Nothing Like Living with a Family: A Qualitative Study of Subjective Well-Being and its Determinants among Migrant and Local Elderly in Dongguan, China

Chinese economic development has led to a significant rise in internal migration over the last 20 years, including large numbers of elderly. When elderly Chinese people migrate, they still register their residency to their place of origin and often do not register with the new administrative office at the destination due to the household registration (hukou) system in China. Thus, most of these migrant elderly do not receive full social services, possibly leading to poor subjective well-being. This study aims to qualitatively examine the level of subjective well-being and its determinants among migrants and local elderly in Dongguan City of Guangdong province, one of the most rapid economically developing areas in China. We also present the results of in-depth interviews among 27 elderly, 15 elderly migrants and 12 local elderly living in Dongguan. The results reveal that the overall subjective well-being of the two groups were good. Most migrants believed their well-being had remained stable or even improved over time due to family reunion and a better physical environment. Elderly’s most valuable needs and the main reason of migration is family reunion; however, inadequacy of social support, including community support and government support (e.g., gift during holiday season, free health examination, healthcare expenditure reimbursement), cannot be neglected for maintaining a good level of well-being. The well-being of migrant elderly can be further enhanced by promoting social services and welfare, recreational activities, and enhancing healthcare reimbursement in their new home.


Introduction
Approximately 18% of the Chinese population have internally migrated to industrialized areas during the country's rapid economic growth in the past decade [1]. Internal migration in China, mainly involves rural-to-urban migration, identifying as 'interregional migration'. Most internal migrants still register their residency to their place of origin and are viewed as a 'floating population' [2]. About 7.2% (18 million) of these were elderly (those aged 60 years or more) who accompanied their only child, primarily to take care of their grandchildren and reunite with their family [1]. Although most internal migrants look for more employment opportunities, their social services and welfare may be limited, especially in highly developed regions such as Beijing, Shanghai, and Guangdong [2]. In the past, internal migration was tightly controlled by the central government, and only in the past few decades have these restrictions been loosened. Migration reforms vary between Chinese cities in terms of their different standards for granting registered migrant households. The more developed cities usually set higher eligibility criteria (e.g., education and job responsibilities) than less developed cites for households to be registered in order for residents to receive benefits from social services and welfare including healthcare insurance. Less developed cities are more willing to attract migrants to fuel economic growth, by relaxing hukou's constraints. However, developed cities like Beijing and Shanghai set constraints aiming to attract wealthy and highly educated migrants rather than the vast majority of rural dwellers and elderly who are unlikely to contribute to the economic growth of the region [3][4][5]. Previous studies by Liu et al. and Gui et al. found that most Chinese migrants have a lower level of subjective well-being (SWB) than local residents in host cities [6,7]. International literature on migrants' SWB in Germany and Thailand led to the same conclusion that migrants have a low level of SWB due to their difficulty in adapting to the host city and relieving pressure [8,9]. Another stream of literature has argued migration is associated with an increase in social status and social well-being [10,11]. Most studies on international migration have shown different patterns and determinants. Studies on elderly migrants in Western countries have found that the retired elderly generally move from large cities to smaller cities with lower living costs. They conceptualized this as a form of 'lifestyle migration' as the result of a search for 'self-fulfillment' [12,13]. Studies on migrants in Middle Eastern and North Africa countries have found that young people from non-wealthy backgrounds and unemployed are more likely to emigrate, and self-select along the cultural traits of religiosity and gender-egalitarian [14,15].
Most previous studies on subjective well-being of Chinese people have focused on migrant workers only, neglecting migrant elderly whose social interactions and emotional status more vulnerable [16][17][18]. As their health status and financial resources decline, migrant elderly may become more disadvantaged and face more difficulties than young adults in adapting to a new environment with limited social support [1,6]. Social networks have a strong impact on well-being of the elderly. For example, interaction with family, friends, and neighbors and their support improved their life satisfaction [19]. As immigrants continue to make up an increasing percentage of the Chinese population, it is essential to understand not only to what extent migration affects their well-being changes but also the factors that contribute to well-being change. Of equal importance is the need to take into account immigrants' perceptions of the key factors that shape a decline in well-being. In China, not only do migrant elderly experience substantial changes, local elderly also experience similar forms of urbanization and industrialization. These changes should substantially affect their well-being and therefore should also be investigated [6]. Previous qualitative studies only focused on either local or migrant elderly's thoughts and feelings as psychological outcomes, rather than the perceptions of both locals and migrants in relation to social well-being [20,21].
This study aimed to qualitatively examine the level of subjective well-being and its determinants among migrant and local elderly in one of the most rapid economically growing areas in China. The findings should give some insights into the current well-being of both migrant and local elderly in light of China's rapidly aging population and suggest ways to support them appropriately in order to ensure a healthy aging policy.

