The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases

Nayeon Shin; Younhee Kang

doi:10.7475/kjan.2015.27.3.294

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The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases

Nayeon Shin¹, Younhee Kang²

Korean Journal of Adult Nursing 2015;27(3):294-303.
Published online: June 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.3.294

¹Graduate School, Ewha Womans University, Seoul

²Division of Nursing Science, Ewha Womans University, Seoul, Korea

Corresponding author: Kang, Younhee Division of Nursing Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea. Tel: +82-2-3277-4483, Fax: +82-2-3277-2850, E-mail: yxk12@ewha.ac.kr

• Received: March 22, 2015 • Accepted: June 15, 2015

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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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to determine the relationships among health locus of control, resilience, social support, and health promoting behavior in patients with coronary artery diseases.
Methods
This study utilized a descriptive correlational design using a survey method. The subjects were 165 coronary artery disease patients at the cardiology out-patient clinic of the C university hospital. Data were collected through Health Locus of Control Scale, Resilience Scale, ENRICHD Social Support Instrument, Health Promoting Lifestyle Profile scale. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient and hierarchial regression.
Results
There were significant positive bivariate correlations of health promoting behavior with internal health locus of control, doctors health locus of control, resilience and social support respectively, and correlation between resilience and social support. Among predictors, internal health locus of control (β=.28), social support (β=.28) and resilience (β=.25) had statistically significant influences on health promoting behavior.
Conclusion
These results proposed that internal health locus of control, social support and resilience have important influences on health promoting behavior. Nursing interventions to enhance internal health locus of control, resilience and social support might be essential for patients with coronary artery disease in order to promote their health behaviors.
Key Words: Coronary artery disease; Internal-external control; Psychological resilience; Social support; Health promotion

Table 1.

The General Characteristics and Risk Factors related Coronary Artery Disease (N=165)

Characteristics	Categories	n (%)	M±SD	Range
Gender	Male	101 (62.5)
Gender	Female	64 (37.5)
Age (year)	40~49	36 (21.0)	60.52±6.39	42~83
	50~59	38 (22.0)
	60~69	79 (49.4)
	≥70	12 (7.6)
Education (year)	Elementary school (≤6)	55 (34.1)	10.32±2.50	0~19
	Middle school (7~9)	38 (22.4)
	High school (10~12)	40 (24.7)
	Undergraduate school (≥13)	32 (18.8)
Spouse	Yes	120 (76.5)
Spouse	No	45 (23.5)
Occupation	Yes	42 (24.7)
Occupation	No	123 (75.3)
Living arrangement of family	Spouse & child	71 (45.9)
	Spouse	50 (29.4)
	Child	32 (18.8)
	Solitude	12 (5.9)
Diagnosis	Stable angina	44 (25.3)
	Unstable angina	75 (48.1)
	Myocardial infarction	38 (21.5)
	Variant angina	8 (5.1)
Periods since diagnosed (month)			2.91±0.45
PCI	Yes	145 (89.9)
PCI	No	20 (10.1)
BMI (kg/m²)			24.57±3.11
Hyperlipidemia (mg/dL) (total cholesterol)	Hyperlipidemia (＞210)	111 (69.6)	198.25±31.24
Hyperlipidemia (mg/dL) (total cholesterol)	Normal (≤210)	54 (30.4)	198.25±31.24
Family History	Yes	78 (41.8)
Family History	No	87 (58.2)
Exercise	No	61 (40.0)
	Occasionally	46 (24.3)
	Frequently (≥3 times/week)	58 (35.7)
Ejection fraction (%)			68.37±15.25
Comorbidity (DM, HTN, CVA)	0	48 (31.6)
	1	42 (24.0)
	2	47 (31.6)
	3	28 (12.6)
Smoking status	Smoker	62 (34.6)
	Ex-smoker	36 (21.8)
	Non-smoker	67 (43.6)

CVA=cardiovascular accident; DM=diabetes mellitus; HTN=hypertension; PCI=percutaneous coronary intervention.

Table 2.

