HEALTH PROMOTION AND QUALITY OF LIFE IN CHRONIC ILLNESS

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Persons with chronic and disabling conditions have health promotion needs even though they are experiencing a disease with long-term consequences (USDHHS, 1991). In fact, the need for health promotion interventions may be accentuated for this group of individuals whose quality of life and ability to continue living independently are often heavily dependent on maintaining their "narrow margin of health" (DeJong & Batavia, 1991). Data specific to the health promotion needs of the chronically ill and disabled are minimal, despite recognition of health promotion activities as a form of symptom management for chronic diseases, including Multiple Sclerosis (MS). Assessment of health promotion needs and design of interventions to foster health promotion behaviors must address how limitations in time, energy, and mobility force chronically ill persons to make choices they perceive as having maximum payoff, given their sense of quality of life. Findings from the few studies of health promotion for adults with chronic illnesses and disabilities suggest that this population has positive, multidimensional perceptions of health (Stuifbergen et al, 1990, Williams, 1983), is interested in health promotion activities (Becker et al, 1989; Stuifbergen, 1991; Warms,1987), and that health knowledge and participation in health-promoting behaviors are positively related to physiological and psychological measures of health (Nosek, 1984). The purpose of this five year nursing study is to refine and confirm an explanatory model that can guide development of health-related interventions for promoting quality of life in individuals with one type of chronic illness, MS, The specific aims will be accomplished in two phases. The focus in Phase I will be to refine and validate, through qualitative methods, the model concepts identified in previous quantitative studies. The focus of this first phase is to extend understanding of the key model concepts of quality of life, health- promoting behaviors, search for possible additional concepts, and to determine that the measurement instruments to be used in the subsequent phases are valid representations of the concepts as viewed from the frame of reference of the person with MS. In Phase II, data collected from a large sample of individuals with MS (N=500) will be used to statistically test variable relationships and overall fit to the theoretical model refined in Phase I. Antecedents and modifying factors identified in Phase II will provide the basis for future tests of the utility of the statistically confirmed model in proposing specific nursing interventions for individuals with MS.