The Effects Of Individual Social Capital On The Health-related Quality Of Life Among Rural Seniors With Hypertension

BackgroundThe rapid development of population aging is accompanying with the acceleration of the incidence of multiple chronic diseases in China.Hypertension is especially one of the most common chronic diseases in the Chinese aging population.Due to its long disease trajectory,high prevalence rate,and high treatment fee,hypertension always leads to heavy burden to patients and their families.In particular,the prevalence of hypertension in the elderly population in rural areas is currently growing faster than the prevalence in urban areas of China.However,the infrastructure construction such as medical and health services in most of Chinese rural areas is relatively weak.Thus,how to contribute the quality of life of rural seniors with hypertension might be a key challenge under the background of "Healthy Aging" in China."Social capital" has been mentioned by lots of scholars in the field of health service research,and it also has been expected to bring some fresh perspectives to the research of health-related quality of life(HRQoL)of old persons.With the promotion and development of"Home Care","Community Care",and "Mutual Care" for the elderly in recent year,assessing the impacts of social capital and its following resources on the HRQoL of rural seniors are meaningfulObjectivesBased on the cross-sectional and longitudinal research design,this study aims to explore the status of individual social capital and its influencing factors in Chinese rural seniors with hypertensive in baseline time,observe the changes in HRQoL of this population over time,and also the impact of individual social capital in baseline time on the HRQoL measured longitudinally.In order to provide evidence-based suggestions for enhancing HRQoL of rural seniors with hypertension.MethodsThe study collected the required variables using the two programs:"Research on the Health Equity of Rural Seniors,based on the Social Network Prospective,Social Capital Theory" and "Development of Medication Adherence Scale of Rural Seniors with Hypertension and Analysis of Working Mechanism of Behavior Model".The investigation team conducted the household surveys on 12 villages in 3 townships of 3 counties in Shandong Province in 2013 and 2016,respectively.According to the objectives of this research,the subjects who were hypertensive patients aged 60-75 would be included.After extracting,sorting,eliminating,and merging of the data,the number of valid samples who successfully finished the whole survey blocks is 306.The variables for the research mainly include three parts:general individual characteristics of the patient in 2013,information on the social capital of the patient in 2013,HRQoL of the patient both in 2013 and 2016.The tool of "Resource Generator"was applied to measure the individual social capital of patients such as domestic resources,expert advice resources,personal skills resources,and problem-solving resources.And the physical health component and mental health component of the HRQoL was measured by the SF-36 scale.Firstly,the statistical description of the general individual characteristics,social capital status in 2013,HRQoL of the sample population in 2013 and 2016 was performed.Second,the independent-sample t-test and One-way ANOVA analysis were applied to analyze the influence of general characteristics on social capital status and HRQoL at different periods,respectively;a paired-sample t-test was used to analyze the significance of the difference between each dimension of the HRQoL of patient in 2013 and each dimension of the HRQoL in 2016;Pearson correlation analysis was used to test the relationship between social capital and the HRQoL of patient at different periods.Finally,as an effective method to deal with the correlation between repeated measurements of an individual variable with fixed characteristic,the Generalized Estimating Equation model was finally applied in this study and aimed to explore the influencing factors of social capital in baseline time on the HRQoL of rural seniors with hypertensive in both of baseline time and follow-up time,after controlling the effects of confounding factors.Main Results(1)The total social capital score of rural seniors with hypertensive measured by"Resource Generator" is(18.26±3.59),which is at a moderately high level.Among them,the accessibility of domestic resources is the best,followed by the accessibility of problem-solving resources.Expert advice resources have a moderate accessibility degree,and personal skill resources have the weakest accessibility.Through single factor analysis,it shows that gender,marital status,living style,education level,occupation,and annual household income are key influencing factors of the total social capital score.(2)Using the SF-36 scale,the average physical health score of rural seniors with hypertensive in 2013 was(255.43±99.35),and the mental health score was(317.07±83.54);the physical health score of the patients in 2016 was(233.90 ±98.96),the mental health score is(288.58±85.51);the overall HRQoL of the patient is relatively poor,and the score in 2016 is slightly lower than that of 2013.Through single factor analysis,it can be seen that gender,marital status,living status,education level,occupation,annual household income,smoking status,and drinking status might bring about different effects on the physical and mental health of patients in different periods.(3)The Generalized Estimating Equation model shows that after controlling for confounding factors,domestic resources(β=10.125,P<0.01),expert advice resources(β=8.177,P<0.01),and problem-solving resources(β=16.508,P<0.01)all have a statistically significant positive impact on the physical health of the population.Domestic resources(β=8.605,P<0.01),problem-solving resources(β=15.031,P<0.01)have a statistically significant positive impact on patients’ mental health,while person skill resources have no statistically significant impact on both of physical and mental health of patients.Conclusion and SuggestionsThis study found that the HRQoL of rural seniors with hypertensive is generally at a low level,and gender,marital status,living style,education level,occupation,annual household income,and social capital are the main influencing factors.Social capital and its constituent elements have an impact on the HRQoL.The main impacts are as follows:(1)Domestic resources,expert advice resources,and problem-solving resources have the impact on the patient’s physical health;(2)Domestic resources and problem-solving resources have the impact on the mental health of patients.In order to further improve the HRQoL of the elderly,we put forward the following suggestions based on the results:(1)Revive traditional Chinese culture of filial piety and rural mutual assistance,promote the formation of a complementary relationship between family care for the elderly and community care for the elderly,for improving the accessibility of the domestic resources and problem-solving resources of the elderly;(2)Health-related departments of government should take measures like improving the health management files of rural elderly,conducting the chronic disease management activities and lectures,popularizing the health knowledge,and medical staff need to communicate actively with the elderly,for improving the accessibility of expert advice resources and person skill resources of the elderly;(3)Community/rural grassroots organizations attach importance to the moral education of residents and advocate the traditional virtues of mutual help among neighbors,at the same time,strengthen the construction of community cultural activities,for contributing the social participation,expanding the social network,and increasing the social capital level of the elderly.(4)Distinguish the vulnerable groups and mainly focusing on the role of social capital in promoting the HQRoL of women,people widowed or living alone,the low-education,the low-income,and agricultural workers.