectations such as providing assistance (e.g., caring for family, sharing resources, etc.) and generally contributing to societal rather than an individual increase (White & Jha, 2018). Similarly, it also resonates with studies that found relational, moral, and social relationships as well-being conceptions among adults in Ghana and other African contexts (Adedeji et al., 2023; Pflug, 2009; Wilson Fadiji et al., 2019). Furthermore, religiosity/spirituality contributed to a positive well-being experience among older adults. This finding is consistent with research that found a positive relationship between spirituality and well-being among Ghanaian older adults (Aglozo et al., 2019). Adedeji et al. (2023) found spirituality as a conception of well-being among adults in South Africa. It is possible that in impoverished contexts, particularly in those lacking a welfare system, religion provides support against emotional and financial distress (Pokimica, et al., 2012). These two conceptions (i.e., contributing to others and religiosity) extend the literature emphasizing that a holistic understanding of well-being in an African setting includes maintaining a horizontal and vertical relationships as well as meeting societal obligations and expectations. In the present study, older adults’ sex did not seem to influence their conception of well-being as all themes were equally represented among women and men. However, the material security theme came up more often among poor than wealthy older adults. This is consistent with human motivation theory and research which argues that individuals of lower economic circumstances often focus on fulfilling basic (material) needs such food, shelter, and financial security before pursuing higher order goals such as personal growth (Schaller et al., 2017). Consistent with cultural schema theory, well-being conceptions of older adults were largely shaped by the socio-cultural context (Joshanloo et al., 2021; Oishie & Gilbert, 2016; Uchida & Oishie, 2016). This is congruent with previous research among adults in Ghana that found materiality, inner peace, and relationality as low-arousal sustainability-oriented themes of well-being (Osei-Tutu et al., 2022). This sustainability orientation emphasizes material sustenance, social interdependence, and fulfilment of social obligations (Coe, 2011; Osei-Tutu et al., 2022). As a conceptual lens, cultural schema theory enabled us to shed light on how older adults’ well-being conceptualizations were embedded in their socio-cultural context (D’Andrade, 1992; Strauss & Quinn, 1997). As our results indicate, the cultural meaning system of older adults played a role in their understanding of well-being (Strauss & Quinn, 1997). Our findings have implications for the well-being literature. As an attestation of the universal nature of well-being, there are some similarities between our findings and conceptions of well-being among older adults in the Western context. For instance, besides the multidimensionality of well-being, health, activities, and independence were most important for well-being of older adults aged 65 and above in the Netherlands (Douma et al., 2017). Likewise, conceptions of well-being such as happiness, material security, and contribution to others were identified among older adults in the United States and other Western settings (Douma et al., 2017; McMahan & Estes, 2011; Van Leeuwen et al., 2019). However, often, for some conceptions such as material security or contribution to others, the difference between the Ghanaian and Western conceptions lies in the exact descriptions that accompany these conceptions. For instance, problems with material security identified among older adults in the Western context extends beyond having the financial ability to meet basic needs (as found in our study) to living comfortably and enjoying life engaging in activities such as holidays and having friends over for dinner, probably due to public support for meeting basic needs (Ward et al., 2012; Van Leeuwen et al., 2019). Similarly, contribution to others involves volunteering or helping others at the community center rather than supporting family, grand parenting, and raising ‘successful’ children as mentioned among older adults in our study. Put differently, well-being conceptions in the western context are often dominated by individualistic life ways aimed at maximizing personal growth, pleasure, and achievement (Henrich et al., 2010). In contrast, well-being conceptions such as material security, religiosity, and contributing to others identified in our study are largely shaped by the socio-cultural context and emphasize sustenance, social interdependence, and fulfilling social and moral expectations (Coe, 2011; Osei-Tutu et al., 2022). The implication is that relying on well-established concepts of well-being in the literature may not fully address context-specific well-being needs in a different social and cultural setting such as Ghana.
Our study is not without limitations. It was part of a larger qualitative study on support and well-being among older adults. It is possible that the findings were skewed towards support aspects and other conceptions of well-being were missed. Nonetheless, this study improves our understanding of well-being from the perspective of older adults in a previously unexplored rural African context.
Our study adds to the scientific literature in several ways. First, it is the first conceptions of well-being study among older adults aged 60 and above in rural Ghana and exemplifies a typical context for many older persons living in SSA. Second, it demonstrates how conceptions of well-being are strongly shaped by the social and cultural context. Third, it shows how older adults’ well-being conceptions were peculiarly interrelated, with inner peace (which encompasses both health and happiness), a low-arousal affect, emerges as a central well-being concept, around which these conceptions revolved. These findings emphasize the importance of the socio-cultural context in well-being conceptualization. Future research on older adults’ well-being should take these context dependent conceptions into account to further elucidate the determinants and inequalities in well-being in SSA. Apart from its academic relevance, our findings may also aid interventions or programmes that seek to enhance well-being for older adults in SSA. Focusing on well-established conceptions of well-being disregard the influence of the specific socio-cultural context and may only partially address well-being needs in SSA.
Declarations
Conflict of interest
The authors have no competing interests to declare that are relevant to the content of this article.
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