Structural Equation Model of Health-Related Quality of Life in School Age Children with Asthma

Yunsoo Kim; Ho Ran Park

doi:10.4040/jkan.2018.48.1.96

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Kim and Park: Structural Equation Model of Health-Related Quality of Life in School Age Children with Asthma

Original Article

J Korean Acad Nurs 2018;48(1):96-108.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.1.96

Structural Equation Model of Health-Related Quality of Life in School Age Children with Asthma

Yunsoo Kim¹, Ho Ran Park^2,

¹Seoul Women's College of Nursing, Seoul

²College of Nursing, The Catholic University of Korea, Seoul, Korea

Address reprint requests to : Park, Ho Ran College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-7406 Fax: +82-2-2258-7772 E-mail: hrpark@catholic.ac.kr

Received 18 September 2017 Revised 9 February 2018 Accepted 9 February 2018

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 construct and test a hypothetical model of the quality of life of school-age children with asthma based on the health-related quality of life model by Wilson and Cleary.

Methods

Data were collected from 205 pairs of pediatric outpatients diagnosed with asthma and their parents in Seoul and Gyeonggi-do from July 2016 to April 2017. The exogenous variables were asthma knowledge, number of accompanying allergic diseases, and social support. The endogenous variables were asthma self-efficacy, asthma symptom control, perceived health status, parental quality of life, and children's quality of life. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed.

Results

Eighteen of the twenty-four hypotheses selected for the hypothetical model were attentive and supported statistically. Quality of life was explained by asthma self-efficacy, asthma symptom control, perceived health, parental quality of life, and asthma knowledge with 83.5%.

Conclusion

Strategies for promoting self-efficacy and enforcing asthma knowledge will be helpful for the improvement of health-related quality of life with school-aged asthmatic children.

Keywords: Asthma, Children, Quality of life, Structural equation model

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Figure 1.

Theoretical and hypothetical framework.

Figure 2.

Effect analysis in the structural equation model.

Table 1.

General and Disease - Specific Characteristics of the Children and Their Parents (N=205)

Variables	Categories	Mean±SD	n (%)
Children
Gender	Male		132 (64.5)
	Female		73 (35.5)
Age (yr)		10.47±1.51
Height (cm)		138.56±8.65
Weight (kg)		35.63±7.24
BMI (kg/m²)		18.39±2.34
Number of siblings		1.68±0.59
Birth order	1st		118 (57.5)
	2nd		84 (41.0)
	3rd		3 (1.5)
Academic year	1st		20 (9.8)
	2nd		39 (19.0)
	3rd		49 (23.9)
	4th		41 (20.0)
	5th		36 (17.5)
	6th		20 (9.8)
Academic achievement	Upper		37 (18.0)
	Mid-upper		81 (39.5)
	Middle		72 (35.2)
	Mid-lower		15 (7.3)
Age at diagnosis (yr)		7.00±2.31
Time since diagnosis (month)		39.51±23.13
Number of admission related to asthma		1.40±1.56
Other allergic disease	Yes		169 (82.4)
	No		36 (17.6)
Number of accompanying allergic diseases		1.07±0.64
Type of other allergic diseases^† (n=169)	Atopic dermatitis		26 (15.4)
	Allergic rhinitis		106 (62.7)
	Food allergy		54 (32.0)
	Others		23 (13.6)
Asthma family history	Yes		85 (41.5)
	No		120 (58.5)
Family history with asthma (n=80)	Father		20 (23.5)
	Mother		51 (60.0)
	Brother		5 (10.6)
	Sister		4 (5.9)
Parents
Relations	Mother		191 (93.2)
	Father		14 (6.8)
Age (yr)		41.02±3.35
Father’s educational level	High school		26 (12.7)
	College		140 (68.3)
	Graduate school		39 (19.0)
Mother’s educational level	High school		49 (23.9)
	College		133 (64.9)
	Graduate school		23 (11.2)
Income (10,000 KW/month)		580.05±232.44
Mother’s job	Yes		75 (36.6)
	No		130 (63.4)
Smoking	Yes		92 (44.9)
	No		113 (55.1)

SD=Standard deviation.