Degree of Health Locus of Control, Resilience, Social Support and Health Promoting Behavior (N=165)

Variables	M±SD	Min	Max	Range
Health locus of control-internal	24.18±3.99	11	30	6~30
Health locus of control-chance	18.07±4.51	6	30	6~30
Health locus of control-power others	12.01±2.77	3	15	3~15
Health locus of control-doctors	12.27±2.70	6	15	3~15
Resilience	119.08±19.88	32	163	25~175
Social support	23.19±4.86	9	30	6~30
Health promoting behavior	129.88±17.84	83	193	52~208

Table 3.

Levels of Health Promoting Behavior according to the Characteristics of the Participants (N=165)

Characteristics	Categories	n (%)	M±SD	t or F	p	Duncan
Gender	Male	101 (61.2)	132.94±23.47	1.04	.299
Gender	Female	64 (39.8)	127.31±20.05	1.04	.299
Age (year)	40~49	36 (21.8)	131.33±28.18	0.67	.060
	50~59	38 (23.0)	131.89±16.69
	60~69	79 (47.9)	133.61±19.60
	≥70	12 (7.3)	134.84±11.50
Education (year)	Elementary school (≤6)	55 (34.1)	128.30±24.51	1.30	.279
	Middle school (7~9)	38 (22.4)	129.67±22.49
	High school (10~12)	40 (24.7)	127.86±19.52
	Undergraduate school (≥13)	32 (18.8)	140.81±22.09
Spouse	Yes	120 (76.5)	132.84±21.52	1.43	.012
Spouse	No	45 (23.5)	124.71±25.05	1.43	.012
Occupation	Yes	42 (24.7)	133.67±18.28	0.49	.620
Occupation	No	123 (75.3)	133.67±18.28	0.49	.620
Living arrangement of family	Spouse & child^d	71 (45.9)	134.13±22.66	1.96	.014	d＞a
	Spouse^c	50 (29.4)	132.76±20.61
	Child^b	32 (18.8)	124.36±25.10
	Solitude^a	12 (5.9)	109.75±12.39
Diagnosis	Stable angina	44 (26.7)	131.75±26.93	0.09	.965
	Unstable angina	75 (45.5)	131.49±22.60
	Myocardial infarction	38 (23.0)	130.65±19.42
	Varient angina	8 (4.8)	125.50±11.00
PCI	Yes	145 (87.9)	130.26±22.33	0.93	.350
PCI	No	20 (12.1)	138.13±23.43	0.93	.350
Hyperlipidemia (total cholesterol)	Hyperlipidemia (＞210)	111 (69.6)	129.40±21.46	1.30	.040
Hyperlipidemia (total cholesterol)	Normal (≤210)	54 (30.4)	134.11±25.56	1.30	.040
Family history	Yes	78 (41.8)	131.91±20.10	-0.28	.778
Family history	No	87 (58.2)	130.44±24.18	-0.28	.778
Exercise	No	61 (40.0)	126.67±23.57	1.00	.047
	Occasionally	46 (24.3)	132.40±17.81
	Frequently (≥3 times/wk)	58 (35.6)	134.82±24.00

PCI=percutaneous coronary intervention.

Table 4.

Relationships between Health Locus of Control, Resilience, Social support and Health Promoting Behavior (N=165)

Variables	Health locus of control				Resilience	Social support
	Internal	Chance	Power-others	Doctors	Resilience	Social support
	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Resilience	.35 (.002)	-.06 (.602)	-.15 (.170)	.17 (.125)
Social support	.27 (.015)	-.25 (.027)	-.35 (.001)	.20 (.070)	.34 (＜.001)
Health promoting behavior	.38 (.001)	.14 (.208)	-.07 (.523)	.21 (.017)	.32 (.002)	.36 (＜.001)

Table 5.

