SOCIAL SUPPORT AND DIGNITY AS DETERMINANTS OF QUALITY OF LIFE IN PATIENTS WITH HEART DISEASE IN MEDAN CITY, INDONESIA

Lilis Pujiati

Authors

Lilis Pujiati Philippine Women’s University

Keywords:

Social Support, Dignity, Health-Related Quality Of Life, Heart Disease

Abstract

Heart disease remains a major global health burden and significantly affects patients’ quality of life. This study aims to examine the role of social support and dignity as determinants of health-related quality of life (HRQoL) among patients with heart disease in Medan City, Indonesia. A cross-sectional design was applied involving 271 respondents selected through structured sampling procedures. Data were collected using validated questionnaires measuring social support, dignity (dignity-related distress), and HRQoL. Descriptive statistics were used to characterize respondent characteristics, while bivariate analyses employed Gamma and Somers’d correlations to assess relationships among variables. Multivariate analysis was conducted using ordinal regression to identify dominant predictors of HRQoL. The results show that most respondents were male (51.3%), aged 55–64 years (27.7%), and married (83.0%). More than half of the participants reported high social support (56.1%) and good HRQoL (53.9%). Bivariate analysis indicated significant positive relationships between social support and HRQoL (p = 0.001) and between dignity and HRQoL (p < 0.001). Ordinal regression analysis revealed that both social support and dignity significantly influenced HRQoL simultaneously (p < 0.001), with a model explanatory power of 52.4% (Nagelkerke R² = 0.524). Social support emerged as the strongest predictor of HRQoL, compared with dignity.

In conclusion, social support and dignity are significant determinants of HRQoL in patients with heart disease in Medan. Strengthening psychosocial support systems and maintaining patient dignity should be prioritized in cardiac care interventions to improve overall quality of life.

References

Abiola, T., Udofia, O., & Zakari, M. (2013). Psychometric Properties of the 3-Item Oslo Social Support Scale among Clinical Students of Bayero University, Kano, Nigeria. The Malaysian Journal of Psychiatry, 22(2), 32–41. https://www.mjpsychiatry.org/index.php/mjp/article/view/264

Adam, A. M. (2020). Sample Size Determination in Survey Research. Journal of Scientific Research and Reports, 90–97. https://doi.org/10.9734/jsrr/2020/v26i530263

Adamu, K., Feleke, A., Muche, A., Yasin, T., Mekonen, A. M., Chanie, M. G., Eshete, S., Mohammed, A., Endawkie, A., & Fentaw, Z. (2022). Health-related quality of life among adult hypertensive patients on treatment in Dessie City, Northeast Ethiopia. PLoS ONE, 17(9). https://doi.org/10.1371/journal.pone.0268150

Agbedeyi, O. D., & Igweze, A. H. (2014). Robust Method for Testing the Significance of Bivariate Correlation of Ordinal Data. 4(11), 169–174. http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.651.7704

Alharbi, M., Alharbi, F., AlTuwayjiri, A., Alharbi, Y., Alhofair, Y., Alanazi, A., AlJlajle, F., Khalil, R., & Al‐Wutayd, O. (2022). Assessment of health-related quality of life in patients with heart failure: a cross-sectional study in Saudi Arabia. Health and Quality of Life Outcomes, 20(1), 128–128. https://doi.org/10.1186/s12955-022-02040-7

Babygeetha, A., & Devineni, D. (2024). Social support and adherence to self-care behavior among patients with coronary heart disease and heart failure: A systematic review. Europe’s Journal of Psychology, 20(1), 63–77. https://doi.org/10.5964/ejop.12131

Badal, T., Baxter, W., Lloyd, L., Ruban, S., Nicholson, C., Strange, G., Rutherford, C., & Celermajer, D. S. (2025). Health-Related Quality of Life in Adults with Congenital Heart Disease - A Population-Based Study from the Australian National Registry. In medRxiv. https://doi.org/10.1101/2025.10.17.25338261

Bannour, R., Harzali, Z., Dhouib, W., Cheikh, A. B., Bhiri, S., Ghali, H., Khéfacha, S., Latiri, H. S., & Rejeb, M. B. (2021). Social support and health-related quality of life among patients with chronic heart failure. European Journal of Public Health, 31. https://doi.org/10.1093/eurpub/ckab165.603

Blakoe, M., Olesen, C. S., Christensen, A. V., Palm, P., Hoejskov, I. E., & Berg, S. K. (2024). The rise and fall of a social support intervention feasibility trial targeting loneliness in patients with cardiac disease - lessons learned and future perspectives. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-02113-6

Chollou, K. M., Shirzadi, S., Pourrazavi, S., Babazadeh, T., & Ranjbaran, S. (2022). The Role of Perceived Social Support on Quality of Life in People with Cardiovascular Diseases. Ethiopian Journal of Health Sciences, 32(5), 1019–1026. https://doi.org/10.4314/ejhs.v32i5.17

Doyal, L. (1997). Informed consent in medical research: Journals should not publish research to which patients have not given fully informed consent–with three exceptions. BMJ, 314(7087), 1107–1107. https://doi.org/10.1136/bmj.314.7087.1107

