Application and Validation of the PRECEDE Model for Measuring the Quality of Life of the People with Physical Disabilities

Background: This study aimed to diagnose the quality of life of people with disabilities through social, epidemiological, behavioural, educational, and ecological factors based on the Predisposing, Reinforcing, and Enabling Causes in Educational Diagnosis and Evaluation (PRECEDE) diagnostic model. Methods: Using the systematic stratified cluster sampling method, 605 people with disabilities from five districts (Seoul, Gyeonggi, Chungcheong, Jeolla, and Gyeongsang) who were registered at the welfare centres in 2019 were recruited. In addition, the study participants were limited to grades 1 to 4 with disabilities, and those with physical disabilities who did not have intellectual disabilities. The final model’s goodness of fit was found to be good χ2 = 554.257 (p $<$ 0.001), Tucker Lewis Index (TLI) = 0.921, comparative fit index (CFI) = 0.939, root mean square error of approximation (RMSEA) = 0.059). Results: The finding demonstrated that physical self-efficacy and social support, excluding the health promotion behavioural intention, were found to have a statistically significant effect. The behavioural factor was found to have a statistically significant effect on the epidemiological and the social factor. The former was also found to have a statistically significant effect on the latter. The results for each group according to gender were the same as for the integrated group in the case of men. In the case of women, it was found that there was a direct effect on the promotion behavior and health status, the promotion behavior and the quality of life, and all other pathways were found to be statistically insignificant. Conclusions: This research demonstrated that it is important to increase the sense of efficacy and social support for enhancing the quality of life of the physically disabled. Moreover, their health promotion behaviour had a positive effect on their health status and quality of life. This evidence could be used as data for establishing an efficient system for improving their quality of life.

diagnosis; health promotion; physically disabled; quality of life

[1] Song CH, Oh BK. Comparison of Physical Self-concept by Par-ticipation Type with Participation Satisfaction of Sports for all in Disabled People. Journal of Sport and Leisure Studies. 2010; 39: 499–509.

[2] Ministry of Culture, Sports and Tourism. Survey on the status of persons with disabilities in 2017. Sejong: Ministry of Culture, Sports and Tourism. 2017. Report No. 11-1352000-000568-12.

[3] Zarb G, Oliver M. Ageing with a disability: What do they expect after all these years? University of Greenwich: London. 1993.

[4] Roh SH, Shin YR, Kim CS. Effects of discrimination experi-ence and social support on physical and mental health among the disabled. Korea Rehabilitation Association for Persons with Disabilities. 2017; 21: 113–137.

[5] Shakespeare T. The Social Model of Disability. The Disability Studies Reader. 2010; 263–273.

[6] Emerson E, Hatton C. Contribution of socioeconomic position to health inequalities of British children and adolescents with in-tellectual disabilities. American Journal of Mental Retardation. 2007; 112: 140–150.

[7] Kinne S, Patrick DL, Doyle DL. Prevalence of secondary condi-tions among people with disabilities. American Journal of Public Health. 2004; 94: 443–445.

[8] Matthews T, Weston N, Baxter H, Felce D, Kerr M. A gen-eral practice-based prevalence study of epilepsy among adults with intellectual disabilities and of its association with psychi-atric disorder, behaviour disturbance and carer stress. Journal of Intellectual Disability Research. 2008; 52: 163–173.

[9] Tyrer F, Mcgrother C. Cause-specific mortality and death certifi-cate reporting in adults with moderate to profound intellectual disabilities. Journal of Intellectual Disability Research. 2009; 53: 898–904.

[10] House JS, Lantz PM, Herd P. Continuity and change in the social stratification of aging and health over the life course: evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans’ Changing Lives Study). The Journals of Gerontology-Series B Psychological Sciences and Social Sci-ences. 2005; 60: 15–26.

[11] Krahn GL, Hammond L, Turner A. A cascade of disparities: health and health care access for people with intellectual disabil-ities. Mental Retardation and Developmental Disabilities Re-search Reviews. 2006; 12: 70–82.

[12] Martin LG, Schoeni RF. Trends in disability and related chronic among the forty-and-over population: 1997-2010. Disability and Health Journal. 2014; 7: S4–S14.

[13] Turk MA, Scandale J, Rosenbaum PF. The health of woman with cerebral palsy. Physical Medicine and Rehabilitation Clinics of North America. 2001; 12: 153–168.

