Defense Date


Document Type


Degree Name

Doctor of Philosophy


Adult Health Nursing

First Advisor

Dr. Jeanne Salyer


Chronic obstructive pulmonary disease (COPD) has a severe impact on quality of life (QOL). Using the Health Promotion Model as a guide, a cross-sectional, correlational design was used to describe relationships among individual characteristics and experiences (age, gender, race, severity of illness, resilience), behavior-specific cognitions and affect (self-efficacy, barriers, social support), behavioral outcomes (health promoting lifestyle), and QOL in this patient population. One hundred and twenty participants were recruited from three clinics at Virginia Commonwealth University Health System. In addition to a demographic survey, participants completed a 151-item questionnaire incorporating measures resilience, severity of illness, self-efficacy, and barriers to a health-promoting lifestyle, social support, lifestyle, and QOL. Spirometric evaluation of lung function and the 6-minute walking test were also completed. Structural equation modeling was used to determine the effect of nine independent variables on QOL.Participants were white (51.2%), female (63.6%), and approximately 60.5 years old. Severity of illness, characterized by symptoms and functional capacity, suggested they were not severely ill (mean = 3.18, S.D.= 2.69). They were somewhat resilient (mean = 136.01, S.D.= 23.01), had adequate social support (mean = 68.10, S.D.= 19.95), were uncertain about their competency (self-efficacy) to manage their health (mean = 24.91, S.D.= 4.92), sometimes experienced barriers (mean = 33.33, S.D.= 9.02), and sometimes included attributes of a healthy lifestyle in their lives (mean = 123.93, S.D.= 25.22). Their QOL was fair to poor (mean = 6.10, S.D.= 2.39).A series of analyses using structural equation modeling was conducted. The first model that was tested did not fit the data χ2(df = 13)= 67.989,p = 0.000, GFI = 0.895, CFI = 0.781, RMSEA = 0.189). Next, modification indices were use to reexamine for fit. Using the recommended modifications, a good fit model was obtained χ2(df = 9)=5.016, p = 0.833, GFI = 0.992, CFI = 1.0, RMSEA = 0.0); however, non-significant paths were present. An alternative model was tested and fit the data very well χ2(df=18)= 10.011, p = 0.932, GFI = 0.981, CFI = 1.0, RMSEA = 0.0). The independent variables explained about 45.1% of the variance in health-promoting lifestyle. All the variables explained 45.3% of variance in QOL. The most significant predictor of a healthy lifestyle was social support (0.383) and the most significant predictor of QOL was self-efficacy (0.364). The findings confirmed the utility of the HPM.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Nursing Commons