DOI QR코드

DOI QR Code

여성 류마티스 관절염 환자의 건강관련 삶의 질 구조모형

Health-related quality of life in female patients with reumatoid arthritis: a structural equation model

  • 김부경 (인제대학교 간호대학) ;
  • 성미혜 (인제대학교 간호대학 건강과학연구소)
  • Bukyung Kim (College of Nursing, Inje University) ;
  • Mi-Hae Sung (Institute of Health Science, College of Nursing, Inje University)
  • 투고 : 2022.10.24
  • 심사 : 2023.06.05
  • 발행 : 2023.06.30

초록

Purpose: This study aimed to construct a structural equation model to explain and predict factors affecting the health-related quality of life (QoL) in female rheumatoid arthritis (RA) patients based on the health-related QoL model by Ferrans et al. (2005) and a literature review. Methods: Patients (N=243) who were either registered members of an internet cafe composed of patients with RA or rheumatology outpatients at two tertiary general hospitals in Busan, Korea, were recruited via convenience sampling. Data were collected from July 2 to September 9, 2021, and the survey was conducted using a web-based questionnaire. The data were analyzed by SPSS and AMOS 26.0. Results: The goodness-of-fit statistics of the final model exhibited good results (χ2/degree of freedom=2.68, Turker-Lewis index=.94, comparative fit index=.96, standardized root mean-squared residual=.04, root mean- square error of approximation=.08), and 11 out of 14 paths of the model were supported. The squared multiple correlation, which reflected the explanatory power of the environmental characteristics, symptoms, functional status, and perceived health status on health-related QoL, was 80%. In the hypothesis model, 10 paths had significant direct effects, 6 paths had significant indirect effects, and 12 paths had significant total (direct and indirect) effects. Conclusion: Considering that factors directly affecting the health-related QoL of female patients with RA were social support, symptoms (fatigue and depression), resilience, and perceived health status, and that resilience was the most influential factor, clinicians can encourage resilience. Hence, to improve the health-related QoL of female patients with RA, continuing management is necessary, using various intervention methods that focus on enhancing resilience from the early stage to the end of treatment for RA.