[14] Bennell KL, Hunter DJ, Hinman RS. Management of os-teoarthritis of the knee. British Medical Journal. 2012; 345: e4934.

[15] Heller A, Elliott MN, Haviland AM, Klein DJ, Kanouse DE. Patient Activation Status as a Predictor of Patient Experience among Medicare Beneficiaries. Medical Care. 2009; 47: 850–857.

[16] Drum CE, Peterson JJ, Culley C, Krahn G, Heller T, Kimp-ton T, et al. Guidelines and criteria for the implementation of community-based health promotion programs for individuals with disabilities. American Journal of Health Promotion. 2009; 24: 93–101, ii.

[17] Temple VA, Walkley JW. Perspectives of constraining and en-abling factors for health-promoting physical activity by adults with intellectual disability. Journal of Intellectual and Develop-mental Disability. 2007; 32: 28–38.

[18] Young AF, Chesson RA, Wilson AJ. People with learning dis-abilities, carers and care workers awareness of health risks and implications for primary care. Family Practice. 2007; 24: 576–584.

[19] Green LW, Kreuter MW. Health program planning: An educa-tional and ecological approach. 4th edn. McGraw-Hill Educa-tion: New York. 2005.

[20] Nakamura J, Morishita M, Horiguchi I, Nakagawa J. Health Pro-motion Program for Adult Dental Health in a Community Part 1: Implementation and Planning of Periodontal Disease Preven-tion Program by PRECEDE-PROCEED Model. Journal of Den-tal Health. 2004; 54: 87–94.

[21] Naruse T, Sakai M, Matsumoto H, Nagata S. Diseases that pre-cede disability among latter-stage elderly individuals in Japan. Bioscience Trends. 2015; 9: 270–274.

[22] Skolasky RL, Scherer EA, Wegener ST, Tosteson TD. Does re-duction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for interverte-bral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial. The Spine Journal. 2018; 18: 1318–1324.

[23] Zia M, Anwar MI. Delayed diagnosis of neural signs of leprosy. Journal of Pakistan Association of Dermatologists. 2017; 27: 183–186.

[24] Gielen AC, Mcdonald EM, Gary TL, Bone LR. Using the precede-proceed model to apply health behavior theories. Health Behavior and Health Education: Theory, Research, and Practice. 2008; 4: 407–429.

[25] Azar FE, Solhi M, Darabi F, Rohban A, Abolfathi M, Ne-jhaddadgar N. Effect of educational intervention based on PRECEDE-PROCEED model combined with self-management theory on self-care behaviors in type 2 diabetic patients. Dia-betes & Metabolic Syndrome. 2018; 12: 1075–1078.

[26] Garcia ML, Gatdula N, Bonilla E, Frank GC, Bird M, Rascón MS, et al. Engaging Intergenerational Hispanics/Latinos to Examine Factors Influencing Childhood Obesity Using the PRECEDE-PROCEED Model. Maternal and Child Health Jour-nal. 2019; 23: 802–810.

[27] Kwon BA. The structural relationship among leisure sports par-ticipants‘ physical self-efficacy, health promotion behavior, per-ceived health status and quality of life. Sport Science. 2014; 31: 19–30.

[28] Kim M, Ko SD, Kim YB, Kim HK, Son YL. Health education and health promotion theory (pp. 1–256). GyechukMunwhasa: Seoul. 2016.

[29] Lee JH, Seok HK. The Relationship among Disability Accep-tance and Sport Socialization of Sport Participation persons with Acquired Disabilities. Journal of Sport and Leisure Stud-ies. 2009; 35: 687–700.

[30] Oh CK. The effects of the self-esteem, social support, and mental health of people with acquired physical disability on their inde-pendent living [dissertation] (pp. 1–165). University of Honam: Gwangju. 2015.

[31] Cohen S, Hoberman HM. Positive events and social supports as buffers of life change stress. Journal of Applied Social Psychol-ogy. 1983; 13: 99–125.

[32] Ajzen I. The theory of planned behavior. Organizational Behav-ior and Human Decision Processes. 1991; 50: 179–211.

[33] Woo JP. In Professor Woo Jong Pil’s concept of structural equa-tion model and understanding (pp. 1–568). Hanahara Publishing Co.: Seoul. 2016.

[34] Shin WS. The effect of behavioral belief on exercise adherence and quality of subjective life of participant in physical disability sport. The Korea Journal of Sports Science. 2015; 24: 239–253.

