An explanatory model of health promotion and quality of life in chronic disabling conditions

Background: Although previous studies have examined selected factors influencing health-promoting behaviors or quality of life, the complex interplay of these variables in persons with chronic disabling conditions has not been investigated. Objective: To test an explanatory model of variables influencing health promotion and quality of life (Stuifbergen & Rogers, 1997) in persons living with the chronic disabling condition of multiple sclerosis (MS). Methods: A sample of 786 persons with MS (630 women and 156 men) completed a battery of instruments measuring severity of illness-related impairment, barriers to health-promoting behaviors, resources, self-efficacy, acceptance, health-promoting behaviors, and perceived quality of life. The proposed model was assessed and modified using the weighted least squares procedure (WLS), which is implemented by LISREL8 (Joreskog & Sorbom, 1993). Results: The initial model was modified to obtain a recursive model with adequate fit, chi (2) (8, N= 786) = 77, p < 0.05; GFI = 0.96; IFI = 0.98; CFI = 0.98. The antecedent variables accounted for 58% of the variance in the frequency of health-promoting behaviors and 66% of the variance in perceived quality of life. The effects of severity of illness on quality of life were mediated partially by health-promoting behaviors, resources, barriers, self-efficacy and acceptance. Conclusions: The final model supports the hypothesis that quality of life is the outcome of a complex interplay among contextual factors (severity of illness), antecedent variables (Stuifbergen & Rogers, 1997), and health-promoting behaviors. The strength of direct and indirect paths suggests that interventions to enhance social support, decrease barriers, and increase specific self-efficacy for health behaviors would result in improved health-promoting behaviors and quality of life. Further research using a longitudinal design is needed to clarify the effects of the interaction between health-promoting behaviors and trajectory of illness on quality of life for persons with chronic disabling conditions.