Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
PLoS One. 2020 Apr 8;15(4):e0231346. doi: 10.1371/journal.pone.0231346. eCollection 2020.
To explore associations among twenty formal and informal, societal and individual-level factors and quality of life (QOL) among people living with congestive heart failure (CHF) in two settings with different healthcare and social care systems and sociocultural contexts.
We recruited 367 adult patients with CHF from a single heart failure clinic within two countries with different national social to healthcare spending ratios: Minneapolis, Minnesota, United States (US), and Nijmegen, Netherlands (NL).
Cross-sectional survey study. We adapted the Social Quality Model (SQM) to organize twenty diverse factors into four categories: Living Conditions (formal-societal: e.g., housing, education), Social Embeddedness (informal-societal: e.g., social support, trust), Societal Embeddedness (formal-individual: e.g., access to care, legal aid), and Self-Regulation (informal-individual: e.g., physical health, resilience). We developed a survey comprising validated instruments to assess each factor. We administered the survey in-person or by mail between March 2017 and August 2018.
We used Cantril's Self-Anchoring Scale to assess overall QOL. We used backwards stepwise regression to identify factors within each SQM category that were independently associated with QOL among US and NL participants (p<0.05). We then identified factors independently associated with QOL across all categories (p<0.05).
367 CHF patients from the US (32%) and NL (68%) participated. Among US participants, financial status, receiving legal aid or housing assistance, and resilience were associated with QOL, and together explained 49% of the variance in QOL; among NL participants, financial status, perceived physical health, independence in activities of daily living, and resilience were associated with QOL, and explained 53% of the variance in QOL.
Four formal and informal factors explained approximately half of the variance in QOL among patients with CHF in the US and NL.
在两个具有不同医疗保健和社会保健系统及社会文化背景的环境中，探索 20 个正式和非正式的、社会和个人层面的因素与充血性心力衰竭（CHF）患者生活质量（QOL）之间的关联。
我们从两个国家的一个单一心力衰竭诊所招募了 367 名成年 CHF 患者，这两个国家的国民社会医疗保健支出比例不同：明尼苏达州明尼阿波利斯（美国）和荷兰奈梅亨（NL）。
横断面调查研究。我们改编了社会质量模型（SQM），将 20 个不同的因素组织成四个类别：生活条件（正式-社会：例如，住房、教育）、社会嵌入（非正式-社会：例如，社会支持、信任）、社会嵌入（正式-个人：例如，获得医疗保健、法律援助）和自我调节（非正式-个人：例如，身体健康、适应力）。我们开发了一个包含经过验证的工具的调查来评估每个因素。我们于 2017 年 3 月至 2018 年 8 月期间通过面对面或邮寄的方式进行了调查。
我们使用 Cantril 的自我锚定量表来评估整体 QOL。我们使用向后逐步回归来确定 SQM 类别中与美国和 NL 参与者的 QOL 独立相关的因素（p<0.05）。然后，我们确定了与所有类别 QOL 独立相关的因素（p<0.05）。
美国（32%）和 NL（68%）的 367 名 CHF 患者参与了研究。在美国参与者中，财务状况、获得法律援助或住房援助以及适应力与 QOL 相关，共同解释了 QOL 变异的 49%；在 NL 参与者中，财务状况、感知身体健康、日常生活活动的独立性和适应力与 QOL 相关，解释了 QOL 变异的 53%。
四个正式和非正式因素解释了美国和 NL 充血性心力衰竭患者 QOL 变异的近一半。
