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여성의 자궁절제술후 삶의 질 구조모형

A Structural Model for Quality of Life in Women Having Hysterectomies


The purpose of this study was to develope and test the structural model for quality of life in women having hysterectomies. A hypothetical model was constructed on the basis of previous studies and a review of literature. The conceptual framework was built around eight constructs. Exogenous variables included in this model were marital intimacy, importance of uterus, professional support, positive coping behavior and pre-operative symptoms. Endogenous variables were spouse's support, sense of loss and quality of life. Empirical data for testing the hypothetical model was collected using a self-report questionnare from 203 women having hysterectomies at the outpatient clinics of four general hospitals and a mail survey in Pusan City. The Data was collected from December, 1997 to January, 1998. Reliability of the eight instruments was tested with Cronbach's alpha which ranged from 0.639-0.915. For the data analysis, SPSS 7.5 WIN Program and LISREL 8.12 WIN Program were used for descriptive statistics and covariance structural analysis. The results of covariance structure analysis were as follows : 1. Hypothetical model showed a good fit with the empirical data. [$\chi$$^2$=6.93(df=5, P=.23), GFI=.99, AGFI=.94, RMSR=.019, NNFI=.97, NFI=.98, CN=440, standardized residuals(-2.14-2.10)] 2. For the parsimony of model, a modified model was constructed by deleting 3 paths and adding 1 path according to the criteria of statistical significance and meaning. 3. The modified model also showed a good fit with the data. [$\chi$$^2$=5.26(df=7, P=.63), GFI=.99, AGFI=.97, RMSR=.014, NNFI=1.02, NFI=.99, CN=710, standardized residuals(-1.46-1.70)] Results of the testing of the hypothesis were as follows : 1. Marital intimacy(${\gamma}$11=.78, t=14.37) and professional support(${\gamma}$13=.12, t=2.12) had a significant direct effect on the spouse's support. 2. Pre-operative symptoms(${\gamma}$25=.32, t=3.12), importance of uterus(${\gamma}$22=.20, t=2.61) and spouse's support($\beta$2l=-.19, t=-2.43) had a significant direct effect on the sense of loss. 3. Sense of loss($\beta$32=-.66, t=-9.83) had a direct effect on the quality of life. Marital intimacy had a direct(${\gamma}$31=.19, t=3.33), indirect(${\gamma}$31=.14, t=2.52) and total effect(${\gamma}$31=.25, t=4.41) on the quality of life. Professional support had a direct effect(${\gamma}$33=.11, t=2.07) and total effect(${\gamma}$33=.13, t=2.31) on the quality of life. The direct effect of pre-operative symptoms(${\gamma}$35=-.36, t=4.02) and positive coping behavior(${\gamma}$34=.15, t=2.06) had the insignificant effect on the quality of life while, due to the idirect effect these variables had overall significant effect on the quality of life. The results of this study showed that the sense of loss had the most significant direct effect on the quality of life. Marital intimacy, pre -operative symptoms and spouse's support had a significant direct effect on this sense of loss. These four variables, the sense of loss, marital intimacy, pre-operative symptoms and spouse's support, were identified as relatively important variables. The results of this study suggested that there is needed to determine if nursing intervention would alleviate this sense of loss and promote a greater quality of life in women who have had hysterectomies.

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