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The Mediating Role of Perceived Stress in the Relationship between Health-Promoting Lifestyles with Illness Anxiety in the Medical Staff of Al-Ghadir Hospital
Hossein Rostami1, Ezatollah Ahmadi *2, Reza Abdi1
1- Department of Psychology, Faculty of Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran
2- Department of Psychology, Faculty of Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran , amiraliahmadi91@yahoo.com
English Extended Abstract:   (851 Views)
Medical staff are always at the forefront of fighting diseases and communicating with patients, and they face many problems [1]. Psychological helplessness, including depression and anxiety, has been reported in many workers working in the fight against diseases [2]. As a result of direct contact with patients, the treatment staff have many concerns about contracting the disease [3]. In the term, anxiety is called a disease and is classified as a cluster of mental disorders and is associated with a sense of uncontrollable anxiety and fear; So that a person's social, occupational and personal functions are affected and may be accompanied by physical and cognitive symptoms such as fatigue, concentration disorder, increased heart rate, chest pain and other symptoms [4]. Many types of research show psychological disorders such as anxiety in nurses of terminally ill patients and have confirmed their anxiety and depression [5-7]. ... [8]. Scientific evidence shows that people's lifestyle patterns affect their health and longevity [1]. ... [11-9]. One type of lifestyle is the health-promoting lifestyle, which includes behaviours that lead to empowering people to increase control over their health and ultimately improve the health of the individual and society [12]. Studies show that health-promoting behaviours are predictors of stress and anxiety, and although various types of research have been conducted on this issue [1], its relationship with illness anxiety in the medical staff in recent years, which has been faced with the spread of Covid-19, has not received much attention from researchers. Various factors can be involved in reducing disease anxiety and improving health [13], of which perceived stress can be one of them and play a mediating role in the relationship between factors that reduce disease anxiety. Some researchers have also confirmed the mediating role of perceived stress in the relationship between psychological capital and anxiety [14] and psychological variables [15]. ... [16-20]. Perceived stress intensity is considered to be one of the basic factors explaining the possibility of adopting a coping strategy by people in stressful situations [21]. Therefore, investigating its role in the relationship between the factors that reduce disease anxiety (which in this research is health-promoting lifestyles) can be very important.
The purpose of this research was to determine the relationship between health-promoting lifestyles and disease anxiety with the mediating role of perceived stress in the medical staff of Al-Ghadir Hospital, Tabriz, Iran.
The current research is applied in terms of purpose and correlational descriptive in nature.
The statistical population of this research was 315 people of all medical staff of Al-Ghadir Hospital in Tabriz in 2022.
175 statistical samples were considered based on Morgan's table, but according to the minimum number of samples required for path analysis (200 people), 250 people from the treatment staff were selected using a simple random sampling method.
In this research, three disease anxiety scale tools [22] ... [23, 24] (with confirmed validity and Cronbach's alpha 0.75, 0.75, 0.77 and 0.70 respectively for the four subscales of fear of cardio-gastrointestinal and intestinal symptoms, fear of respiratory symptoms, fear of anxiety symptoms visible to the public and fear of signs of lack of cognitive control), perceived stress questionnaire [25] ... [26, 27] (with confirmed validity and Cronbach's alpha 0.75) and the health-promoting lifestyle questionnaire [28] ... [29] (with confirmed validity and Cronbach's alpha 0.75), were used to measure the research variables.
In this research, to comply with the ethical permissions, the ethical principles including the introduction of the research, the aims and methods of the research and the privacy policy were presented to the participants.
