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Park and Son: Social Network, Self-Care Agency and Quality of Life of High-risk Beneficiaries in Case Management of Medicaid
Original Article

J Korean Acad Community Health Nurs 2017;28(4):421-430.

Published online: 12 December 2017

DOI: https://doi.org/10.12799/jkachn.2017.28.4.421

Social Network, Self-Care Agency and Quality of Life of High-risk Beneficiaries in Case Management of Medicaid

Ju Young Park1, Jung Tae Son2

1Department of Nursing, Graduate School, Daegu Catholic University, Daegu, Korea

2College of Nursing · Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea

Corresponding author: Park, Ju Young College of Nursing, Daegu Catholic University, 33 Duryugongwon-ro, 17 gil, Nam-gu, Daegu 42472 Korea. Tel: +82-53-555-4891, Fax: +82-53-650-4392, E-mail: jy4you4891@gmail.com

Received 20 July 2017       Revised 8 November 2017       Accepted 14 November 2017

Copyright © 2017 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study investigates the social network, self-care agency, and quality of life of high-risk beneficiaries in case management of Medicaid and the correlations between these variables. It also identifies influencing factors on their quality of life.

Methods

The subjects included 187 individuals chosen from the high-risk beneficiaries in case management of Medicaid in D Metropolitan City. Data was collected through direct interviews based on a structured questionnaire on home visits.

Results

The perceived health status was the most influential factor in their quality of life, followed by self-care agency, mutual support network, and natural support network in order. These factors explained 40.6% of their quality of life.

Conclusion

These findings raise a need to develop a nursing intervention program to increase the self-care agency of the high-risk beneficiaries in case management of Medicaid.

Keywords: Case management, Self care, Quality of life, Medicaid

References

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Table 1.
Differences of Quality of Life according to General and Health-related Characteristics (N=187)
Variables Categories n(%) Quality of life
M±SD t or F (p)
Age (year) ≤49 50~59 31 44 (16.6) (23.5) 2.21±0.51 2.13±0.58 0.38 (.823)
60~69 71~79 40 50 (21.4) (26.7) 2.10±0.34 2.13±0.34
≥80 22 (11.8) 2.20±0.39
Gender Male 66 (35.3) 2.09±0.43 1.23
Female 121 (64.7) 2.18±0.45 (.220)
Marital status Single 18 (9.6) 2.03±0.41 1.60
Married 74 (39.6) 2.17±0.50 (.189)
Divorced 47 (25.1) 2.07±0.41
Bereavement 48 (25.7) 2.23±0.37
Education None 39 (20.9) 2.17±0.45 0.89
Elementary school 63 (33.7) 2.11±0.36 (.445)
Middle school 37 (19.8) 2.08±0.54
≥High school 48 (25.7) 2.22±0.44
Religion Have 81 (43.3) 2.20±0.43 1.42
Have not 106 (56.7) 2.11±0.45 (.155)
Live with Alonea 82 (43.9) 2.25±0.32 5.10
Spouseb 32 (17.1) 2.09±0.31 (.002)
Childrenc 35 (18.7) 2.29±0.33 b＜d
Spouse & childrend 38 (20.3) 2.40±0.36
Perceived health status Not too bada 10 (5.3) 2.66±0.23 22.40
Badb 102 (54.5) 2.25±0.43 (＜.001)
Very badc 75 (40.1) 1.94±0.37 a＞b＞c
Number of disease 1 15 (8.0) 2.22±0.41 1.39
2 3 60 63 (32.0) (33.7) 2.15±0.44 2.20±0.46 (.245)
≥4 49 (26.3) 2.04±0.42
Number of complication 1 2 22 65 (11.8) (34.6) 2.14±0.44 2.20±0.49 0.75 (.519)
3 62 (33.1) 2.13±0.42
≥4 38 (20.3) 2.07±0.39
Total 2.14±0.44

a, b, c, d=Scheffé test.

