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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases

Nayeon Shin1, Younhee Kang2
Korean Journal of Adult Nursing 2015;27(3):294-303.
Published online: June 30, 2015

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Corresponding author: Kang, Younhee Division of Nursing Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea. Tel: +82-2-3277-4483, Fax: +82-2-3277-2850, E-mail: yxk12@ewha.ac.kr
• Received: March 22, 2015   • Accepted: June 15, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to determine the relationships among health locus of control, resilience, social support, and health promoting behavior in patients with coronary artery diseases.
  • Methods
    This study utilized a descriptive correlational design using a survey method. The subjects were 165 coronary artery disease patients at the cardiology out-patient clinic of the C university hospital. Data were collected through Health Locus of Control Scale, Resilience Scale, ENRICHD Social Support Instrument, Health Promoting Lifestyle Profile scale. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient and hierarchial regression.
  • Results
    There were significant positive bivariate correlations of health promoting behavior with internal health locus of control, doctors health locus of control, resilience and social support respectively, and correlation between resilience and social support. Among predictors, internal health locus of control (β=.28), social support (β=.28) and resilience (β=.25) had statistically significant influences on health promoting behavior.
  • Conclusion
    These results proposed that internal health locus of control, social support and resilience have important influences on health promoting behavior. Nursing interventions to enhance internal health locus of control, resilience and social support might be essential for patients with coronary artery disease in order to promote their health behaviors.
  • Key Words: Coronary artery disease; Internal-external control; Psychological resilience; Social support; Health promotion
Table 1.
The General Characteristics and Risk Factors related Coronary Artery Disease (N=165)
Characteristics Categories n (%) M±SD Range
Gender Male 101 (62.5)    
Female 64 (37.5)
Age (year) 40~49 36 (21.0) 60.52±6.39 42~83
50~59 38 (22.0)
60~69 79 (49.4)
≥70 12 (7.6)
Education (year) Elementary school (≤6) 55 (34.1) 10.32±2.50 0~19
Middle school (7~9) 38 (22.4)
High school (10~12) 40 (24.7)
Undergraduate school (≥13) 32 (18.8)
Spouse Yes 120 (76.5)  
No 45 (23.5)
Occupation Yes 42 (24.7)  
No 123 (75.3)
Living arrangement of family Spouse & child 71 (45.9)  
Spouse 50 (29.4)
Child 32 (18.8)
Solitude 12 (5.9)
Diagnosis Stable angina 44 (25.3)  
Unstable angina 75 (48.1)
Myocardial infarction 38 (21.5)
Variant angina 8 (5.1)
Periods since diagnosed (month)   2.91±0.45
PCI Yes 145 (89.9)  
No 20 (10.1)
BMI (kg/m2)   24.57±3.11
Hyperlipidemia (mg/dL) (total cholesterol) Hyperlipidemia (＞210) 111 (69.6) 198.25±31.24
Normal (≤210) 54 (30.4)
Family History Yes 78 (41.8)  
No 87 (58.2)
Exercise No 61 (40.0)  
Occasionally 46 (24.3)
Frequently (≥3 times/week) 58 (35.7)
Ejection fraction (%)   68.37±15.25
Comorbidity (DM, HTN, CVA) 0 48 (31.6)  
1 42 (24.0)
2 47 (31.6)
3 28 (12.6)
Smoking status Smoker 62 (34.6)  
Ex-smoker 36 (21.8)
Non-smoker 67 (43.6)

CVA=cardiovascular accident; DM=diabetes mellitus; HTN=hypertension; PCI=percutaneous coronary intervention.

Table 2.
Degree of Health Locus of Control, Resilience, Social Support and Health Promoting Behavior (N=165)
Variables M±SD Min Max Range
Health locus of control-internal 24.18±3.99 11 30 6~30
Health locus of control-chance 18.07±4.51 6 30 6~30
Health locus of control-power others 12.01±2.77 3 15 3~15
Health locus of control-doctors 12.27±2.70 6 15 3~15
Resilience 119.08±19.88 32 163 25~175
Social support 23.19±4.86 9 30 6~30
Health promoting behavior 129.88±17.84 83 193 52~208
Table 3.
Levels of Health Promoting Behavior according to the Characteristics of the Participants (N=165)
Characteristics Categories n (%) M±SD t or F p Duncan
Gender Male 101 (61.2) 132.94±23.47 1.04 .299  
Female 64 (39.8) 127.31±20.05
Age (year) 40~49 36 (21.8) 131.33±28.18 0.67 .060  
50~59 38 (23.0) 131.89±16.69
60~69 79 (47.9) 133.61±19.60
≥70 12 (7.3) 134.84±11.50
Education (year) Elementary school (≤6) 55 (34.1) 128.30±24.51 1.30 .279  
Middle school (7~9) 38 (22.4) 129.67±22.49
High school (10~12) 40 (24.7) 127.86±19.52
Undergraduate school (≥13) 32 (18.8) 140.81±22.09
Spouse Yes 120 (76.5) 132.84±21.52 1.43 .012  
No 45 (23.5) 124.71±25.05
Occupation Yes 42 (24.7) 133.67±18.28 0.49 .620  
No 123 (75.3)
Living arrangement of family Spouse & childd 71 (45.9) 134.13±22.66 1.96 .014 d＞a
Spousec 50 (29.4) 132.76±20.61
Childb 32 (18.8) 124.36±25.10
Solitudea 12 (5.9) 109.75±12.39
Diagnosis Stable angina 44 (26.7) 131.75±26.93 0.09 .965  
Unstable angina 75 (45.5) 131.49±22.60
Myocardial infarction 38 (23.0) 130.65±19.42
Varient angina 8 (4.8) 125.50±11.00
PCI Yes 145 (87.9) 130.26±22.33 0.93 .350  
No 20 (12.1) 138.13±23.43
Hyperlipidemia (total cholesterol) Hyperlipidemia (＞210) 111 (69.6) 129.40±21.46 1.30 .040  
Normal (≤210) 54 (30.4) 134.11±25.56
Family history Yes 78 (41.8) 131.91±20.10 -0.28 .778  
No 87 (58.2) 130.44±24.18
Exercise No 61 (40.0) 126.67±23.57 1.00 .047  
Occasionally 46 (24.3) 132.40±17.81
Frequently (≥3 times/wk) 58 (35.6) 134.82±24.00

