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The Relationship between Illness Perception and Health Behaviors among Patients with Tuberculosis: Mediating Effects of Self-efficacy and Family Support

Hye-jin Kim, MSN, RN, Myung Kyung Lee, RN, Ph.D.
Korean Journal of Adult Nursing 2017;29(6):626-636.
Published online: December 18, 2017

College of Nursing, Kyungpook National University, Daegu, Korea

Corresponding author: Lee, Myung Kyung College of Nursing, Kyungpook National University, 680 Gukchabosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-200-4792, Fax: +82-53-425-1258, E-mail: mlee@knu.ac.kr
- This work was supported by the National Research Foundation funded by Korea MSIT(No. NRF-2017R1A1A1A05001045). - 본 논문은 제1저자 김혜진의 석사학위논문의 축약본임. - This article is a condensed form of the first author's master's thesis from Kyungpook National University.
• Received: August 28, 2017   • Accepted: December 16, 2017

© 2017 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
    The purpose of this study was to identify the mediating effects of self-efficacy and family support in the relationship between illness perception and health behaviors among patients with tuberculosis.
  • Methods
    A descriptive, cross-sectional study was conducted with 219 patients with tuberculosis from one general hospital in D city in Korea. The participants took medication over a two months period. Data were collected from four self-re-ported questionnaires including Health behaviors Questionnaire and Family Support Questionnaire. Of the four questionnaires, Venereal Disease Education Health Belief Model Scales and Health Belief Model Scales were modified for this study population with tuberculosis. Data were analyzed by descriptive statistics, Pearson's corre-lation coefficients, and multiple regression analysis using SPSS statistics 23.0 program.
  • Results
    A positive corre-lation existed between health behaviors and illness perception (r=0.80, p<.001), self-efficacy (r=0.66, p<.001), and family support (r=0.73, p<.001). Self-efficacy and family support had partial mediating effect on the relationship between illness perception and health behaviors.
  • Conclusion
    Theses results indicated that in order to im-prove the health behaviors of patients with tuberculosis, it is necessary to develop a management plan that focuses not only on the illness perception but also on the self-efficacy and the role of the family support.
  • Key Words: Tuberculosis; Health behavior; Self efficacy; Family; Perception
Figure 1.
Mediation analysis pathway. C vs. C‘
kjan-29-626f1.jpg
Figure 2.
