Exploring the Effect of Self-Efficacy on Spiritual Health among Middle-Aged and Older Adults with Chronic Diseases: An Empirical Study Based on Structural Equation Modeling

Background: By 2025, Taiwan is projected to enter a super-aging society. Although significant advancements in medical technology have been made, the challenges associated with chronic diseases persist, particularly the issue of "multiple comorbidities" that often accompanies aging. Maintaining good spiritual health is not only crucial for psychological well-being but also plays a significant role in disease recovery, fostering positive health behaviors, and improving overall well-being. This study therefore aimed to investigate the effect of self-efficacy on spiritual health and explore other influencing factors. Methods: Stratified sampling was employed to survey individuals aged 45 years or older, who had been diagnosed with chronic diseases for a duration exceeding 3 month. A total of 120 valid samples were obtained with an effective response rate of 93%. The research instruments used in this study consisted of a demographic information questionnaire, the Herth Hope Index, an Acceptance of Illness Scale, and a Spiritual Health Scale. The collected questionnaire data underwent analysis using a structural equation model. Results: Among middle-aged and older adults living with chronic diseases, hope in life was found to be positively associated with self-efficacy ( β  = 0.48, P < 0.000). Their acceptance of illness was also found to be positively correlated with self-efficacy ( β  = 0.20, P < 0.019). Furthermore, self-efficacy exerts a significant positive impact on various dimensions of spiritual health, encompassing religious sustenance ( β  = 0.23, P < 0.017), connection with oneself ( β  = 0.38, P < 0.000), the meaning of life ( β  = 0.56, P < 0.000), transcendence of adversity ( β  = 0.61, P < 0.000), and connection with nature ( β  = 0.43, P < 0.000). Conclusions: Self-efficacy has a positive impact on the spiritual health of older adults with chronic diseases. Higher levels of self-efficacy are associated with better spiritual health outcomes. Additionally, hope in life and acceptance of the disease influence self-efficacy, subsequently affecting spiritual health indirectly. Greater levels of hope in life and acceptance of the disease can lead to increased self-efficacy, which in turn contributes to improved spiritual health. In the future, enhancing spiritual health can be achieved by promoting factors that influence spiritual well-being. Individuals can make adjustments to their lifestyle and adopt healthy behaviors, thereby improving self-worth and fostering positive emotions that contribute to overall health improvement.