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Jang and Jeon: Prediction Model for Health-Related Quality of Life in Hospitalized Patients with Pulmonary Tuberculosis
Original Article

Journal of Korean Academy of Nursing 2017; 47(1): 60-70.

Published online: 28 February 2017

DOI: https://doi.org/10.4040/jkan.2017.47.1.60

Prediction Model for Health-Related Quality of Life in Hospitalized Patients with Pulmonary Tuberculosis

Kwang-Sim Jang1, Gyeong-Suk Jeon2

1Department of Nursing, Donga College of Health, Youngam, Korea.

2Department of Nursing, Mokpo National University, Muan, Korea.

Address reprint requests to: Jeon, Gyeong-Suk. Department of Nursing, Mokpo National University, 1666 Youngsan-ro, Cheonggye-myeon, Muan 58554, Korea. Tel: +82-61-450-2675, Fax: +82-61-450-2679, sookie@mokpo.ac.kr

Received 20 July 2016       Revised 6 November 2016       Accepted 7 November 2016

© 2017 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was conducted to construct and test a structural equation model of health-related quality of life (HRQoL) among hospitalized patients with pulmonary tuberculosis (PTB).

Methods

Participants were 256 patients with PTB who were 20 years or older and admitted in two national tuberculosis hospitals. The patients participated in pulmonary function testing and responded to structured questionaries.

Results

The goodness-of-fit statistics of the final hypothetical model were as follows: χ2/df=2.19, RMSEA=.07, SRMR=.05, GFI=.95, NFI=.95, CFI=.96, TLI=.92, and PCFI=.52. Symptoms and general health perception had significant direct effects, and subjective economic status, social support and stigma had significant indirect effect on HRQoL of hospitalized patients with PTB. These variables explained 64% of variance in the prediction model.

Conclusion

Findings suggest that strategies and intervention for physical symptoms and depressive symptoms are crucial to improve the quality of life in hospitalized patients with PTB. The development of various social support programs is also recommended.

Keywords: Pulmonary tuberculosis, Quality of life, Depression, Social support, Social stigma

Figures and Tables

Figure 1

Path diagram for the hypothetical model.

jkan-47-60-g001
Table 1

Descriptive Statistics of Measured Variables (N=256)

jkan-47-60-i001
Variables Measurement M±SD Number of items Cronbach's α Range Skewness Kurtosis
Individual characteristics Economic status 2.23±1.03 1 - 1~5 0.16 -0.81
Social support Family support 14.00±4.64 4 .94 4~20 -0.59 -0.49
Friends support 11.29±4.53 4 .93 4~20 0.00 -0.91
Medical staff support 11.97±4.37 4 .93 4~20 -0.30 -0.80
Stigma Community perspectives 38.45±9.64 11 .95 11~55 -0.99 0.95
Patient perspectives 33.11±8.67 10 .91 10~50 -0.72 0.27
Symptoms Physical symptoms 31.48±7.84 16 .86 16~64 0.45 -0.14
Depressive symptoms 19.99±11.27 20 .90 0~60 0.49 -0.26
Functional status Pulmonary function 59.18±21.67 1 - 0~100 -0.12 -0.98
General health perception Self-rated health 6.85±2.92 3 .89 3~15 0.58 -0.33
Quality of life Physical component summary (PCS) 40.63±21.19 21 .94 0~100 0.41 -0.72
Mental component summary (MCS) 39.24±13.10 14 .82 0~100 0.32 -0.40
Table 2

Factor Loading of Confirmatory Factor Analysis

jkan-47-60-i002
Construct Variables NSRW (B) Standardized estimate (β) SE CR p AVE
Individual characteristics Economic status 1.00 -
Social support Family support 1.40 .70 .22 6.49 <.001 .40
Friends support 1.49 .75 .23 6.57 <.001
Medical staff support 1.00 .54
Stigma Community perspectives 0.95 .85 .12 8.27 <.001 .81
Patient perspectives 1.00 .88
Symptoms Physical symptoms 0.86 .76 .08 10.47 <.001 .85
Depressive symptoms 1.00 .77
Functional status Pulmonary function 1.00 -
General health perception Self-rated health 1.00 -
Quality of life Physical component summary (PCS) 2.87 .98 .35 8.24 <.001 .82
Mental component summary (MCS) 1.00 .58

NSRW=Non-standardized regression weight; AVE=Average variance extracted; SE.=Standard error; CR=Critical ratio.

Table 3

The Correlation Coefficient between the Latent Variables

jkan-47-60-i003
Individual characteristics Social support Stigma Symptoms Functional status General health perception Quality of life
Individual characteristics -
Social support .39 .40*
Stigma .09 -.08 .81*
Symptoms -.24 -.55 .44 .85*
Functional status .10 .28 .07 -.43 -
General health perception .15 .36 -.22 -.66 .38 -
Quality of life .19 .45 -.24 -.74 .37 .71 .82*

*The diagonal matrix for each factor is average variance extracted (AVE).

Table 4

Standardized Direct, Indirect and Total Effects for Hypothetical Model (N=256)

jkan-47-60-i004
Endogenous variables Exogenous variables Direct effect (p) Indirect effect (p) Total effect (p) SMC
Social support Individual characteristics .39 (.012) .39 (.012) .15
Stigma Individual characteristics .15 (.108) -.06 (.268) .09 (.205) .03
Social support -.14 (.338) -.14 (.338)
Symptoms Individual characteristics -.08 (.227) -.15 (.016) -.24 (.006) .44
Social support -.48 (.020) -.05 (.199) -.54 (.018)
Stigma .37 (.014) .37 (.014)
Functional status Individual characteristics -.07 (.262) .17 (.009) .10 (.142) .26
Social support .03 (.746) .26 (.018) .29 (.005)
Stigma .30 (.006) -.21 (.009) .10 (.223)
Symptoms -.56 (.013) -.56 (.013)
General health perception Individual characteristics -.01 (.688) .16 (.007) .15 (.039) .45
Social support -.01 (.971) .37 (.020) .36 (.013)
Stigma .03 (.841) -.23 (.008) -.20 (.019)
Symptoms -.64 (.014) -.06 (.165) -.70 (.011)
Functional status .10 (.207) .10 (.207)
Quality of life Individual characteristics -.00 (.908) .20 (.005) .19 (.007) .64
Social support .05 (.475) .39 (.009) .44 (.007)
Stigma .04 (.469) -.25 (.006) -.21 (.049)
Symptoms -.48 (.009) -.27 (.009) -.75 (.008)
Functional status .00 (.906) .04 (.198) .04 (.787)
General health perception .39 (.006) .39 (.006)

SMC=Squared multiple correlation.

Notes

This manuscript is based on a part of the first author's doctoral dissertation from Mokpo National University.

CONFLICTS OF INTEREST The authors declared no conflict of interest.

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