A Structural Model of Alcohol Abstinence Behavior among Patients with Chronic Liver Diseases

Tae Kyung Kim; Hye Sook Min

doi:10.7475/KJAN.2018.30.1.30

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Kim and Min: A Structural Model of Alcohol Abstinence Behavior among Patients with Chronic Liver Diseases

Original Research

Korean J Adult Nurs 2018;30(1):30-40.

Published online: 18 February 2018

DOI: https://doi.org/10.7475/KJAN.2018.30.1.30

A Structural Model of Alcohol Abstinence Behavior among Patients with Chronic Liver Diseases

Tae Kyung Kim¹, Hye Sook Min^2,

^¹Department of Nursing, Dongju College, Busan, Korea

^²Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Min, Hye Sook https://orcid.org/0000-0002-9292-1944 Department of Nursing, Dong-A University, 32 Dasingongwon-ro, Se-gu, Busan 49201, Korea. Tel: +82-51-240-2872, Fax: +82-51-240-2920, E-mail: hsmin@dau.ac.kr

- This manuscript is a revision of the first author's doctoral dissertation from Dong-A University.

Received 19 September 201730 January 2018 Accepted 14 February 2018

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 was conducted to construct and test a hypothetical model for alcohol abstinence behavior of patients with chronic liver diseases (CLD). The model was based on the theory of planned behavior.

Methods

Participants consisted of 240 adult patients with CLD who had regular visits to Busan medical center and Kyungsang universisty hospital from February 12 to March 14, 2014. Data were collected using self-report questionnaires. Collected data were analyzed using SPSS 18.0, AMOS 21.0 programs.

Results

The modified model was a good fit for the data. The model fit indices were x²/df=1.78, GFI=.86, AGFI=.90, RMR=.08, RMSEA=.05, NFI=.88, TLI=.92, CFI=.87, PNFI=.70. Alcohol abstinence intention (β=.56) had significant direct effects on alcohol abstinence behavior in patients with CLD. This variable explained 32% of the variance in alcohol abstinence behavior. Attitude (β=.47), perceived behavioral control (β=.41) and subjective norms (β=.25) had direct effects on alcohol abstinence intention. These variables explained 46% of the variance in alcohol abstinence intention.

Conclusion

Findings suggest that the intention of alcohol abstinence is important for patients with CLD to engage in alcohol abstinence behavior. It provides the basis for developing an intervention program to induce alcohol abstinence in patients with CLD.

Keywords: Liver diseases, Alcohol abstinence, Behavior, Intention

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Figure 1.

Path diagram of the modified model.

Table 1.

Characteristics of Study Participants (N=240)

Characteristics	Categories	n (%) or M± SD
Gender	Male	173 (72.1)
Gender	Female	67 (27.9)
Age (year)	20~29	11 (4.6)
	30~39	33 (13.7)
	40~49	69 (28.8)
	50~59	78 (32.5)
	≥60	49 (20.4)
		51.00±11.54
Marital status	Married	173 (72.1)
	Other	40 (16.7)
	Unmarried	27 (11.2)
Living with	Spouse and child	141 (58.8)
	Alone	38 (15.8)
	Spouse	28 (11.7)
	Other	33 (13.7)
Education level	Junior high school	39 (16.2)
	High school	113 (47.1)
	≥ College	88 (36.7)
Religion	No	159 (66.3)
Religion	Yes	81 (33.7)
Occupation	Office worker	81 (33.7)
	laborer	51 (21.3)
	Other	40 (16.7)
	Service/Trader	68 (28.3)
Monthly household income (10,000 won)	＜100	26 (10.8)
	100~199	72 (30.0)
	200~299	73 (30.4)
	≥300	30 (12.5)
	None	39 (16.3)
Smoking	Yes	181 (75.4)
Smoking	No	59 (24.6)
Type of chronic liver diseases	Chronic hepatitis	128 (53.3)
	Alcoholic liver disease	44 (18.3)
	Nonalcoholic liver disease	11 (4.6)
	Liver cirrhosis/liver cancer	57 (23.8)
Years since diagnosed	＜3	107 (44.4)
	3~5	67 (28.1)
	6~9	40 (16.6)
	≥10	26 (10.8)
		52.04±51.88 (month)
Current symptom(s) (multiple selection)	Fatigue, weakness	136 (56.7)
	Indigestion	71 (29.6)
	None	60 (25.8)
	Insomnia	58 (24.2)
	Oral dryness	54 (22.5)
	Anorexia	53 (22.1)
	Myalgia	46 (19.0)
	Abdominal distension	27 (11.3)
	Edema	22 (9.6)
	Pain in right upper quadrant	15 (6.5)
	Gum bleeding	13 (5.4)
	Itching	11 (4.6)
	Nausea, vomiting	11 (4.6)
	Other	34 (14.2)

Table 1.

