The Relationships Among Social Support, Self-efficacy And Quality Of Life In Community-dwelling Elderly With Chronic Pain

ObjectiveThrough investigating the demographic and general health related information, pain characteristics, social support, self-efficacy and quality of life in community-dwelling elderly with chronic pain, to analyze the differences of social support, self-efficacy, quality of life in the demographic characteristics, general health related information and pain characteristics; To analyze the relationships among social support, self-efficacy and quality of life; To clear the the path of social support, self-efficacy influencing quality of life; So as to provide references to optimize quality of life in community-dwelling elderly with chronic pain.MethodsA cross-sectional study was conducted. A total of220community-dwelling elderly with chronic pain were recruited via convenience sampling and required to complete the following questionnaires:the self-designed general information questionnaire, Social Support Rating Scale (SSRS), Chronic Pain Self-Efficacy Scale (CPSS) and The Medical Outcomes study36-Item Short-Form Health survey (SF-36). All the data collected were analyzed by SPSS11.5and AMOS7.0, including descriptive analysis, single factor analysis, multiple stepwise regression analysis, correlation analysis and structural equation modeling (SEM) analysis.Results(1)204out of240questionnaires were valid; the valid response rate was92.73%. Among the204community-dwelling elderly with chronic pain, the mean age was68.42±6.32years, with45(22.06%) male patients and159(77.94%) female patients.(2) Among the community-dwelling elderly with chronic pain, the history of chronic pain was5(2-15) years; the pain severity was2.75(2.00-3.75); the pain interference was2.57(1.28-4.00).80.39%patients had2or more pain sites, lower extremity and lower back were the two most commonly described pain sites.66.67%paitients could take1or more methods to relieve pain, and37.25%patients prefered to choose medication. While the degree of pain relief was just about30%among most of the patients.(3) Among the community-dwelling elderly with chronic pain, the average scores of social support and its three dimensions including objective support, subjective support and social support utilization were32.35±6.52,8.02±2.84,18.45±3.75and5.88±2.03. The multiple stepwise regression analysis indicated that marital status, presence of chronic disease and pain interference were the influencing factors and explained16.2%of the variances in social support.(4) Among the community-dwelling elderly with chronic pain, the average scores of self-efficacy and its three dimensions including PSE, FSE and CSE were71.06±14.24,15.19±4.06,32.57±7.91and23.30±5.12. The multiple stepwise regression analysis indicated that pain interference, age, BMI and financial balance were the influencing factors and explained65.4%of the variances in self-efficacy.(5) Among the community-dwelling elderly with chronic pain, the average scores of quality of life and its two components including PCS and MCS were55.29±16.90,48.24±16.65and62.34±19.82. Compared with the norms, patients’8dimension (PF, RP, BP, GH, VT, SF, RE and MH) scores of the quality of life were lower (t=19.031, P<0.001;t=22.878, P<0.001;t=28.594, P<0.001;t=13.021; P<0.001;t=7.433; P<0.001; t=9.793; P<0.001;t=8.548, P<0.001;t=6.233, P<0.001). The multiple stepwise regression analysis indicated that pain interference, financial balance and presence of chronic pain were the influencing factors and explained53.0%of the variances in quality of life.(6) The correlation analysis indicated that patients’social support was positively correlated with chronic pain self-efficacy (r=0.252, P<0.001); chronic pain self-efficacy was positively correlated with quality of life (r=0.788,P<0.001); And the positive correlation between social support and quality of life was also proved (r=0.253,P<0.001).(7) The structural equation modeling analysis indicated that the patients’quality of life was directly predicted by self-efficacy, the standardized regression weight was0.934; And self-efficacy played a completely mediating role in the relation between social support and quality of life, the mediating effect was0.266; All the results were statistically significant (P<0.001).Conclusion(1) The community-dwelling elderly with chronic pain had a long history of pain, the overall degree of pain and pain interference were mild. Most of the patients had more than1pain sites. Although many patients could take one or more measures to relieve pain, mostly choosing medical treatment, yet the effect was not satisfying.(2) The social support among the community-dwelling elderly with chronic pain was in the medium level; Higher level of social support mainly distributed in the patients having spouse, without other chronic disease and with lesser pain interference. The self-efficacy was also in the medium level; The patients with lesser pain interference, younger age, lower BMI and better financial status tended to show higher self-efficacy. The quality of life was poor; The patients with lesser pain interference, better financial status and without other chronic disease tended to have better quality of life.(3) The positive relationships among social support, self-efficacy and quality of life in community-dwelling elderly with chronic pain were verified. Self-efficacy showed a complete mediating role between social support and quality of life. It was suggested that the community medical staff could create a good social environment to improve chronic pain patients’ self-efficacy and optimize their quality of life during the process of chronic pain management.