Introduction
Health is one of the main pillars of sustainable development and an integral part of prosperity and promoting the quality of life in every society. In other words, maintaining and promoting health is a prerequisite for development and consistent economic and social planning. Health reflects society’s conditions and is based on many factors [1]. Health is a crucial issue in all cultures. This issue is the most fundamental thing on which human life is established and has always been discussed in the history of human life. Social health includes the levels of social skills, social performance, and the ability of each person to recognize self as a member of society and pay attention to economic and social conditions, well-being, and personal integrity in his social network [14]. Considering the emerging psychological and social harms caused by the inevitable societal changes, including the COVID-19 epidemic, the need to prevent and maintain social health among welfare seekers has increased more than ever. In addition to material assistance, clients also need mental and spiritual health, and they should be encouraged to acquire an ideal life by strengthening their mental and social health. While enhancing and developing social health, people’s quality of life and societal satisfaction increases significantly [3].
The necessary condition for fulfilling social roles is health. People can be fully active if society considers them healthy. In this case, health is included in the rank of social values, and any biological variables will not be enough to define it. Therefore, health is one of the main components in people’s lives to be placed in different social classes, as well as a determining factor in creating opportunities for growth, development, and excellence of the individual and society. Many studies have been conducted separately on social health and its influential factors; however, no research has been conducted to measure social health among the clients covered by the welfare department. While examining the concept of social health, this study aims to determine a person’s level of activity and performance in society by asking questions in the field of social health. Based on this, the critical questions that will be answered during the research process are as follows: “What are the social factors affecting the social health of the welfare clients in Nowshahr City, Iran?” and “How much each of these factors affects the social health of clients?” 

Materials and Methods 
This research is applied in terms of purpose and is a survey in terms of method. The research population included 3951 female clients aged 18 to 60 under the Welfare Organization in Nowshahr, including healthy and disabled clients. The sample size was determined to be 350 using Morgan’s table and was selected using simple random sampling. Statistical samples were selected among clients referred to the Welfare Organization of Nowshahr for 3 months in the spring of 2022. Data were collected using a valid questionnaire with two independent and dependent variables. In this research, to measure social health and its components, we used the 33-item scale of social health with 5 components: cohesion, acceptance, flourishing, participation, and social adaptation. Keyes (1998) designed this social health questionnaire based on his theoretical model of the social well-being structure. It was first translated by Safarinia (2012) [7] into Persian, and then the translated Persian version was translated into English. This questionnaire, which is a pencil-paper and self-reporting type, consists of 33 items and 4 subscales. To examine the reliability of this tool, Safarinia and Tabrizi used internal consistency and reported that the obtained value for the whole scale was 0.78, which shows that this tool has good reliability. Also, Babapour et al.’s valid questionnaire [8] was used for social factors, which includes 30 items and is scored on a 5-point Likert scale. Talebi et al. reported the internal consistency of the questionnaire to be 0.82. According to the Cronbach α coefficient (higher than 0.7), the reliability of the variables was confirmed. Considering the validity of the questionnaires, their content validity was confirmed by several experts. After the objectives of the project were explained to the participants, the principle of confidentiality of the responses was established, and oral consent was obtained from them. Then the questionnaires were distributed among them anonymously. The samples filled out the questionnaires voluntarily. Afterward, the self-administered questionnaire was completed. To analyze the research data, correlation coefficient and regression tests were used at the significance level of 0.05 in SPSS software, version 24.

Results 
Demographic information showed that among the respondents regarding marital status, more than 50% were single. In terms of age, most people (53%) were aged 30 years and younger, and in terms of employment status, most (>43%) were homemakers, and in terms of physical condition, most (98%) were healthy. 
Considering that the significance level of the Kolmogorov-Smirnov test was higher than the standard significance level (0.05), the distribution of the data was normal and parametric tests were used to measure the relationship between the variables.
The results of the Pearson correlation test showed a positive and significant relationship between all variables, that is, between the independent variables of the research, including social integration, social skills, social participation, and social acceptance, and the dependent variable of the study, i.e., social health (Table 1). 


The value of the multiple correlation coefficients of the dimensions of social integration, social skills, social participation, and social acceptance with the variable of social health and its estimated value under the final regression model is equal to 0.612. The value of the multiple coefficients of determination in the final model was equal to 0.567, indicating that 57% of the changes in social health can be explained by the independent variables included in the model, i.e., dimensions of social integration, social skills, social participation, and social acceptance (Table 2).


