Dignity and its components in Palestinian adolescents and young people: a pilot study

Abstract

Background The results of previous studies have indicated an association between loss of dignity, or humiliation, with negative health outcomes in Palestinian youth living under chronic exposure to military occupation and violence in the West Bank, Gaza Strip, and East Jerusalem, occupied Palestinian territory. We therefore sought to identify features of the obverse of humiliation—namely, dignity—because the results would be useful for the development of a measure of dignity and its association with health outcomes. Methods In a pilot study, we used qualitative methods to assess how Palestinian adolescents and young people (aged 14–25 years) define dignity and its components; the factors that affect dignity; and the importance of dignity to young people's sense of wellbeing. 102 adolescents and young people (aged 14–25 years) were interviewed with a semistructured questionnaire based on previous findings. We used convenience sampling to select male and female participants in a ratio of 1:1 from four academic institutions in the centre of the West Bank—undergraduates from Birzeit University (n=34), and high-school students from a private coeducational school in Ramallah city (n=34) and two single-sex governmental schools (one for boys and one for girls) in the semirural town of Birzeit (n=34, 18 female students). The qualitative data were assessed carefully through repeated readings for familiarisation, gradually showing patterns and themes. Data were then coded systematically in thematic tables so that the responses could be clustered. The results were interpreted on the basis of the research objectives and emergent themes. Formal approval to undertake this pilot study was obtained from the Palestinian Ministry of Education. We obtained verbal informed consent from the participants. Findings The mean age of all 102 participants was 17·26 years (SD 2·49), undergraduates from Birzeit University 20·29 years (1·82), girls at a governmental school 15·91 years (0·36), boys at a governmental school 15·18 years (0·39), and students at the private coeducational school 15·94 years (1·01). Four potential domains for dignity or the loss of dignity emerged: respect for oneself and others; abiding by social norms, traditions, and customs; pride and honour; and personal and collective freedom and independence. The most frequently cited dignity domain was respect for oneself and others, followed by the personal and collective freedom and independence domain. Dignity was reported as being important to wellbeing by all the participants. The loss of dignity was expressed with two specific Arabic terms, ihaneh and thul . The definition of ihaneh is a private and personal feeling, usually during or after an event, related to an individual (such as being humiliated by your parents or siblings), and is transient because it can usually be overcome. Thul is described as an emotion much larger than is ihaneh , affecting the collective rather than the individual (such as the thul in people crossing Israeli army checkpoints), and cannot usually be overcome and can therefore be a permanent feeling. Interpretation These initial results need to be validated for meaning and internal consistency in the local context and affirm the need for continued development of a quantitative method for the measurement of dignity. Measurement of dignity can be used as one of the indicators of social suffering related to war and for the assessment of wellbeing, health-related quality of life, and other subjective measures of health. In view of the recent Arab uprisings and the call by young Arab people for dignity, and not only bread, it could also be useful for the assessment of wellbeing in young people in a regional context. Funding Medical Aid for Palestinians.