Health Status Influence Acceptance of Illness in Patients with Chronic Respiratory Diseases?

Gender

Women

148

53.2

Men

130

46.8

Age

≤24

6.1

25–44

9.0

45–64

111

39.9

65–84

112

40.3

≥85

4.7

Place of residence

Village

34.9

Town/city population

< 5,000

13.3

5,000–10,000

3.6

10,000–50,000

23.0

50,000–100,000

14.0

100,000–200,000

6.1

Over 200,000

5.0

Education

Primary

22.3

Vocational

30.2

Secondary

23.0

Post-secondary

13.3

Higher

11.2

Marital status

Single

9.0

Married

182

65.5

Divorced

5.0

Widowed

20.5

Table 2

Patients’ diagnoses according to the 2013 ICD-10-CM Diagnosis Codes and comorbidity (n = 278)

	n	%
Diagnosis^a
J45 Bronchial asthma	130	46.8
J44 Other chronic obstructive pulmonary diseases	86	30.9
J42 Unspecified chronic bronchitis	39	14.0
J41 Chronic simple and mucous-purulent bronchitis	35	12.6
J43 Pulmonary emphysema	29	10.4
J47 Bronchiectasis	24	8.6
Most common co-existing diseases^a
I10 Primary hypertension	75	27.0
M47 Spondylosis	58	20.9
I70 Atherosclerosis	39	14.0
E11 Type 2 diabetes mellitus	26	9.4
I50 Heart failure	26	9.4
I11 Hypertensive heart disease	24	8.6
M15 Osteoarthritis of multiple joints	24	8.6
I25 Chronic ischemic heart disease	22	7.9
E10 Type 1 diabetes mellitus	15	5.4
K58 Irritable bowel syndrome	15	5.4
Comorbidity
1 chronic disease	56	20.1
2 and more	222	79.9
3 and more	172	61.9
4 and more	112	40.3
5 and more	65	23.4
6 and more	39	14.0
7 and more	25	9.0
8 and more	14	5.0
9 and more	9	3.2
10 and more	5	1.8
11 and more	3	1.1
15 and more	2	0.7

^aSome patients were diagnosed as having at least two pathological entities

The patients’ adaptation to life with a disease was assessed using the Acceptance of Illness Scale developed by Felton et al. (1984), and adapted to the Polish conditions by Juczynski (2009). The scale consists of eight statements about negative consequences of health state, where every statement is rated on a five-point Likert scale, where one denotes poor adaptation to a disease and 5 its full acceptance. The score for illness acceptance is a sum of all points and can range from 8 to 40. Low scores (0–29) indicate the lack of acceptance and poor adaptation to a disease, and a strong feeling of mental discomfort. High scores (35–40) indicate the acceptance of illness, manifest as the lack of negative emotions associated with a disease. The scale can be used to assess the degree of acceptance of every disease. The α-Cronbach coefficient of the Polish version is 0.85 (Juczynski 2009) and that of the original version is 0.82 (Felton et al. 1984).

The clinical condition of patients was determined by means of a questionnaire measuring the improvement of somatic and psychic health, somatic symptoms occurring most frequently, and the results of spirometry and laboratory tests during the past 12 months. For the sake of analysis, the somatic index was calculated for each patient. Somatic symptoms reported by the patients were assigned a value from one (symptoms occurring once a year) to seven (permanent symptoms). The index was calculated by summing up the values assigned to somatic symptoms, and then dividing the sum by 49 (the highest possible score for the frequency of somatic symptoms).

2.1 Statistical Elaboration

Statistical analysis was performed using R 2.10.1 (for Mac OS X Cocoa GUI). The type of distribution for all variables was determined. Overall, the results of variables were not normally distributed, which was confirmed by the Shapiro-Wilk normality test. Arithmetic means, standard deviations, medians, as well as the range of variability (extremes) were calculated for measurable (quantitative) variables, while for qualitative variables, the frequency (percentage) was determined. For each variable pair, the Spearman rank correlation coefficient (r) was calculated. The null hypothesis was tested that the correlation coefficient is 0, which would denote no correlation between variables.

The analysis of multiple regressions was used in order to examine the impact of explanatory variables on the level of illness acceptance, somatic index, and on the subjective improvement of the somatic and psychic health of patients. An initial set of explanatory variables for each response variable included only these variables that significantly correlated with a particular response variable. All available models with different numbers of explanatory variables were checked. Ultimately, 13 significant models which met the assumptions of multiple regressions were found; namely, 8 models with 4 explanatory variables for the response variable ‘level of illness acceptance’ and 5 models with 3 explanatory variables for the response variable ‘somatic index’. No model was found for the response variable ‘subjective improvement of the somatic and psychic health’. The critical level of significance was assumed at p < 0.05.