The coefficients of the final regression model show that the investigated variables are significant, and each has different weights. Also, the regression coefficients indicated that the variable of social skills (Beta= 0.157) has the highest impact (Table 3).



Discussion
The research results showed that social integration, social skills, social participation, and social acceptance directly affected the level of social health of the clients covered by the Welfare Organization of Nowshahr. Also, the variable of social skills has the most influence. Nowruzzadeh and Mohammadzadeh [12] studied the relationship between social skills and social health, moderating the role of social support, and stated that a significant relationship is observed between social skills and social health. Also, Keyes [16], in research titled structural validity of social health scale dimensions, showed that his 5-factor theory is the most suitable model for social health as one of the dimensions of mental health and concluded that the elements of social and mental health are empirically distinct. The results of the above research are consistent with the present research results.
Benefiting from health indicators in different groups and strata of society, including the youth group as the pioneers of development, is an approach that improves the quality of life, well-being, and life satisfaction. Considering the youth’s constructive role in society, this group’s health is vital. Social integration, social skills, social participation, and social acceptance effectively promote social health and feeling good and improve the quality of life and social health of the clients covered by the Welfare Organization of Nowshahr. Therefore, measures should be taken to increase social health in various dimensions to improve the social health of the clients covered by The Welfare Organization of Nowshahr. Regarding informational support, measures, such as training life skills for the clients and their families, should definitely be taken by the welfare organization and other related organizations and institutions. Therefore this issue increases the awareness level of their families about the effectiveness of these measures, increases their trust in the welfare organization and society, and strengthens their sense of the value of their position; hence, the emotional support level will be improved. Accordingly, people can enhance the ability to make decisions, solve problems, and establish effective relationships, as well as the ability of self-awareness and empathetic and deal with emotions and stress so that their families achieve healthy relationships and lead to the effective expression of feelings and increased tolerance level among family members.
The formation of support groups and associations among the clients covered by the Welfare Organization of Nowshahr helps these people to know more about each other’s feelings and concerns and to express sympathy with each other to increase the sources of emotional and informational support for these people and raised awareness level of clients covered by the Welfare Organization and strengthen family relationships and improve the lives of family members. Considering that the welfare organization is the main custodian of the affairs of the clients covered by the welfare organization of Nowshahr, it is essential to evaluate and know more about their families’ current situation and living conditions. Providing the necessary specialized training to family members in the personality characteristics of clients covered by the welfare organization of Nowshahr leads to an increased awareness level of these people on how to adopt appropriate behavior toward clients’ behaviors in the home environment and outside of it. The family’s referral continuously to expert consultants in this field and providing information about elite specialists or inviting the mentioned specialists to provide their services to these families and facilitate easy access can lead to increased informational support and, consequently, their social health.
Considering that most clients are not fully aware of the services provided by the welfare organization, the level of informational support can be increased by preparing the necessary brochures and providing continuous and up-to-date information using the facilities accessible to everyone, such as social media and home visits by social workers and the knowledge that social workers can provide to families during these visits. Another tangible dimension of social support is instrumental support which includes measures such as facilitating the access of the clients to the financial resources of banks and other financial institutions, restoring the living conditions, providing various gifts and incentives, and actions leading to reducing the need of their families when facing financial problems. If this material aids lead to the empowerment of the clients, we can somehow observe increased instrumental support. This issue can somewhat strengthen their sense of social participation and consequently improve their social health. In this regard, it will be useful to help the clients with employment and self-sufficiency and have a stable income, enhancing the atmosphere of family life and emotional support. The critical limitation of this research is the small population covered by the Welfare Organization of Nowshahr because some consideration should be given to expanding it to other communities. For this purpose, further research is suggested with the same title in other societies. Also, it is suggested to provide educational interventions and health promotion in the field of social health among the studied clients until reaching a high level, as well as develop flexible mechanisms for public information about the state of social health, risk factors, and individual and social decisions in changing them.

Ethical Considerations
Compliance with ethical guidelines
After explaining the study objectives to the participants, their verbal consent was obtained. There were assured of the confidentiality of their information. 

Funding
This study was extracted from the PhD thesis of Mohammad Nabi Najafi Andarvar, Approved by Islamic Azad University of Babol branch. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors' contributions
Supervision: Majedeh Gholipour, Abolghasem Heydarabadi and Manouchehr Pahlavan; Conceptualization, methodology, resources, writing, editing & review: All Authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank participants for their cooperation.


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