PCI=percutaneous coronary intervention.

Table 4.
Relationships between Health Locus of Control, Resilience, Social support and Health Promoting Behavior (N=165)
Variables Health locus of control Resilience Social support
Internal Chance Power-others Doctors
r (p) r (p) r (p) r (p) r (p) r (p)
Resilience .35 (.002) -.06 (.602) -.15 (.170) .17 (.125)    
Social support .27 (.015) -.25 (.027) -.35 (.001) .20 (.070) .34 (＜.001)  
Health promoting behavior .38 (.001) .14 (.208) -.07 (.523) .21 (.017) .32 (.002) .36 (＜.001)
Table 5.
Results of Multiple Regression Analysis of Factors Affecting to the Health Promoting Behavior (N=165)
Variables Step I Step II
β t p β t p
Spouse .00 0.07 .823 .00 0.09 .852
Living arrangement of family .25 0.17 .560 .01 0.26 .793
Exercise -.35 -0.18 .102 -.25 -1.68 .093
Hyperlipidemia -.09 0.81 .352 -.08 0.72 .491
Health locus of control-internal   .28 2.30 .024
Health locus of control-doctors .00 -0.02 .977
Resilience .25 2.36 .021
Social support .28 2.50 .015
  R2=.32, F=3.85, p＜.001 R2=.43, F=5.95, p＜.001
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    The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases
    Korean J Adult Nurs. 2015;27(3):294-303.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.294
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    The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases
    Korean J Adult Nurs. 2015;27(3):294-303.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.294
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    The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases
    The Relationships among Health Locus of Control and Resilience, Social Support and Health Promoting Behavior in Patients with Newly Diagnosed Coronary Artery Diseases

    The General Characteristics and Risk Factors related Coronary Artery Disease (N=165)

    Characteristics Categories n (%) M±SD Range
    Gender Male 101 (62.5)    
    Female 64 (37.5)
    Age (year) 40~49 36 (21.0) 60.52±6.39 42~83
    50~59 38 (22.0)
    60~69 79 (49.4)
    ≥70 12 (7.6)
    Education (year) Elementary school (≤6) 55 (34.1) 10.32±2.50 0~19
    Middle school (7~9) 38 (22.4)
    High school (10~12) 40 (24.7)
    Undergraduate school (≥13) 32 (18.8)
    Spouse Yes 120 (76.5)  
    No 45 (23.5)
    Occupation Yes 42 (24.7)  
    No 123 (75.3)
    Living arrangement of family Spouse & child 71 (45.9)  
    Spouse 50 (29.4)
    Child 32 (18.8)
    Solitude 12 (5.9)
    Diagnosis Stable angina 44 (25.3)  
    Unstable angina 75 (48.1)
    Myocardial infarction 38 (21.5)
    Variant angina 8 (5.1)
    Periods since diagnosed (month)   2.91±0.45
    PCI Yes 145 (89.9)  
    No 20 (10.1)
    BMI (kg/m2)   24.57±3.11
    Hyperlipidemia (mg/dL) (total cholesterol) Hyperlipidemia (＞210) 111 (69.6) 198.25±31.24
    Normal (≤210) 54 (30.4)
    Family History Yes 78 (41.8)  
    No 87 (58.2)
    Exercise No 61 (40.0)  
    Occasionally 46 (24.3)
    Frequently (≥3 times/week) 58 (35.7)
    Ejection fraction (%)   68.37±15.25
    Comorbidity (DM, HTN, CVA) 0 48 (31.6)  
    1 42 (24.0)
    2 47 (31.6)
    3 28 (12.6)
    Smoking status Smoker 62 (34.6)  
    Ex-smoker 36 (21.8)
    Non-smoker 67 (43.6)

    CVA=cardiovascular accident; DM=diabetes mellitus; HTN=hypertension; PCI=percutaneous coronary intervention.

