Correlation Between Patient Activation,Psychological Distress And Quality Of Life In Elderly Hypertensive Patients In The Community

Objective:To investigate the status quo of patient activation,psychological distress and quality of life of elderly hypertensive patients in the community,and analyze the influence of patient’s activation and psychological distress on quality of life and the correlation among these three variables,and construct a structural equation model to explore the relationship between these three variables.The path relationship and effect size can provide a theoretical basis for further formulating corresponding measures to improve the quality of life of patients.Methods:This study selected 450 elderly hypertensive patients in two communities in Xixiangtang District and Qingxiu District,Nanning City,Guangxi from March to October 2021 as the research objects.Patient activation measure（PAM）,the Kessler Psychological Distress Scale（K10）,and the MOS item short form health survey（SF-36）were used to conduct questionnaires.SPSS26.0 software was used to analyze the collected data.The general data of the patients were analyzed by descriptive statistics.The factors related to the patient’s activation,psychological distress and quality of life were analyzed by univariate analysis,nonparametric test and multiple linear regression analysis.Pearson correlation analysis was used to analyze the relationship among patient activation,psychological distress and quality of life.A structural equation model of the relationship among patient’s activation,psychological distress and quality of life was constructed by using the AMOS24.0 software.Results:1.This study distributed 457 questionnaires and recovered 450 valid questionnaires,with an effective rate of 98.5%.The activation score of elderly hypertensive patients in the community was（58.14±14.37）points,which was at the third level.The results of univariate analysis and multiple linear regression analysis showed that the educational level,per capita monthly income of the family,exercise habits,eating habits,hypertension classification,hypertension duration,other chronic diseases,weekly weight measurement and control,and participation in hypertension health educational lectures are the main affecting factors.2.The psychological distress score of elderly hypertensive patients in the community was（24.14±7.78）,which was at a poor level.The scores of anxiety and depression were（12.92±4.10）and（11.24±4.22）respectively.The results of univariate analysis and multiple linear regression analysis showed that education level,medical insurance,living conditions,exercise habits,eating habits,hypertension classification and participation in hypertension health education lectures were the main influencing factors.3.In this study,the total score of the quality of life of elderly hypertensive patients in the community was（435.33±106.48）points,and the scores of each dimension from high to low were physical pain（68.78±21.57）points,physiological function（68.01±16.01）points,emotional function（68.01±16.01）points（66.67±39.20）points,social function（66.67±16.51）points,mental health（49.12±10.93）points,physiological function（48.18±35.94）points,general health status（44.69±8.06）points and energy（44.62±14.40）points,the scores are lower than the domestic norm.The results of univariate analysis and multiple linear regression analysis showed that age,education level,medical insurance,exercise habits,eating habits,weekly weight measurement and control,and participation in hypertension health education lectures were the main factors for the quality of life of elderly hypertensive patients in the community.4.Correlation analysis showed that psychological distress was negatively correlated with activation,psychological distress was negatively correlated with quality of life,and activation was positively correlated with quality of life in community-based elderly hypertensive patients,the differences were statistically significant（P<0.05）.5.Structural equation model path analysis showed that psychological distress in community elderly patients with hypertension had a direct negative effect on enthusiasm（β=-3.367,P<0.001）;psychological distress had a direct negative effect on quality of life（β=-0.685）,P<0.001);positivity has a direct positive effect on quality of life（β=0.302,P<0.001）;positivity as a mediating variable of psychological distress and quality of life has an indirect effect on quality of life（β=-3.367×0.302=-1.017,P<0.001）.The total effect of psychological distress on quality of life wasβ_total=-1.702,of which positivity as a mediating effect accounted for 59.75%.Conclusions:1.Activation of elderly patients with hypertension in the community is positively correlated with quality of life,and psychological distress is negatively correlated with quality of life.In community-based elderly hypertensive patients,higher activation and lower psychological distress can improve the quality of life to a certain extent,respectively.2.Activation of elderly patients with hypertension in the community is the mediating effect of psychological distress and quality of life,that is,lower psychological distress can lead to higher activation,thereby changing the quality of life.The relationship among these three variables can also be verified by the structural equation model,that is,psychological distress directly affects activation,activation can directly affect quality of life,and positivity plays a mediating role between psychological distress and quality of life.Therefore,medical staff can improve the patient’s activation by improving the patient’s psychological state,and ultimately achieve the purpose of improving the quality of life of this population,and provide direction and theoretical basis for the formulation of health management plans.