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A Structural Model of Alcohol Abstinence Behavior among Patients with Chronic Liver Diseases

Tae Kyung Kim1, Hye Sook Min2
Korean Journal of Adult Nursing 2018;30(1):30-40.
Published online: February 18, 2018

1Department of Nursing, Dongju College, Busan, Korea

2Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Min, Hye Sook https://orcid.org/0000-0002-9292-1944 Department of Nursing, Dong-A University, 32 Dasingongwon-ro, Se-gu, Busan 49201, Korea. Tel: +82-51-240-2872, Fax: +82-51-240-2920, E-mail: hsmin@dau.ac.kr
- This manuscript is a revision of the first author's doctoral dissertation from Dong-A University.
• Received: September 19, 2017   • Accepted: February 14, 2018

© 2018 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was conducted to construct and test a hypothetical model for alcohol abstinence behavior of patients with chronic liver diseases (CLD). The model was based on the theory of planned behavior.
  • Methods
    Participants consisted of 240 adult patients with CLD who had regular visits to Busan medical center and Kyungsang universisty hospital from February 12 to March 14, 2014. Data were collected using self-report questionnaires. Collected data were analyzed using SPSS 18.0, AMOS 21.0 programs.
  • Results
    The modified model was a good fit for the data. The model fit indices were x2/df=1.78, GFI=.86, AGFI=.90, RMR=.08, RMSEA=.05, NFI=.88, TLI=.92, CFI=.87, PNFI=.70. Alcohol abstinence intention (β=.56) had significant direct effects on alcohol abstinence behavior in patients with CLD. This variable explained 32% of the variance in alcohol abstinence behavior. Attitude (β=.47), perceived behavioral control (β=.41) and subjective norms (β=.25) had direct effects on alcohol abstinence intention. These variables explained 46% of the variance in alcohol abstinence intention.
  • Conclusion
    Findings suggest that the intention of alcohol abstinence is important for patients with CLD to engage in alcohol abstinence behavior. It provides the basis for developing an intervention program to induce alcohol abstinence in patients with CLD.
  • Key Words: Liver diseases; Alcohol abstinence; Behavior; Intention
Figure 1.
Path diagram of the modified model.
kjan-30-30f1.jpg
Table 1.
Characteristics of Study Participants (N=240)
Characteristics Categories n (%) or M± SD
Gender Male 173 (72.1)
Female 67 (27.9)
Age (year) 20~29 11 (4.6)
30~39 33 (13.7)
40~49 69 (28.8)
50~59 78 (32.5)
≥60 49 (20.4)
  51.00±11.54
Marital status Married 173 (72.1)
Other 40 (16.7)
Unmarried 27 (11.2)
Living with Spouse and child 141 (58.8)
Alone 38 (15.8)
Spouse 28 (11.7)
Other 33 (13.7)
Education level Junior high school 39 (16.2)
High school 113 (47.1)
≥ College 88 (36.7)
Religion No 159 (66.3)
Yes 81 (33.7)
Occupation Office worker 81 (33.7)
laborer 51 (21.3)
Other 40 (16.7)
Service/Trader 68 (28.3)
Monthly household income (10,000 won) ＜100 26 (10.8)
100~199 72 (30.0)
200~299 73 (30.4)
≥300 30 (12.5)
None 39 (16.3)
Smoking Yes 181 (75.4)
No 59 (24.6)
Type of chronic liver diseases Chronic hepatitis 128 (53.3)
Alcoholic liver disease 44 (18.3)
Nonalcoholic liver disease 11 (4.6)
Liver cirrhosis/liver cancer 57 (23.8)
