A Structural Model for Quality of Life in Individuals with Rheumatoid Arthritis

류마치스성 관절염 환자의 삶의 질에 대한 구조 모형

The main purposes of the study were to develop and test a model which explains the dynamic relationship among factors reported as affecting to the quality of life of individuals with rheumatoid arthritis and to examine the relationship between self-help response and quaility of life. Data for the study were collected from March 1996 to December 1996 from 153 female patients who regularly visited a clinic for people with rheumatism. The patients were introduced to the investigators by nurses who worked at that clinic, and then the investigator interviewed the patients for 30 to 40 minutes to collect the data. Instruments used in the study were modified self-report questionaires from the ones which were already developed in previous studies or from related literature. Data analysis were performed using LISREL(Lineal Structural Relations) 8 program to test whether the proposed hypothesized model fit the collected data. To test the fitablity of the hypothesized model both a general fit measure and a detailed fit measure were used. Based on the test results from the various fit measures, the hypothesized model was found to be well suited to the real data. As characteristics related to illness becomes severe, the feasibility for these characteristics leading to the perception of uncertainty about the illness tend to increase, but, the direct effects from the illness characteristics(such as level of physical symptoms, sense of social-psychologic change, limitations of action) as they are related to the other intrinsic variables (self-efficacy or self-help behavior and quality of life), were found to be not significant. It was found that uncertainty had a direct effect on self-efficacy but did not have a direct effect on self-help behavior or quality of life. Also, it is noted that self-efficacy had a positive effect on self-help behavior and quality of life and there was a bilateral relationship between self-efficacy and self-help behavior. Lastly, the hypothesis proposed from the theoretical model in this study was supported basis of the results that self-help behavior provides both direct and positive effects to quality of life. Particularity, since a bilateral relationship was also found between self-help behavior and quality of life in the modified model, as self-help behavior increased, so did quality of life. And, reversely, as quality of life increased, so did self-help behavior. In conclusion, the results of this study suggest that focusing on both acquirement and reinforcement of adjustment factors or self-help behavior is more efficient than focusing on the characteristics of illness in establishing the stategies for improving quality of life of individuals with rheumatoid arthritis.