Structural Equation Modeling on Health-Related Quality of Life in Adults with Epilepsy

Jeong Ok Ko; Myung Ha Lee

doi:10.4040/jkan.2017.47.5.624

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Ko and Lee: Structural Equation Modeling on Health-Related Quality of Life in Adults with Epilepsy

Original Article

J Korean Acad Nurs 2017;47(5):624-637.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.5.624

Structural Equation Modeling on Health-Related Quality of Life in Adults with Epilepsy

Jeong Ok Ko¹, Myung Ha Lee^2,

¹Department of Nursing, Jeonbuk Science College, Jeongeup

²College of Nursing, Chonbuk National University, Jeonju, Korea

Address reprint requests to : Lee, Myung Ha College of Nursing, Chonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea Tel: +82-63-270-3122 Fax: +82-63-270-3127 E-mail: leemh@jbnu.ac.kr

Received 27 April 2017 Revised 15 September 2017 Accepted 17 September 2017

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 aimed to identify variables influencing the health-related quality of life (HRQoL) of adults with epilepsy in order to establish a structural model and design an intervention strategy to improve patients’ HRQoL.

Methods

The selected subjects were 212 patients with epilepsy aged between 18 and 70 years who were currently receiving treatment from hospital, general hospital, and clinic. They were surveyed using a structured questionnaire.

Results

The goodness of fit measures of the final hypothetical model were as follows: c²/df=2.51, GFI=.91, AGFI=.90, CFI=.96, SRMR=.04, NFI=.93, and RMSEA=.08. The major variables influencing the HRQoL of adults with epilepsy were epilepsy self-efficacy, depression, social support, and side effects of anti-epileptic drugs (AEDs), which were significant in the mentioned order, whereas the duration of AEDs use and perceived stigma did not show any effects. Six variables accounted for 75.6% of HRQoL. Variables having a direct and total effect on the HRQoL of adults with epilepsy were the side effects of AEDs, social support, epilepsy self-efficacy, and depression, and those with an indirect effect were the side effects of AEDs and social support.

Conclusion

It is necessary to accurately identify the side effects of AEDs in adults with epilepsy and accurately observe the physical changes caused by depression. In addition, it is imperative to establish an active and effective nursing intervention program to strengthen the self-efficacy of the patients and to improve their quality of life through social support provided by family members and medical professionals.

Keywords: Epilepsy, Quality of life, Social support, Self-efficacy, Depression

References

1. Korean Epilepsy Society. Epidemiological study of seizure and epilepsy using nationwide database for Corean epilepsy patients (ESSENCE). Seoul: Author;2012. p. 4–79.

2. Kim JE. Social issues and quality of life with epilepsy, legal concerns and effective advocatory strategies. Journal of Korean Epilepsy Society. 2008; 12(1):3–10.

3. Youn SY, Jeong SC, Kang YW, Lee HW, Yi J, Seo DW, et al. Clinical factors influencing quality of life in patients with epilepsy. Journal of the Korean Neurological Association. 2000; 18(2):156–161.

4. Smith G, Ferguson PL, Saunders LL, Wagner JL, Wannamaker BB, Selassie AW. Psychosocial factors associated with stigma in adults with epilepsy. Epilepsy & Behavior. 2009; 16(3):484–490. https://doi.org/10.1016/j.yebeh.2009.08.028.

5. Lee SA. Cognitive effects newer antiepileptic drugs. Journal of Korean Epilepsy Society. 2004; 8(1):18–25.

6. Lee SK. Antiepileptic drugs. Journal of Korean Medical Association. 2007; 50(7):645–651. https://doi.org/10.5124/jkma.2007.50.7.645.

7. Quintas R, Raggi A, Giovannetti AM, Pagani M, Sabariego C, Cieza A, et al. Psychosocial difficulties in people with epilepsy: A systematic review of literature from 2005 until 2010. Epilepsy & Behavior. 2012; 25(1):60–67. https://doi.org/10.1016/j.yebeh.2012.05.016.

8. Kim EJ. The effect of human potential seminars on the perceived stigma of adults with epilepsy. Journal of Korean Academy of Nursing. 1998; 28(4):1003–1012. https://doi.org/10.4040/jkan.1998.28.4.1003.