Study Area and Study Design
Dongguan City has become one of the biggest industrialized areas in China during the past decade. In 2016, 75% of the 8.3 million population immigrated there for employment or family reunion [22]. The study was conducted in collaboration with the Dongguan community committee in the areas with the highest density of immigrants, an industrial city in the Pearl River Delta and the Guangdong-Hong Kong-Macau Greater Bay.
In-depth interviews were conducted among both migrant and local elderly during December 2018 to February 2019.

Interview Procedure and Data Analysis
The elderly in this study were defined as any person aged 60 years or more. A migrant was defined as a person who had moved to Dongguan and had been living there for six months or more and whose household was not currently registered whereas a local resident was defined as a person whose household was currently registered in the study area. The community committee provided a list of immigrants and local elderly eligible for the study.
Initially, we purposively selected participants of diverse gender, socioeconomic status, working status, and duration of stay from the list. Using these "seeds," a snowballing technique was then used to recruit subsequent participants until the data were saturated. Data was collected through individual semi-structured interviews. Each interview lasted for between 30 and 40 min. Interviews were audio-recorded after obtaining permission from each participant. Observational notes were also taken on nonverbal behaviors such as their facial expressions and pose/posture during the interview. Participants were asked how they perceived and defined subjective well-being (using a 5-item Likert scale ranging from very good to very poor), how it had changed compared to before they migrated (better, same, worse), and factors that qualitatively determined their SWB. Social relationships were defined as friend/neighborhood relationships and having leisure activities with friends. We also examined support given and services provided by their community and the government. We explored, in depth, the ways migrant elderly have adapted their lives to a new and changing environment. Interviews were conducted until the data were saturated.
The data were transcribed, and thematic analysis was done. NVivo software package was used for data management and thematic coding.

Ethical Considerations
Ethical approval was received from the Institutional Ethics Committee of Guangdong Medical University, China (REC: PJ2018037) and the Institutional Ethics Committee of the Faculty of Medicine, Prince of Songkla University, Thailand (REC: 61-232-18-1). Privacy and data confidentiality were ensured. Voluntary participation and unconditional withdrawal were offered to all participants. A small incentive was given as a thank you for their participation.

Results
Out of 28 elderly invited, 27 (15 migrant and 12 local elderly) agreed to participate in the study (96.4% response rate).

Baseline Characteristics of the Elderly
Of the 15 migrant elderly, all had moved from other areas in mainland China, mostly from underdeveloped and agricultural areas. The 12 local elderly had been living in Dongguan since birth. Table 1 shows baseline characteristics of the two groups. Gender, age, marital status, and working status of the two groups were similar. Most of them were aged under 70 years, married, and were not currently employed. While all migrants lived with other family members, only seven of the 12 local elderly did so. Pension was the main source of financial income, and less than half either had a salary from work or relied on interest from their own savings. Migrant elderly had some financial support from their family members, whereas the local elderly did not, regardless of whether or not they lived with other family members. The median duration of living in Dongguan for the migrant group was seven years (range: 6 months to 30 years).

Subjective Well-Being (SWB) Status and Its Change
Most participants acknowledged that SWB was part of life's satisfaction; others perceived it as consisting of positive and negative emotions, moods, or feelings. Table 2 shows a summary of the self-rated subjective well-being for both groups. Most reported that they had a fair to a very good level of SWB and only one migrant, who had recently immigrated, reported having a poor level. All six migrants who had been living in Dongguan for longer than 10 years reported having a better SWB than what they experienced in their original hometown but two of the five migrants who had lived in Dongguan for 10 years or less reported having the same SWB and one reported that their SWB was worse. Three of the four migrants who had recently immigrated expressed a similar SWB and one said that it was worse. None of the migrant elderly expressed a desire to return to their hometown as long as their child still worked and lived in Dongguan. All mentioned that Dongguan was a better place for living than their hometown. Table 2. Self-rated subjective well-being (SWB) among migrant and local elderly and change in SWB among migrant elderly (n = 27).

Perceived Contributions of SWB
Both migrant and local elderly revealed four common contributing factors to their SWB, including physical and mental health status, family relationship, social relations, and residential environment. Table 3 shows a selection of statements given by the participants describing their perceptions of how health and subjective well-being are related. All elderly affirmed that physical health status was a supreme contribution to their SWB. Health was perceived as a form of capital to enable a better life. Better health conditions can lead to a better sense of happiness. Not only good physical health, but also good mental health indicated good SWB. They tried to maintain physical exercise, a positive attitude, and good mental health. Illness, on the other hand, was an important threat to SWB.

