대한간호학회지 (Journal of Korean Academy of Nursing)

한국간호과학회 (Korean Society of Nursing Science)
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Influence of Illness Uncertainty on Health Behavior in Individuals with Coronary Artery Disease: A Path Analysis

  • Jeong, Hyesun (Department of Nursing, Graduate School, Pusan National University) ;
  • Lee, Yesul (Department of Nursing, Graduate School, Pusan National University) ;
  • Park, Jin Sup (Department of Cardiology, Medical Research Institute, Pusan National University Hospital) ;
  • Lee, Yoonju (College of Nursing, Research Institute of Nursing Science, Pusan National University)
  • 투고 : 2023.10.16
  • 심사 : 2024.04.15
  • 발행 : 2024.05.31
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초록

Purpose: This study aimed to investigate the influence of uncertainty-related factors on the health behavior of individuals with coronary artery disease (CAD) based on Mishel's uncertainty in illness theory (UIT). Methods: We conducted a cross-sectional study and path analysis to investigate uncertainty and factors related to health behavior. The study participants were 228 CAD patients who visited the outpatient cardiology department between September 2020 and June 2021. We used SPSS 25.0 and AMOS 25.0 software to analyze the data. Results: The final model demonstrated a good fit with the data. Eleven of the twelve paths were significant. Uncertainty positively affected danger and negatively affected self-efficacy and opportunity. Danger had a positive effect on perceived risk. Opportunity positively affected social support, self-efficacy, perceived benefit and intention, whereas it negatively affected perceived risk. Social support, self-efficacy, perceived benefit and intention had a positive effect on health behavior. We found that perceived benefit and intention had the most significant direct effects, whereas self-efficacy indirectly affected the relationship between uncertainty and health behavior. Conclusion: The path model is suitable for predicting the health behavior of CAD patients who experience uncertainty. When patients experience uncertainty, interventions to increase their self-efficacy are required first. Additionally, we need to develop programs that quickly shift to appraisal uncertainty as an opportunity, increase perceived benefits of health behavior, and improve intentions.

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과제정보

The authors acknowledge the contributions of all the study participants.

