A Structural Equation Model of Quality-of-Life Determinants
DOI:
https://doi.org/10.37287/ijghr.v8i4.2088Keywords:
elderly, hypertension, IPMA, PLS-SEM, quality of life, self- managementAbstract
Hypertension is a growing global health challenge, affecting about 51.3 million adults in Indonesia as of 2019. In urban areas like Babakan Ciparay, Bandung, it remains a leading cause of mortality among the elderly. Despite its prevalence, effective management of hypertension and its impact on quality of life (QoL) in this demographic are not well understood. This study examines the relationships between demographic factors (age, gender), clinical status (hypertension stage), and behavioral components (physical activity, self-management) in predicting the QoL of elderly hypertension patients. A quantitative cross-sectional study was conducted with 62 elderly participants at the Caringin Community Health Elderly Clinic in Bandung. Data were collected using the Physical Activities Scale for Elderly (PASE), Hypertension Self-Management Behavior (HSMBQ) and SF36 Quality of Life questionnaires, all of which exhibited strong reliability, with coefficients generally surpassing 0,70 across various international and Indonesian pilot tests. Additionally, the instruments demonstrated robust validity through consistent item-total correlation scores and convergent validity values ≥ 0,4. Analysis was performed using Partial Least Squares Structural Equation Modeling (PLS-SEM) and Importance-Performance Map Analysis (IPMA). The measurement model showed high reliability and validity. Structural analysis revealed that gender is a primary determinant of self-management, with a large effect size (f2=0.503) and a strong negative path coefficient (β=−0.580, p<0.001). Notably, physical activity had a significant negative impact on quality of life (β=−0.285, p=0.024), suggesting that high-exertion activity may reduce perceived well-being in this high-risk group. IPMA identified gender as critical for immediate intervention due to its high importance but low performance. The findings underscore a significant disconnect between clinical adherence and subjective well-being. Effective hypertension management in the elderly requires tailored, gender-specific interventions and personalized physical activity programs prioritizing psychosocial support and functional independence over strict biomedical metrics.
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