Years since diagnosed ＜3 107 (44.4)
3~5 67 (28.1)
6~9 40 (16.6)
≥10 26 (10.8)
  52.04±51.88 (month)
Current symptom(s) (multiple selection) Fatigue, weakness 136 (56.7)
Indigestion 71 (29.6)
None 60 (25.8)
Insomnia 58 (24.2)
Oral dryness 54 (22.5)
Anorexia 53 (22.1)
Myalgia 46 (19.0)
Abdominal distension 27 (11.3)
Edema 22 (9.6)
Pain in right upper quadrant 15 (6.5)
Gum bleeding 13 (5.4)
Itching 11 (4.6)
Nausea, vomiting 11 (4.6)
Other 34 (14.2)
Table 1.
Characteristics of Study Participants (Continued) (N=240)
Characteristics Categories n (%) or M± SD
Information related to liver disease Medical personnel 119 (49.6)
Media (TV, internet) 66 (27.5)
None 41 (17.1)
Other 14 (5.8)
Number of hospitalization in the past None 86 (35.8)
1~3 times 87 (36.3)
≥4 times 67 (27.9)
Treatment experience (multiple selection) Antiviral drugs 100 (41.7)
Arterial embolization 17 (7.1)
Chemotherapy 14 (5.8)
Radio-frequency ablation 7 (2.9)
Liver transplant 3 (1.3)
Comorbidities (multiple selection) None 150 (62.5)
Hypertension 57 (23.8)
Diabetes mellitus 41 (17.1)
Other 5 (2.1)
Drinking with Coworkers/friend 190 (79.2)
Other 25 (10.4)
Alone 25 (10.4)
Have been advised about alcohol abstinence Yes 165 (68.8)
No 75 (31.3)
Attempted alcohol abstinence Yes 148 (61.7)
No 92 (38.3)
Necessity of alcohol abstinence education Necessary 195 (81.2)
Unnecessary 45 (18.8)
Frequency of drinking per week   2.01±1.15
Amount of drinking (glass/each time)   8.85±4.72
Table 2.
Descriptive Statistics of Measured Variables (N=240)
Variables Range M± SD Skewness Kurtosis Standardized estimate
Alcohol abstinence behavior 3~21 6.45±5.01      
 To stop drinking within the last two weeks          
  Stopped drinking 1~7 1.97±1.65 1.75 1.77 .95
  Tried my best 1~7 2.00±1.46 1.74 1.74 .95
  Drinking refusal self-efficacy 1~7 2.48±1.90 0.98 -0.43 .83
Alcohol abstinence intention 4~28 15.07±4.06      
 To stop drinking within two weeks          
  Will intend 1~7 3.59±1.14 0.56 -0.31 .94
  Will do my best 1~7 3.77±1.17 0.32 -0.63 .86
  Will aim to stop drinking 1~7 3.62±1.12 0.50 -0.32 .92
  Will refuse a chance to drink 1~7 4.09±1.17 -0.05 -0.71 .67
Alcohol abstinence attitude 4~28 16.32±3.47      
  Bad/good 1~7 4.33±0.97 -0.56 0.66 .67
  Not important/important 1~7 3.92±0.75 -0.17 1.48 .63
  Option/essential 1~7 3.80±0.67 -0.98 0.19 .72
  Hard/simple 1~7 4.27±1.08 -0.22 -0.28 .70
Alcohol abstinence subjective norms 3~21 12.57±3.09      
  Normative belief 1~7 4.23±1.11 0.14 -0.74 .91
  Motivation to comply 1~7 4.21±1.01 0.25 -0.52 .95
  Positive normative belief 1~7 4.13±0.97 0.24 -0.51 .87
Alcohol abstinence perceived behavioral control 4~28 12.34±3.69      
  Control belief 1~7 3.06±0.94 0.39 -0.65 .92
  Self-efficacy 1~7 3.13±0.84 0.24 -0.87 .83
  Positive control belief 1~7 3.14±0.95 0.41 -0.52 .96
  Control power 1~7 3.01±0.96 0.40 -0.56 .91
Table 3.
Fitness Indices of Hypothetical and Modified Model (N=240)
Model x2 (p) df x2/df GFI AGFI RMSEA (LO HI) NFI TLI CFI PNFI
Criteria ＞.05   ＜3.0 ≥.90 ≥.90 (≤.05 ≤.08) ≥.90 ≥.90 ≥.90 ＞.60
Hypothetical model 241.65 130 2.56 .84 .85 .06 .88 .84 .87 .62
(＜.001) (.05 .07)
Modified model 240.31 131 1.78 .86 .90 .05 .88 .92 .87 .70
(＜.001) (.04 .06)