9. Lee SA, Yoo HJ, Heo K, Park HK, Shin DJ, Song HK, et al. The social stigma of epilepsy in Korea. Journal of Korean Epilepsy Society. 2002; 6(2):128–136.

10. Leaffer EB, Hesdorffer DC, Begley C. Psychosocial and sociodemographic associates of felt stigma in epilepsy. Epilepsy & Behavior. 2014; 37:104–109. https://doi.org/10.1016/j.yebeh.2014.06.006.

11. Lee SA, Lee BI. Korean QoL in Epilepsy Study Group. Disclosure management behaviors in Korean adults with well-controlled epilepsy: Their relation to perception of stigma. Epilepsy & Behavior. 2017; 67:28–32. https://doi.org/10.1016/j.yebeh.2016.11.034.

12. Hwang KJ, Kim EH, Kim YJ, Hong SB. Frequency of depression and suicidality in patients with neurological disorders: Epilepsy, Parkinson’s disease, and ischemic stroke. Journal of the Korean Neurological Association. 2016; 34(3):193–200. https://doi.org/10.17340/jkna.2016.3.4.

13. Fiest KM, Dykeman J, Patten SB, Wiebe S, Kaplan GG, Maxwell CJ, et al. Depression in epilepsy: A systemic review and meta-analysis. Neurology. 2013; 80(6):590–599. https://doi.org/10.1212/WNL.0b013e31827b1ae0.

14. Amir M, Roziner I, Knoll A, Neufeld MY. Self-efficacy and social support as mediators in the relation between disease severity and quality of life in patients with epilepsy. Epilepsia. 1999; 40(2):216–224. https://doi.org/10.1111/j.1528-1157.1999.tb02078.x.

15. Whatley AD, DiIorio CK, Yeager K. Examining the relationships of depressive symptoms, stigma, social support and regimen-specific support on quality of life in adult patients with epilepsy. Health Education Research. 2010; 25(4):575–584. https://doi.org/10.1093/her/cyq001.

16. Robinson E, DiIorio C, DePadilla L, McCarty F, Yeager K, Henry T, et al. Psychosocial predictors of lifestyle management in adults with epilepsy. Epilepsy & Behavior. 2008; 13(3):523–528. https://doi.org/10.1016/j.yebeh.2008.05.015.

17. Sin SO. The effects and development of a comprehensive health education program on improvement of quality of life in persons with epilepsy. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2002; 11(2):221–235.

18. Shon YM, Joung WJ. Illness experience of married Korean women with epilepsy. Journal of Korean Academy of Nursing. 2017; 47(3):289–304. https://doi.org/10.4040/jkan.2017.47.3.289.

19. Cohen S, Hoberman HM. Positive events and social supports as buffers of life change stress. Journal of Applied Social Psychology. 1983; 13(2):99–125. https://doi.org/10.1111/j.1559-1816.1983.tb02325.x.

20. Bandura A. Self-efficacy: The exercise of control. New York, WH: Freeman;1997. p. 1–604.

21. DiIorio C, Yeager K. The epilepsy self-efficacy scale. Strickland OL, DiIorio C, editors. Measurement of Nursing Outcomes. Volume 3: Self Care and Coping. 2nd ed. New York: Springer Publishing Company;2003. p. 40–51.

22. Yu JP. The misunderstanding and prejudice of structural equation models. Seoul: Hannare Publishing Co.;2014. p. 150–372.

23. Harrington D. Confirmatory factor analysis: Pocket guides to social work research methods. New York: Oxford University Press;2009. p. 78–99.

24. WHOQOL group. Study protocol for the World Health Organization project to develop a quality of life assessment instrument (WHOQOL). Quality of Life Research. 1993; 2(2):153–159. https://doi.org/10.1007/bf00435734.

25. Min SK, Lee CI, Kim KI, Suh SY, Kim DK. Development of Korean version of WHO quality of life scale abbreviated version (WHOQOL-BREF). Journal of Korean Neuropsychiatric Association. 2000; 39(3):571–579.

26. Baker GA, Jacoby A, Francis P, Chadwick DW. The Liverpool adverse drug events profile. Epilepsia. 1995; 36(Suppl 3):59.