Results of Multiple Regression Analysis of Factors Affecting to the Health Promoting Behavior (N=165)

Variables	Step I			Step II
Variables	β	t	p	β	t	p
Spouse	.00	0.07	.823	.00	0.09	.852
Living arrangement of family	.25	0.17	.560	.01	0.26	.793
Exercise	-.35	-0.18	.102	-.25	-1.68	.093
Hyperlipidemia	-.09	0.81	.352	-.08	0.72	.491
Health locus of control-internal				.28	2.30	.024
Health locus of control-doctors				.00	-0.02	.977
Resilience				.25	2.36	.021
Social support				.28	2.50	.015
	R²=.32, F=3.85, p＜.001			R²=.43, F=5.95, p＜.001

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The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases

Korean J Adult Nurs. 2015;27(3):294-303. Published online June 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.3.294

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The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases

Korean J Adult Nurs. 2015;27(3):294-303. Published online June 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.3.294

The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases

Table 1.

The General Characteristics and Risk Factors related Coronary Artery Disease (N=165)

Characteristics	Categories	n (%)	M±SD	Range
Gender	Male	101 (62.5)
Gender	Female	64 (37.5)
Age (year)	40~49	36 (21.0)	60.52±6.39	42~83
	50~59	38 (22.0)
	60~69	79 (49.4)
	≥70	12 (7.6)
Education (year)	Elementary school (≤6)	55 (34.1)	10.32±2.50	0~19
	Middle school (7~9)	38 (22.4)
	High school (10~12)	40 (24.7)
	Undergraduate school (≥13)	32 (18.8)
Spouse	Yes	120 (76.5)
Spouse	No	45 (23.5)
Occupation	Yes	42 (24.7)
Occupation	No	123 (75.3)
Living arrangement of family	Spouse & child	71 (45.9)
	Spouse	50 (29.4)
	Child	32 (18.8)
	Solitude	12 (5.9)
Diagnosis	Stable angina	44 (25.3)
	Unstable angina	75 (48.1)
	Myocardial infarction	38 (21.5)
	Variant angina	8 (5.1)
Periods since diagnosed (month)			2.91±0.45
PCI	Yes	145 (89.9)
PCI	No	20 (10.1)
BMI (kg/m²)			24.57±3.11
Hyperlipidemia (mg/dL) (total cholesterol)	Hyperlipidemia (＞210)	111 (69.6)	198.25±31.24
Hyperlipidemia (mg/dL) (total cholesterol)	Normal (≤210)	54 (30.4)	198.25±31.24
Family History	Yes	78 (41.8)
Family History	No	87 (58.2)
Exercise	No	61 (40.0)
	Occasionally	46 (24.3)
	Frequently (≥3 times/week)	58 (35.7)
Ejection fraction (%)			68.37±15.25
Comorbidity (DM, HTN, CVA)	0	48 (31.6)
	1	42 (24.0)
	2	47 (31.6)
	3	28 (12.6)
Smoking status	Smoker	62 (34.6)
	Ex-smoker	36 (21.8)
	Non-smoker	67 (43.6)

CVA=cardiovascular accident; DM=diabetes mellitus; HTN=hypertension; PCI=percutaneous coronary intervention.

Table 2.

Degree of Health Locus of Control, Resilience, Social Support and Health Promoting Behavior (N=165)

Variables	M±SD	Min	Max	Range
Health locus of control-internal	24.18±3.99	11	30	6~30
Health locus of control-chance	18.07±4.51	6	30	6~30
Health locus of control-power others	12.01±2.77	3	15	3~15
Health locus of control-doctors	12.27±2.70	6	15	3~15
Resilience	119.08±19.88	32	163	25~175
Social support	23.19±4.86	9	30	6~30
Health promoting behavior	129.88±17.84	83	193	52~208

Table 3.