Etikan, İ. (2016). Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–1. https://doi.org/10.11648/j.ajtas.20160501.11

Fatima, Z., Aziz, I., & Noureen, S. (2023). Impact Of Social Support and Coping Mechanisms on Health-Related Quality of Life Among Heart Patients. Global Sociological Review, 403–403. https://doi.org/10.31703/gsr.2023(viii-ii).41

Feng, Y., Kohlmann, T., Janssen, M. F., & Buchholz, I. (2020). Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Quality of Life Research, 30(3), 647–673. https://doi.org/10.1007/s11136-020-02688-y

Ghafoor, H., Nordbeck, P., Ritter, O., Pauli, P., & Schulz, S. M. (2021). Can Religiosity and Social Support Explain Effects of Trait Emotional Intelligence on Health-Related Quality of Life: A Cross-Cultural Study. Journal of Religion and Health, 61(1), 158–174. https://doi.org/10.1007/s10943-020-01163-9

. Hurst, N. P., Kind, P., Ruta, D., Hunter, M. M., & Stubbings, A. (1997). Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Lara D. Veeken, 36(5), 551–559. https://doi.org/10.1093/rheumatology/36.5.551

Jellestad, L., Meier, V. G., Bierbauer, W., Bermudez, T., Auschra, B., Günther, M. P., Scholz, U., Känel, R. von, Hermann, M., & Euler, S. (2022). Differential associations of emotional and physical domains of the MacNew Heart with changes in the 6-minute walking test. Quality of Life Research, 32(2), 615–624. https://doi.org/10.1007/s11136-022-03247-3

Ji, Q., Zhang, L., Xu, J., Ji, P., Song, M., Chen, Y., & Guo, L. (2024). The relationship between stigma and quality of life in hospitalized middle-aged and elderly patients with chronic diseases: the mediating role of depression and the moderating role of psychological resilience. Frontiers in Psychiatry, 15, 1346881–1346881. https://doi.org/10.3389/fpsyt.2024.1346881

Kažukauskienė, N., Bunevičius, A., Gečaitė-Stončienė, J., & Burkauskas, J. (2021). Fatigue, Social Support, and Depression in Individuals With Coronary Artery Disease. Frontiers in Psychology, 12, 732795–732795. https://doi.org/10.3389/fpsyg.2021.732795

Kim, H., Bae, S. H., Lim, S., & Park, J. (2022). Predictors of health-related quality of life after coronary artery bypass graft surgery. Scientific Reports, 12(1), 16119–16119. https://doi.org/10.1038/s41598-022-20414-1

Kocalevent, R., Berg, L., Beutel, M. E., Hinz, A., Zenger, M., Härter, M., Nater, U. M., & Brähler, E. (2018). Social support in the general population: standardization of the Oslo Social Support Scale (OSSS-3). BMC Psychology, 6(1), 31–31. https://doi.org/10.1186/s40359-018-0249-9

Laksmana, R., Afriyanti, E., & Bawono, A. S. (2025). FACTORS RELATED TO QUALITY OF LIFE IN CORONARY HEART DISEASE PATIENTS AT CARDIAC POLYCLINIC DR. M. DJAMIL PADANG HOSPITAL. Menara Medika, 7(2), 227–242. https://doi.org/10.31869/mm.v7i2.6269

Lanini, L. L. S., Euler, S., Zuccarella‐Hackl, C., Artiles, R. F., Niederseer, D., Auschra, B., Känel, R. von, & Jellestad, L. (2024). Differential associations of sex and age with changes in HRQoL during outpatient cardiac rehabilitation. Journal of Patient-Reported Outcomes, 8(1), 11–11. https://doi.org/10.1186/s41687-024-00688-x

Liu, M., Chiou, A., Wang, C., Yu, W., & Lin, M. (2021). Relationship of symptom stress, care needs, social support, and meaning in life to quality of life in patients with heart failure from the acute to chronic stages: a longitudinal study. Health and Quality of Life Outcomes, 19(1), 252–252. https://doi.org/10.1186/s12955-021-01885-8

Milayanti, W., Ansariadi, A., WAHIDUDDIN, W., Maria, I. L., Arsyad, D. S., Stang, & Amqan, H. (2021). Determinants of Quality of Life of Coronary Heart Disease Patients in Integrated Heart Center, Dr. Wahidin Sudirohusodo, Central General Hospital, Makassar. Journal of Cardiovascular Disease Research, 12(6), 286–291. http://jcdronline.org/?mno=136558

Muliantino, M. R., Ananda, Y., Mailani, F., Sarfika, R., Safitri, D. A., & Aulia, N. (2024). Understanding quality-of-life determinants in coronary arterial disease patients. International Journal of Public Health Science (IJPHS), 13(3), 1208–1208. https://doi.org/10.11591/ijphs.v13i3.24277

Murshid, B. Z., Alnasser, Z. I., Almaiman, W. K., Almubireek, N. A., Alshammari, R. E., Albariqi, S. F., & Alanazi, F. A. (2022). EFFECT OF PERCEIVED SOCIAL SUPPORT ON PROMOTING SELF- CARE BEHAVIOURS AMONG PATIENTS WITH CVD, AT NGHA. RIYADH, SAUDI ARABIA. Journal of Pharmaceutical Negative Results, 1437–1452. https://doi.org/10.47750/pnr.2022.13.s09.175

