Causal relationship between health promoting behavior and quality of life in cervical cancer patients undergoing radiotherapy.

The purpose of this cross-sectional study was to examine the causal relationships among age, education, family income, and stage of carcinoma, perceived benefits, perceived barriers, perceived self-efficacy, health promoting behavior and quality of life in patients with cervical cancer. Pender's Health Promotion Model (1996) provided a guide for the conceptual framework of this study. Purposive sampling was employed to recruit 488 cervical cancer patients who were undergoing radiotherapy at seven public hospitals in five areas of Thailand. The instruments used in this study included a Personal Data Form, Cognitive perception Form, Health promoting behavior scale, the social support questionnaire and The Functional Assessment of Cancer Therapy General (FACT-G) form. The proposed model was tested and modified by the LISREL Program. The modified model adequately fitted with the data. The results demonstrate that health promoting behavior had a significant direct positive effect on quality of life (beta = 0.71, p < 0.01). Cognitive perceptual factors had a significant direct effect on health promoting behaviors (P = 0.69, p < 0.01). Social support had a significant direct effect on the cognitive perceptual factors (P = 0.64, p < 0.01), health promoting behavior (beta = 0.70, p < 0.01), and the quality of life (beta = 0.48, p < 0.01). Age and education did not have a significant total effect on the quality of life. Family income had a significant direct effect on cognitive perceptual factors (beta = 0.10, p < 0.05). The stage of cancer had a significant direct negative effect on cognitive perceptual factors (beta = -0.11, p < 0.05) and the quality of life (beta = -0.12, p < 0.01). The direct effect of the predictors on the quality of life indicated that cervical cancer patients with higher practice of health promoting behavior tended to have a higher quality of life. The findings indicate that Pender's Health Promotion Model is a useful guide for explaining and predicting the health promoting behavior and the quality of life of Thai cervical cancer patients who were undergoing radiotherapy. The significance of cognitive perceptual factors and social support confirm health promoting behavior as a goal directed towards the level of well being. This has implications for health care systems in planning interventions to promote health promoting behavior in a health promotion setting in cervical cancer patients for a better quality of life and healthy. A longitudinal study and experimental study are recommended for further study.