참고문헌

  1. World Health Organization (WHO). Cardiovascular diseases (CVDs) [Internet]. WHO; c2021 [cited 2023 May 3]. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
  2. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: Update from the GBD 2019 Study. Journal of the American College of Cardiology. 2020;76(25):2982-3021. Erratum in: Journal of the American College of Cardiology. 2021;77(15):1958-1959.  https://doi.org/10.1016/j.jacc.2020.11.010
  3. Korea National Statistical Office. Statistics on causes of death [Internet]. Statistics Korea; c2019 [cited 2023 May 3]. Available from: https://kostat.go.kr/board.es?mid=a10301060200&bid=218&act=view&list_no=385219.
  4. Ritchey MD, Wall HK, George MG, Wright JS. US trends in premature heart disease mortality over the past 50 years: Where do we go from here? Trends in Cardiovascular Medicine. 2020;30(6):364-374. https://doi.org/10.1016/j.tcm.2019.09.005
  5. Ohira T, Iso H. Cardiovascular disease epidemiology in Asia: An overview. Circulation Journal. 2013;77(7):1646-1652. https://doi.org/10.1253/circj.cj-13-0702
  6. Chacko L, Howard JP, Rajkumar C, Nowbar AN, Kane C, Mahdi D, et al. Effects of percutaneous coronary intervention on death and myocardial infarction stratified by stable and unstable coronary artery disease: A meta-analysis of randomized controlled trials. Circulation: Cardiovascular Quality and Outcomes. 2020;13(2):e006363. http://doi.org/10.1161/CIRCOUTCOMES.119.006363
  7. Health Insurance Review & Assessment Service (HIRA). Results of the 6th adequacy evaluation for coronary artery bypass surgery [Internet]. Health Insurance Review & Assessment Service; c2020 [cited 2021 Aug 10]. Available from: https://www.hira.or.kr/cms/open/04/04/12/2020_3.pdf.
  8. Lemesle G, Sudre A, Modine T, Delhaye C, Rosey G, Gourlay T, et al. High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis. Catheterization and Cardiovascular Interventions. 2008;72(4):470-478. https://doi.org/10.1002/ccd.21709
  9. Ahn S, Song R, Choi SW. Effects of self-care health behaviors on quality of life mediated by cardiovascular risk factors among individuals with coronary artery disease: A structural equation modeling approach. Asian Nursing Research. 2016;10(2):158-163. https://doi.org/10.1016/j.anr.2016.03.004
  10. Subih M, Al-Kalaldeh M, Salami I, Al-Hadid L, Abu-Sharour L. Predictors of uncertainty among postdischarge coronary artery bypass graft patients in Jordan. Journal of Vascular Nursing. 2018;36(2):85-90. https://doi.org/10.1016/j.jvn.2017.11.001
  11. Mishel MH. Reconceptualization of the uncertainty in illness theory. Image: The Journal of Nursing Scholarship. 1990;22(4):256-262. https://doi.org/10.1111/j.1547-5069.1990.tb00225.x
  12. Mishel MH. Uncertainty in illness. Image: The Journal of Nursing Scholarship. 1988;20(4):225-232. https://doi.org/10.1111/j.1547-5069.1988.tb00082.x
  13. Karami N, Kazeminia M, Karami A, Salimi Y, Ziapour A, Janjani P. Global prevalence of depression, anxiety, and stress in cardiac patients: A systematic review and meta-analysis. Journal of Affective Disorders. 2023;324:175-189. https://doi.org/10.1016/j.jad.2022.12.055
  14. Chen TY, Kao CW, Cheng SM, Chang YC. Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure. PLoS One. 2018;13(11):e0205953. Erratum in: PLoS One. 2019;14(3):e0214825. https://doi.org/10.1371/journal.pone.0205953
  15. Liu N, Liu S, Yu N, Peng Y, Wen Y, Tang J, et al. Correlations among psychological resilience, self-efficacy, and negative emotion in acute myocardial infarction patients after percutaneous coronary intervention. Frontiers in Psychiatry. 2018;9:1. https://doi.org/10.3389/fpsyt.2018.00001
  16. Li X, He L, Wang J, Wang M. Illness uncertainty, social support, and coping mode in hospitalized patients with systemic lupus erythematosus in a hospital in Shaanxi, China. PLoS One. 2019;14(2):e0211313. https://doi.org/10.1371/journal.pone.0211313
  17. Guan T, Santacroce SJ, Chen DG, Song L. Illness uncertainty, coping, and quality of life among patients with prostate cancer. Psychooncology. 2020;29(6):1019-1025. https://doi.org/10.1002/pon.5372
  18. Jang HS, Lee CS, Yang YH. Influence of uncertainty and uncertainty appraisal on self-management in hemodialysis patients. Journal of Korean Academy of Nursing. 2015;45(2): 271-279. https://doi.org/10.4040/jkan.2015.45.2.271
  19. White RE, Frasure-Smith N. Uncertainty and psychologic stress after coronary angioplasty and coronary bypass surgery. Heart & Lung. 1995;24(1):19-27. https://doi.org/10.1016/s0147-9563(05)80091-3
  20. Webster KK, Christman NJ. Perceived uncertainty and coping post myocardial infarction. Western Journal of Nursing Research. 1988;10(4):384-400. https://doi.org/10.1177/019394598801000403 
  21. Budner S. Intolerance of ambiguity as a personality variable. Journal of Personality. 1962;30(1):29-50. https://doi.org/10.1111/j.1467-6494.1962.tb02303.x
  22. Pearlin LI, Schooler C. The structure of coping. Journal of Health and Social Behavior. 1978;19(1):2-21. https://doi.org/10.2307/2136319
  23. Cho SH, Yun KS. Influence of uncertainty, physiologic risk factors, self-efficacy on self-management in stroke patients. Journal of Muscle and Joint Health. 2016;23(2):114-124. https://doi.org/10.5953/JMJH.2016.23.2.114
