The mediating effect of health-promoting behaviors on the relationship between infertility stress and fertility-related quality of life of infertile women: a cross-sectional study

Abstract

Purpose: Infertility is a global health problem that affects many people of reproductive age. This study aimed to examine the mediating effects of health-promoting behaviors (HPBs) on the relationship between infertility stress and fertility-related quality of life (QoL) in infertile women.

Methods: A cross-sectional survey was conducted with 138 infertile women in Korea, who were recruited from August to October 2022, from two public health centers and two infertility clinics at obstetrics and gynecology hospitals in Jeonju, Korea. The participants completed a self-reported questionnaire via an online survey. The data were analyzed using an independent t-test, one-way analysis of variance, Scheffé test, Pearson correlation coefficients, and multiple regression analysis using PROCESS macro with 95% bias-corrected bootstrap confidence interval (CI) (5,000 bootstrap resampling).

Results: The mean scores for fertility-related QoL, infertility stress, and HPB were all greater than the midpoint. Fertility-related QoL was positively correlated with HPBs (r=.20, p=.022) and negatively correlated with infertility stress (r=-.41, p<.001). The total effect of infertility stress on fertility-related QoL (B=-0.34, p<.001) and infertility stress on HPBs were significant (B=-0.01, p=.024). The effects of HPBs on fertility-related QoL (B=6.54, p<.001) and infertility stress on fertility-related QoL (direct effect; B=-0.30, p<.001) were significant. After controlling for demographic covariates, HPBs partially mediated the relationship between infertility stress and fertility-related QoL in infertile women (B=-0.03; 95% CI, -0.08 to -0.00).

Conclusion: To improve fertility-related QoL for infertile women, interventions to reduce infertility stress and improve HPBs should be developed and implemented.

Keywords: Infertility; Quality of life; Stress; Women; Health behavior.

Figure 1.

Statistical relationships for simple mediation model among fertility-related quality of life (QoL), infertility stress, and health-promoting behaviors while controlling for general characteristic variables. a: regression coefficient for infertility stress in a model predicting health-promoting behaviors by infertility stress; b and c’: regression coefficient in a model predicting fertility-related QoL by health-promoting behaviors and infertility stress; c: total effect of infertility stress on fertility-related QoL while controlling for general characteristic covariates; a∙b: indirect effect of infertility stress on fertility-related QoL mediated by health-promoting behaviors while controlling for general characteristic covariates; 95% CI: 95% bias-corrected bootstrap confidence interval.