The Relationship between Illness Perception and Health Behaviors among Patients with Tuberculosis: Mediating Effects of Self-efficacy and Family Support

Hye-jin Kim; Myung Kyung Lee

doi:10.7469/KJAN.2017.29.6.626

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Kim and Lee: The Relationship between Illness Perception and Health Behaviors among Patients with Tuberculosis: Mediating Effects of Self-efficacy and Family Support

Original Research

Korean J Adult Nurs 2017;29(6):626-636.

Published online: 18 December 2017

DOI: https://doi.org/10.7469/KJAN.2017.29.6.626

The Relationship between Illness Perception and Health Behaviors among Patients with Tuberculosis: Mediating Effects of Self-efficacy and Family Support

Hye-jin Kim, MSN, RN, Myung Kyung Lee, RN, Ph.D.

College of Nursing, Kyungpook National University, Daegu, Korea

Corresponding author: Lee, Myung Kyung College of Nursing, Kyungpook National University, 680 Gukchabosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-200-4792, Fax: +82-53-425-1258, E-mail: mlee@knu.ac.kr

- This work was supported by the National Research Foundation funded by Korea MSIT(No. NRF-2017R1A1A1A05001045). - 본 논문은 제1저자 김혜진의 석사학위논문의 축약본임. - This article is a condensed form of the first author's master's thesis from Kyungpook National University.

Received 28 August 201724 October 2017 Accepted 16 December 2017

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

The purpose of this study was to identify the mediating effects of self-efficacy and family support in the relationship between illness perception and health behaviors among patients with tuberculosis.

Methods

A descriptive, cross-sectional study was conducted with 219 patients with tuberculosis from one general hospital in D city in Korea. The participants took medication over a two months period. Data were collected from four self-re-ported questionnaires including Health behaviors Questionnaire and Family Support Questionnaire. Of the four questionnaires, Venereal Disease Education Health Belief Model Scales and Health Belief Model Scales were modified for this study population with tuberculosis. Data were analyzed by descriptive statistics, Pearson's corre-lation coefficients, and multiple regression analysis using SPSS statistics 23.0 program.

Results

A positive corre-lation existed between health behaviors and illness perception (r=0.80, p<.001), self-efficacy (r=0.66, p<.001), and family support (r=0.73, p<.001). Self-efficacy and family support had partial mediating effect on the relationship between illness perception and health behaviors.

Conclusion

Theses results indicated that in order to im-prove the health behaviors of patients with tuberculosis, it is necessary to develop a management plan that focuses not only on the illness perception but also on the self-efficacy and the role of the family support.

Keywords: Tuberculosis, Health behavior, Self efficacy, Family, Perception

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Figure 1.

Mediation analysis pathway. C vs. C‘

Figure 2.

Mediating effects of self-efficacy and family support in the relationship between illness perception and health behaviors.

Table 1.

Illness Perception, Health Behaviors, Self-efficacy and Family Support according to Characteristics of Participants (N=219)

Variables	Categories	n (%)	Illness perception		Self-efficacy		Family support		Health behaviors
Variables	Categories	n (%)	M± SD	t or F (p)	M± SD	t or F (p)	M± SD	t or F (p)	M± SD	t or F (p)
Gender	Male	134 (61.2)	3.49±0.56	-3.03	3.62±0.74	-0.40	2.62±0.74	-0.56	2.57±0.62	-4.43
Gender	Female	85 (38.8)	3.71±0.47	(.003)	3.66±0.58	(.691)	2.67±0.61	(.576)	2.90±0.44	(＜.001)
Age (year)	＜50	99 (45.2)	3.60±0.56	0.61	3.67±0.73	0.59	2.62±0.72	-0.36	2.67±0.59	-0.70
Age (year)	≥50	120 (54.8)	3.55±0.52	(.544)	3.61±0.64	(.559)	2.67±0.67	(.718)	2.72±0.57	(.484)
Religion	No	128 (58.4)	3.46±0.61	-4.14	3.61±0.78	-0.83	2.51±0.76	-3.76	2.55±0.62	-5.06
Religion	Yes	91 (41.6)	3.73±0.36	(＜.001)	3.68±0.52	(.407)	2.83±0.55	(＜.001)	2.91±0.44	(＜.001)
Education	≤ JHS	58 (26.5)	3.41±0.50	-2.74	3.38±0.73	-3.44	2.42±0.77	-2.70	2.56±0.52	-2.15
Education	≥ High school	161 (73.5)	3.63±0.53	(.007)	3.73±0.64	(.001)	2.72±0.65	(.009)	2.75±0.60	(.033)
Marital status	Married	130 (59.4)	3.61±0.51	-1.13	3.57±0.65	-1.25	2.71±0.64	-1.82	2.77±0.57	-2.28
Marital status	Alone	89 (40.6)	3.52±0.57	(.262)	3.57±0.71	(.212)	2.53±0.76	(.071)	2.59±0.58	(.024)
Main caregiver	Family	175 (79.9)	3.61±0.49	2.54	3.68±0.66	1.63	2.71±0.64	6.49	2.74±0.57	2.80
	Self	38 (17.4)	3.40±0.69	(.081)	3.50±0.80	(.199)	2.28±0.85	(.002)	2.51±0.65	(.063)
	Others	6 (2.7)	3.57±0.53		3.36±0.34		2.70±0.54		2.53±0.20
Occupation	Unemployed	58 (26.5)	3.63±0.56	0.95	3.62±0.70	-0.25	2.79±0.76	2.01	2.86±0.57	2.55
Occupation	Employed	161 (73.5)	3.55±0.52	(.345)	3.64±0.68	(.803)	2.58±0.66	(.045)	2.64±0.57	(.011)
Comorbidity	None	116 (53.0)	3.66±0.53	2.70	3.73±0.68	2.09	2.70±0.73	1.38	2.80±0.59	2.73
Comorbidity	Yes	103 (47.0)	3.47±0.52	(.007)	3.54±0.67	(.038)	2.57±0.65	(.168)	2.59±0.55	(.007)
Past history of TB	No	155 (70.8)	3.60±0.52	0.97	3.61±0.61	2.07	2.63±0.70	072	2.71±0.53	0.35
	Yes	45 (20.5)	3.47±0.65	(.380)	3.60±0.88	(.129)	2.59±0.80	(.490)	2.63±0.79	(.702)
	Trace	19 (8.7)	3.60±0.27		3.94±0.67		2.81±0.44		2.74±0.41
Family history of TB	No	179 (81.7)	3.54±0.56	2.25	3.61±0.68	1.21	2.81±0.61	1.79	2.66±0.59	2.10
Family history of TB	Yes	40 (18.3)	3.71±0.38	(.027)	3.75±0.68	(.229)	2.60±0.71	(.075)	2.87±0.53	(.037)
Side effect of TB medication	None	96 (43.8)	3.65±0.51	1.91	3.71±0.62	1.34	2.78±0.60	2.71	2.80±0.56	2.27
Side effect of TB medication	Yes	123 (56.2)	3.51±0.55	(0.58)	3.58±0.72	(.182)	2.53±075	(.007)	2.62±0.58	(.024)
Discontinuation of TB medication	Never	187 (85.4)	3.63±0.48	3.21	3.71±0.58	2.67	2.71±0.64	3.21	2.77±0.53	3.49
Discontinuation of TB medication	Yes	32 (14.6)	3.23±0.69	(.003)	3.22±1.01	(.011)	2.21±0.83	(.003)	2.30±0.72	(.001)

