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coping styles, coronary heart disease, health locus of control, health-promoting behavior, self-esteem



  1. Zou, Huijing BM, RN
  2. Tian, Qian MM, RN
  3. Chen, Yuxia BM, RN
  4. Cheng, Cheng BSN, RN
  5. Fan, Xiuzhen PhD, RN


Background: Health-promoting behavior plays an important role in reducing the burden of coronary heart disease. Self-esteem and health locus of control may contribute to health-promoting behavior, and coping styles may mediate these associations.


Objective: The aims of our study were to examine whether self-esteem and health locus of control are associated with health-promoting behavior and examine the possible mediating effect of coping styles in patients with coronary heart disease.


Methods: Health-promoting behavior, self-esteem, health locus of control, and coping styles were assessed in 272 hospitalized patients (60 +/- 12 years, 61% male) with coronary heart disease. Hierarchical regression analysis was conducted to analyze the relationships between health-promoting behavior and other variables. Mediation effect was examined according to the methods of Baron and Kenny.


Results: The mean score for health-promoting behavior was 2.57 +/- 0.51; 38.2% of patients (n = 104) scored lower than 2.5. Self-esteem ([beta] = .139, P < .05), confrontation coping style ([beta] = .491, P < .001), disease duration (>=6 months, [beta] = .147, P < .05), and monthly income (>=1000 RMB [approximately US$154], [beta] = .111, P < .05) were positively associated with health-promoting behavior, accounting for 47.5% of its variance (F = 19.828). Confrontation partly mediated the association between self-esteem and health-promoting behavior and completely mediated the relationship between internal health locus of control and health-promoting behavior.


Conclusions: Confrontation plays a mediating role in the association among self-esteem, internal health locus of control, and health-promoting behavior. Strategies should be undertaken to encourage the use of confrontation coping style, which will facilitate health-promoting behavior.