Relationship and Harmony in a Family
The elderly moved to Dongguan mostly to be reunited with their families. Some anticipated that they would take care of their grandchildren; others wanted their children to take care of them. Keeping family harmony, in some cases, was more important than their own needs. Lack of family quality time and having family conflicts due to personal and lifestyle compatibility caused loneliness, isolation, and decreased SWB among the elderly.
"My children invited me to come and live in the city. To be honest, I did not want to come. They are very busy at work, go out early and return late every day, I cannot see them very often, and my relatives and friends are not around, I feel very lonely." "I came here mainly to take care of my grandson because my son and daughter-in-law have to work, and it is not convenient for them to take care of their son. I feel that well-being is to bring up my grandson, and then everything will be good as long as he is fine." "Sometimes my children and I have a little friction. There are inevitable gaps between our two generations, especially with my daughter-in-law. She is so picky, much more than the nanny, making me feel very uncomfortable." (Female, 63 years old, local)

Social Relationships and Activities
Close friends filled extended family roles and shared common interests which improved their SWB. A cohesive friendship can reinforce social norms (e.g., social activities, physical exercises, and help-seeking). Good friends relived stress and prevent loneliness and isolation in their daily life. Local elderly had better social relationships than migrants. Similarly, migrants who lived longed in Dongguan had more social relationships and, in turn, it increased their SWB.  Table 4 shows that even living in the same area, migrants and local residents had different perceptions. All migrants perceived that the overall environment of Dongguan city was better than their hometown. Good climate, clean air, as well as conveniences in daily life, such as access to public facilities, markets and banks, increased their SWB. Most local elderly perceived that the city was good, somehow only few thought they lived in a polluted and unsafe city, had poor public transport, and poor waste management.

Community and Government Support of SWB
Without asking a prompted question, none of the participants mentioned anything about community and government support.

•
Community support Migrant and local elderly had quite opposite views about community support. The majority of locals were satisfied with social support from the community. For example, community activities, holiday gifts, recreation activities, and home visits. While only a few immigrants had similar views as the locals, the vast majority of immigrants thought they had no community support, and some perceived a high level of social disparity. "I hope that they will improve the river. It is so smelly. It really disgusts me. The water quality in the river is very bad. The river is filled with stagnant water, the river is blocked, and the water is black as ink.
[ . . . ] The water quality in the river is very bad. It is not so stinky these two days because they have flowing water.
If not, a terrible smell will come from it. Also, the mosquitos will breed." Female, 60 years old, local "I am not satisfied with the public transportation system. Because where we live is too remote. It is not convenient to take the bus. There used to be a bus from there, but it was canceled because few people took it." Male, 66 years old, local "There are many non-locals here; they rent houses here, creating much garbage, and the environment has become worse. Also, many rental houses will definitely cause security problems." "They regularly organize activities for the elderly, such as square dancing, hiking competitions, etc.
[...] Mid-Autumn Festival and Spring Festival will give us gifts such as rice and oil, as well as some daily necessities. [...] There are also dividend benefits for us in the village. I think it is very nice." (Female, 62 years old, local) "I think it is unfair in many respects. They discriminate against us. For example, they organized an activity last year, but the community never invited us. I hope that they can treat us better, give us more benefits, and show us that they care about us." • Government support Nearly all locals felt that the government was supportive of welfare benefits, pension, and health care insurance, and only a few local elderly wanted more support. The majority of migrants claimed that there was a lack of support from the government in their new home. They expected more support in terms of welfare and healthcare services. Migrants reported difficulties in receiving healthcare reimbursement and what they did receive was considered inadequate. They expected that the reimbursement process could be made wherever they lived in China.

• Pension
"What satisfies me most is that the government gives us good benefits. They give us our pension on time every month. We do not have to work anymore, to have some fun." (Male, 72 years old, local) "I want the government to give older citizens more pension due to the cost of living nowadays is much higher than before." (Male, 64 years old, local) "I do not think there is any special support for us. I think the government treats us differently. I think it is reasonable to give the local residents better treatment, such as social benefits and welfare. However, I think it is too much." Most migrant elderly adapted well to the food, climate, and lifestyle in Dongguan. Their values in life, somehow, could be different from their adult children. The principle of diligence and frugality applied to elderly migrants while hedonism was their adult child's value in life. Some elderly could accept this difference, while others tried to tolerate it silently to avoid argument. This incompatibility with their children negatively affected the elderly's well-being. Moreover, some migrants found temporary jobs because they felt too lonely and bored staying home alone. From their expressions and language, the migrant elderly who had a job could better adapt their lives and integrate into the community.
"I am used to eating habits and climate. There is nothing different from my hometown because we often cook at home."

