{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:33:46Z","timestamp":1786628026944,"version":"build-2736575974"},"reference-count":52,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["West J Nurs Res"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ulcerative colitis is a chronic inflammatory bowel disease that profoundly affects patients\u2019 physical, psychological, and social well-being. Understanding the psychological and behavioral mechanisms that bridge the relationship between biological disease activity and quality of life is essential for developing effective nursing interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This cross-sectional study aimed to examine the relationship between clinical disease activity and quality of life in patients with ulcerative colitis, specifically investigating the mediating roles of comfort and patient activation within a biopsychosocial framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data were collected from 223 adult patients diagnosed with ulcerative colitis attending an outpatient gastroenterology clinic in Western T\u00fcrkiye between May and August 2025. Clinical disease activity, comfort, patient activation, and quality of life were measured using standardized, validated scales. Data were analyzed using hierarchical multiple regression and serial mediation analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Disease activity was strongly and negatively correlated with both quality of life (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u20090.69) and comfort (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u2009\u22120.47). Comfort, in turn, showed a strong positive correlation with quality of life (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u20090.66). Mediation analysis confirmed that comfort partially mediated the negative relationship between clinical disease activity and quality of life. However, patient activation did not demonstrate a significant mediating effect in the proposed serial model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Comfort acts as a critical psychological and experiential mechanism that helps mitigate the adverse effects of disease activity on the quality of life of patients with ulcerative colitis. Nursing care should prioritize strategies focusing on enhancing patients\u2019 physical, psychological, and emotional comfort to achieve better health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/01939459261459349","type":"journal-article","created":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T16:56:15Z","timestamp":1783875375000},"page":"909-922","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Linking Clinical Disease Activity to Quality of Life in Ulcerative Colitis: Serial Mediation by Patient Activation and Comfort"],"prefix":"10.1177","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9723-9127","authenticated-orcid":false,"given":"Ya\u011fmur","family":"Artan","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, Nursing Department, Ardahan University, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amine","family":"Terzi","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Nursing Department, Artvin \u00c7oruh University, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derin","family":"Kahilogullari","sequence":"additional","affiliation":[{"name":"Buca Seyfi Demirsoy Training and Research Hospital, Intensive care unit, \u0130zmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehra Sabah","family":"Yarikkaya","sequence":"additional","affiliation":[{"name":"Ege University Institute of Health Sciences MSc student, \u0130zmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasemin","family":"Yildirim","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Internal Medicine Nursing, Ege University, \u0130zmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalan G\u00fcl\u015fen","family":"Unal","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ege University, Gastroenterology, \u0130zmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,12]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14131384"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17010060"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.2147\/CEG.S557464"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2021.1966093"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2020.1716704"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.disamonth.2023.101672"},{"issue":"2","key":"e_1_3_3_8_2","first-page":"88","article-title":"The effects of surgical treatment for ulcerative colitis on patient comfort and quality of life","volume":"17","author":"Aky\u00fcz N","year":"2007","unstructured":"Aky\u00fcz N, Bal\u0131k E, Kanan N, et al The effects of surgical treatment for ulcerative colitis on patient comfort and quality of life. Turk J Colorectal Dis. 2007;17(2):88-101.","journal-title":"Turk J Colorectal Dis"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.5222\/terh.2016.027"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izab016"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.1994.tb01202.x"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2004.00269.x"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1061"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-077810"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pbj.2016.11.003"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.847460"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-056982"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S440652"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-021-07025-y"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18158038"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.17509"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.5152\/tjg.2022.21355"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.709295"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/crocol\/otac009"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(89)90905-0"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.5152\/tjg.2020.19553"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005110-200611000-00010"},{"issue":"2","key":"e_1_3_3_28_2","first-page":"16","article-title":"General Comfort Questionnaire Short Form Turkish validity and reliability study","volume":"10","author":"\u00c7\u0131tl\u0131k SC","year":"2018","unstructured":"\u00c7\u0131tl\u0131k SC, \u00c7evik S, \u00d6zden G. General Comfort Questionnaire Short Form Turkish validity and reliability study [Genel Konfor \u00d6l\u00e7e\u011fi K\u0131sa Formunun T\u00fcrk\u00e7e ge\u00e7erlik ve g\u00fcvenirlik \u00e7al\u0131\u015fmas\u0131]. Nursing Forum J Diabetes Obes Hypertens [Diyabet, Obezite ve Hipertansiyonda Hem\u015firelik Forumu Dergisi]. 2018;10(2):16-22.","journal-title":"Nursing Forum J Diabetes Obes Hypertens"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2005.00438.x"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v19i1.58"},{"key":"e_1_3_3_31_2","volume-title":"Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach","author":"Hayes AF.","year":"2013","unstructured":"Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Guilford Press; 2013."},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.13795"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-020-1164-0"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0124211"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.5009\/gnl16422"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/ibd.21863"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0000000000001008"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.21673\/anadoluklin.1322030"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izad142"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S517510"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izy378"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0000000000000278"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0452"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.3390\/nursrep15070231"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu16081185"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-91670-0"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1002\/ibd.20520"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003420"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.1031"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1637017"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnab306"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.51754\/cusbed.1465857"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjy020"}],"container-title":["Western Journal of Nursing Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/01939459261459349","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/01939459261459349","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/01939459261459349","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:52:26Z","timestamp":1786625546000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/01939459261459349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,12]]},"references-count":52,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/01939459261459349"],"URL":"https:\/\/doi.org\/10.1177\/01939459261459349","relation":{},"ISSN":["0193-9459","1552-8456"],"issn-type":[{"value":"0193-9459","type":"print"},{"value":"1552-8456","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,12]]}}}