title: Inner strength as a mediator of the relationship between disease and self-rated health among old people.
abstract: OBJECTIVE
  To explore inner strength as a mediator of the relationship between disease and self-rated health among older people.
  
  
  BACKGROUND
  Qualitative research has indicated that inner strength is an essential resource for an individual affected by disease. A hypothesis of inner strength as a mediator of the relationship between disease and self-rated health was proposed. The theoretical framework of inner strength was based on the Model of Inner Strength.
  
  
  METHODS
  A cross-sectional design was used.
  
  
  METHODS
  The sample included 6119 participants from Finland and Sweden, in the ages of 65, 70, 75 and 80 years. The GERDA-Botnia questionnaire, which included the Inner Strength Scale and items related to diseases and self-rated health, was sent out between October and December 2010. Structural equation modelling was used to test a hypothesized model.
  
  
  RESULTS
  The result indicated that having a disease was associated with poorer self-rated health and a lower degree of inner strength and a higher degree of inner strength was associated with better self-rated health. The result supported the hypothesis by indicating that inner strength partially mediated the relationship between disease and self-rated health.
  
  
  CONCLUSIONS
  This large cross-sectional study with participants from 65 to 80 years of age from Finland and Sweden showed that inner strength can be a resource for older people affected by disease. Increasing inner strength in older people affected by disease may be one intervention to support experiences of health despite disease.
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Viglund
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jonsén
authors.affiliation: Department of Nursing, Umeå University, Skellefteå, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Strandberg
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Berit
authors.initials: B
authors.lastname: Lundman
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Nygren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004194:Disease / Q000523:psychology*; D005260:Female; D005387:Finland; D006304:Health Status; D006801:Humans; D008297:Male; D012649:Self Concept; D020377:Self Efficacy; D057566:Self Report; D013548:Sweden
keywords: disease; health; inner strength; mediating; nursing; older people; structural equation modelling