Mediating effects of self-efficacy and family support in the relationship between illness perception and health behaviors.
kjan-29-626f2.jpg
Table 1.
Illness Perception, Health Behaviors, Self-efficacy and Family Support according to Characteristics of Participants (N=219)
Variables Categories n (%) Illness perception Self-efficacy Family support Health behaviors
M± SD t or F (p) M± SD t or F (p) M± SD t or F (p) M± SD t or F (p)
Gender Male 134 (61.2) 3.49±0.56 -3.03 3.62±0.74 -0.40 2.62±0.74 -0.56 2.57±0.62 -4.43
Female 85 (38.8) 3.71±0.47 (.003) 3.66±0.58 (.691) 2.67±0.61 (.576) 2.90±0.44 (＜.001)
Age (year) ＜50 99 (45.2) 3.60±0.56 0.61 3.67±0.73 0.59 2.62±0.72 -0.36 2.67±0.59 -0.70
≥50 120 (54.8) 3.55±0.52 (.544) 3.61±0.64 (.559) 2.67±0.67 (.718) 2.72±0.57 (.484)
Religion No 128 (58.4) 3.46±0.61 -4.14 3.61±0.78 -0.83 2.51±0.76 -3.76 2.55±0.62 -5.06
Yes 91 (41.6) 3.73±0.36 (＜.001) 3.68±0.52 (.407) 2.83±0.55 (＜.001) 2.91±0.44 (＜.001)
Education ≤ JHS 58 (26.5) 3.41±0.50 -2.74 3.38±0.73 -3.44 2.42±0.77 -2.70 2.56±0.52 -2.15
≥ High school 161 (73.5) 3.63±0.53 (.007) 3.73±0.64 (.001) 2.72±0.65 (.009) 2.75±0.60 (.033)
Marital status Married 130 (59.4) 3.61±0.51 -1.13 3.57±0.65 -1.25 2.71±0.64 -1.82 2.77±0.57 -2.28
Alone 89 (40.6) 3.52±0.57 (.262) 3.57±0.71 (.212) 2.53±0.76 (.071) 2.59±0.58 (.024)
Main caregiver Family 175 (79.9) 3.61±0.49 2.54 3.68±0.66 1.63 2.71±0.64 6.49 2.74±0.57 2.80
Self 38 (17.4) 3.40±0.69 (.081) 3.50±0.80 (.199) 2.28±0.85 (.002) 2.51±0.65 (.063)
Others 6 (2.7) 3.57±0.53   3.36±0.34   2.70±0.54   2.53±0.20  
Occupation Unemployed 58 (26.5) 3.63±0.56 0.95 3.62±0.70 -0.25 2.79±0.76 2.01 2.86±0.57 2.55
Employed 161 (73.5) 3.55±0.52 (.345) 3.64±0.68 (.803) 2.58±0.66 (.045) 2.64±0.57 (.011)
Comorbidity None 116 (53.0) 3.66±0.53 2.70 3.73±0.68 2.09 2.70±0.73 1.38 2.80±0.59 2.73
Yes 103 (47.0) 3.47±0.52 (.007) 3.54±0.67 (.038) 2.57±0.65 (.168) 2.59±0.55 (.007)
Past history of TB No 155 (70.8) 3.60±0.52 0.97 3.61±0.61 2.07 2.63±0.70 072 2.71±0.53 0.35
Yes 45 (20.5) 3.47±0.65 (.380) 3.60±0.88 (.129) 2.59±0.80 (.490) 2.63±0.79 (.702)
Trace 19 (8.7) 3.60±0.27   3.94±0.67   2.81±0.44   2.74±0.41  
Family history of TB No 179 (81.7) 3.54±0.56 2.25 3.61±0.68 1.21 2.81±0.61 1.79 2.66±0.59 2.10
Yes 40 (18.3) 3.71±0.38 (.027) 3.75±0.68 (.229) 2.60±0.71 (.075) 2.87±0.53 (.037)
Side effect of TB medication None 96 (43.8) 3.65±0.51 1.91 3.71±0.62 1.34 2.78±0.60 2.71 2.80±0.56 2.27
Yes 123 (56.2) 3.51±0.55 (0.58) 3.58±0.72 (.182) 2.53±075 (.007) 2.62±0.58 (.024)
Discontinuation of TB medication Never 187 (85.4) 3.63±0.48 3.21 3.71±0.58 2.67 2.71±0.64 3.21 2.77±0.53 3.49
Yes 32 (14.6) 3.23±0.69 (.003) 3.22±1.01 (.011) 2.21±0.83 (.003) 2.30±0.72 (.001)