Norris, C. M., Ghali, W. A., Galbraith, P. D., Graham, M. M., Jensen, L., & Knudtson, M. L. (2004). Women with coronary artery disease report worse health-related quality of life outcomes compared to men. Health and Quality of Life Outcomes, 2(1), 21–21. https://doi.org/10.1186/1477-7525-2-21

Nuraeni, A., Suryani, S., Trisyani, Y., & Pramukti, I. (2021). Social and Emotional Support Highly Associated with Helplessness among Coronary Heart Disease Patients. Open Access Macedonian Journal of Medical Sciences, 9, 1–6. https://doi.org/10.3889/oamjms.2021.7308

Nurhamsyah, D., Trisyani, Y., & Nuraeni, A. (2022). Factors Affecting Quality of Life of Post-Acute Coronary Syndrome Patients in Indonesia. Open Access Macedonian Journal of Medical Sciences, 9, 203–206. https://doi.org/10.3889/oamjms.2021.7319

Pedreso, E., Alamban, L., & Faderan, B. (2021). Health-related quality of life among cardiovascular patients enrolled in an adult cardiology clinic in a tertiary hospital. European Journal of Preventive Cardiology, 28. https://doi.org/10.1093/eurjpc/zwab061.263

Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261–261. https://doi.org/10.4103/0019-5154.182410

Shafiq, S., & Shahzadi, I. (2023). MENTAL HEALTH AND QUALITY OF LIFE IN PATIENTS WITH CARDIOVASCULAR DISEASES: SOCIAL SUPPORT AS MEDIATOR. Journal of Postgraduate Medical Institute, 37(2), 114–118. https://doi.org/10.54079/jpmi.37.2.3101

Shibeshy, A. B., Tilahun, W., Tsegabirhan, H., Haftu, M., & Belay, K. (2021). Health-Related Quality of Life and Associated Factors Among Adult Patients With Heart Failure in Tertiary Hospitals in the Tigray Region, Northern Ethiopia, 2020. In Research Square. https://doi.org/10.21203/rs.3.rs-548193/v1

Stratton, S. J. (2021). Population Research: Convenience Sampling Strategies. Prehospital and Disaster Medicine, 36(4), 373–374. https://doi.org/10.1017/s1049023x21000649

Syaiful, S., Pratikso, P., & Mudjanarko, S. W. (2023). Literature Study of the Sustainability Model of Transportation Facilities and Infrastructure in the Management of Public Transportation with the Concept of Inter-Regional Cooperation (Case in the City and District of Bogor). ASTONJADRO, 12(2), 613–634. https://doi.org/10.32832/astonjadro.v12i2.14114

Talin, I. A., Abid, M. H., Samad, M. A., Azpíroz, I. D., Díez, I. de la T., Ashraf, I., & Nahid, A.-A. (2023). Exploring factors influencing the severity of pregnancy anemia in India: a study using the proportional odds model. Scientific Reports, 13(1), 22816–22816. https://doi.org/10.1038/s41598-023-49872-x

Tito, K., Gebremariam, G. T., Beyene, K., Sander, B., & Gebretekle, G. B. (2022). Health-related quality of life and treatment satisfaction of patients with cardiovascular disease in Ethiopia. Frontiers in Public Health, 10, 972378–972378. https://doi.org/10.3389/fpubh.2022.972378

Tušek-Bunc, K., & Petek, D. (2016). Comorbidities and characteristics of coronary heart disease patients: their impact on health-related quality of life. Health and Quality of Life Outcomes, 14(1), 159–159. https://doi.org/10.1186/s12955-016-0560-1

Upadhyay, V., Bhandarı, S. S., Prasad, D., Dutta, S. K., García‐Grau, P., & Vaddiparti, K. (2022). Improving depression and perceived social support enhances overall quality of life among myocardial infarction survivors: necessity for integrating mental health care into cardiac rehabilitation programs. The Egyptian Journal of Neurology, Psychiatry, and Neurosurgery, 58(1). https://doi.org/10.1186/s41983-022-00521-6

Wan, L., Yang, G., Dong, H., Liang, X., & He, Y. (2024). Impact of cardiovascular disease on health-related quality of life among older adults in eastern China: evidence from a national cross-sectional survey. Frontiers in Public Health, 11, 1300404–1300404. https://doi.org/10.3389/fpubh.2023.1300404

Zangirolami-Raimundo, J., Echeimberg, J. de O., & Leone, C. (2018). Research methodology topics: Cross-sectional studies. Journal of Human Growth and Development, 28(3), 356–360. https://doi.org/10.7322/jhgd.152198

Zhang, H., Wang, Y., Cai, X., Tang, N., Wei, S., & Yang, Y. (2022). Family functioning and health-related quality of life of inpatients with coronary heart disease: a cross-sectional study in Lanzhou city, China. BMC Cardiovascular Disorders, 22(1), 397–397. https://doi.org/10.1186/s12872-022-02844-x