Structural Equation Modeling of Self-Management in Patients with Hemodialysis

Jieun Cha

doi:10.4040/jkan.2017.47.1.14

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Cha: Structural Equation Modeling of Self-Management in Patients with Hemodialysis

Original Article

Journal of Korean Academy of Nursing 2017; 47(1): 14-24.

Published online: 28 February 2017

DOI: https://doi.org/10.4040/jkan.2017.47.1.14

Structural Equation Modeling of Self-Management in Patients with Hemodialysis

Jieun Cha

College of Nursing · The Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea.

Address reprint requests to: Cha, Jieun. College of Nursing · The Research Institute of Nursing Science, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-420-4930, Fax: +82-53-421-2758, jecha@knu.ac.kr

Received 5 May 2016 Revised 29 August 2016 Accepted 29 August 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to construct and test a hypothetical model of self-management in patients with hemodialysis based on the Self-Regulation Model and resource-coping perspective.

Methods

Data were collected from 215 adults receiving hemodialysis in 17 local clinics and one tertiary hospital in 2016. The Hemodialysis Self-management Instrument, the Revised Illness Perception Questionnaire, Herth Hope Index and Multidimensional Scale of Perceived Social Support were used. The exogenous variable was social context; the endogenous variables were cognitive illness representation, hope, self-management behavior, and illness outcome. For data analysis, descriptive statistics, Pearson correlation analysis, factor analysis, and structural equation modeling were performed.

Results

The hypothetical model with six paths showed a good fitness to the empirical data: GFI=.96, AGFI=.90, CFI=.95, RMSEA=.08, SRMR=.04. The factors that had an influence on self-management behavior were social context (β=.84), hope and cognitive illness representation (β=.37 and β=.27) explaining 92.4% of the variance. Self-management behavior mediated the relationship between psychosocial coping resources and illness outcome.

Conclusion

This research specifies a more complete spectrum of the self-management process. It is important to recognize the array of clinical resources available to support patients' self-management. Healthcare providers can facilitate self-management through collaborative care and understanding the ideas and emotions that each patient has about the illness, and ultimately improve the health outcomes. This framework can be used to guide self-management intervention development and assure effective clinical assessment.

Keywords: Renal dialysis, Chronic disease, Health resources, Self-control, Health behavior

Figures and Tables

Figure 1

Hypothetical model.

Figure 2

Path diagram for the hypothetical model.

Table 1

Demographic and Disease Related Characteristics of the Participants (N=215)

Variables	Categories	n (%)
Age (yr) (M±SD 50.70±9.95)	20~39	29 (13.5)
	40~49	67 (31.1)
	50~59	75 (34.9)
	≥60	44 (20.5)
Gender	Male	143 (66.5)
Gender	Female	72 (33.5)
Marital status	Married	136 (63.3)
	Single	55 (25.6)
	Divorced or separated	19 (8.8)
	Bereaved	5 (2.3)
Education level	≤High school	120 (55.8)
Education level	≥College	95 (44.2)
Monthly family income (10,000 won)	<200	102 (47.4)
	200~399	69 (32.1)
	≥400	44 (20.5)
Current job	Yes	85 (39.5)
Current job	No	130 (60.5)
Primary disease	Diabetes	45 (20.9)
	Hypertension	60 (27.9)
	Glomerular diseases	57 (26.5)
	Unknown or others	53 (24.7)
HD period (yr) (M±SD 8.25±6.35)	<5	84 (39.1)
	5~9	66 (30.7)
	≥10	65 (30.2)
Waiting for KTPL	Yes	123 (57.2)
Waiting for KTPL	No	92 (42.8)
History of KTPL	Yes	29 (13.5)
History of KTPL	No	186 (86.5)

HD=Hemodialysis; KTPL=Kidney transplantation.

