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심부전 환자의 건강관련 삶의 질 영향요인
- Subtitle
- Rector의 심부전 관련 삶의 질 모델을 중심으로
- Alternative Title
- Factors affecting the Health-Related Quality of Life in Patient with Heart Failure - Based on Rector's Model of Quality of Life Relation to Heart Failure -
- Author(s)
- 박주경
- Alternative Author(s)
- Ju-kyung Park
- Advisor
- 김춘자
- Department
- 일반대학원 간호학과
- Publisher
- The Graduate School, Ajou University
- Publication Year
- 2022-02
- Language
- kor
- Abstract
- 본 연구는 Rector의 심부전 관련 삶의 질 모델을 중심으로 심부전 환자의 건강관련 삶의 질에 대한 영향요인을 파악하기 위해 시도된 서술적 조사연구이다. 본 연구는 경기도 S시 소재 일 대학병원에서 총 165명의 심부전 환자를 대상으로 2021년 7월 23일부터 9월 15일까지 구조화된 설문조사 및 신체계측을 통하여 자료수집 하였다. 건강관련 삶의 질은 Rector 등(1987)의 한국판 미네소타 심부전 삶의 질 도구를 사용하여 측정하였다. 영향요인으로 증상은 Friedman(2003)의 한국판 심부전 관련 증상 체크리스트로, 기능 제한은 성지동 등(2000)의 한국판 기능수행척도를 사용하여 각각 측정하였다. 심리적 디스트레스에서 디스트레스는 김종흔(2009)이 번안한 한국판 디스트레스 온도계 및 문제목록 도구를, 우울은 Radloff(1977)의 한국판 역학연구 우울척도를 사용하여 각각 측정하였다. 사회적 지지는 임민경(2002)이 번안한 한국판 Medical Outcomes Study Social Support Survey (MOS-SSS)도구를 사용하여 측정하였다. 수집된 자료는 IBM SPSS Statistics 25.0 프로그램을 이용하여 연구목적 및 측정변수의 척도수준에 따라 기술통계, Independent t-test와 one-way ANOVA, Pearson’s correlation coefficient 및 Hierarchical multiple regression analysis로 분석하였다. 본 연구목적에 따른 주요 결과는 다음과 같다. 1. 연구대상자의 건강관련 삶의 질 정도는 평균 24.32점(가능범위 0-105점, 점수가 낮을수록 삶의 질이 높음)으로 중등도 이상으로 나타났다. 영향요인에서 증상과 기능 제한 정도는 각각 평균 4.32점(최대 13점), 43.89점(최대 77점)으로 낮았으나, 사회적 지지는 평균 75.58점(최대 100점)으로 중등도 이상으로 나타났다. 심리적 디스트레스에서 우울 정도는 평균 16.81점(최대 60점)으로 우울절단점(16점 이상)수준이었으며 디스트레스 정도는 온도계 평균 3.41점(최대 10점)과 문제목록 평균 6.31점(최대 24점)으로 낮았다. 2. 일반적 및 질병관련 특성 따른 건강관련 삶의 질의 관련성에 대한 단변량 분석에서 성별(t=-3.059, p=.003)과 연령(t=-6.792, p<.001), 교육 정도(t=8.677, p<.001), 결혼상태(F=14.078, p<.001), 배우자유무(t=-2.708, p=.007), 직업유무(t=-7.350, p<.001), 월 총수입(t=3.182, p=.002), 주관적 경제 상태(F=5.153, p=.007), 1회 복용 약물(t=-3.959, p<.001), 상대 악력(t=5.025, p=.002), 종아리 둘레(F=12.331, p<.001), 좌심실 박출률(t=2.360, p=.019), NYHA class(F=132.136, p<.001), 호흡곤란-피로 지수(t=12.824, p<.001), 동반질환도(t=-3.119, p=.002)에 따라 건강관련 삶의 질에 통계적으로 유의한 차이가 있었다. 3. 건강관련 삶의 질은 주요 영향요인인 증상(r=.586, p<.001), 심리적 디스트레스(우울 r=.712, p<.001, 디스트레스 온도계 r=.423, p<.001, 디스트레스 문제목록 r=.671, p<.001)와 유의한 양의 상관관계가 있었으며, 기능 제한(r=-.756, p<.001), 사회적 지지(구조적 지지 r=-.370, p<.001, 기능적 지지 r=-.226, p=.001)와 유의한 음의 상관관계가 있었다. 4. 단변량 분석에서 유의하였던 변수를 통제한 후의 최종회귀모형에서 건강관련 삶의 질에 통계적으로 유의한 영향요인은 증상(β=120, p=.034), 기능 제한(β=-.351, p<.001), 심리적 디스트레스(우울 β=322, p<.001, 디스트레스 β=.112, p=.038)로 나타났다. 최종 회귀모형은 건강관련 삶의 질을 총 72% 설명하였다(R2=.747, Adjusted. R²=.721; F=29.261, p<.001). 본 연구결과 심부전 환자의 건강관련 삶의 질의 유의한 영향요인은 증상과 기능 제한, 심리적 디스트레스로 확인되었다. 따라서 본 연구결과를 토대로 심부전 환자의 증상을 완화시키고 신체기능을 향상시키며 심리적 디스트레스를 완화시키는 중재전략을 활용한 프로그램을 개발하여 궁극적으로 건강관련 삶의 질의 향상을 개선하는 전향적 연구를 제언한다.