  24. Orom H, Biddle C, Waters EA, Kiviniemi MT, Sosnowski AN, Hay JL. Causes and consequences of uncertainty about illness risk perceptions. Journal of Health Psychology. 2020; 25(8):1030-1042. https://doi.org/10.1177/1359105317745966
  25. Thompson NM, Bevan JL, Sparks L. Healthcare reform information-seeking: Relationships with uncertainty, uncertainty discrepancy, and health self-efficacy. Journal of Communication in Healthcare. 2012;5(1):56-66. https://doi.org/10.1179/1753807611Y.0000000016
  26. Bentler PM, Chou CP. Practical issues in structural modeling. Sociological Methods & Research. 1987;16(1):78-117. https://doi.org/10.1177/0049124187016001004
  27. Hair JF. Multivariate data analysis: A global perspective. 7th ed. Prentice Hall; 2009. p. 637.
  28. Mishel MH. The measurement of uncertainty in illness. Nursing Research. 1981;30(5):258-263. https://doi.org/10.1097/00006199-198109000-00002
  29. Chung C, Kim MJ, Rhee MH, Do HG. Functional status and psychosocial adjustment in gynecologic cancer patients receiving chemotherapy. Korean Journal of Women Health Nursing. 2005;11(1):58-66. https://doi.org/10.4069/kjwhn.2005.11.1.58
  30. Mishel MH, Sorenson DS. Uncertainty in gynecological cancer: A test of the mediating functions of mastery and coping. Nursing Research. 1991;40(3):167-171. https://doi.org/10.1097/00006199-199105000-00010
  31. Cha K, Kim K. Impact of uncertainty on resilience in cancer patients. Asian Oncology Nursing. 2012;12(2):139-146. https://doi.org/10.5388/aon.2012.12.2.139
  32. Sherbourne CD, Stewart AL. The MOS social support survey. Social Science & Medicine. 1991;32(6):705-714. https://doi.org/10.1016/0277-9536(91)90150-b
  33. Lim MK, Kim MH, Shin YJ, Yoo WS, Yang BM. Social support and self-rated health status in a low income neighborhood of Seoul, Korea. Korean Journal of Preventive Medicine. 2003;36(1):54-62.
  34. Gruber-Baldini AL, Velozo C, Romero S, Shulman LM. Validation of the PROMIS®  measures of self-efficacy for managing chronic conditions. Quality of Life Research. 2017;26(7): 1915-1924. https://doi.org/10.1007/s11136-017-1527-3
  35. Woringer M, Nielsen JJ, Zibarras L, Evason J, Kassianos AP, Harris M, et al. Development of a questionnaire to evaluate patients' awareness of cardiovascular disease risk in England's National Health Service Health Check preventive cardiovascular programme. BMJ Open. 2017;7(9):e014413. https://doi.org/10.1136/bmjopen-2016-014413
  36. Song R, Oh H, Ahn S, Moorhead S. Validation of the cardiac health behavior scale for Korean adults with cardiovascular risks or diseases. Applied Nursing Research. 2018;39:252-258. https://doi.org/10.1016/j.apnr.2017.11.011
  37. Kline RB. Principles and practice of structural equation modeling. 3rd ed. Guilford Press; 2011. p. 60-214. 
  38. Becker TE. Potential problems in the statistical control of variables in organizational research: A qualitative analysis with recommendations. Organizational Research Methods. 2005;8(3):274-289. https://doi.org/10.1177/1094428105278021
  39. Kim K, Park W. Effects of mobile navigation program in colorectal cancer patients based on uncertainty theory. Journal of Korean Academy of Nursing. 2019;49(3):274-285.  https://doi.org/10.4040/jkan.2019.49.3.274
  40. Jones CJ, Smith HE, Llewellyn CD. A systematic review of the effectiveness of interventions using the Common Sense Self-Regulatory Model to improve adherence behaviours. Journal of Health Psychology. 2016;21(11):2709-2724. https://doi.org/10.1177/1359105315583372
  41. Sankaran S, Dendale P, Coninx K. Evaluating the impact of the HeartHab app on motivation, physical activity, quality of life, and risk factors of coronary artery disease patients: Multidisciplinary crossover study. JMIR mHealth and uHealth. 2019;7(4):e10874. https://doi.org/10.2196/10874
  42. Karatas T, Polat u. Effect of nurse-led program on the exercise behavior of coronary artery patients: Pender's Health Promotion Model. Patient Education and Counseling. 2021; 104(5):1183-1192. https://doi.org/10.1016/j.pec.2020.10.003
  43. Komasi S, Saeidi M. A perceived risk factor may lead to increased anxiety and depression in cardiovascular patients. Jundishapur Journal of Chronic Disease Care. 2016;5(4): e34159. https://doi.org/10.17795/jjcdc-34159 
  44. Won MH, Son YJ. Perceived social support and physical activity among patients with coronary artery disease. Western Journal of Nursing Research. 2017;39(12):1606-1623. https://doi.org/10.1177/0193945916678374
  45. Jiang X, Wang J, Lu Y, Jiang H, Li M. Self-efficacy-focused education in persons with diabetes: A systematic review and meta-analysis. Psychology Research and Behavior Management. 2019;12:67-79. https://doi.org/10.2147/PRBM.S192571
  46. Kim SY, Kim MY. Development and effectiveness of tailored education and counseling program for patients with coronary artery disease undergoing percutaneous coronary intervention. Korean Journal of Adult Nursing. 2017;29(5):547-559. https://doi.org/10.7475/kjan.2017.29.5.547
  47. Kim J, Kim O. A health behavior prediction model for patients with coronary artery disease. Clinical Nursing Research. 2019;28(2):217-234. https://doi.org/10.1177/1054773817725868