Table 2

Descriptive Statistics of the Observed Variables (N=215)

Variable	Categories	M±SD	Range	Skewness	Kurtosis
Social context	Family support	16.05±3.43	4~20	-1.13	1.26
	Friend/Peer support	13.72±3.47	4~20	-0.55	0.08
	Medical support	13.20±3.62	4~20	-0.33	-0.34
Cognitive illness representation	Treatment belief	11.58±1.85	5~15	-0.41	0.99
Cognitive illness representation	Personal control	13.86±2.81	4~20	-0.58	0.39
Hope	Hope	21.21±3.81	7~28	-0.43	0.91
Self-management behavior	Self-management behavior	60.35±8.18	35~76	-0.31	-0.24
Illness outcome	General health	2.49±0.90	1~5	0.01	-0.20
Illness outcome	Subjective well-being	3.94±1.23	1~5	-1.07	0.03
Multivariate					17.26

Table 3

Effects of Predictive Variables on Endogenous Variables in the Model

Endogenous variables	Exogenous variables	Standardized estimate	C.R. (p)	SMC	Standardized direct effect (p)	Standardized indirect effect (p)	Standardized total effect (p)
Cognitive illness representation	Social context	.47	4.58 (<.001)	.22	.47 (.003)		.47 (.003)
Hope	Social context	.58	5.89 (<.001)	.34	.58 (.003)		.58 (.003)
Self-management behavior	Social context	.50	3.29 (.001)	.92	.50 (.020)	.34 (.003)	.84 (.003)
	Cognitive illness representation	.27	2.02 (.044)		.27 (.076)		.27 (.078)
	Hope	.37	2.82 (.005)		.37 (.041)		.37 (.045)
Illness outcome	Social context			.60		.65 (.005)	.65 (.005)
	Cognitive illness representation					.21 (.063)	.21 (.063)
	Hope					.29 (.039)	.29 (.039)
	Self-management behavior	.78	5.32 (<.001)		.78 (.010)		.78 (.010)

C.R.=Critical ratio; SMC=Squared multiple correlations (R²).

Notes

This research was supported by Kyungpook National University Research Fund, 2015.

^{CONFLICTS OF INTEREST} The author declared no conflict of interest.

References

1. ESRD Registry Committee, Korean Society of Nephrology. Current renal replacement therapy in Korea: Insan memorial dialysis registry [Internet]. Seoul: The Korean Society of Nephrology;2015. cited 2016 October 24. Available from: http://www.ksn.or.kr/rang_board/list.html?code=sinchart.

2. Curtin RB, Sitter DC, Schatell D, Chewning BA. Self-management, knowledge, and functioning and well-being of patients on hemodialysis. Nephrol Nurs J. 2004; 31(4):378–386. 396quiz 387.

3. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002; 288(19):2469–2475. DOI: 10.1001/jama.288.19.2469.

4. Ryan P, Sawin KJ. The Individual and family self-management theory: Background and perspectives on context, process, and outcomes. Nurs Outlook. 2009; 57(4):217–225.e6. DOI: 10.1016/j.outlook.2008.10.004.

5. Schulman-Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, et al. Processes of self-management in chronic illness. J Nurs Scholarsh. 2012; 44(2):136–144. DOI: 10.1111/j.1547-5069.2012.01444.x.

6. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: A review. Patient Educ Couns. 2002; 48(2):177–187. DOI: 10.1016/S0738-3991(02)00032-0.

7. Lorig KR, Holman H. Self-management education: History, definition, outcomes, and mechanisms. Ann Behav Med. 2003; 26(1):1–7. DOI: 10.1207/S15324796ABM2601_01.

8. Leventhal H, Diefenbach M, Leventhal EA. Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognit Ther Res. 1992; 16(2):143–163. DOI: 10.1007/BF01173486.

9. Newman S, Steed L, Mulligan K. Chronic physical illness: Self-management and behavioural interventions. Maidenhead, UK: Open University Press/McGraw Hill;2009. p. 47–60.

10. Kaptein AA, van Dijk S, Broadbent E, Falzon L, Thong M, Dekker FW. Behavioural research in patients with end-stage renal disease: A review and research agenda. Patient Educ Couns. 2010; 81(1):23–29. DOI: 10.1016/j.pec.2009.10.031.

11. Holahan CJ, Moos RH. Personal and contextual determinants of coping strategies. J Pers Soc Psychol. 1987; 52(5):946–955. DOI: 10.1037//0022-3514.52.5.946.

12. de Ridder D, Geenen R, Kuijer R, van Middendorp H. Psycho lo gical adjustment to chronic disea se. Lancet. 2008; 372(9634):246–255. DOI: 10.1016/s0140-6736(08)61078-8.

13. McCarley P. Patient empowerment and motivational interviewing: Engaging patients to self-manage their own care. Nephrol Nurs J. 2009; 36(4):409–413.

