Structural Equation Modeling of Self-Management of Liver Transplant Recipients

Mi-Kyeong Jeon; Yeon-Hwan Park

doi:10.4040/jkan.2017.47.5.663

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Jeon and Park: Structural Equation Modeling of Self-Management of Liver Transplant Recipients

Original Article

J Korean Acad Nurs 2017;47(5):663-675.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.5.663

Structural Equation Modeling of Self-Management of Liver Transplant Recipients

Mi-Kyeong Jeon¹, Yeon-Hwan Park^2,

¹College of Nursing, Eulji University, Daejeon

²College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Address reprint requests to : Park, Yeon-Hwan College of Nursing · The Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8846 Fax: +82-2-765-4103 E-mail: hanipyh@snu.ac.kr

Received 28 June 2017 Revised 28 September 2017 Accepted 28 September 2017

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 structural equation model of self-management of liver transplant recipients based on self-determination theory.

Methods

Participants were 275 outpatients who received liver transplantation. A structured self-report questionnaire was used to assess health care providers’ autonomy support, transplant-related characteristics, illness consequence perception, autonomy, competence, family relatedness, depression and self-management. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0 program.

Results

The modified model showed a good fitness with the data: GFI=.96, RMSEA=.06, CFI=.96, NFI=.93, TLI=.93, PGFI=.43, PNFI=.49. The health care providers’ autonomy support, competence, family relatedness and depression were factors with a direct influence on the self-management of liver transplant recipients. The health care providers’ autonomy support and illness consequence perception had an indirect influence through competence, family relatedness and depression. However, the transplant-related characteristics and autonomy did not have a significant effect on self-management. This model explained 59.4% of the variance in self-management.

Conclusion

The result suggests that continuous education must be done to promote the competence of liver transplant recipients and to encourage the patient to positively perceive their current health condition with a view that enhances one's self-management. Additionally, the liver transplant recipients should be screened for depression, which would affect self-management. Most of all, health care providers, who have the most influence on self-management, should improve therapeutic communication and try to form a therapeutic relationship with the liver transplant recipients.

Keywords: Self care, Health behavior, Liver transplantation, Chronic disease

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Figure 1.

Conceptual framework.

Figure 2.

Path diagram for the modified model.

Table 1.

Demographic and Transplant-related Characteristics of the Participants (N=275)

Variables		Categories		n (%)	M±SD Median (IQR)
Age (yr)	18~39			9 (3.3)	56.85±8.47
	40~59			161 (58.5)
	60~79			105 (38.2)
Gender	Male			210 (76.4)
	Female			65 (23.6)
Marital status	Married			251 (91.3)
	Not married			24 (8.7)
Level of education	≤Middle school			46 (16.7)
	High school			105 (38.2)
	≥College			124 (45.1)
Religion	Yes			189 (68.7)
	No			86 (31.3)
Current job status	Yes			174 (63.3)
	No			101 (36.7)
Monthly family income (10,000 won)	≤100			21 (8.2)
(n=256)	101~300			84 (32.8)
	301~500			80 (31.3)
	≥501			71 (27.7)
Previous diagnosis	HCC	Yes	HBV LC	107 (38.9)
		(n=113) Other	6 (2.2)
		No HBV LC	142 (51.6)
		(n=162) Acute liver failure	9 (3.3)
			Other	11 (4.0)
Type of operation	Living donor liver transplantation			233 (84.7)
	Deceased donor liver transplantation			42 (15.3)
Duration after operation (yr)	0.1~<1			31 (11.3)	6.43±4.48
	1~<5			91 (33.1)
	5~<10			93 (33.8)
	≥10			60 (21.8)
Total numbers of immunosuppressant types					4.33±2.03
Total numbers of medications					8.25±4.71
Preoperative MELD sore					18.21±10.17
					15 (12)
Preoperative CTP sore					8.70±2.57
Total hospital day for operation					42.58±29.49
					34 (25)

HCC=Hepatocellular carcinoma; HBV LC=Hepatitis B virus liver cirrhosis; HCV LC=Hepatitis C virus liver cirrhosis; HAV LC=Hepatitis A virus liver cirrhosis; MELD=Model for end-stage liver disease; CTP=Child-Turcotte–Pugh.

Table 2.

Descriptive Statistics and Convergent Validity of Measured Variables (N=275)

Variables	Measured range	M±SD	Skewness	Kurtosis	Standardized Estimate	CCR	AVE
Health care providers’ autonomy support	26~98	81.38±13.09	−1.26	2.40	.59~.83	.92	.56
Transplant-related characteristics
Duration after liver transplantation(yr)	0.1~22.9	6.43±4.47	0.64	0.02
Total numbers of immunosuppressant types	1~5	4.33±2.03	0.15	−1.32
Total numbers of medications	1~37	8.25±4.71	1.74	5.52
Illness consequence perception	3~15	7.89±2.40	−0.06	−0.19	.53~.89	.69	.48
Autonomy	5~24	20.48±3.28	−1.42	2.91	.50~.86	.76	.50
Competence	4~28	20.94±4.77	−0.35	−0.22	.75~.82	.75	.61
Family relatedness	14~50	40.88±6.57	−0.86	1.23	.71~.87	.95	.65
Depression	0~13	3.53±2.76	0.62	0.08	.51~.65	.80	.45
Self-management	31~104	85.83±13.20	−0.89	0.78		.83	.55
Knowledge	3~16	12.71±2.67	−0.74	0.12	.78~.79
Partnership in treatment	6~32	28.71±3.96	−2.22	7.54	.55~.77
Recognition and management of symptoms	1~16	13.37±2.81	−1.61	3.25	.73~.76
Coping	0~32	24.45±5.90	−0.92	0.91	.59~.91

CCR=Composite construct reliability; AVE=Average variance extracted.

Table 3.

Effects of Predictive Variables in the Modified Model

Endogenous variables	Endogenous variables	Standardized direct effects (p)	Standardized indirect effects (p)	Standardized total effects (p)	SMC
Autonomy	Health care providers’ autonomy support	.27 (.002)		.27 (.002)	.27
	Transplant-related characteristics	−.13 (.120)		.13 (.120)
	Illness consequence perception	−.38 (.001)		−.38 (.001)
Competence	Health care providers’ autonomy support	.27 (.002)		.27 (.002)	.18
	Transplant-related characteristics	−.14 (.091)		−.14 (.091)
	Illness consequence perception	−.24 (.001)		−.24 (.001)
Family relatedness	Health care providers’ autonomy support	.40 (.003)		.40 (.003)	.21
	Transplant-related characteristics	.01 (.972)		.01 (.972)
	Illness consequence perception	−.16 (.016)		−.16 (.016)
Depression	Health care providers’ autonomy support	−.19 (.007)		−.19 (.007)	.21
	Transplant-related characteristics	.04 (.581)		.04 (.581)
	Illness consequence perception	.39 (.002)		.39 (.002)
Self-management	Health care providers’ autonomy support	.18 (.015)	.25 (.002)	.43 (.002)	.59
	Transplant-related characteristics	.10 (.118)	−.07 (.138)	.03 (.625)
	Illness consequence perception	−.01 (.984)	−.22 (.001)	−.22 (.002)
	Autonomy	.05 (.552)		.05 (.552)
	Competence	.42 (.001)		.42 (.001)
	Family relatedness	.23 (.006)		.23 (.006)
	Depression	−.16 (.014)		−.16 (.014)

SMC=Squared multiple correlations (R²).

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