키워드

참고문헌

  1. de Melo LF, Da-Silva SL. Neuropsychological assessment of cognitive disorders in patients with fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus. Rev Bras Reumatol. 2012;52(2):181-188. https://doi.org/10.1590/s0482-50042012000200003
  2. The Korea Disease Control and Prevention Agency. Rheumatoid arthritis [Internet]. Cheongju (Korea): Author; 2020 [cited 2022 Oct 23]. Available from: https://health.kdca.go.kr/healthinfo/biz/health/gnrlzHealthInfo/gnrlzHealthIn-fo/gnrlzHealthInfoView.do
  3. Yoo KH, Kim KS. A study on the pain, depression and relative factor perceived by rheumatoid arthritis patients. J Korean Acad Fundam Nurs. 2001;8(2):189-198.
  4. Lee HY. Structural equation modeling on quality of life in patients with rheumatoid arthritis [dissertation]. Chuncheon: Kangwon University; 2013. 97 p.
  5. Ware JE, Kosinski MA, Dewey JE. How to score version 2 of the SF-36 health survey (standard & acute forms). 3rd ed. Lincoln, RI: Quality Metric Inc.; 2001.
  6. Santos EJ, Duarte C, Ferreira RJ, Pinto AM, Geenen R, da Silva JA, et al. Determinants of happiness and quality of life in patients with rheumatoid arthritis: a structural equation modelling approach. Ann Rheum Dis. 2018;77(8):1118-1124. https://doi.org/10.1136/annrheumdis-2017-212934
  7. Oh HS, Kim YR. A structural model for quality of life in individuals with rheumatoid arthritis. J Korean Acad Nurs. 1997;27(3):614-626. https://doi.org/10.4040/jnas.1997.27.3.614
  8. Lee HO, Yoo JS. A structural equation model of health-related quality of life among older women following bilateral total knee replacement. J Korean Acad Nurs. 2020;50(4):554-570. http://doi.org/10.4040/jkan.19216
  9. Lim SY, Park HS. The effect of social support and cancer-specific posttraumatic growth on quality of life in female cancer patients in long-term hospital. J Wellness. 2018;13(4):1-11. https://doi.org/10.21097/ksw.2018.11.13.4.1
  10. Song YS. Determinants of resilience of the physically disabled at home [master's thesis]. Busan: Kosin University; 2004. 61 p.
  11. Steunebrink LM, Oude Voshaar MA, Taal E, Vonkeman HE, Zijlstra TR, van de Laar MA. Determinants of perceived health nonimprovement in early rheumatoid arthritis patients with favorable treatment outcomes. Arthritis Care Res (Hoboken). 2018;70(4):510-515. https://doi.org/10.1002/acr.23305
  12. Ferrans CE, Zerwic JJ, Wilbur JE, Larson JL. Conceptual model of health-related quality of life. J Nurs Scholarsh. 2005;37(4):336-342. https://doi.org/10.1111/j.1547-5069.2005.00058.x
  13. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273(1):59-65. https://doi.org/10.1001/jama.1995.03520250075037
  14. Jun SY, Ko IS. Structural equation modeling of quality of life in patients with uterine cancer. Korean J Adult Nurs. 2020;32(2):109-123. http://doi.org/10.7475/kjan.2020.32.2.109
  15. Lee SH, Kim HL. Structural equation modeling on self-care behavior and quality of life in older adults with diabetes using citizen health promotion centers. J Korean Acad Nurs. 2017;47(4):514-525. https://doi.org/10.4040/jkan.2017.47.4.514
  16. Wangsom A, Othaganont P, Ladores S. The factors predicting the health-related quality of life among persons with chronic obstructive pulmonary disease in public health region 4, Thailand: a mixed-methods study. Open Public Health J. 2020;13:105-113. https://doi.org/10.2174/1874944502013010105
  17. Leidy NK. Functional status and the forward progress of merry-go-rounds: toward a coherent analytical framework. Nurs Res. 1994;43(4):196-202. https://doi.org/10.1097/00006199-199407000-00002
  18. Eyler AE, Wilcox S, Matson-Koffman D, Evenson KR, Sanderson B, Thompson J, et al. Correlates of physical activity among women from diverse racial/ethnic groups. J Womens Health Gend Based Med. 2002;11(3):239-253. https://doi.org/10.1089/152460902753668448
  19. Wagnild GM, Young HM. Development and psychometric evaluation of the resilience scale. J Nurs Meas. 1993;1(2):165-178.
  20. Oh JH, Yi M. Structural equation modeling on quality of life in older adults with osteoarthritis. J Korean Acad Nurs. 2014;44(1):75-85. https://doi.org/10.4040/jkan.2014.44.1.75
  21. Ko YJ. The relationships among health behavior and self-efficacy, family support and depression in patients with rheumatoid arthritis. Nurs Sci. 2009;21(2):22-35.