Discussion
Our study examined the subjective well-being of both migrant and local elderly living in one of the most rapidly developing areas of China. Both groups of elderly share the same perception of SWB as life satisfaction or the balance between positive and negative emotions which are also found in other studies [23][24][25]. However, some studies defined SWB as a dimension of quality of life, something that brings joy and meaning to life [20,26].
Our study found that overall SWB of both local and migrant elderly were good. Most migrant elderly believed that their SWB had remained stable or even improved over time. Older adults who had positive expectations for the future and ageing were more likely to report high levels of SWB, which is consistent with previous studies [27,28]. Optimism may tend to benefit psychological well-being [29]. Migrant subjective well-being can be strongly influenced by the process of migration, which includes changes to established social networks and sources. Though migrant elderly lost their social relationships, community support, and government support that they received in their hometown, they reported having a more positive psychological attitude for ageing than local elderly. Previous studies in developed countries and other developed areas of China found that migrant elderly had higher rates of depression and had lower levels of SWB than local elderly [6,[30][31][32][33]. Studies on international elderly migrants in European countries and the United States found that the migrants felt economic disadvantages, culture pressure, and exclusion of social benefits such as healthcare and welfare when they moved to the new countries [30][31][32]. Similarly, internal elderly migrants in China who moved from rural-urban areas to developed areas (e.g., Shanghai, Guangzhou) showed worse SWB than local elderly [6,33]. These studies found that migrants were vulnerable to residential segregation and inadequate social benefits [6,33]. However, a study from Hainan province, a developing area which is a popular place for retirement, showed that migrant elderly had lower rates of depression than local elderly [34]. However, those migrants had higher incomes and had higher education levels than the local elderly. Our study found a unique result of increased SWB among migrant elderly than local elderly in a developed area of China. Possible reasons include Dongguan having a larger migrant population than local residents (75% vs. 25%), thus migrants might not feel a sense of exclusion. Besides, migrant elderly are generally younger than local elderly, which supports the "healthy migrant effect" and is commonly considered as a positive outcome among immigrants [35]. Disabled or older elderly are also less likely to migrate [35]. Additionally, better climate, and physical and social environments compared to their places of origin might be positive influencing factors on their SWB. Table 5 suggests that SWB is a psychological outcome determined by many different factors ranging from the individual to society and the environment. The elderly with good SWB report good health and harmony in family. Our study found that health was the most important asset of the participants. Previous studies showed that good health status was one of the most important prerequisites for maintaining elders' SWB, which would make their life better [26,36,37]. Family factors, such as family reunion, were the main migration motivation of Chinese elderly, which differs from the motivation of international migrants [21,38]. The "one-child" policy has reduced the size of Chinese families. Many Chinese people, particularly the elderly, place a high value on family, which is ingrained in their Confucian culture. Taking good care of parents and children and having good relationships with family members are considered as the source of happiness [21]. Chinese elderly's most valuable needs and the main reason of immigration is family reunion fulfillment. This can outweigh inadequacy of social support, welfare, and health insurance. Regarding social support and physical environment in relation to SWB, migrant and local elderly shared mixed perceptions. On the one hand, most migrant elderly suffered from a lack of social support. Social relations is considered as an important factor in experience of well-being with elderly, affecting well-being in both positive and negative ways. Loss of social relations from friends or neighborhood restricted migrant elderly to leisure activities and social activities [39][40][41][42]. Few friends and low social cohesion resulted in feelings of loneliness and homesickness. Previous studies showed that a lack of social support from friends in the migrant's original home town was positively associated with depression among Chinese elderly [43,44]. Local elderly perceived social relations in a positive way, by which close friendship and various activities could enhance their well-being. Our study found that migrant elderly are falling through a support gap, whereby they no longer enjoy the benefits of welfare (e.g., additional financial support, free health examination, healthcare expenditure reimbursement) from their place of origin, yet they do not fully enjoy these benefits in their new place of migration. With respect to accessing healthcare, migrants complained of difficulties in receiving healthcare reimbursement in host cities, and they required out-of-pocket payments. This barrier to access to health insurance plans would make it difficult to ensure proper health services for migrant elderly. Whereas, healthcare expenditure is mostly free of charge for local residents. A study by Zhang, based on China Health and Retirement Longitudinal Study (CHARLS), found that large gaps vary across health insurance plans, where inpatient reimbursement rates for urban residence was much higher than rural residence [45]. Migrant elderly hold negative perceptions