    Degree of Health Locus of Control, Resilience, Social Support and Health Promoting Behavior (N=165)

    Variables M±SD Min Max Range
    Health locus of control-internal 24.18±3.99 11 30 6~30
    Health locus of control-chance 18.07±4.51 6 30 6~30
    Health locus of control-power others 12.01±2.77 3 15 3~15
    Health locus of control-doctors 12.27±2.70 6 15 3~15
    Resilience 119.08±19.88 32 163 25~175
    Social support 23.19±4.86 9 30 6~30
    Health promoting behavior 129.88±17.84 83 193 52~208

    Levels of Health Promoting Behavior according to the Characteristics of the Participants (N=165)

    Characteristics Categories n (%) M±SD t or F p Duncan
    Gender Male 101 (61.2) 132.94±23.47 1.04 .299  
    Female 64 (39.8) 127.31±20.05
    Age (year) 40~49 36 (21.8) 131.33±28.18 0.67 .060  
    50~59 38 (23.0) 131.89±16.69
    60~69 79 (47.9) 133.61±19.60
    ≥70 12 (7.3) 134.84±11.50
    Education (year) Elementary school (≤6) 55 (34.1) 128.30±24.51 1.30 .279  
    Middle school (7~9) 38 (22.4) 129.67±22.49
    High school (10~12) 40 (24.7) 127.86±19.52
    Undergraduate school (≥13) 32 (18.8) 140.81±22.09
    Spouse Yes 120 (76.5) 132.84±21.52 1.43 .012  
    No 45 (23.5) 124.71±25.05
    Occupation Yes 42 (24.7) 133.67±18.28 0.49 .620  
    No 123 (75.3)
    Living arrangement of family Spouse & childd 71 (45.9) 134.13±22.66 1.96 .014 d＞a
    Spousec 50 (29.4) 132.76±20.61
    Childb 32 (18.8) 124.36±25.10
    Solitudea 12 (5.9) 109.75±12.39
    Diagnosis Stable angina 44 (26.7) 131.75±26.93 0.09 .965  
    Unstable angina 75 (45.5) 131.49±22.60
    Myocardial infarction 38 (23.0) 130.65±19.42
    Varient angina 8 (4.8) 125.50±11.00
    PCI Yes 145 (87.9) 130.26±22.33 0.93 .350  
    No 20 (12.1) 138.13±23.43
    Hyperlipidemia (total cholesterol) Hyperlipidemia (＞210) 111 (69.6) 129.40±21.46 1.30 .040  
    Normal (≤210) 54 (30.4) 134.11±25.56
    Family history Yes 78 (41.8) 131.91±20.10 -0.28 .778  
    No 87 (58.2) 130.44±24.18
    Exercise No 61 (40.0) 126.67±23.57 1.00 .047  
    Occasionally 46 (24.3) 132.40±17.81
    Frequently (≥3 times/wk) 58 (35.6) 134.82±24.00

    PCI=percutaneous coronary intervention.

    Relationships between Health Locus of Control, Resilience, Social support and Health Promoting Behavior (N=165)

    Variables Health locus of control Resilience Social support
    Internal Chance Power-others Doctors
    r (p) r (p) r (p) r (p) r (p) r (p)
    Resilience .35 (.002) -.06 (.602) -.15 (.170) .17 (.125)    
    Social support .27 (.015) -.25 (.027) -.35 (.001) .20 (.070) .34 (＜.001)  
    Health promoting behavior .38 (.001) .14 (.208) -.07 (.523) .21 (.017) .32 (.002) .36 (＜.001)

    Results of Multiple Regression Analysis of Factors Affecting to the Health Promoting Behavior (N=165)

    Variables Step I Step II
    β t p β t p
    Spouse .00 0.07 .823 .00 0.09 .852
    Living arrangement of family .25 0.17 .560 .01 0.26 .793
    Exercise -.35 -0.18 .102 -.25 -1.68 .093
    Hyperlipidemia -.09 0.81 .352 -.08 0.72 .491
    Health locus of control-internal   .28 2.30 .024
    Health locus of control-doctors .00 -0.02 .977
    Resilience .25 2.36 .021
    Social support .28 2.50 .015
      R2=.32, F=3.85, p＜.001 R2=.43, F=5.95, p＜.001
    Table 1. The General Characteristics and Risk Factors related Coronary Artery Disease (N=165)

    CVA=cardiovascular accident; DM=diabetes mellitus; HTN=hypertension; PCI=percutaneous coronary intervention.

    Table 2. Degree of Health Locus of Control, Resilience, Social Support and Health Promoting Behavior (N=165)

    Table 3. Levels of Health Promoting Behavior according to the Characteristics of the Participants (N=165)

    PCI=percutaneous coronary intervention.

    Table 4. Relationships between Health Locus of Control, Resilience, Social support and Health Promoting Behavior (N=165)

    Table 5. Results of Multiple Regression Analysis of Factors Affecting to the Health Promoting Behavior (N=165)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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