GFI=goodness-of-fit index; AGFI=adjusted goodness-of-fit index; NFI=normed fit index; RMSEA=root mean square error of approximation;

TLI=Tuker-Lewis index; PNFI=parsimony normed fit index; CFI=comparative fit index; LO=low; HI=high.

Table 4.
Direct, Indirect, and Total Effect Analysis of Modified Models (N=240)
Endogenous variables Exogenous variables Direct effect Indirect effect β Total effect SMC
β (p) (p) β (p)
Alcohol abstinence behavior Alcohol abstinence intention .56 (.021) - .56 (.021) .32
Alcohol abstinence behavior Attitude - .27 (.016) .27 (.016) -
Subjective norms - .15 (.009) .15 (.009)
Perceived behavioral control - .23 (.005) .23 (.005)
Alcohol abstinence intention Attitude .47 (.015) - .47 (.015) .46
Subjective norms .25 (.012) - .25 (.012)
Perceived behavioral control .41 (.005) - .41 (.005)

SMC=squared multiple correlation.

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    • Perioperative patient safety management activities: A modified theory of planned behavior
      Nam Yi Kim, Sun Young Jeong, Camelia Delcea
      PLOS ONE.2021; 16(6): e0252648.     CrossRef
    • A Structural Model Explaining the Health Behaviors among Adults with Metabolic Syndrome: Theory of Planned Behavior Approach
      Taejeong Jang, Rhayun Song
      Korean Journal of Adult Nursing.2020; 32(1): 98.     CrossRef

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    A Structural Model of Alcohol Abstinence Behavior among Patients with Chronic Liver Diseases
    Korean J Adult Nurs. 2018;30(1):30-40.   Published online February 28, 2018
    DOI: https://doi.org/10.7475/kjan.2018.30.1.30
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    A Structural Model of Alcohol Abstinence Behavior among Patients with Chronic Liver Diseases
    Korean J Adult Nurs. 2018;30(1):30-40.   Published online February 28, 2018
    DOI: https://doi.org/10.7475/kjan.2018.30.1.30
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    A Structural Model of Alcohol Abstinence Behavior among Patients with Chronic Liver Diseases
    Image
    Figure 1. Path diagram of the modified model.

    Figure 1.

    A Structural Model of Alcohol Abstinence Behavior among Patients with Chronic Liver Diseases

    Characteristics of Study Participants (N=240)

    Characteristics Categories n (%) or M± SD
    Gender Male 173 (72.1)
    Female 67 (27.9)
    Age (year) 20~29 11 (4.6)
    30~39 33 (13.7)
    40~49 69 (28.8)
    50~59 78 (32.5)
    ≥60 49 (20.4)
      51.00±11.54
    Marital status Married 173 (72.1)
    Other 40 (16.7)
    Unmarried 27 (11.2)
    Living with Spouse and child 141 (58.8)
    Alone 38 (15.8)
    Spouse 28 (11.7)
    Other 33 (13.7)
    Education level Junior high school 39 (16.2)
    High school 113 (47.1)
    ≥ College 88 (36.7)
    Religion No 159 (66.3)
    Yes 81 (33.7)
    Occupation Office worker 81 (33.7)
    laborer 51 (21.3)
    Other 40 (16.7)
    Service/Trader 68 (28.3)
    Monthly household income (10,000 won) ＜100 26 (10.8)
    100~199 72 (30.0)
    200~299 73 (30.4)
    ≥300 30 (12.5)
    None 39 (16.3)
    Smoking Yes 181 (75.4)
    No 59 (24.6)
    Type of chronic liver diseases Chronic hepatitis 128 (53.3)
    Alcoholic liver disease 44 (18.3)
    Nonalcoholic liver disease 11 (4.6)
    Liver cirrhosis/liver cancer 57 (23.8)
    Years since diagnosed ＜3 107 (44.4)
    3~5 67 (28.1)
    6~9 40 (16.6)
    ≥10 26 (10.8)
      52.04±51.88 (month)
    Current symptom(s) (multiple selection) Fatigue, weakness 136 (56.7)
    Indigestion 71 (29.6)
    None 60 (25.8)
    Insomnia 58 (24.2)
    Oral dryness 54 (22.5)
    Anorexia 53 (22.1)
    Myalgia 46 (19.0)
    Abdominal distension 27 (11.3)
    Edema 22 (9.6)
    Pain in right upper quadrant 15 (6.5)
    Gum bleeding 13 (5.4)
    Itching 11 (4.6)
    Nausea, vomiting 11 (4.6)
    Other 34 (14.2)

    Characteristics of Study Participants (Continued) (N=240)

    Characteristics Categories n (%) or M± SD
    Information related to liver disease Medical personnel 119 (49.6)
    Media (TV, internet) 66 (27.5)
    None 41 (17.1)
    Other 14 (5.8)
    Number of hospitalization in the past None 86 (35.8)
    1~3 times 87 (36.3)
    ≥4 times 67 (27.9)
    Treatment experience (multiple selection) Antiviral drugs 100 (41.7)
    Arterial embolization 17 (7.1)
    Chemotherapy 14 (5.8)
    Radio-frequency ablation 7 (2.9)
    Liver transplant 3 (1.3)
    Comorbidities (multiple selection) None 150 (62.5)
    Hypertension 57 (23.8)
    Diabetes mellitus 41 (17.1)
    Other 5 (2.1)
    Drinking with Coworkers/friend 190 (79.2)
    Other 25 (10.4)
    Alone 25 (10.4)
    Have been advised about alcohol abstinence Yes 165 (68.8)
    No 75 (31.3)
    Attempted alcohol abstinence Yes 148 (61.7)
    No 92 (38.3)
    Necessity of alcohol abstinence education Necessary 195 (81.2)
    Unnecessary 45 (18.8)
    Frequency of drinking per week   2.01±1.15
    Amount of drinking (glass/each time)   8.85±4.72

