Linking Clinical Disease Activity to Quality of Life in Ulcerative Colitis: Serial Mediation by Patient Activation and Comfort

Abstract

Background: Ulcerative colitis is a chronic inflammatory bowel disease that profoundly affects patients’ 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. Objective: 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. Methods: Data were collected from 223 adult patients diagnosed with ulcerative colitis attending an outpatient gastroenterology clinic in Western Türkiye 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. Results: Disease activity was strongly and negatively correlated with both quality of life (r = 0.69) and comfort (r = −0.47). Comfort, in turn, showed a strong positive correlation with quality of life (r = 0.66). 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. Conclusion: 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’ physical, psychological, and emotional comfort to achieve better health outcomes.