of accessibility and quality of healthcare due to perceived discrimination. They felt unfair and unhappy when recognizing the disparities in, for example, community involvement and health services, between local elderly and themselves. In contrast, local elderly could enjoy welfare fully and benefit from government policies, which made them satisfied and enhanced their SWB. For example, they could enjoy many public facilities or resources (parks, cinemas, by bus) free. Local elderly with access to urban health insurance plans are more likely to use healthcare services [44]. This result verified the "buffer effect"-a theory that accounts for the positive implications of social support for SWB [46]. On the other hand, effects on SWB from the physical environment are also important to elderly. A previous study by Paiva et al. found that physical environment is an important factor for elderly migrants' SWB [47]. In our study, it is interesting to note that even when living in the same area, migrants showed better perception of overall environment than locals. One possible reason might be that migrants' perceptions of the environment were shaped by the comparison between a new and old environment. Migrant elderly are living in a new neighborhood which has a comparatively better physical environment (e.g., tropical climate, convenient facilities, and transportation) to their place of origin. Few local elderly, however, felt that their environment worsened after a large influx of migrants.
Factors related to post-migration adaptation, such as lifestyle and economic situation were associated with migrants' SWB. In our study, all migrants were internal migrants, therefore differences in culture and language might be relatively smaller for them than for international migrants [17,48]. Besides, most migrants voluntarily migrated to be reunited with their family and to take care of their grandchildren, thus, relationships with their family in Dongguan nourished a wish to stay rather than return to the home town. Previous studies in China found that city adaptation was positively related to SWB, which in turn was associated with length of stay in the city, job satisfaction, and social support received [49,50].
Our study is the first qualitative study exploring the underlying influencing factors of SWB in both migrant and local elderly residents in China. Our findings add insights into the co-determinants of SWB in migrant and local elderly groups which have not been assessed in any previous studies. Our study emphasized the positive role of physical health, family ties and social support, and physical environment in enhancing the SWB of elderly. Our findings can provide evidence to help governments design healthy aging policies to improve the SWB of both migrant and local elderly at the individual, community, and national levels.
There are a few limitations which deserve mention. First, the participants were recruited through community committees, indicating that they were well connected with their communities, thus having a positive influence on their SWB. It is possible that those who were less connected with the community (e.g., being isolated or having a disability) would be more likely to have a poor SWB. Second, we did not assess the effect of changes in the socioeconomic status of the whole family on SWB. This could be explored further in future research studies. Third, the change in SWB of migrant elderly might be subject to recall bias since, for some of them, more than 10 years had elapsed since they migrated.
There are some policy implications drawn from the findings of this study. Our study suggests that social support strongly affects elderly migrants' SWB. Previous studies found that elderly migrants' restricted access to social support was detrimental to their mental health [17,40,51]. Our findings confirm this point and further suggest that migrant elderly have lower social support for their health and welfare which was detrimental to their well-being. Therefore, addressing potentially discriminatory attitudes toward migrant elderly, and providing appropriate community-based support is required for reducing perceived discrimination on the side of migrants. First, elderly migrants should be taken into account in the policy of social services, and these services should be included both migrants and local residents rather than local residence only. Second, it is advisable to enhance migrant elderly healthcare reimbursement in their new home, access to healthcare needed, taking into account in service delivery of community planning. Third, more community centers and recreational space are needed to facilitate the interaction and mutual help between migrants and local elderly.

Conclusions
Overall subjective well-being among both migrant and local elderly in Dongguan is good. Migrant elderly have moved to the industrialized areas mainly for family reunion, which is the most valuable and meaningful to them. Compared to local elderly, migrant elderly have lower social and community support for their health and welfare. Subjective well-being among migrant elderly can be further enhanced by promoting social services, welfare, and recreational activities and enhancing healthcare reimbursement in their new home. The evidence provided in this study suggests that further periodic SWB evaluation is needed to ensure elderly do not experience mental health problems.
Author Contributions: Y.L. contributed to the study design, data collection, data analysis, and manuscript writing. R.S. contributed to study design, data analysis, and manuscript writing. T.I. contributed to the study design and made comments on the paper. C.W. contributed to preparation of materials, data collection, and comments on manuscript.
Funding: This research was funded by the National Science and Technology Foundation of China (2015FY111600) and the National Natural Science Foundation of China (71373058).