    Descriptive Statistics of Measured Variables (N=240)

    Variables Range M± SD Skewness Kurtosis Standardized estimate
    Alcohol abstinence behavior 3~21 6.45±5.01      
     To stop drinking within the last two weeks          
      Stopped drinking 1~7 1.97±1.65 1.75 1.77 .95
      Tried my best 1~7 2.00±1.46 1.74 1.74 .95
      Drinking refusal self-efficacy 1~7 2.48±1.90 0.98 -0.43 .83
    Alcohol abstinence intention 4~28 15.07±4.06      
     To stop drinking within two weeks          
      Will intend 1~7 3.59±1.14 0.56 -0.31 .94
      Will do my best 1~7 3.77±1.17 0.32 -0.63 .86
      Will aim to stop drinking 1~7 3.62±1.12 0.50 -0.32 .92
      Will refuse a chance to drink 1~7 4.09±1.17 -0.05 -0.71 .67
    Alcohol abstinence attitude 4~28 16.32±3.47      
      Bad/good 1~7 4.33±0.97 -0.56 0.66 .67
      Not important/important 1~7 3.92±0.75 -0.17 1.48 .63
      Option/essential 1~7 3.80±0.67 -0.98 0.19 .72
      Hard/simple 1~7 4.27±1.08 -0.22 -0.28 .70
    Alcohol abstinence subjective norms 3~21 12.57±3.09      
      Normative belief 1~7 4.23±1.11 0.14 -0.74 .91
      Motivation to comply 1~7 4.21±1.01 0.25 -0.52 .95
      Positive normative belief 1~7 4.13±0.97 0.24 -0.51 .87
    Alcohol abstinence perceived behavioral control 4~28 12.34±3.69      
      Control belief 1~7 3.06±0.94 0.39 -0.65 .92
      Self-efficacy 1~7 3.13±0.84 0.24 -0.87 .83
      Positive control belief 1~7 3.14±0.95 0.41 -0.52 .96
      Control power 1~7 3.01±0.96 0.40 -0.56 .91

    Fitness Indices of Hypothetical and Modified Model (N=240)

    Model x2 (p) df x2/df GFI AGFI RMSEA (LO HI) NFI TLI CFI PNFI
    Criteria ＞.05   ＜3.0 ≥.90 ≥.90 (≤.05 ≤.08) ≥.90 ≥.90 ≥.90 ＞.60
    Hypothetical model 241.65 130 2.56 .84 .85 .06 .88 .84 .87 .62
    (＜.001) (.05 .07)
    Modified model 240.31 131 1.78 .86 .90 .05 .88 .92 .87 .70
    (＜.001) (.04 .06)

    GFI=goodness-of-fit index; AGFI=adjusted goodness-of-fit index; NFI=normed fit index; RMSEA=root mean square error of approximation;

    TLI=Tuker-Lewis index; PNFI=parsimony normed fit index; CFI=comparative fit index; LO=low; HI=high.

    Direct, Indirect, and Total Effect Analysis of Modified Models (N=240)

    Endogenous variables Exogenous variables Direct effect Indirect effect β Total effect SMC
    β (p) (p) β (p)
    Alcohol abstinence behavior Alcohol abstinence intention .56 (.021) - .56 (.021) .32
    Alcohol abstinence behavior Attitude - .27 (.016) .27 (.016) -
    Subjective norms - .15 (.009) .15 (.009)
    Perceived behavioral control - .23 (.005) .23 (.005)
    Alcohol abstinence intention Attitude .47 (.015) - .47 (.015) .46
    Subjective norms .25 (.012) - .25 (.012)
    Perceived behavioral control .41 (.005) - .41 (.005)

    SMC=squared multiple correlation.
    Table 1. Characteristics of Study Participants (N=240)

    Table 1. Characteristics of Study Participants (Continued) (N=240)

    Table 2. Descriptive Statistics of Measured Variables (N=240)

    Table 3. Fitness Indices of Hypothetical and Modified Model (N=240)

    GFI=goodness-of-fit index; AGFI=adjusted goodness-of-fit index; NFI=normed fit index; RMSEA=root mean square error of approximation;

    TLI=Tuker-Lewis index; PNFI=parsimony normed fit index; CFI=comparative fit index; LO=low; HI=high.

    Table 4. Direct, Indirect, and Total Effect Analysis of Modified Models (N=240)

    SMC=squared multiple correlation.

    Table 1.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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