A causal model of functional status among persons with liver cirrhosis
This cross-sectional correlation study aimed to develop and test a causal relationship among alcohol consumption, illness perception, social support, fatigue, and functional status among persons with liver cirrhosis. The hypothesized model was constructed based on the theory of unpleasant symptoms and the review of the literature. A stratified three-stage random sampling approach was utilized to recruit 400 persons with liver cirrhosis aged 40 years old and older who visited four hospitals from three regions of Thailand. Research instruments consisted of the demographic data form, Alcohol Use Disorders Identification Test Consumption, Brief Illness Perception Questionnaire, Multidimensional Scale of Perceived Social Support, Fatigue Severity Scale, and the Functional Status Questionnaire. Data were collected from May to August 2020. The developed model was verified via a structural equation modeling using SPSS and Mplus program. The study findings revealed that the hypothesized model fit the empirical data and explained 71.3% of the variance of functional status ?2 = 386.458, df = 172, (p =.061), ?2/df = 2.397, RMSEA = .056, CFI = .985, TLI = .981, SRMR = .048. Social support was the most the influential factor affecting functional status by having both positive direct and indirect effects on functional status through illness perception and alcohol consumption (? = .744, p<.001). In addition, illness perception had a negative both direct and indirect effects on functional status through fatigue (? = -.291, p<.001). Alcohol consumption had a negative direct and indirect effects on functional status through fatigue (? = -.231, p<.001). Fatigue had only a negative direct effect on functional status (? = -.218, p<.001). The findings indicated that social support, alcohol consumption, illness perception, and fatigue were important factors influencing functional status among persons with liver cirrhosis. Therefore, further nursing intervention should consider on enhancing social support, reducing alcohol consumption, promoting positive illness perception, and managing fatigue into account to maintain or enhance functional status among persons with liver cirrhosis.