[35] Lim KH. A study on shifting nurses’ health conditions and job satisfaction. Unpublished master’s thesis [dissertation] (pp. 1–76). University of Hanyang: Seoul. 2002.

[36] Hwang SH. The relationship between the demographic-sociological characteristic and preparation for later life of the physically challenged in middle and older ages. Journal of the Korean Academy of Health and Welfare for Elderly. 2015; 7: 25–42.

[37] Walker SN, Volkan K, Sechrist KR, Pender NJ. Health-promoting life styles of older adults: comparisons with young and middle-aged adults, correlates and patterns. ANS. Advances in Nursing Science. 1988; 11: 76–90.

[38] Kim H, Ko D, Kim J. The Relationship of Exercise Satisfac-tion, Health behavior and Sociality of Disability Participating in Life-Time Sports. Journal of the Korean Association for Physi-cal Education. 2018; 27: 133–145.

[39] Ryckman RM, Robbins MA, Thornton B, Cantrell P. Develop-ment and validation of a physical self-efficacy scale. Journal of Personality and Social Psychology. 1982; 42: 891–900.

[40] Yoo EK, Seol HS. Factorial structure of the Social Support Scale. The Korean Association for Survey Research. 2015; 16: 155–184.

[41] Kim SJ, Cha HW. The effect of responsibility attribution mes-sage and emotion of obesity on policy support and health be-havior intention: Focusing on attribution theory and planned be-havior theory. Korean Journal of Journalism & Communication Studies. 2016; 60: 369–398.

[42] West SG, Finch JF, Curran PJ. Structural equation models with non-normal variables: Problems and remedies. In Hoyle RH (ed.) Structural equation modeling: Concepts, issues, and ap-plications. Sage Publications: Thousand Oaks, CA. 1995.

[43] Bae BR. Structural equation modeling by AMOS 27 (pp. 1–572). Cheongram Publishing: Seoul. 2021.

[44] Choi YJ. Converged Relationship between Oral Health Beliefs, Oral Disease Preventive Intention and Oral Disease Preventive Activities in Partial Middle Aged Adults. Journal of the Korea Convergence Society. 2016; 7: 209–215.

[45] Choi K, Han S. A Study of Factors Affecting Health Promoting Behaviors in Physically Disabled Person - Application of Pen-der’s Health Promotion Model. Korean Association for Learner-Centered Curriculum and Instruction. 2017; 17: 647–663.

[46] Huh JY, Song KH. Relationship between Social Support, Moti-vation Regulation, Health Promoting Behavior and Intention to Continuance in Female Participants of Life Time Sports. Journal of Sport and Leisure Studies. 2011; 45: 531–543.

[47] Kim B, Cheon SH. Relationship between Students’ Beliefs about Collegiate Physical Education, Intention, and Leisure-Time Ex-ercise Behavior: Theory of Planned Behavior’s Perspective. The Korean Journal of Physical Education. 2018; 57: 305–319.

[48] Oh JS, Han HW. The Influence of Social Support on Health Pro-motion Behavior and Level of Participation in Female Leisure Dance Participants. Official Journal of the Koeran Society of Dance Science. 2012; 27: 1–16.

[49] Lee HY, Hwang SS, Back JE, Kim YS, Ka MH, Sin JY, et al. The relationship of the social support and health promotion be-havior in rural communities. Journal of Agricultural Medicine and Community Health. 2002; 27: 55–66.

[50] Lee JS, Lee IS. A study of impacts of health promotion activities and socio-economic status on health status of the aged. Korean Society of Gerontological Social Welfare. 2005; 27: 231–253.

[51] Namgung W. The Difference of Health Promotion Lifestyle of an Aged Person as Exercise Participation, Perceived Health and Sex. Journal of Sport and Leisure Studies. 2010; 39: 439–449.

[52] Kim JT. Relationship among Perceived Health Status, Health Promotion Behavior, and Life Quality of Participants in Life-time Sports Program. Journal of the Korean Society for Special Sports. 2011; 19: 43–55.

[53] Jang EJ. Effect of aging awareness and health of middle-aged and elderly persons on quality of life [dissertation] (pp. 1–75). University of Dagu Hany: Gyeongbuk. 2017.

[54] Jung JP, Lee ER, Sin MS. The health of the elderly impact on quality of life. Journal of the Korean Academy of Health and Welfare for Elderly. 2012; 4: 51–61.