Table 2.
The Differences of Quality of Life according to Social Network (N=187)
Variables Categories Size Quality of life Contact frequency n (%) Quality of life
n (%) M±SD M±SD t or F (p) M±SD t or F (p)
Natural support network Family or relative 108 (57.8) 3.66±4.08 2.13±0.47 2.10 ≥3 times/week 109 (58.3) 2.04±0.43 2.03
Neighborhood 38 (20.3) 2.72±7.71 2.07±0.40 (.124) 1~3 times/month 45 (24.1) 2.24±0.50 (.134)
Friend 36 (19.3) 1.72±2.74 2.27±0.40 ≤3 times/year 33 (17.6) 2.14±0.42
None 5 (2.7) 0 2.01±0.41
Subtotal 187 (100.0) 8.10±1.45
Professional support network Social worker 63 (33.7) 0.71±0.78 2.16±0.45 0.75 ≥3 times/week 43 (23.0) 2.04±0.43 1.80
Official 9 (4.8) 0.29±0.49 2.14±0.43 (.519) 1~3 times/month 92 (49.2) 2.19±0.42 (.168)
Nurse or doctor in clinic 40 (21.4) 1.12±1.52 2.21±0.47 ≤3 times/year 52 (27.8) 2.16±0.47
Nurse case manager 52 (27.8) 0.45±0.67 2.08±0.40
None 23 (12.3) 0 2.14±0.48
Subtotal 187 (100.0) 2.57±2.01
Mutual support network Senior citizen centera 14 (7.5) 0.55±2.77 2.40±0.42 8.34 ≥3 times/weeka 43 (23.0) 2.25±0.41 9.18
Gatheringsb 27 (14.4) 0.73±2.02 2.36±0.41 (＜.001) 1~3 times/monthb 92 (49.2) 2.44±0.48 (＜.001)
Society organizationc 34 (18.1) 0.88±2.31 2.25±0.46 a, b＞d ≤3 times/yearc 52 (27.8) 2.06±0.42 b＞c
Noned 112 (59.9) 0 2.02±0.40
Subtotal 187 (100.0) 2.16±4.34
Total 12.07±14.40

a, b, c, d=Scheffé test.

Table 3.
Level of Self-care Agency of Subjects (N=187)
Categories M±SD Min Max Range
Self-care agency 3.34±0.61 1.88 5.02 1~6
 Cognitive aspects of self-care 3.41±0.80 1.27 5.45
 Physical skills 2.83±0.83 1.11 4.66
 Judgement & decision making process 3.22±0.79 1.40 5.00
 Perception of self-monitoring 4.00±0.75 2.00 6.00
 Information-seeking behaviors 3.40±0.84 1.25 5.50
 Attention to self-management 4.08±0.72 2.00 6.00
Table 4.
Correlation among Size of Social Network, Self-care Agency and Quality of Life (N=187)
Variables X1 X2 X3 Self-care agency Quality of life
r (p) r (p) r (p) r (p) r (p)
X1. size of natural support network 1 　 　 　 　
X2. size of professional support network .25 (＜.001) 1 　 　 　
X3. size of mutual support network .41 (＜.001) .05 (.497) 1 　 　
Self-care agency .18 (.011) .09 (.197) .17 (.016) 1 　
Quality of life .33 (＜.001) .09 (.190) .36 (＜.001) .38 (＜.001) 1
Table 5.
Factors Related to Quality of Life (N=187)
Predictors B SE β t p
(Constant) 45.26 5.10 8.86 ＜.001
Perceived health status† -14.38 3.19 -.61 -4.50 ＜.001
Perceived health status‡ -7.26 3.11 -.31 -2.23 .021
Self-care agency 0.16 0.03 .30 4.97 ＜.001
Size of mutual support network 0.63 0.16 .24 3.90 ＜.001
Size of natural support network 0.13 0.09 .18 2.09 .039
F=19.64 (p＜.001), R2=.424, Adjusted R2=.406, Durbin-Watson=1.45

Dummy variables:

† Perceived health status (0=not bad, 1=very bad);

‡ Perceived health status (0=not bad, 1=bad).

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