| Objective:To improve the health literacy of patients received modified radical mastectomy, we investigated the health literacy, exercise adherence and quality of life in patients with modified radical mastectomy; and then we analyzed factors which affect health literacy,exercise adherence and quality of life in breast cancer patients; Besides, we discussed the effects of patient’s health literacy and exercise adherence on their quality of life.Last, we analyzed the mediating effect of exercise adherence between patient’s health literacy and quality of life.Methods:With convenience sampling method, we selected patients received modified radical mastectomy in three hospital as research subjects. Then questionnaires were applied to382 breast cancer patients who met the inclusion criteria from July to December in 2015.The questionnaire included five parts: the General Information of breast cancer patients,the Health Literacy Scale for Patients with Chronic Disease, Perceived Social Support Scale, the Functional Exercise Compliance Scale for Postoperative Breast Cancer Patients, and the Quality of Life Scale for Breast Cancer Patients. In this study, the measurement data was described by Mean ± SE. The count data was described by frequency and constituent ratio. ANOVA analysis, t-test, and rank sum were used for the one-way analysis of variance. Multiple regression analysis was used for multiple-factor analysis. Spearman analysis and Pearson analysis were used for correlation analysis.Besides, the Amos software was used to build the mediating model of exercise adherence between patient’s health literacy and quality of life.Results:1. The average score of health literacy was(91.97±13.82). There were statistically differences on the health literacy level between the breast cancer patients with different characteristics, such as : postoperative complications, place of residence, stage of disease, the types of health insurance, the average family income, treatment method, age,work status, time away from the diagnosis of breast cancer, education, occupation,social support(P <0.05).2. The average score of exercise adherence was(50.65±9.20).And the average score of quality of life was(83.26 ± 18.84).3. The total health literacy and its different dimensions( access to information,communication interactive capability, willingness to improve the health, economic support) were positively related to the total functional exercise compliance and its different dimensions(compliance to exercise, compliance to considerations, compliance to seek recommendations)(P <0.05).4. The total health literacy and its different dimensions(access to information,communication interactive capability, willingness to improve the health, economic support) were positively related to the total quality of life and its different dimensions( physiological condition, social / family status, emotional status, functional status,additional concerns)(P <0.05).5. The total functional exercise compliance and its different dimensions( compliance to exercise, compliance to considerations, compliance to seek recommendations) were positively related to the total quality of life and its different dimensions(physical condition, social / family status, emotional status, functional status,additional attention)(P <0.05).6. The mediating effect of functional exercise compliance accounted for 43.58% of the total effect, and the mediating effect explained 30.5% of the total variance of patients’ quality of life.7. Fitness indices of the established structural equation model were:root mean square of approximation( RMSEA) = 0.031, goodness-of-fit( GFI) = 0.981, adjusted goodness-of-fit( AGFI) = 0. 9560,normed-fit index( NFI) = 0.974, comparative fitness index( CFI) = 0. 993,incremental fit index( IFI) = 0. 993,,parsimony goodness-of-fit index.The fitness of the structural equation model was fine for health literacy influence mode based on the threshold theory.The direct influence path coefficient for health literacy on functional exercise adherence was 0.775. The total effect coefficient for health literacy on quality of life was 0.7060.Conclusions:1. The health literacy of breast cancer patients was at the moderate level and there were still cases with low health literacy. Education, social support, occupation, the type of health insurance were the main factors that affected patients’ health literacy.2. The functional exercise adherence of breast cancer patients was at the moderate level.And the quality of life among breast cancer patients was also at the moderate level.3. The health literacy and the functional exercise adherence of breast cancer patients could both positively predict their quality of life respectively. The functional exercise compliance was the mediator between patients’ health literacy and quality of life.4. The health literacy influence mode can be used in the interventions on health education and health promotion in postoperative breast cancer patients. |
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