JHS= junior high school; TB=tuberculosis.

Table 2.
Level of Illness Perception, Health Behaviors, Selfefficacy and Family Support (N=219)
Scales M± SD Min~Max
Illness perception 3.57±0.53 2.25~4.68
      Perceived barrier 3.35±0.84 1.44~5.00
      Perceived benefit 3.99±0.65 2.42~5.00
      Perceived seriousness 3.14±0.68 1.43~5.00
Health behaviors 2.70±0.58 1.29~3.94
      Complying with TB medication 3.28±0.68 1.00~4.00
      Following healthy diet 2.44±0.64 1.14~3.86
      Performing physical exercise 2.36±0.82 1.00~4.00
      Maintaining environmental hygiene 2.53±0.80 1.00~4.00
      Preventing disease transmission 2.88±0.76 1.25~4.00
      Avoiding TB risk factors 2.84±0.66 1.20~4.00
Self-efficacy 3.64±0.68 1.67~5.00
Family support 2.64±0.70 1.06~4.00
      Emotional support 2.47±0.76 1.00~4.00
      Instrumental support 2.83±0.81 1.00~4.00
      Information support 2.47±0.80 1.00~4.00
      Appraisal support 2.83±0.66 1.00~4.00

TB=tuberculosis.

Table 3.
Relationships among Key Variables (N=219)
Variables Health behaviors Illness perception Self-efficacy Family support
r (p) r (p) r (p) r (p)
Health behaviors 1      
Illness perception .801 (＜.001) 1    
Self-efficacy .660 (＜.001) .692 (＜.001) 1  
Family support .732 (＜.001) .742 (＜.001) .543 (＜.001) 1
Table 4.
Mediating Effects of Self-Efficacy and Family Support in the Relationship between Illness Perception and Health Behaviors (N=219)
Variables Step (Path) B β t p∗ Adj. R2 F p∗∗
Mediating effect of self-efficacy Step 1 (Path c)         .64 388.2 ＜.001
      Outcome: health behaviors              
      Predictor: illness perception 0.87 .80 19.7 ＜.001      
Step 2 (Path a)         .48 199.4 ＜.001
      Outcome: self-efficacy              
      Predictor: illness perception 0.88 .69 14.1 ＜.001      
Step 3,4 (Path b and c’)         .66 212.4 ＜.001
      Outcome: health behaviors              
      Mediator: self-efficacy (Path b) 0.17 .20 3.7 ＜.001      
      Predictor: illness perception 0.72 .66 12.1 ＜.001      
  Sobel test: Z=4.08, p＜.001
Mediating effect of family support Step 1 (Path c)         .64 388.2 ＜.001
      Outcome: health behaviors              
      Predictor: illness perception 0.87 .80 19.7 ＜.001      
Step 2 (Path a)         .55 265.0 ＜.001
      Outcome: family support              
      Predictor: illness perception 0.97 .74 16.3 ＜.001      
Step 3 (Path b and c’)         .68 233.7 ＜.001
      Outcome: health behaviors              
      Mediator: family support (Path b) 0.26 .31 5.4 ＜.001      
      Predictor: illness perception 0.62 .57 10.1 ＜.001      
      Sobel tes st: Z=4.95, , p＜.001    

B=unstandardized coefficients; β=standardized coefficients; p∗= p-value of independent variable; p∗∗= p-value of model; Adj. R

2=adjusted R-squared.

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    The Relationship between Illness Perception and Health Behaviors among Patients with Tuberculosis: Mediating Effects of Self-efficacy and Family Support
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    DOI: https://doi.org/10.7475/kjan.2017.29.6.626
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    The Relationship between Illness Perception and Health Behaviors among Patients with Tuberculosis: Mediating Effects of Self-efficacy and Family Support
    Korean J Adult Nurs. 2017;29(6):626-636.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.626
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    The Relationship between Illness Perception and Health Behaviors among Patients with Tuberculosis: Mediating Effects of Self-efficacy and Family Support
    Image Image
    Figure 1. Mediation analysis pathway. C vs. C‘
    Figure 2. Mediating effects of self-efficacy and family support in the relationship between illness perception and health behaviors.

    Figure 1.

    Figure 2.

    The Relationship between Illness Perception and Health Behaviors among Patients with Tuberculosis: Mediating Effects of Self-efficacy and Family Support

    Illness Perception, Health Behaviors, Self-efficacy and Family Support according to Characteristics of Participants (N=219)