27. Kim JH, Lee JH. Relations of perceived stress, cognitive set, and coping behaviors to depression. A focus on freshmen’s stress. The Korean Journal of Counseling and Psychotherapy. 1988; 1(1):25–45.

28. Beck AT, Steer RA, Brown GK. BDI-II: Beck depression inventory: Manual. San Antonio (TX): Psychological Corporation;1996. p. 1–82.

29. Ryan R, Kempner K, Emlen AC. The stigma of epilepsy as a self-concept. Epilepsia. 1980; 21(4):433–444. https://doi.org/10.1111/j.1528-1157.1980.tb04091.x.

30. Hoyle RH. Model specification in structural equation modeling. Hoyle RH, editor. Handbook of Structural Equation Modeling. New York: Guilford Press;2012. p. 126–144.

31. Moon SM. The relationship of self efficacy and social support to the psychosocial adjustment in people with epilepsy. Journal of Korean Academy of Nursing. 2000; 30(3):694–708. https://doi.org/10.4040/jkan.2000.30.3.694.

32. Ridsdale L, Wojewodka G, Robinson E, Landau S, Noble A, Taylor S, et al. Characteristics associated with quality of life among people with drug-resistant epilepsy. Journal of Neurology. 2017; 264(6):1174–1184. https://doi.org/10.1007/s00415-017-8512-1.

33. Charyton C, Elliott JO, Lu B, Moore JL. The impact of social support on health related quality of life in persons with epilepsy. Epilepsy Behavior. 2009; 16(4):640–645. https://doi.org/10.1016/j.yebeh.2009.09.011.

34. Tong X, Chen J, Park SP, Wang X, Wang C, Su M, et al. Social support for people with epilepsy in China. Epilepsy & Behavior. 2016; 64(Pt A):224–232. https://doi.org/10.1016/j.yebeh.2016.08.010.

35. Shi Y, Wang S, Ying J, Zhang M, Liu P, Zhang H, et al. Correlates of perceived stigma for people living with epilepsy: A meta-analysis. Epilepsy & Behavior. 2017; 70(Pt A):198–203. https://doi.org/10.1016/j.yebeh.2017.02.022.

Figure 1.

Path diagram of the final model.

Table 1.

Sociodemographic and Clinical Characteristics of Participants (N=212)

Characteristics	Categories	n (%)	M±SD (Range)/Median (IQR)
Gender	Male	132 (62.3)
	Female	80 (37.7)
Age (yr)	≤29	33 (15.6)	43.90±12.69 (18.00~70.00)
	30~39	44 (20.8)
	40~49	51 (24.1)
	50~59	62 (29.2)
	≥60	22 (10.4)
Education	≤Middle school	73 (34.4)
	High school	79 (37.3)
	≥College	60 (28.3)
Marital status	Single	93 (43.9)
	Married	89 (42.0)
	Divorced or widowed	30 (14.2)
Living together	Yes	182 (85.8)
	No	30 (14.2)
Occupation	Yes	99 (46.7)
	No	113 (53.3)
Age of seizure onset (yr)	≤10	40 (18.9)	19.77±13.20 (1.00~64.00)/
	11~20	107 (50.4)	16.00 (12.75)
	21~49	54 (25.5)
	≥50	11 (5.2)
Seizure presentation (within 2 weeks)	Yes	49 (23.1)
	No	163 (76.9)
Type of epileptic seizure	Generalized	146 (68.9)
	Partial	34 (16.0)
	Unknown	32 (15.1)
Number of current AEDs	1	53 (25.0)	2.54±1.22 (1.00~5.00)
	2~3	112 (52.8)
	≥4	47 (22.2)
Number of injury due to epileptic seizure (within 5years)	0	119 (56.1)	2.31±1.90 (1.00~7.00)/
	1~2	45 (21.2)	1.00 (2.00)
	3~4	27 (12.8)
	≥5	21 (9.9)

AEDs=Anti epileptic drugs.

Table 2.

