A Study On Teh Quality Of Life Of Primipara Based On The Structural Equation Model (SEM)

Abstract:Objective To describe the status quo of primiparas'quality of life and to identify the influential factors ralated to primiparas'quality of life.Then construct the structural equation model?SEM?,and introduce the mediating effect to explore the main factors influencing the quality of life of the primipara.To provide reference for improving and enhancing the quality of life of primiparas,and have great practical significance to promote the development of maternal and child health care in China.Methods A descriptive design was used.276 primiparas from The Maternal and Child Health Hospital of Hunan Province,The Maternal and Child Health Hospital of Hengyang,the First Affiliated Hospital and the Second Affiliated Hospital of Nanhua University between march and september 2016 were enrolled in this survey.Postnatal Social Support questionnaire,Edinburgh Postnatal Depression Scale?EPDS?and WHO Quality of Life-BREF?WHOQOL-BREF?were administered to assess primiparas'postnatal social support,postnatal depression and the quality of life.Subjects filled in the questionnaire or completed WeChat electronic questionnaire or mailed questionnaire or at 6^th weeks postpartum,245 valid questionnaires were finally obtained.All data were analyzed by software SPSS18.0 and AMOS21.0.Statistical methods included descriptive analysis,correlation analysis,one-way ANOVA,multiple linear regression and structural equation modeling analysis.Measurement data was expressed by the modality???±s,while count data was percentage?%?,?=0.05.Results?The reliability and validity of WHO Quality of Life-BREF?WHOQOL-BREF?were good.The canonical correlation analysis showed:The correlation coefficient of the EPDS and the WHOQOL-BREF scale was-0.53,the correlation coefficient of the EPDS and the Postnatal Social Support questionnaire was-0.43,and the correlation coefficient of the Postnatal Social Support questionnaire and the WHOQOL-BREF scale was 0.66.?The mean of 238 primiparas'quality of life score at 3^rd days and 6^th weeks postpartum were 56.87±7.27,53.19±7.95,at medium level.The mean of 238 primiparas'postnatal social support score at 3^rd days and 6^th weeks postpartum were 49.35±7.76,43.29±9.94,at medium level.Morbidity of postpartum depression at 3^rd days and 6^th weeks postpartum were16.8%,31.5%.?Multiple linear regression showed that occupational status,family economic status,family relationship,emotional support,evaluation support,lack of emotion,depression were the factors affecting the quality of life in puerperium?P<0.05?,the seven factors can explain 44.8 percent of the total variation of the equation?F=26.719,P=0.000?.?The postnatal social support had positive correlation with the quality of life in puerperium?r=0.506,P<0.01?,the more social support had gained and the higher quality of life in puerperium.The postpartum depression had negative correlation with the quality of life in puerperium?r=-0.429,P<0.01?,the more serious of the postpartum depression and the lower quality of life in puerperium.?The structural equation model?SEM?showed that:The action path of postnatal social support to the quality of life in puerperium were:social support?the quality of life,social support?the postpartum depression?the quality of life.The direct effect values of postnatal social support to the quality of life in puerperium was 0.14,while the indirect effect were 0.45.The social support was mainly through the intermediary role of postpartum depression to affect the quality of life in puerperium,it also proved that the mediating effect of postpartum depression.Conclusions?With the postpartum time prolonged,the quality of life of primipara decreased gradually.careers,family economic status,family relationship,emotional support,evaluation support,lack of emotion,depression were influenced the quality of life of the puerperium.?The postnatal social support that primipara had received was on the middle level,and with the postpartum time prolonged,the social support gradually reduced.The incidence of postpartum depression was high among the primiparas,and with the postpartum time prolonged,the postpartum depression symptoms showed increasing trend.?Postpartum social support had a direct and indirect effects on the quality of life in puerperium,the postpartum depression,as an intermediary variable,adjusted the relationship between the quality of life and the social support in puerperium.