    Variables Categories n (%) Illness perception Self-efficacy Family support Health behaviors
    M± SD t or F (p) M± SD t or F (p) M± SD t or F (p) M± SD t or F (p)
    Gender Male 134 (61.2) 3.49±0.56 -3.03 3.62±0.74 -0.40 2.62±0.74 -0.56 2.57±0.62 -4.43
    Female 85 (38.8) 3.71±0.47 (.003) 3.66±0.58 (.691) 2.67±0.61 (.576) 2.90±0.44 (＜.001)
    Age (year) ＜50 99 (45.2) 3.60±0.56 0.61 3.67±0.73 0.59 2.62±0.72 -0.36 2.67±0.59 -0.70
    ≥50 120 (54.8) 3.55±0.52 (.544) 3.61±0.64 (.559) 2.67±0.67 (.718) 2.72±0.57 (.484)
    Religion No 128 (58.4) 3.46±0.61 -4.14 3.61±0.78 -0.83 2.51±0.76 -3.76 2.55±0.62 -5.06
    Yes 91 (41.6) 3.73±0.36 (＜.001) 3.68±0.52 (.407) 2.83±0.55 (＜.001) 2.91±0.44 (＜.001)
    Education ≤ JHS 58 (26.5) 3.41±0.50 -2.74 3.38±0.73 -3.44 2.42±0.77 -2.70 2.56±0.52 -2.15
    ≥ High school 161 (73.5) 3.63±0.53 (.007) 3.73±0.64 (.001) 2.72±0.65 (.009) 2.75±0.60 (.033)
    Marital status Married 130 (59.4) 3.61±0.51 -1.13 3.57±0.65 -1.25 2.71±0.64 -1.82 2.77±0.57 -2.28
    Alone 89 (40.6) 3.52±0.57 (.262) 3.57±0.71 (.212) 2.53±0.76 (.071) 2.59±0.58 (.024)
    Main caregiver Family 175 (79.9) 3.61±0.49 2.54 3.68±0.66 1.63 2.71±0.64 6.49 2.74±0.57 2.80
    Self 38 (17.4) 3.40±0.69 (.081) 3.50±0.80 (.199) 2.28±0.85 (.002) 2.51±0.65 (.063)
    Others 6 (2.7) 3.57±0.53   3.36±0.34   2.70±0.54   2.53±0.20  
    Occupation Unemployed 58 (26.5) 3.63±0.56 0.95 3.62±0.70 -0.25 2.79±0.76 2.01 2.86±0.57 2.55
    Employed 161 (73.5) 3.55±0.52 (.345) 3.64±0.68 (.803) 2.58±0.66 (.045) 2.64±0.57 (.011)
    Comorbidity None 116 (53.0) 3.66±0.53 2.70 3.73±0.68 2.09 2.70±0.73 1.38 2.80±0.59 2.73
    Yes 103 (47.0) 3.47±0.52 (.007) 3.54±0.67 (.038) 2.57±0.65 (.168) 2.59±0.55 (.007)
    Past history of TB No 155 (70.8) 3.60±0.52 0.97 3.61±0.61 2.07 2.63±0.70 072 2.71±0.53 0.35
    Yes 45 (20.5) 3.47±0.65 (.380) 3.60±0.88 (.129) 2.59±0.80 (.490) 2.63±0.79 (.702)
    Trace 19 (8.7) 3.60±0.27   3.94±0.67   2.81±0.44   2.74±0.41  
    Family history of TB No 179 (81.7) 3.54±0.56 2.25 3.61±0.68 1.21 2.81±0.61 1.79 2.66±0.59 2.10
    Yes 40 (18.3) 3.71±0.38 (.027) 3.75±0.68 (.229) 2.60±0.71 (.075) 2.87±0.53 (.037)
    Side effect of TB medication None 96 (43.8) 3.65±0.51 1.91 3.71±0.62 1.34 2.78±0.60 2.71 2.80±0.56 2.27
    Yes 123 (56.2) 3.51±0.55 (0.58) 3.58±0.72 (.182) 2.53±075 (.007) 2.62±0.58 (.024)
    Discontinuation of TB medication Never 187 (85.4) 3.63±0.48 3.21 3.71±0.58 2.67 2.71±0.64 3.21 2.77±0.53 3.49
    Yes 32 (14.6) 3.23±0.69 (.003) 3.22±1.01 (.011) 2.21±0.83 (.003) 2.30±0.72 (.001)

    JHS= junior high school; TB=tuberculosis.