To analyze the data, the path analysis method with partial least squares was used. For this purpose, first, the assumptions of this method (including the absence of multiple collinearities, the validity of each of the items, the combined validity of each of the constructs and the average validity of the extracted variance) were examined. Partial least squares for evaluating structural equation models cover three parts: measurement model fit, structural model fit, and general model fit [30]. Structural fit indices include determination coefficient or R2, Q2 criterion and t value. The most basic criterion for measuring the relationship between structures in the model of the structural part of numbers is the significance of t. If the value of t is greater than 1.96, it indicates the correctness of the relationship between the constructs at the 95% confidence level. The coefficient of determination (R2) is a measure that indicates the influence of an exogenous variable on an endogenous variable, and Q2 or the Stone-Geisser index determines the predictive power of the model. All analyzes were performed using Smart PLS 3 software. The fit of the overall model, which controls the previous two parts of the measurement and structural model, was calculated in PLS software through the equation Gof=Root(
14 questionnaires with errors were removed and data analysis was done with 236 questionnaires. Descriptive findings showed that 188 (79.7%) of the participants were female and 48 (20.3%) of the participants were male. 20 people (8.47%) had a work experience of 1 to 5 years, 96 people (40.67%) had a work experience of 6 to 10 years, 53 people (22.48%) had 16 to 20 years, 40 people (17%) 21 to 25 years old and 27 people (11.4%) were more than 21 years old. The average disease anxiety of the research participants was 79.40±18.75, perceived stress was 38.88±11.85, and health-promoting lifestyles were 165.61±21.35. At the beginning and after testing the assumptions, the state of data distribution was checked using the Shapiro-Wilk test and the results showed that the data did not have a normal distribution. Therefore, partial least squares test was used for data analysis.
Measurement model fit: index reliability, convergent validity and divergent validity were used to check the measurement model fit. To evaluate the reliability of the index, the results of the variance inflation factor showed that the VIF value for all research items was not greater than 5. As a result, there was no multiple collinearity problem for the research model test. Also, the absolute value of the standard factor loading for the items of all questionnaires was greater than 0.4 and the absolute value of their t statistic was greater than 2.58. As a result, the items of these questionnaires had sufficient validity. The results of combined reliability indices, Cronbach's alpha coefficient and average variance extracted were also used to check the convergence. The results showed that the combined reliability value for three research variables including disease anxiety (0.901), health-promoting lifestyles (0.791) and perceived stress (0.924) was greater than 0.7. Cronbach's alpha was greater than 0.7 for all constructs (variables) including disease anxiety (0.894), health-promoting lifestyles (0.807) and perceived stress (0.906). The average variance extracted for all constructs (variables) including disease anxiety (0.556), health-promoting lifestyles (0.545) and perceived stress (0.560) was greater than 0.5; Therefore, the constructs of this research had sufficient validity in terms of convergence and correlation. Finally, to test the validity of the constructs, the Pearson correlation matrix and the separate validity index were used (Table 1). The values on the main diameter of this matrix represent the square root of the average variance explained (AVE). Table 1 shows that the values on the main diameter had the highest value of the column, which indicated the appropriate validity of the structures.
Fit of the structural model: R2 and Q2 values were obtained above 0.19 and 0.15, respectively, and therefore we can trust the fit of the model from the structural dimension, the closer these numbers are to one, the higher the strength of the structural fit of the model (Table 2).
Fit of the overall model: First, the shared values were calculated and then it was introduced as the fit index of the overall model of the research in the average coefficient of determination of multiplication and square root, which was obtained in the current research as 0.621 and considering that the values were 0.01, 0.25and 0.36 respectively for the weak, medium and strong fit of the overall model, so the value of 0.621 indicated a strong overall fit of the model. Next, the relationship analysis was performed using the bootstrap test, the results of which are presented in Figure 1 and Table 3. The tested model of the research based on Figure 1 showed that the calculated t-value for all path coefficients was greater than 1.96 and therefore they were considered significant at the 0.01 level. Table 3 shows the direct and indirect and significant paths. The Sobel test was used to investigate the mediating role of perceived stress in the relationship between health-promoting lifestyle and illness anxiety, and the results are presented in Table 3. The path coefficient and t-statistic related to the relationship between health-promoting lifestyle and disease anxiety (β=-0.144, t=2.418) were significant because the value of the t-statistic was greater than 1.96. Also, the relationship between health-promoting lifestyle and perceived stress (β=-0.215, t=3.494) was significant, because the value of the t statistic was greater than 1.96. The relationship between perceived stress and disease anxiety (β=0.607, t=16.280) was also significant because the value of the t statistic was greater than 1.96. In examining the mediating role of perceived stress using the Sobel test, considering that the absolute value of Z was greater than 2.58, the indirect effect of the independent variable on the dependent variable through the mediating variable was found to be significant with 99% confidence. The VAF index showed what proportion of the total effect is related to indirect effects and was calculated with VAF=.a×b. a×b+c. Therefore, the relationship between the variable of health-promoting styles and disease anxiety through the mediating variable of perceived stress was significant; Because the absolute value of the Z statistic was greater than 2.58 (Table 3). Also, based on the results of the VAF (inclusion of variance) test, it can be said that the total effect of the variable of health-promoting: styles on disease anxiety was explained47% by the mediating variable of perceived stress.