- Alternative Abstract
- This research was conducted as a descriptive study to identify the factors influencing health-related quality of life in patients with heart failure using Rector’s conceptual model of quality of life relation to heart failure. The participants in this study were 165 patients with heart failure from A university medical center located in Suwon, South Korea. The data were collected via structured surveys and physical examinations performed between July 23 and September 15, 2021 after approval of IRB. Health-related Quality of Life was measured using the Korean version of the Minnesota Living with Heart Failure questionnaire(MLHFQ) developed by Rector et al. (1987). Regarding influencing factors, symptoms were measured using the Korean version of the Heart Failure Symptom Checklist by Friedman(2003), and functional limitations were measured using the Korean Activity Scale/Index (KASI) by Seong(2000). To measure psychological distress, the Korean version of the distress thermometer(DT) and problem list(PL) that was translated by Kim (2009) were used, and depression was measured using the Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D) by Radloff (1977). The Korean version of the Medical Outcomes Study Social Support Survey (MOS-SSS) translated by Lim (2002) was used to measure social support. The collected data were analyzed using the IBM SPSS Statistics 25.0 program. The measured variables were analyzed through descriptive statistics, an independent t-test, a one-way ANOVA, Pearson’s correlation coefficient, and hierarchical multiple regression analysis. The main results of this study are as follows. 1. The mean score of participants’ health-related quality of life was 24.32 points(score range:0-105, with lower scores indicating higher levels of QoL), suggesting a moderate or high health-related quality of life. Regarding influencing factors, the mean scores of symptoms and functional limitations were low, at 4.32 point (maximum of 13) and 43.89 point (maximum of 77), respectively, while the score for social support was 75.58 point (maximum of 100), indicating a moderate or high level. Regarding psychological distress, the mean score of depression was 16.81 point (maximum of 60), which is close to the cut-off (16 point of higher), and the mean scores of distress were low at 3.41 point (maximum of 10) on the DT and 6.31 point (maximum of 24) on the PL. 2. In the univariate analysis of the correlation of health-related quality of life with general and disease-related characteristics, a significant variation in health-related quality of life was found for gender (t=-3.059, p=.003), age (t=-6.792, p<.001), education (t=8.677, p<.001), marital status (F=14.078, p<.001), presence or absence of spouse (t=-2.708, p=.007), occupation (t=-7.350, p<.001), monthly income (t=3.182, p=.002), subjective economic status (F=5.153, p=.007), single dose drug (t=-3.959, p<.001), relative grip strength (t=5.025, p=.002), calf circumference (F=12.331, p<.001), LVEF (t=2.360, p=.019), NYHA class (F=132.136, p<.001), Dyspnea-Fatigue Index (t=12.824, p<.001), and Charlson Comorbidity Index (t=-3.119, p=.002). 3. Health-related quality of life showed a significantly positive correlation with the main influencing factors of symptoms (r=.586, p<.001) and psychological distress (CES-D r=.712, p<.001, DT r=.423, p<.001, PL r=.671, p<.001) and a significantly negative correlation with functional limitations (r=-.756, p<.001) and social support (structural support r=-.370, p<.001, functional support r=-.226, p=.001). 4. The final regression model after the adjustment of variables with a significant result in the univariate analysis showed that the significant influencing factors of health-related quality of life were symptoms (β=120, p=.034), functional limitations (β=-.351, p<.001), and psychological distress (depression β=322, p<.001, distress β=.112, p=.038). The final regression model had an explanatory power of 72% for health-related quality of life (R2=.747, adjusted R²=.721; F=29.261, p<.001). The findings in this study show that the significant influencing factors of health-related quality of life in patients with heart failure are symptoms, functional limitations, and psychological distress. Based on these findings, an intervention program should be developed to alleviate symptoms in patients with heart failure, enhance their physical functions, and moderate their psychological distress with an ultimate goal of enhancing their health-related quality of life. For this, a prospective study should be conducted.
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- Graduate School of Ajou University > Department of Nursing > 3. Theses(Master)
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