DOI: 10.14457/tu.the.2020.121
title: Causal factors in health-related quality of life among Thai persons with chronic obstructive pulmonary disease: a mixed methods study

description: Health-related quality of life (HRQOL) is an important consideration for persons living with chronic obstructive pulmonary disease (COPD). This convergent parallel mixed methods study aimed to examine the factors predicting HRQOL and explore a comprehensive in-depth understanding of the factors associated with HRQOL among Thai persons with COPD. The conceptual framework was a revised version of Wilson and Cleary’s health-related quality of life and integrative literature review. The simple random sampling resulted in 240 participants who were Thai persons with COPD coming for follow-ups at the chest clinics of hospitals in Health Region 4 of Thailand from August to December 2018. The research instruments were self-reported questionnaires including a demographic data form, St. George’s Respiratory Questionnaire for COPD patients (SGRQ-C), a fat-free mass index (FFMI) record form, the Multi-dimensional Scale of Perceived Social Support (MSPSS), a peak expiratory flow rate (PEFR) record form and the Functional Performance Inventory Short Form (FPI-SF). Concurrently, the purposive sampling resulted in 30 participants who had different scores for the SGRQ-C in the qualitative semi-structured interviews. The quantitative data were analyzed by the computer software, Statistical Package for the Social Sciences (SPSS) for Windows, by using descriptive statistics, ANOVA, independent t-test and hierarchical stepwise multiple regression analysis. The qualitative data were analyzed by the computer software, ATLAS.ti for Windows, by using content analysis. Side-by-side joint display tables were used to merge the data and compare the quantitative and qualitative findings presented as both similar and dissimilar within each predictor variable. The results of the study indicate that the majority of the participants had moderate levels of HRQOL associated with experience of physical symptoms, psychological symptoms, perceived social isolation and adherence to self-care practices related to COPD. Social support was the strongest predictor of HRQOL, followed by nutritional status, pulmonary function and functional performance accounting for 80.10 percent of the variances in HRQOL, which is interpreted as a high level. Four variables had significantly negative direct effects and negative indirect effects on HRQOL by using SGRQ-C scores. The participants perceived that social support can create encouragement, build convenience and lead to good recommendations received among persons with COPD. The participants also reported the effects of COPD to be insufficient nutrients, deterioration of pulmonary function and activity limitations. As a result, the participants had greater awareness of self-care with regard to food consumption, reducing and preventing and functional performance in living with COPD. However, age was not statistically significant in terms of negative direct effects on HRQOL and had insignificant positive indirect effects on HRQOL. Most of the participants in the present study were elderly persons with COPD who perceived differences in age as incapable of predicting disease prognosis. Gender was not statistically significant in terms of negative direct effects on HRQOL and had insignificant negative indirect effects on HRQOL. Most of the participants were males who perceived differences in gender as incapable of predicting disease prognosis. Therefore, the results of this study indicate that nurses and healthcare teams can modify the predicting factors and implement appropriate care leading to increased HRQOL among persons with COPD.