In this study, we aimed to construct a hypothetical model and verify the significance of the direct/indirect paths and the goodness of fit of the model under the theoretical assumption that demographic factors, personal related factors, social relation, environmental factor, physical factor, disease-related factors, and behavioral factors, including depression, anxiety, fatigue, pain, sexual activity, and body image, determine the HRQOL of patients with CHF directly and indirectly.
In this study, we found that patients with CHF had lower quality of life in all domains of the WHOQOL-BREF especially in environmental health domain (mean score of 38.56) and an overall quality life, which indicate that they know that their heath is poor and affecting their HRQOL. This finding is congruent with other previous study (25). This consistence result might be heart failure is a serious condition and leads to poor quality of life when the condition is not managed with heart failure management’s.
From structural equation model, we found that environmental health factors like physical security, financial resources and health care facility had the most substantial causal effect on HRQOL of patients with CHF with path coefficient of 0.53 (95%CI, 0.32, 0.75), which was larger than the causal effects psychological health, and physical health, which were in turn larger than the causal effect of social relation domain. This finding is Inconsistent with other study (26). This inconsistency may be due to the research was conducted in developed country and the environmental health may not had larger cause on HRQOL than the other factors. In Environmental health factor physical security, information and skill, and health facility (with loading of 0.80) are the highly influcial items on HRQOL as compared with physical environment, financial resource and recreation items (with loading 0.6). and transportation and home environment items (with loading 0.58). This result might be, heart failure often leads to the development of physical disabilities that, in turn, can have a detrimental effect on a patient’s quality of life.
Our finding demonstrated that, among domains of HRQOL, the physical health domain was most affected domain for HRQOL next to environmental health domain. This finding is In line with a couple of studies (26–28). This consistency could be defensible by CHF has more physical than mental (psychological) manifestations and social relations.
Similarly, psychological health and social relation was the least affected domain among the CHF patients. This finding is in line with other studies that was conducted southwest (29) and northwest (30) Ethiopia among DM patients. This consistence result in social relation and psychological health might be their social-culture that gives support for diseased individuals with DM and CHF. Patients manifest more physically than mentally (psychologically).
Our results revealed that age had significant association with all domains of HRQOL and had both a positive direct and indirect effect that resulted in a total positive effect on overall HRQOL of CHF patients. Aged 60 and above years had worse mental state, physical health, social relation and environmental health. This finding is lined with previous studies conducted in different research setting (31, 32). Based on the knowledge that CHF incidence increases with age, researchers would anticipate that older patients who experience several limitations such as cognitive impairment, loss of personal autonomy, or anxiety and depression may have poor quality of life(31).
A study conducted in Greece (31) documented that male adults have lower HRQOL in social relation domain than female adult. However, the present study demonstrates that gender have no effect on any domain of HRQOL. Direct comparisons with the findings of other studies are difficult because there are no other comprehensive HRQOL models of patients with CHF from Ethiopia or other African countries. Rural resident was associated with lower HRQOL for an environmental health domain, physical health domain and overall HRQOL with negative path coefficients.
There is a study’s (31) which had consistence finding with our study. This congruent finding might be patients’ lives in rural area are more likely low in income, the physical environment may not be good, low health care accessibility to get medical treatment and most of them are uneducated so have the low awareness about CHF. Being married was another socio-demographic factor that had a positive effect on environmental health and social relation among CHF patients and this is of course in congruent with other reports (31). This positive effect may be due to, support from others can facilitate recovery from physical illness and enhance the ability to cope with and adapt to the consequences of chronic illnesses.
Also associated with both physical and mental (psychological) health were the years of suffering from the disease (duration of CHF) which may reflect symptoms’ severity. Patients often experience loss of functional independence in daily activities such as feeding, dressing, housekeeping, bathing, and walking (33).
It is noteworthy that evaluation is needed of all the changes that take place through years and that may exacerbate HF patients’ quality of life such as inability to fulfill their prior role (social, professional, and family), diminished self-esteem, and distorted picture of themselves.
The finding of the present study also showed that income had positive direct effect on physical health, psychological health and environmental health domain of HRQOL. These findings were consistent with previous studies (34). We know that financial situation is are important determinants of health, negatively affecting health outcomes and contributing to health inequities. Patients with low income had low quality of life because most of CHF patients are medical treatment dependence and unable to afford treatment costs.