Levels of Health Promoting Behavior according to the Characteristics of the Participants (N=165)

Characteristics	Categories	n (%)	M±SD	t or F	p	Duncan
Gender	Male	101 (61.2)	132.94±23.47	1.04	.299
Gender	Female	64 (39.8)	127.31±20.05	1.04	.299
Age (year)	40~49	36 (21.8)	131.33±28.18	0.67	.060
	50~59	38 (23.0)	131.89±16.69
	60~69	79 (47.9)	133.61±19.60
	≥70	12 (7.3)	134.84±11.50
Education (year)	Elementary school (≤6)	55 (34.1)	128.30±24.51	1.30	.279
	Middle school (7~9)	38 (22.4)	129.67±22.49
	High school (10~12)	40 (24.7)	127.86±19.52
	Undergraduate school (≥13)	32 (18.8)	140.81±22.09
Spouse	Yes	120 (76.5)	132.84±21.52	1.43	.012
Spouse	No	45 (23.5)	124.71±25.05	1.43	.012
Occupation	Yes	42 (24.7)	133.67±18.28	0.49	.620
Occupation	No	123 (75.3)	133.67±18.28	0.49	.620
Living arrangement of family	Spouse & child^d	71 (45.9)	134.13±22.66	1.96	.014	d＞a
	Spouse^c	50 (29.4)	132.76±20.61
	Child^b	32 (18.8)	124.36±25.10
	Solitude^a	12 (5.9)	109.75±12.39
Diagnosis	Stable angina	44 (26.7)	131.75±26.93	0.09	.965
	Unstable angina	75 (45.5)	131.49±22.60
	Myocardial infarction	38 (23.0)	130.65±19.42
	Varient angina	8 (4.8)	125.50±11.00
PCI	Yes	145 (87.9)	130.26±22.33	0.93	.350
PCI	No	20 (12.1)	138.13±23.43	0.93	.350
Hyperlipidemia (total cholesterol)	Hyperlipidemia (＞210)	111 (69.6)	129.40±21.46	1.30	.040
Hyperlipidemia (total cholesterol)	Normal (≤210)	54 (30.4)	134.11±25.56	1.30	.040
Family history	Yes	78 (41.8)	131.91±20.10	-0.28	.778
Family history	No	87 (58.2)	130.44±24.18	-0.28	.778
Exercise	No	61 (40.0)	126.67±23.57	1.00	.047
	Occasionally	46 (24.3)	132.40±17.81
	Frequently (≥3 times/wk)	58 (35.6)	134.82±24.00

PCI=percutaneous coronary intervention.

Table 4.

Relationships between Health Locus of Control, Resilience, Social support and Health Promoting Behavior (N=165)

Variables	Health locus of control				Resilience	Social support
	Internal	Chance	Power-others	Doctors	Resilience	Social support
	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Resilience	.35 (.002)	-.06 (.602)	-.15 (.170)	.17 (.125)
Social support	.27 (.015)	-.25 (.027)	-.35 (.001)	.20 (.070)	.34 (＜.001)
Health promoting behavior	.38 (.001)	.14 (.208)	-.07 (.523)	.21 (.017)	.32 (.002)	.36 (＜.001)

Table 5.

Results of Multiple Regression Analysis of Factors Affecting to the Health Promoting Behavior (N=165)

Variables	Step I			Step II
Variables	β	t	p	β	t	p
Spouse	.00	0.07	.823	.00	0.09	.852
Living arrangement of family	.25	0.17	.560	.01	0.26	.793
Exercise	-.35	-0.18	.102	-.25	-1.68	.093
Hyperlipidemia	-.09	0.81	.352	-.08	0.72	.491
Health locus of control-internal				.28	2.30	.024
Health locus of control-doctors				.00	-0.02	.977
Resilience				.25	2.36	.021
Social support				.28	2.50	.015
	R²=.32, F=3.85, p＜.001			R²=.43, F=5.95, p＜.001

Table 1. The General Characteristics and Risk Factors related Coronary Artery Disease (N=165)

CVA=cardiovascular accident; DM=diabetes mellitus; HTN=hypertension; PCI=percutaneous coronary intervention.

Table 2. Degree of Health Locus of Control, Resilience, Social Support and Health Promoting Behavior (N=165)

Table 3. Levels of Health Promoting Behavior according to the Characteristics of the Participants (N=165)

PCI=percutaneous coronary intervention.

Table 4. Relationships between Health Locus of Control, Resilience, Social support and Health Promoting Behavior (N=165)

Table 5. Results of Multiple Regression Analysis of Factors Affecting to the Health Promoting Behavior (N=165)

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The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases

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