Ab.Lah, Nurzulaikha Mahd
(2021)
Structural equation modeling of health belief, intention, health promoting behaviour, social support, symptom severity and quality of life among people with abdominal bloating in Kelantan.
PhD thesis, Universiti Sains Malaysia.
Abstract
Abdominal bloating (AB) is regarded as one of the common bothersome
symptoms by people of diverse backgrounds and all ages worldwide. However, there
were still limited validated measures to explore the psychological behaviour of
people with AB and its relationship with the outcome measures, such as
psychological well-being, symptom severity and quality of life (QoL). This research
aimed to develop validated measures for Bloating Health Belief, Intention, Bloating
Health Promoting Behaviour, Bloating Social Support, Pictogram AB, Bloating
Severity Questionnaire, Bloating Quality of Life and to examine the relationship
between health belief, intention, health promoting behaviour, social support,
symptom severity and QoL among people with AB in Kelantan. The study consisted
of three phases, Phase I: Questionnaires development and translation; Phase II:
Exploratory study by validating questionnaires through the exploratory factor
analysis (EFA); and Phase III: Confirmatory study consisting of the validity of the
measurement model with confirmatory factor analysis (CFA) and structural equation
modeling (SEM) model development. The purposive sampling method was used in
recruiting the participants for Phase II and Phase III. A cross-sectional study design
was employed in all three phases. In Phase I, four new Malay language
questionnaires were developed through literature search, experts‘ input and in-depth
interviews. Besides, the English version of the Pictogram AB, Bloating Severity
Questionnaire and Bloating Quality of Life were translated into Malay version. All of
the questionnaires were examined for content validity based on experts‘ opinion and
then pre-tested by the participants. In Phase II, all newly developed and translated
questionnaires (except for intention as it consisted of one item and Pictogram AB)
were tested for construct validity through exploratory factor analysis (EFA) and the
reliability of internal consistency based on Cronbach alpha was reported. In Phase
III, validity of the measurement models with CFA were confirmed for all the
measures tested in Phase II, which were then used in a SEM analysis to determine
the inter-relationships among the study variables. The validated Hospital Anxiety and
Depression Scale was used to measure the anxiety and depression of the participants.
Statistical analysis for Phase II and Phase III were performed by using SPSS 26 and
Mplus 8, respectively. The newly developed and translated questionnaires were
content validated based on seven experts‘ opinion and were comprehended by 30
participants during the pre-testing process. There were 152 participants with a mean
age of 31.27 years old (standard deviation, (SD) = 14.36) and 323 participants with a
mean age of 27.69 years old (SD = 11.50) participated in Phase II and Phase III
studies. In Phase II of the exploratory study, the final models were established with
all factor loading and Cronbach alpha showing evidence of validity and reliability for
the questionnaires tested. Next, final measurement models of CFA with acceptable fit
indices were obtained in Phase III of the confirmatory analysis. The final CFA
measurement models were included in the SEM model, which explained the
connections between the study variables. The final SEM model indicated good fit
based on several fit indices and 15 significant path relationships were established.
The final SEM model explained the variance of the social support by 16%, intention
by 39%, and QoL by 53.8%. Significant relationships were found between severity
general towards QoL, social support and intention towards severity general, health
belief towards social support, depression and health belief towards severity 24 hours,
health belief towards intention and health promoting behaviour, intention and health
promoting behaviour towards depression and intention towards health promoting
behaviour. The newly developed and translated questionnaires were considered to be
valid and reliable in the assessment of health belief, intention, health promoting
behaviour, social support, symptom severity and QoL among people with AB in
Kelantan. The SEM model indicated that there were some inter-relationships
between the study variables and there were significant contributing factors
influencing the symptom severity and QoL of people with AB. The present study
provides valuable insight to the health care providers in reducing the symptom
severity and improving QoL among people with AB.
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