  22. Lee KM. Factors influencing self-rated health in people with osteoarthritis and rheumatoid arthritis [master's thesis]. Seoul: Korea University; 2018. 74 p.
  23. Kim GS. Amos 18.0 analysis structural equating modeling. Seoul: Hannarae Academy; 2010. 664 p.
  24. Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Qual Life Res. 1993;2(2):153-159. https://doi.org/10.1007/BF00435734
  25. Min SK, Lee CI, Kim KI, Seo SY, Kim DK. Development of Korean version of WHO quality of life scale abbreviated version (WHOQOL-BREF). J Korean Neuropsychiatr Assoc. 2000;39(3):571-579.
  26. Chen G, Gully SM, Eden D. Validation of a new general self-efficacy scale. Organ Res Methods. 2001;4(1):62-83. https://doi.org/10.1177/109442810141004
  27. Cho SH, Lee HK, Oh EG, Kim GS, Kim YC, Park CG. Health-related quality of life among migrant workers: The impact of health-promoting behaviors. Nurs Health Sci. 2020;22(2):318-327. https://doi.org/10.1111/nhs.12660
  28. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30-41. https://doi.org/10.1207/s15327752jpa5201_2
  29. Shin JS, Lee YB. The effects of social supports on psychosocial well-being of the unemployed. Korean J Soc Welf. 1999;37:241-269.
  30. Schwartz JE, Jandorf L, Krupp LB. The measurement of fatigue: a new instrument. J Psychosom Res. 1993;37(7):753-762. https://doi.org/10.1016/0022-3999(93)90104-n
  31. Chang SJ. Standardization of collection and measurement of health statistics data. Seoul: The Korean Society for Preventive Medicine Seoul; 2000. p. 92-143.
  32. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385-401. https://doi.org/10.1177/014662167700100306
  33. Eaton WW, Muntaner C, Smith C, Tien A, Ybarra M. Center for epidemiologic studies depression scale: review and revision (CESD and CESD-R). In: Maruish ME, ed. The use of psychological testing for treatment planning and outcomes assessment. 3rd ed. Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 2004. p.363-377.
  34. Lee S, Oh ST, Ryu SY, Jun JY, Lee K, Lee E, et al. Validation of the Korean version of center for epidemiologic studies depression scale-revised (K-CESD-R). Korean J Psychosom Soc. 2016;24(1):83-93. https://doi.org/10.22722/KJPM.2016.24.1.083
  35. Speake DL, Cowart ME, Pellet K. Health perceptions and lifestyles of the elderly. Res Nurs Health. 1989;12(2):93-100. https://doi.org/10.1002/nur.4770120206
  36. Hwang MH. Structural model for self-care and well-being of the elderly [dissertaion]. Daegu: Kyungpook National University; 2000. 94 p.
  37. Woo JP. Structural equation model concept and understanding. Seoul: Hannarae Academy; 2012. 568 p.
  38. Liu L, Xu X, Xu N, Wang L. Disease activity, resilience and health-related quality of life in Chinese patients with rheumatoid arthritis: a multi-center, cross-sectional study. Health Qual Life Outcomes. 2017;15(1):149. https://doi.org/10.1186/s12955-017-0725-6
  39. Koo BJ. The influence of resilience, hope, marital intimacy, and family support on quality of life for middle-aged women. J Korean Acad Psych Mental Health Nurs. 2008;17(44):421-430. https://doi.org/10.12934/jkpmhn.2008.17.4.421
  40. Park JS, Oh H, Park W, Kwon S, Ham O, Suh Y, et al. Causal relationships between modifiable risk factors of cognitive impairment, cognitive function, self-management, and quality of life in patients with rheumatic diseases. Orthopaedic Nursing. 2018;37(5):305-315. https://doi.org/10.1097/nor.0000000000000481
  41. Overman CL, Kool MB, Da Silva JA, Geenen R. The prevalence of severe fatigue in rheumatic diseases: an international study. Clin Rheumatol. 2016;35(2):409-415. https://doi.org/10.1007/s10067-015-3035-6
  42. Sheehy C, Murphy E, Barry M. Depression in rheumatoid arthritis--underscoring the problem. Rheumatology (Oxford). 2006;45(11):1325-1327. https://doi.org/10.1093/rheumatology/kel231
  43. Strating MM, Suurmeijer TP, van Schuur WH. Disability, social support, and distress in rheumatoid arthritis: results from a thirteen-year prospective study. Arthritis Rheum. 2006;55(5):736-744. https://doi.org/10.1002/art.22231
  44. Martinez-Marti ML, Ruch W. Character strengths predict resilience over and above positive affect, self-efficacy, optimism, social support, self-esteem, and life satisfaction. J Posit Psychology. 2017;12(2):110-119. https://doi.org/10.1080/17439760.2016.1163403