Predicting Health-related Quality of Life: Testing the Contextual Model Using Structural Equation Modeling

Abstract

This study aims to investigate the utility of the Contextual Model of HealthRelated Quality of Life (HRQOL) to explain the relationship among the domains of HRQOL with a diverse, population-based sample of breast cancer survivors (BCS). We employed a cross-sectional design to investigate HRQOL among 703 multiethnic, population-based BCS. The study methodology was guided by the Contextual Model of HRQOL. Structural Equation Modeling (SEM) was conducted to assess the hypothesized model. SEM identified significant relationships among the biopsychological domain (general health status, cancer-related factors, and psychological factors), the cultural-socio-ecological domain (health care satisfaction, socioecological factor, and socio-economic status), and HRQOL. The best fitting model indicates direct pathways from 'general health status', 'years since diagnosis', 'health care satisfaction' and 'socio-ecological factor' to 'HRQOL' variables. Additionally, 'socio-ecological factor' and 'socio-economic status' variables were indirectly associated with HRQOL through 'general health status'. Findings suggest that the Contextual Model of HRQOL adds valid factors to explain overall HRQOL and increases our understanding of the socio-ecological dimensions predicting HRQOL outcomes. The revelation of inter-relations among the dimensions of HRQOL may inform the translational and clinical utility of the HRQOL construct. AbbreviationsHRQOL Health-related quality of life BCS Breast cancer survivors SEM Structural equation modeling SES Socio-economic status FACTThe functional assessment of cancer therapy SF-36The RAND 36-item health survey ADQ Adherence determinants questionnaire RMSEA Root mean square error of approximation CFIThe comparative fit index AICThe akaike information criterion CFI Confirmatory factor analysis

Recruitment and Retention Strategies of African American and Latina American Breast Cancer Survivors in a Longitudinal Psycho-Oncology Study

“…Study approach and guiding principles: The theoretical and analytical foundation of this study is the Contextual Model of HRQOL (Ashing-Giwa, 2005b;Ashing-Giwa & Lim, 2008;Ashing-Giwa, Tejero, Kim, Padilla, & Hellemann, 2007). The model was developed by quantitative and qualitative outcomes research that included ethnically and linguistically diverse and populationbased samples (Ashing-Giwa et al, 2007).…”

Predictors of Quality of Life in Transfusion-dependent Thalassemia Patients Based on the PRECEDE Model: A Structural Equation Modeling Approach

“…Structural equation modeling includes a series of statistical methods and mathematical models that specify the causal relationship between one or more independent variables and one or more dependent variables by combining the measurement model and structural model [25]. Whereas the measurement model explains the relationship between latent variables and manifest variables, the structural model illustrates the direct and indirect effects of the latent variables (exogenous and endogenous latent variables) on each other [25]. In the current study, the relationship between some of the potential factors affecting QoL was analyzed in two steps.…”

Predicting physical quality of life among a multiethnic sample of breast cancer survivors

“…This model also assumes the mediating effects of individual-level factors in the relationship between systemic-level factors and HRQOL outcomes [17]; such that systemic-level factors such as the socio-ecological factor or health care system may have a positive effect on individuallevel factors (i.e., improved psychological well-being) which then may improve HRQOL [18,19]. This Contextual Model of HRQOL promises broader application and has been used as a framework to more comprehensively investigate the sub-dimension of HRQOL [20]. This study will explore the utility of the Contextual Model to explain physical quality of life (PQOL).…”