The results showed that there was an inverse and significant relationship between health promotion styles and disease anxiety and its subscales, which is in line with the findings of Fathi et al. FarivarAziz Aram and Basharpour [32], Norouz Nia et al. [33], a study by KimShin and Lee [34], Hoying, Melnyk, and Hutson [35], Keele's study [36], and also Ross et al.'s study [37]. [38]... [39] Also, the results showed that perceived stress has a mediating role and can play a mediating role in the relationship between health-promoting styles and disease anxiety the researcher could not find strong support for this finding in the research literature and it can only be said that it was in line with the findings of Seyedi et al [14] and the study of ZhangPeters and Chen [40]. ... [41].
Based on the findings of the research, it is suggested that sports facilities should be established in the country's medical centres, especially hospitals, and cultural infrastructure should be increased to promote health-enhancing lifestyles among medical staff which ultimately reduces the anxiety of the employees of the treatment department and improves their job performance. Future researchers are suggested to investigate the relationships of these variables in another statistical population that are exposed to high-stress jobs.
The most important limitation of the present study was the possibility of bias of the research participants in answering the research questions, which requires caution in generalizing the results. Also, the inability and impossibility of controlling some influencing variables in the relationship between variables like other psychological variables was another limitation of the research.
Perceived stress can significantly mediate the relationship between health-promoting styles and disease anxiety in a selected sample of people referred to Al-Ghadir Hospital in Tabriz, Iran.
Clinical & Practical Tips in Police Medicine
According to the results of the current research on the mediating role of perceived stress in the relationship between health-promoting lifestyles and disease anxiety in the treatment staff of Al-Ghadir Hospital, such psychological variables can be considered in the counselling and treatment centres of police including police hospitals. By teaching health-promoting lifestyles to the treatment staff of the directorate of health, rescue and treatment, it is possible to prevent the occurrence of anxiety disorders, especially illness anxiety, and improve their mental health, which in turn improves the performance and quality of people's work life.
This article is taken from the master's thesis of the first author and thanks to all the participants in the research.
Conflict of Interest
The authors state that there is no conflict of interest in the present study.
Funding Sources
The present study had no financial support.

Table 1) Pearson correlation matrix and separate validity index
Variable 1 2 3
1- Perceived stress 0.678 - -
2- Disease anxiety 0.506 0.638 -
3- Health promoting life style 0.215 0.275 0.380

Table 2) structural model fit
Variable Q2 R2
Health promoting life style 0.110 Exogenous variable
disease anxiety 0.205 0.119
Perceived Stress 0.397 0.179

Figure 1) The tested research model based on t-statistics

Table 3) path coefficients, t value and Sobel test
Theories Path coefficient t-statistics P-value Z-
Health promoting lifestyle (disease anxiety) -0.144 2.494 <0.05 - -
Health promoting lifestyle (perceived stress) -0.215 3.494 <0.05 - -
Perceived stress (illness anxiety) 0.607 16.280 <0.05 - -
Health-promoting lifestyle perceived stress
 (disease anxiety).
-0.215 - <0.05 3.541 0.475
Article number: 39
Keywords: Health Promotion [MeSH], Anxiety Disorder [MeSH], Stress [MeSH]
Full-Text [PDF 655 kb]   (608 Downloads)    
Article Type: Original Research | Subject: Police Related Psychology
Received: 2022/10/6 | Accepted: 2022/11/13 | Published: 2022/12/6
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Rostami H, Ahmadi E, Abdi R. The Mediating Role of Perceived Stress in the Relationship between Health-Promoting Lifestyles with Illness Anxiety in the Medical Staff of Al-Ghadir Hospital. JPMed 2022; 11 (1)
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نشریه علمی پژوهشی طب انتظامی Journal of Police Medicine
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