This section presents the results of the qualitative study done among 23 study participants who constituted focus group discussions (FGDs). Of the 23 participants, 13 (56.7%) were aged between 65-74 years, 15 (65%) were females, and 10(43.5%) were Catholics as indicated in Table 1 (see appendix).

Through consensus, 14 codes were generated, and 3 codes related to HRQoL were categorized into themes. The 3 themes that emerged as older persons subjectively relayed their understanding of HRQoL: (1) holistic well-being, (2) lifestyle modification, (3) and financial stability. Themes with the corresponding verbatims in quotes were generated (see Table 2 in the appendix section) as described below with narrative examples.

Holistic well-being involves the complete state of health, including physical, mental, and social well-being. Participants noted that being physically healthy and able to perform daily duties, maintaining good mental health described and informed by the absence of worries and stress, and being supported and loved by family members: the majority of the participants pointed out support from a spouse and biological children, and having access to social health as the important aspects of HRQoL. The participants viewed HRQoL as having basic health, access to mental and physical, and social amenities. To some participants having access to medical care was reassuring.

“Health-related quality of life to me means being happy, no pain, no stress, good food, and support from family” (FGD-1)

“Being healthy, having access to medical treatment, absence of disease, pain, care from my family, and having a community that relates well with people” (FGD-14)

“Having what it takes to improve my life, Medicine, house, food, and having enough money to earn a living” (FGD-20)

The participants highlighted the importance of healthy living through behavioral change like regulating one's diet, refraining from drug abuse, and engaging in physical activities like exercising and weight management. A common thought was as easy as “adjustments of harmful habits”

“I perceive health-related quality of life to be things that l do that make me healthy like avoiding alcohol intake and eating foods low in fats” (FGD_6) 

“To me, l perceive health-related quality of life as being healthy, absence of disease, absence of pain, and care from my family. (FGD-4)”

“For me, it’s taking a long period without visiting the health facility for any ailment that implies health-related quality of life (FGD-8)

Participants discussed the importance of finances in enhancing good HRQoL. The majority of the participants asserted that money helps to facilitate transport, and buying medication in the event there is a drug stockout, a common phenomenon in public health facilities in Uganda. Financial stability was centered on good financial status and enhanced access to healthcare. Participants perceived financial status to have a positive impact on both individual and local economic development through the operation of small businesses and farming and went ahead to state that having access to finances from relatives, friends, and financial institutions through development loans and government funds for senior citizens improves HRQoL,

“Receiving constant assistance in the form of money from family, relatives, and friends makes me worry less. Having money promotes happiness, when l have money, I feel very healthy and active (FGD-I2)

“Having access to government funds and pension as a retired senior citizen would define my health-related quality of life because l can use the money to start a business and be able to acquire assets like land” (FGD-7)

The study used a qualitative approach to understand older people s perceptions of HRQoL. The study found understanding of HRQoL to be characterized by holistic well-being, lifestyle modification, and financial stability. The study highlighted the physical domain as the key component of HRQoL, indicating that older individuals view physical well-being as a crucial factor in promoting overall well-being. Findings from previous studies are in line with the current findings where the majority highlighted the physical component of HRQoL to influence well-being compared to the mental component 11122324. Other studies identified common themes related to older adults' perceptions of HRQoL, including anxiety stemming from emotional experiences, a strong desire to regain physical function, the impact of health on quality of life through social interactions, socio-economic factors such as high income and education levels, and personal experiences of physical and mental health status 424. Furthermore, self-efficacy, numeracy in health literacy, physical health-promoting behavior, perceived support, and a lesser frequency of comorbidities were themes from a study conducted by 24.

Findings from another study are divergent from the current findings, with poorer self-perceptions of HRQOL among elderly persons in rural areas being recorded compared to their counterparts in urban areas 11. A similar study conducted in Iran found self-reported HRQOL among older persons to be poor and characterized by poor mental health status 25. A discrepancy in findings from middle-income and low-income countries indicates that HRQOL was perceived to be driven by poverty, lack of social support, psychological status, and negative self-perceptions of aging 1626. A study by Gumikiriza-Onoria et al. (2022) in Uganda found that older persons had positive perceptions of HRQoL, aligning with the current findings where only positive HRQoL was recorded 10. However, despite these positive perceptions, the previous study revealed that 86% of respondents still had poor HRQoL when assessed quantitatively.

Several factors that influence older adults' perceptions of their health-related quality of life (HRQOL) include inadequate social and financial support, poor housing conditions, and loneliness 104. The discrepancies in findings between developed and developing countries may be due to the more favorable socio-economic conditions and greater development of the aging population in developed countries. Additionally, older adults in developed countries often experience significant mental and psychological issues, largely due to loneliness, as many live alone, which adversely affects their mental health.

Plotnikoff et al., (2015) argue that regular physical activity, and improved health interventions like maintaining a healthy body weight and refraining from a sedentary lifestyle influence health decisively and promote HRQoL 27. Addressing both the physical and mental health aspects of HRQoL begins with the healthcare workers' knowledge and inquiry 28. Understanding older persons' perceptions of HRQoL helps to design health interventions targeting improvements in HRQoL. At the same time, it shows that older persons know what HRQoL implies, which was one of the main focus of the current study. In addition to informing primary healthcare-based geriatric patient care, the study s findings may be most applicable in HRQoL status evaluations in the future.

The current study reported a positive perception of HRQoL among older persons, but it had some limitations. First, participants were recruited from PHC facilities in two selected districts of central Uganda. Therefore, the limited sample size and sampling methods limit generalizability to a larger population in central Uganda. Secondly, the focus group guide was well-articulated hindering leading questions. However, HRQoL being a new term to older participants, some responses may have been steered by the carefully designed question guide. Thirdly, since the participants gave their subjective opinions concerning HRQoL, it is possible that some participants gave socially desirable responses to the moderators to please them. Despite these limitations, FGDs are an important qualitative research approach to evaluate concepts, such as how older persons conceptualize HRQoL.