3 Results

During the past 12 months preceding the study, the improvement of somatic health was reported by 193 (69.4 %) patients, while no improvement was reported by 85 (30.6 %) patients. The improvement of psychic health was reported by 194 (69.8 %) patients, and no improvement was found by 84 (30.2 %) patients. The average value of the somatic index in the study group was 0.4 ± 0.2, average forced expiratory volume in 1 s (FEV1) was 75.0 ± 12.7 l, serum creatinine 0.9 ± 0.5 mg/dl, total cholesterol 219.2 ± 43.8 mg/dl, and glucose 125.4 ± 54.3 mg/dl. The most common complaints were: permanent pain of the spine (39, 29.8 %) and peripheral joints (47, 33.3 %), high blood pressure (above 140/90 mmHg) 2–3 times a week (56, 29.0 %), permanent dyspnea (72, 28.4 %), chest pain 2–3 times a week (52, 27.2 %), stomachache once a month (27, 21.6 %). Most patients (175, 62.9 %) had abnormal body mass: overweight (85, 30.6 %), obesity (81, 29.1 %), and underweight (9, 3.2 %). The Body Mass Index (BMI) of 191 (41.9 %) patients was within normal range.

The average number of chronic diseases was 3.4 ± 2.2 and that of medications taken by patients was 4.4 ± 3.0. The top 10 medications used by the patients are presented in Table 3. The average score in the Acceptance of Illness Scale was 26.2 ± 7.6. The low level of illness acceptance (score of 1–29 points) was noted in 174 (62.6 %), medium (30–34 points) in 58 (20.9 %), and high (35–40 points) in 46 (16.6 %) patients.

Table 3

Top 10 medications used by patients

Active substance	n	%
Formoterol fumarate	57	20.5
Theophylline	45	16.2
Acetylsalicylic acid	43	15.5
Salbutamol	39	14.0
Ipratropium bromide	31	11.2
Salmeterol	27	9.7
Fluticason propionate	25	9.0
Ramipril	21	7.6
Budesonide	19	6.8
Furosemide	18	6.5

3.1 Results of Correlations

More men than women lived in rural areas and the majority of women lived in places with a population of over 200,000 citizens (r = −0.12, p = 0.048). Incomplete primary education was more common among widows/widowers and graduate education more common among unmarried women/men (r = −0.20, p = 0.001).

Patients in advanced age were more often widows/widowers (r = 0.51, p < 0.0001), had incomplete primary education (r = −0.48, p < 0.0001), and lived in rural areas (r = 0.37, p < 0.0001). This group of patients more often had high BMI values (r = 0.13, p = 0.032), a higher number of chronic diseases (r = 0.52, p < 0.0001), no improvement of somatic (r = −0.23, p < 0.0001) and psychic (r = −0.28, p < 0.0001) health during the past 12 months, high values of the somatic index (r = 0.41, p < 0.0001), used a higher number of medications (r = 0.22, p < 0.001), and had abnormal creatinine levels (r = −0.54, p = 0.008).

Patients with incomplete primary education (vs. graduate education) more often lived in rural areas (r = −0.56, p < 0.0001), and had a higher number of chronic diseases (r = −0.36, p < 0.0001), no improvement of somatic (r = 0.13, p = 0.037) and psychic (r = 0.16, p = 0.009) health during the past 12 months, higher values of the somatic index (r = −0.30, p < 0.0001), and high FEV1 values (r = −0.49, p = 0.043).

Widows/widowers (vs. unmarried women/men) more often had high BMI values (r = 0.19, p = 0.001), a higher number of chronic diseases (r = 0.36, p < 0.0001), no improvement of somatic (r = −0.17, p = 0.006) and psychic (r = −0.16, p = 0.008) health during the past 12 months, high values of the somatic index (r = 0.19, p = 0.001), and severe asthma or chronic obstructive pulmonary disease (COPD) as assessed by spirometry (r = −0.60, p = 0.012).

Patients from rural areas (vs. patients from cities/towns with a population over 200,000) more often had a higher number of chronic diseases (r = 0.18, p = 0.003), no improvement of somatic (r = −0.14, p = 0.017) and psychic (r = −0.13, p = 0.032) health during the past 12 months, and high values of the somatic index (r = 0.16, p = 0.010).

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