Characteristics of Study Participants (Continued) (N=240)

Characteristics	Categories	n (%) or M± SD
Information related to liver disease	Medical personnel	119 (49.6)
	Media (TV, internet)	66 (27.5)
	None	41 (17.1)
	Other	14 (5.8)
Number of hospitalization in the past	None	86 (35.8)
	1~3 times	87 (36.3)
	≥4 times	67 (27.9)
Treatment experience (multiple selection)	Antiviral drugs	100 (41.7)
	Arterial embolization	17 (7.1)
	Chemotherapy	14 (5.8)
	Radio-frequency ablation	7 (2.9)
	Liver transplant	3 (1.3)
Comorbidities (multiple selection)	None	150 (62.5)
	Hypertension	57 (23.8)
	Diabetes mellitus	41 (17.1)
	Other	5 (2.1)
Drinking with	Coworkers/friend	190 (79.2)
	Other	25 (10.4)
	Alone	25 (10.4)
Have been advised about alcohol abstinence	Yes	165 (68.8)
Have been advised about alcohol abstinence	No	75 (31.3)
Attempted alcohol abstinence	Yes	148 (61.7)
Attempted alcohol abstinence	No	92 (38.3)
Necessity of alcohol abstinence education	Necessary	195 (81.2)
Necessity of alcohol abstinence education	Unnecessary	45 (18.8)
Frequency of drinking per week		2.01±1.15
Amount of drinking (glass/each time)		8.85±4.72

Table 2.

Descriptive Statistics of Measured Variables (N=240)

Variables	Range	M± SD	Skewness	Kurtosis	Standardized estimate
Alcohol abstinence behavior	3~21	6.45±5.01
To stop drinking within the last two weeks
Stopped drinking	1~7	1.97±1.65	1.75	1.77	.95
Tried my best	1~7	2.00±1.46	1.74	1.74	.95
Drinking refusal self-efficacy	1~7	2.48±1.90	0.98	-0.43	.83
Alcohol abstinence intention	4~28	15.07±4.06
To stop drinking within two weeks
Will intend	1~7	3.59±1.14	0.56	-0.31	.94
Will do my best	1~7	3.77±1.17	0.32	-0.63	.86
Will aim to stop drinking	1~7	3.62±1.12	0.50	-0.32	.92
Will refuse a chance to drink	1~7	4.09±1.17	-0.05	-0.71	.67
Alcohol abstinence attitude	4~28	16.32±3.47
Bad/good	1~7	4.33±0.97	-0.56	0.66	.67
Not important/important	1~7	3.92±0.75	-0.17	1.48	.63
Option/essential	1~7	3.80±0.67	-0.98	0.19	.72
Hard/simple	1~7	4.27±1.08	-0.22	-0.28	.70
Alcohol abstinence subjective norms	3~21	12.57±3.09
Normative belief	1~7	4.23±1.11	0.14	-0.74	.91
Motivation to comply	1~7	4.21±1.01	0.25	-0.52	.95
Positive normative belief	1~7	4.13±0.97	0.24	-0.51	.87
Alcohol abstinence perceived behavioral control	4~28	12.34±3.69
Control belief	1~7	3.06±0.94	0.39	-0.65	.92
Self-efficacy	1~7	3.13±0.84	0.24	-0.87	.83
Positive control belief	1~7	3.14±0.95	0.41	-0.52	.96
Control power	1~7	3.01±0.96	0.40	-0.56	.91

Table 3.

Fitness Indices of Hypothetical and Modified Model (N=240)

Model	x² (p)	df	x²/df	GFI	AGFI	RMSEA (LO HI)	NFI	TLI	CFI	PNFI
Criteria	＞.05		＜3.0	≥.90	≥.90	(≤.05 ≤.08)	≥.90	≥.90	≥.90	＞.60
Hypothetical model	241.65	130	2.56	.84	.85	.06	.88	.84	.87	.62
Hypothetical model	(＜.001)	130	2.56	.84	.85	(.05 .07)	.88	.84	.87	.62
Modified model	240.31	131	1.78	.86	.90	.05	.88	.92	.87	.70
Modified model	(＜.001)	131	1.78	.86	.90	(.04 .06)	.88	.92	.87	.70

GFI=goodness-of-fit index; AGFI=adjusted goodness-of-fit index; NFI=normed fit index; RMSEA=root mean square error of approximation;

TLI=Tuker-Lewis index; PNFI=parsimony normed fit index; CFI=comparative fit index; LO=low; HI=high.

Table 4.

Direct, Indirect, and Total Effect Analysis of Modified Models (N=240)

Endogenous variables	Exogenous variables	Direct effect	Indirect effect β	Total effect	SMC
Endogenous variables	Exogenous variables	β (p)	(p)	β (p)	SMC
Alcohol abstinence behavior	Alcohol abstinence intention	.56 (.021)	-	.56 (.021)	.32
Alcohol abstinence behavior	Attitude	-	.27 (.016)	.27 (.016)	-
	Subjective norms	-	.15 (.009)	.15 (.009)
	Perceived behavioral control	-	.23 (.005)	.23 (.005)
Alcohol abstinence intention	Attitude	.47 (.015)	-	.47 (.015)	.46
	Subjective norms	.25 (.012)	-	.25 (.012)
	Perceived behavioral control	.41 (.005)	-	.41 (.005)

SMC=squared multiple correlation.

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