^†Means multiple choice.

Table 2.

Descriptive Statistics of the Measured Variables (N=205)

Variables	Mean	SD	Measurment range	Skewness	Kurtosis
Asthma knowledge	13.75	3.37	0~26	−0.25	−0.90
Number of accompanying allergic diseases	1.07	0.64		0.16	0.02
Social support	3.14	0.33	1~4	0.45	1.894
Self-efficacy
Total	43.99	6.83	20~60	−0.52	−0.55
Medical treatment	16.34	2.92		−0.98	0.50
Environment	14.45	2.23		−0.23	−0.75
Problem solving	13.30	2.61		−0.27	−0.46
Asthma symptom control	69.78	15.37	5~100	−0.21	−0.53
Perceived health status	3.80	1.02	1~5	−0.55	−0.47
Parental quality of life
Total	3.54	0.60	1~5	0.25	0.27
Emotion	3.47	0.62		0.14	0.14
Activity	3.61	0.65		0.07	0.08
Children’s health-related quality of life
Total	3.88	0.73	1~5	−0.18	−1.02
Symptom	3.89	0.90		−0.48	−1.08
Emotion	4.16	0.73		−0.85	−0.09
Activity	3.58	0.89		−0.16	0.17

SD=Standard deviation.

Table 3.

Standardized Direct, Indirect, and Total Effects for the Hypothetical Model

Endogenous Variables	Exogenous variables	Direct effect (p)	Indirect effect (p)	Total effect (p)
Asthma self-efficacy	Social support	.29 (<.001)		.29 (.011)
	Asthma knowledge	.18 (.010)		.18 (.019)
	Number of accompanying allergic disease	−.17 (.016)		−.17 (.045)
Asthma symptom control	Asthma self-efficacy	.49 (<.001)		.49 (.010)
	Social support	.15 (.012)	.15 (.011)	.30 (.021)
	Asthma knowledge	.18 (.003)	.09 (.012)	.26 (.021)
	Number of accompanying allergic disease	.07 (.211)	−.08 (.045)	−.01 (.958)
Perceived health status	Asthma self-efficacy	.50 (<.001)	.15 (.010)	.65 (.031)
	Social support	.12 (.014)	.24 (.010)	.36 (.013)
	Asthma symptom control	.31 (<.001)		.31 (.004)
	Asthma knowledge	.07 (.158)	.17 (.010)	.24 (.019)
	Number of accompanying allergic disease	.01 (.769)	−.09 (.074)	−.07 (.284)
Parental quality of life	Asthma self-efficacy	.24 (.010)	.22 (.016)	.48 (.029)
	Social support	.27 (<.001)	.20 (.010)	.47 (.007)
	Perceived health status	.29 (.002)		.29 (.043)
	Asthma symptom control	.07 (.345)	.09 (.029)	.16 (.041)
	Asthma knowledge		.13 (.010)	.13 (.013)
	Number of accompanying allergic disease	−.02 (.732)	−.06 (.132)	−.08 (.188)
Children’s health-related quality of life	Asthma self-efficacy	.32 (<.001)	.38 (.010)	.71 (.021)
	Asthma symptom control	.31 (<.001)	.10 (.010)	.41 (.005)
	Asthma knowledge	.12 (<.001)	.21 (.010)	.34 (.028)
	Social support	−.01 (.674)	.35 (.010)	.33 (.009)
	Perceived health status	.22 (<.002)	.05 (.026)	.27 (.032)
	Parental quality of life	.17 (.010)		.16 (.007)
	Number of accompanying allergic disease	−.05 (.073)	−.09 (.081)	−.14 (.018)

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