14. Li H, Jiang YF, Lin CC. Factors associated with self-management by people undergoing hemodialysis: A descriptive study. Int J Nurs Stud. 2014; 51(2):208–216. DOI: 10.1016/j.ijnurstu.2013.05.012.

15. Cha J. Structural equation modeling of quality of life focused on the self-management process in patients with hemodialysis [dissertation]. Seoul: Seoul National University;2014. 1–98.

16. Hagger MS, Orbell S. A meta-analytic review of the commonsense model of illness representations. Psychol Health. 2010; 18(2):141–184. DOI: 10.1080/088704403100081321.

17. Salovey P, Rothman AJ, Detweiler JB, Steward WT. Emotional states and physical health. Am Psychol. 2000; 55(1):110–121. DOI: 10.1037/0003-066X.55.1.110.

18. Yu JP. The concept and understanding of structural equation modeling. Seoul: Hannare Publishing Co.;2012. p. 1–391.

19. Hair JF Jr, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. Upper Saddle River, NJ: Pearson Prentice Hall;2010. p. 599–638.

20. Zimet GD, Dahlem NW, Zimet SG, Farley GK. Multidimensional scale of perceived social support. J Pers Assess. 1988; 52(1):30–41. DOI: 10.1207/s15327752jpa5201_2.

21. Shin JS, Lee YB. The effects of social supports on psychosocial well-being of the unemployed. Korean J Soc Welf. 1999; 37:241–269.

22. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised illness perception questionnaire (IPQ-R). Psychol Health. 2002; 17(1):1–16. DOI: 10.1080/08870440290001494.

23. Cha J, Yi M. Relationships between treatment belief, personal control, depressive mood and health-related quality of life in patients with hemodialysis. Korean J Adult Nurs. 2014; 26(6):693–702. DOI: 10.7475/kjan.2014.26.6.693.

24. Herth K. Abbreviated instrument to measure hope: Development and psychometric evaluation. J Adv Nurs. 1992; 17(10):1251–1259. DOI: 10.1111/j.1365-2648.1992.tb01843.x.

25. Tae YS, Youn SJ. Effects of a forgiveness nursing intervention program on hope and quality of life in woman cancer patients. J Korean Oncol Nurs. 2006; 6(2):111–120.

26. Lynn MR. Determination and quantification of content validity. Nurs Res. 1986; 35(6):382–385. DOI: 10.1097/00006199-198611000-00017.

27. Cha J, Yi M. The influence of cognitive coping on hope, depression and satisfaction with life in hemodialysis patients. Korean J Adult Nurs. 2013; 25(4):389–399. DOI: 10.7475/kjan.2013.25.4.389.

28. Garnefski N, Kraaij V. Cognitive emotion regulation questionnaire - development of a short 18-item version (CERQ-short). Pers Individ Dif. 2006; 41(6):1045–1053. DOI: 10.1016/j.paid.2006.04.010.

29. Yu JP. The item parceling bias of multi-dimensionality in the structural equation modeling. Korean Manage Rev. 2015; 44(4):1131–1147. DOI: 10.17287/kmr.2015.44.4.1131.

30. Park HJ, Kim S, Yong JS, Han SS, Yang DH, Meguro M, et al. Reliability and validity of the Korean version of kidney disease quality of life instrument (KDQOL-SF). Tohoku J Exp Med. 2007; 211(4):321–329. DOI: 10.1620/tjem.211.321.

31. Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985; 49(1):71–75. DOI: 10.1207/s15327752jpa4901_13.

32. Baumeister RF, Bratslavsky E, Muraven M, Tice DM. Ego depletion: Is the active self a limited resource? J Pers Soc Psychol. 1998; 74(5):1252–1265. DOI: 10.1037/0022-3514.74.5.1252.

33. Larsen PD, Lubkin IM, editors. Chronic illness: Impact and intervention. 8th ed. Burlington, MA: Jones & Bartlett Learning;2013. p. 311–323.

34. Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol. 2001; 56(3):218–226. DOI: 10.1037/0003-066X.56.3.218.

35. Thomas-Hawkins C, Zazworsky D. Self-management of chronic kidney disease. Am J Nurs. 2005; 105(10):40–48. quiz 48-49.

36. The Kidney Foundation of Canada. Self management skills: A primer to ease the path of living with chronic kidney disease (CKD). Living Well for Kidney Health. 2009; 4(1):1–3.

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