Convergent Validity of Latent Variables (N=212)

Variables	Mean±SD	Min	Max	Range	Skewness	Kurtosis	Standardized factor loading	S.E	C.R (p)	AVE	CR
Duration of AEDs use (yr)	19.00±12.25	1.00	55.00	1~55	.44	−.44
Side effects of AEDs	1.57±0.46	1.00	3.00	1~4	.59	−.51
Social support	3.64±0.94	1.00	5.00	1~5						.65	.92
Family support	3.48±1.14	1.00	5.00		−.43	−.75	.98	−	−
Medical team support	3.86±0.97	1.00	5.00		−.82	.51	.51	.05	8.48 (<.001)
Epilepsy self-efficacy	66.77±19.16	16.67	100.00	0~100						.51	.79
Medication management	68.59±20.23	1.54	100.00		−.62	−.38	.89	.05	19.35 (<.001)
Seizure management	68.52±22.18	0.00	100.00		−.38	−.69	.95	.05	21.64 (<.001)
General management	63.14±20.34	3.00	100.00		−.16	−.96	.89	−	−
Depression	14.58±12.12	0.00	54.00	0~63	.96	.45
Perceived stigma	2.33±0.69	1.00	4.00	1~4	−.11	−.31
HRQoL	2.99±0.70	1.54	4.81	1~5						.52	.78
Physical QoL	3.00±0.73	1.60	5.00		.17	−.63	.89	−	−
Psychological QoL	3.00±0.85	1.00	5.00		.22	−.49	.87	.06	17.77 (<.001)
Environmental QoL	3.00±0.76	1.40	5.00		.14	.27	.84	.05	16.79 (<.001)
Social relationships QoL	2.98±0.84	1.00	5.00		.04	−.12	.81	.06	15.41 (<.001)
Overall QoL	2.95±0.82	1.00	5.00		−.04	−.38	.81	.06	15.55 (<.001)

S.E.=Standard error; C.R.=Critical ratio; AVE=Average variance extracted; CR=Construct reliability.

Table 3.

The Correlation Coefficient between the Latent Variables

	Duration of AEDs use	Side effect of AEDs	Social support	Epilepsy self-efficacy	Depression	Perceived stigma	HRQoL
Duration of AEDs use	−
Side effects of AEDs	.18	−
Social support	−.25	−.26	.65*
Epilepsy self-efficacy	.04	−.33	.23	.51*
Depression	.13	.50	−.33	−.29	−
Perceived stigma	.20	.63	−.42	−.42	.68	−
HRQoL	−.22	−.59	.52	.54	−66	−68	.52*

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

Table 4.

Standardized Direct, Indirect, and Total Effects of the Final Model

Endogenous variables	Variables	β	CR (p)	SMC	Standardized direct effect (p)	Standardized indirect effect (p)	Standardized total effect (p)
Epilepsy self-efficacy	Duration of AEDs use	.14	1.99 (.050)	17.1	.14 (.050)		.14 (.050)
	Side effects of AEDs	−.34	−4.89 (<.001)		−.34 (<.001)		−.34 (<.001)
	Social support	.17	2.43 (.015)		.17 (.015)		.17 (.015)
Depression	Duration of AEDs use	−.01	−.14 (.887)	31.4	−.01 (.887)		−.01 (.887)
	Side effects of AEDs	.44	7.25 (<.001)		.44 (<.001)		.44 (<.001)
	Social support	−.25	−3.94 (<.001)		−.25 (<.001)		−.25 (<.001)
Perceived stigma	Duration of AEDs use	.03	.52 (.602)	49.4	.03 (.602)		.03 (.602)
	Side effects of AEDs	.54	10.51 (<.001)		.54 (<.001)		.54 (<.001)
	Social support	−.30	−5.53 (<.001)		−.30 (<.001)		−.30 (<.001)
HRQoL	Duration of AEDs use	−.06	−1.47 (.141)	75.6	−.06 (.152)	.04 (.204)	−.02 (.638)
	Side effects of AEDs	−.21	−3.93 (<.001)		−.21 (<.001)	−.29 (.001)	−.50 (.002)
	Social support	.28	5.74 (<.001)		.28 (<.001)	.16 (.007)	.44 (.005)
	Epilepsy self efficacy	.29	6.03 (<.001)		.29 (.002)		.29 (.002)
	Depression	−.29	−5.12 (<.001)		−.29 (.004)		−.29 (.004)
	Stigma	−.12	−1.76 (.079)		−.12 (.126)		−.12 (.126)

β=Standardized regression coefficients; SMC=Squared multiple correlation.

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