Relationship Between Social Capital And The Quality Of Life Among Malignant Tumor Patients Living In Rural And Urban Communities Of Anhui Province

Background: With the progress of treatments and control techniques, the malignant tumor patients’ survival had been significantly extended. Thus, community had been the important place for malignant tumor patients to rehabilitation and live, and QOL(quality if life) index had been widely used in cancer filed. Due to the particularity of malignant tumor diseases as well as lack of research on community patients, it has important academic and social significance to study the QOL of malignant tumor patients living in community. In addition, there have been an increasing number of studies that have found that social factors were associated with QOL. So social capital had been a new clue to explore the mechanism of social factor acting on health, and had become a hot research topic in recent years. Social capital was helpful to discover and effective use of potential intangible resources, and provided a new direction for exploring the means to improve the QOL of malignant tumor patients.Objects: To explore social capital status of malignant tumor patients and the association between social capital and QOL of malignant tumor patients living in rural and urban communities, from the micro social capital perspective. On the one hand, to make up for the shortage of the existing research in theory, on the other hand, to take advantage of social capital which is an intangible resources in practice, thus, to control the disease, relieve symptoms, improve quality of life of malignant tumor patients living in rural and urban communities.Methods: Multi-stage sampling was used to recruit participants in our study. First, considering the geographic location and economic level in Anhui province, we chose three cities including Tongling(Tongguanshan district, Tongling county), Hefei(Baohe district, Feixi county) and Fuyang(Yinzhou district, Yinshang county) as the study settings. Then, we extracted 1-2 neighborhoods /villages from sample counties, using the simple sampling approach. Finally, according to the information of chronic disease patients provided by sample areas, we used a self-developed questionnaire to interview the eligible malignant tumor patients via the centrally or household surveys, from September 2014 to November. SPSS 18.0 was used for descriptive statistics analysis, factor analysis, single factor correlation analysis and multiple linear regression analysis,in the process of data analysis.Results:(1) Basic characteristics of malignant tumor patients: 64.3% were men, most of the patients were elderly and 78% were over the age of 60 years old, the subjects’ education level was generally low and 38.3% were illiterate, 57.1% were farmers/migrant workers, personal and family monthly income were low and majority of patients were less than RMB 500 a month; Most of patients were gastric cancer(23.3%),secondly were esophageal cancer(16.7%).The time of confirmed diagnosis was long and the highest proportion of time were 1-3 years(28.7%), the incidence rate of metastasis, recurrence and complications were low(9.5%, 11.2% and 11.2%, respectively), the incidence of pain was 69.5%, and the highest proportion of pain was mild pain(35.4%).There were significant differences in monthly income, education, occupation, number of family member, types of cancer, kinds of combined disease, pain and treatment among malignant tumor patients living in urban and rural communities.(2) Reliability and validity of social capital questionnaire: about construct validity, 6 common factors were extracted through, principal component analysis, which could explain 79.190% of the total variance. The overall Cronbach’s α was 0.926. Cronbach’s α of social participants dimension was 0.640, Cronbach’s α of other dimensions were over 0.8.(3) Current situation of social capital among malignant tumor patients:Social participation: 57.6% of respondents did not take part in any organization and 77.8% of respondents did not take part in any network activities in previous one year. Respondents in urban community were better than rural community in social participation(organizational participation:46.7% VS. 39%; network participation:26.3% VS. 19%)。Trust: respondents were generally at high level in trust. The percentage of participants who completely trust family members or relatives was the highest in 49.9%; the percentage of participants who partial trust other objects(strangers, friends, neighbors, general hospital doctors, community doctors, and neighborhood committees/village committee staffs) was the highest. There was no statistical difference in the trust dimension between urban and rural community(P>0.05).Social support: in the area of personal support, when respondents were in trouble, in the majority of cases, 53.6% of them could get spiritual support, 51.9% could get material support; In the area of organizational support, the percentage of participants who could not get spiritual support(27.7%) and material support(28.0%) was the highest, the proportion of urban community patients who could not get spiritual support and material support was lower than the rural community(18.4% VS. 34.9%, 18.4% VS. 34.9%);Reciprocity: when relatives, neighbors and friends were in trouble, the percentage of respondents who would like to help them in the majority of cases was 51.0%, 51.0% and 55.9%, respectively. The proportion of urban community patients who would like to help them in any case was higher than rural community(relatives: 36.2% VS. 17.9%, neighbors: 21.1% VS. 13.8%, friends: 23.0% VS. 15.4%);cohesion and belonging: 46.7% of respondents agreed that the interpersonal relationships of among the community/village they live was more harmonious, 39.5% of respondents were generally concerned about the community/village and 36.3% agreed that others were generally concerned about the community/village, 69.4% of respondents considered that they would be not reluctant to move off the community/village they live. There were statistical differences between urban and rural communities in cohesion and belonging(P<0.05).(4) Current situation of QOL among malignant tumor patients: mean score in physical well-being, social/family well-being, emotional well-being, functioning well-being domain were 19.994 points, 19.867 points, 16.896 points, 15.127 points, respectively. The overall mean score of quality of life was 71.884 points. Univariate analysis showed that the influence factors of QOL among malignant tumor patients were rural and urban, sex, marriage status, education, occupation, monthly income, time of confirmed diagnosis, metastasis, recurrence, complications pain and source of treatment costs; Multivariate linear regression analysis showed that the influence factors of QOL were age, family monthly income, pain and time of confirmed diagnosis.(5) Association between social capital and QOL: the results of multiple linear regression analysis and correlation analysis were consistent. Results showed that the higher social capital, the better QOL(beta = 0.241, p < 0.01), cohesion and belonging(beta = 0.209, p < 0.01), reciprocity(beta = 0.247, p < 0.01) and social participation(beta = 0.096, p < 0.05) were positively related with QOL, but trust and social participation was not associated with QOL. Cohesion and belonging was positively related to the physical well-being and functional well-being domain; Reciprocity had effect on all domain of quality of life; Organizational support was positively correlated with physical well-being domain; Personal support was positively correlated with social/family well-being domain; Social participation was positively correlated with emotional well-being domain; Total scores of social capital had effect on all domain of quality of life.Conclusions:(1) The social capital questionnaire which was applied to malignant tumor patients among urban and rural communities in our study had good reliability and validity;(2) Malignant tumor patients in urban and rural communities were at low level in social participation dimension, got less organizational support, were at high level in trust and reciprocity dimension, and had a strong sense of community cohesion and belonging. All dimensions score and total score of social capital of malignant tumor patients in urban community were higher than rural patients;(3) Higher social capital was helpful to improve the quality of life of malignant tumor patients in urban and rural community. In addition to trust, the rest of social capital factors had different degrees of influence on QOL, especially the mutual factor had a significant impact on QOL of malignant tumor patients.Suggestions:(1) The measures, including the perfection of social organization in the urban and rural communities, improvement of group support system and enhancement of reciprocity, cohesion and belonging among malignant tumor patients in the urban and rural community, can be taken to promote social capital and improve the quality of life of malignant tumor patients;(2)To take measures of adaptation to local conditions and narrow the gap between malignant tumor patients in rural and urban areas.