    Level of Illness Perception, Health Behaviors, Selfefficacy and Family Support (N=219)

    Scales M± SD Min~Max
    Illness perception 3.57±0.53 2.25~4.68
          Perceived barrier 3.35±0.84 1.44~5.00
          Perceived benefit 3.99±0.65 2.42~5.00
          Perceived seriousness 3.14±0.68 1.43~5.00
    Health behaviors 2.70±0.58 1.29~3.94
          Complying with TB medication 3.28±0.68 1.00~4.00
          Following healthy diet 2.44±0.64 1.14~3.86
          Performing physical exercise 2.36±0.82 1.00~4.00
          Maintaining environmental hygiene 2.53±0.80 1.00~4.00
          Preventing disease transmission 2.88±0.76 1.25~4.00
          Avoiding TB risk factors 2.84±0.66 1.20~4.00
    Self-efficacy 3.64±0.68 1.67~5.00
    Family support 2.64±0.70 1.06~4.00
          Emotional support 2.47±0.76 1.00~4.00
          Instrumental support 2.83±0.81 1.00~4.00
          Information support 2.47±0.80 1.00~4.00
          Appraisal support 2.83±0.66 1.00~4.00

    TB=tuberculosis.

    Relationships among Key Variables (N=219)

    Variables Health behaviors Illness perception Self-efficacy Family support
    r (p) r (p) r (p) r (p)
    Health behaviors 1      
    Illness perception .801 (＜.001) 1    
    Self-efficacy .660 (＜.001) .692 (＜.001) 1  
    Family support .732 (＜.001) .742 (＜.001) .543 (＜.001) 1

    Mediating Effects of Self-Efficacy and Family Support in the Relationship between Illness Perception and Health Behaviors (N=219)

    Variables Step (Path) B β t p∗ Adj. R2 F p∗∗
    Mediating effect of self-efficacy Step 1 (Path c)         .64 388.2 ＜.001
          Outcome: health behaviors              
          Predictor: illness perception 0.87 .80 19.7 ＜.001      
    Step 2 (Path a)         .48 199.4 ＜.001
          Outcome: self-efficacy              
          Predictor: illness perception 0.88 .69 14.1 ＜.001      
    Step 3,4 (Path b and c’)         .66 212.4 ＜.001
          Outcome: health behaviors              
          Mediator: self-efficacy (Path b) 0.17 .20 3.7 ＜.001      
          Predictor: illness perception 0.72 .66 12.1 ＜.001      
      Sobel test: Z=4.08, p＜.001
    Mediating effect of family support Step 1 (Path c)         .64 388.2 ＜.001
          Outcome: health behaviors              
          Predictor: illness perception 0.87 .80 19.7 ＜.001      
    Step 2 (Path a)         .55 265.0 ＜.001
          Outcome: family support              
          Predictor: illness perception 0.97 .74 16.3 ＜.001      
    Step 3 (Path b and c’)         .68 233.7 ＜.001
          Outcome: health behaviors              
          Mediator: family support (Path b) 0.26 .31 5.4 ＜.001      
          Predictor: illness perception 0.62 .57 10.1 ＜.001      
          Sobel tes st: Z=4.95, , p＜.001    

    B=unstandardized coefficients; β=standardized coefficients; p∗= p-value of independent variable; p∗∗= p-value of model; Adj. R

    2=adjusted R-squared.
    Table 1. Illness Perception, Health Behaviors, Self-efficacy and Family Support according to Characteristics of Participants (N=219)

    JHS= junior high school; TB=tuberculosis.

    Table 2. Level of Illness Perception, Health Behaviors, Selfefficacy and Family Support (N=219)

    TB=tuberculosis.

    Table 3. Relationships among Key Variables (N=219)

    Table 4. Mediating Effects of Self-Efficacy and Family Support in the Relationship between Illness Perception and Health Behaviors (N=219)

    B=unstandardized coefficients; β=standardized coefficients; p∗= p-value of independent variable; p∗∗= p-value of model; Adj. R

    =adjusted R-squared.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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