title: The role of quality of care and attitude towards disability in the relationship between severity of disability and quality of life: findings from a cross-sectional survey among people with physical disability in China.
abstract: BACKGROUND
  People with physical disability (PWPD) is the largest subgroup of people with disability (PWD) in China, but few studies have been conducted among this vulnerable population. The objective of this study was to investigate the level of quality of life (QoL), self-perceived quality of care and support (QOCS), severity of disability and personal attitude towards disability among people with physical disability in China, as well as to identify how QoL can be affected by severity of disability through QOCS and personal attitude towards disability among PWPD.
  
  
  METHODS
  A cross-sectional study was conducted among 1,853 PWPD in Guangzhou, China. Data were collected on participants' QoL, QOCS, personal attitude towards disability and severity of disability. Structural equation modeling was used to examine the effects of the other variables on QoL.
  
  
  RESULTS
  Even with a mild disability (mean score:1.72), relatively low levels of QoL (mean score: 2.65- 3.22) and QOCS (mean score: 2.95 to 3.28), as well as unfavorable personal attitude towards disability (mean score: 2.75 to 3.36) were identified among PWPD. According to SEM, we found that the influence of severity of physical disability on QoL is not only exerted directly, but is also indirectly through QOCS and their personal attitudes towards disability, with QOCS playing a more important mediating role than PWPD's attitudes towards their own disability.
  
  
  CONCLUSIONS
  Unfavorable health status was identified among PWPD in China. Focusing on improvement of assistance and care services has the potential to substantially improve PWPD's QoL. Further research should focus on understanding the needs and their current state of health care of PWPD in China thus being able to develop better interventions for them.
authors.forename: Qiao-Lan
authors.initials: QL
authors.lastname: Zheng
authors.forename: Qi
authors.initials: Q
authors.lastname: Tian
authors.affiliation: Department of Medical Statistics and Epidemiology & Center for Health Informatics Research & Guangdong Key Laboratory of Medicine, Laboratory of Health Informatics, School of Public Health, Sun Yat-sen University, Guangzhou Guangdong, P,R, China. chao@hsph.harvard.edu.
authors.forename: Chun
authors.initials: C
authors.lastname: Hao
authors.forename: Jing
authors.initials: J
authors.lastname: Gu
authors.forename: Ramona
authors.initials: R
authors.lastname: Lucas-Carrasco
authors.forename: Jian-Ting
authors.initials: JT
authors.lastname: Tao
authors.forename: Zuo-Yi
authors.initials: ZY
authors.lastname: Liang
authors.forename: Xin-Lin
authors.initials: XL
authors.lastname: Chen
authors.forename: Ji-Qian
authors.initials: JQ
authors.lastname: Fang
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Ruan
authors.forename: Qiu-Xiang
authors.initials: QX
authors.lastname: Ai
authors.forename: Yuan-Tao
authors.initials: YT
authors.lastname: Hao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002681:China; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards*; D011788:Quality of Life; D012111:Residence Characteristics; D012720:Severity of Illness Index; D012944:Social Support; D011795:Surveys and Questionnaires; D055815:Young Adult