JHS= junior high school; TB=tuberculosis.

Table 2.

Level of Illness Perception, Health Behaviors, Selfefficacy and Family Support (N=219)

Scales	M± SD	Min~Max
Illness perception	3.57±0.53	2.25~4.68
Perceived barrier	3.35±0.84	1.44~5.00
Perceived benefit	3.99±0.65	2.42~5.00
Perceived seriousness	3.14±0.68	1.43~5.00
Health behaviors	2.70±0.58	1.29~3.94
Complying with TB medication	3.28±0.68	1.00~4.00
Following healthy diet	2.44±0.64	1.14~3.86
Performing physical exercise	2.36±0.82	1.00~4.00
Maintaining environmental hygiene	2.53±0.80	1.00~4.00
Preventing disease transmission	2.88±0.76	1.25~4.00
Avoiding TB risk factors	2.84±0.66	1.20~4.00
Self-efficacy	3.64±0.68	1.67~5.00
Family support	2.64±0.70	1.06~4.00
Emotional support	2.47±0.76	1.00~4.00
Instrumental support	2.83±0.81	1.00~4.00
Information support	2.47±0.80	1.00~4.00
Appraisal support	2.83±0.66	1.00~4.00

TB=tuberculosis.

Table 3.

Relationships among Key Variables (N=219)

Variables	Health behaviors	Illness perception	Self-efficacy	Family support
Variables	r (p)	r (p)	r (p)	r (p)
Health behaviors	1
Illness perception	.801 (＜.001)	1
Self-efficacy	.660 (＜.001)	.692 (＜.001)	1
Family support	.732 (＜.001)	.742 (＜.001)	.543 (＜.001)	1

Table 4.

Mediating Effects of Self-Efficacy and Family Support in the Relationship between Illness Perception and Health Behaviors (N=219)

Variables	Step (Path)	B	β	t	p∗	Adj. R²	F	p∗∗
Mediating effect of self-efficacy	Step 1 (Path c)					.64	388.2	＜.001
	Outcome: health behaviors
	Predictor: illness perception	0.87	.80	19.7	＜.001
	Step 2 (Path a)					.48	199.4	＜.001
	Outcome: self-efficacy
	Predictor: illness perception	0.88	.69	14.1	＜.001
	Step 3,4 (Path b and c’)					.66	212.4	＜.001
	Outcome: health behaviors
	Mediator: self-efficacy (Path b)	0.17	.20	3.7	＜.001
	Predictor: illness perception	0.72	.66	12.1	＜.001
		Sobel test: Z=4.08, p＜.001
Mediating effect of family support	Step 1 (Path c)					.64	388.2	＜.001
	Outcome: health behaviors
	Predictor: illness perception	0.87	.80	19.7	＜.001
	Step 2 (Path a)					.55	265.0	＜.001
	Outcome: family support
	Predictor: illness perception	0.97	.74	16.3	＜.001
	Step 3 (Path b and c’)					.68	233.7	＜.001
	Outcome: health behaviors
	Mediator: family support (Path b)	0.26	.31	5.4	＜.001
	Predictor: illness perception	0.62	.57	10.1	＜.001
				Sobel tes	st: Z=4.95,	, p＜.001

B=unstandardized coefficients; β=standardized coefficients; p∗= p-value of independent variable; p∗∗= p-value of model; Adj. R

² =adjusted R-squared.

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