A Structural Analysis for Psychosocial Variables related to Sick Role Behavioral Compliance in Hemodialysis Patients

Young-Mun Cho

doi:10.7469/kjan.2016.28.4.415

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Cho: A Structural Analysis for Psychosocial Variables related to Sick Role Behavioral Compliance in Hemodialysis Patients

Original Article

Korean J Adult Nurs 2016;28(4):415-423.

Published online: NaN August 2016

DOI: https://doi.org/10.7469/kjan.2016.28.4.415

A Structural Analysis for Psychosocial Variables related to Sick Role Behavioral Compliance in Hemodialysis Patients

Young-Mun Cho, Ph.D., APN

Assistant Professor, Department of Nursing, Dongshin University, Naju, Korea

Corresponding author: Cho, Young-Mun Department of Nursing, Dongshin University, 185 Geonjae-ro, Naju 58245, Korea. Tel: +82-61-330-3596, Fax: +82-61-330-3580, E-mail: cymun@hanmail.net

Received 6 May 201622 June 2016 Accepted 22 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was designed to identify the structural relationships among psychosocial variables related to sick role behavioral compliance among patients undergoing hemodialysis.

Methods

The subjects were 476 patients from seven major hospitals and twelve dialysis centers located in D and P cities. Data were collected using self-report questionnaires. Data analysis was done by using SPSS/WIN 18.0 and AMOS 18.0 programs for structural equation modeling, to estimate the hypothesized model.

Results

This findings support that a modified path model is efficient and appropriate to explain sick role behavioral compliance among hemodialysis patients. These factors account for 80.1% of the variance of sick-role behavioral compliance among hemodialysis patients. The variables having direct effect on sick role behavioral compliance were knowledge related to hemodialysis, social support, attitude, self-efficacy and intention.

Conclusion

The modified model explains the integration process of psychosocial and behavior variables for sick-role behavioral compliance among patients undergoing hemodialysis.

Keywords: Sick role, Behavior, Self-determination, Hemodialysis

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Figure 1.

Research model.

Figure 2.

Structural equation model of sick role behavioral compliance in hemodialysis patients.

Table 1.

Descriptive Statistics for Latent Variables and Measured Variables (N=476)

Latent variables	Measured variables	Range	M±SD	Min-Max	Skewness	Kurtosis
KN		0~20	16.47±2.69	7~20	-0.90	0.46
	Knowledge 1	0~10	8.34±0.53	3~10	-0.94	0.48
	Knowledge 2	0~10	8.12±1.59	2~10	-0.84	0.34
SS		18~90	70.33±12.05	21~90	-0.68	1.06
	Medical staff support	8~40	31.82±5.27	8~40	-0.68	1.55
	Family support	10~50	38.50±8.47	12~50	-0.77	0.29
BPN		18~90	63.06±9.83	18~90	-0.26	0.63
	Autonomy	6~30	22.27±0.96	6~30	-0.28	0.11
	Competency	6~30	18.31±4.51	6~30	-0.08	-0.26
	Relatedness	6~30	21.96±3.83	6~30	-0.30	0.38
AT		10~70	59.40±10.76	10~70	-0.87	0.40
	Behavioral belief	5~35	28.26±5.49	5~35	-1.24	1.79
	Outcome evaluation	5~35	30.64±4.80	5~35	-1.46	2.41
SN		10~70	53.52±11.96	10~70	0.13	-0.42
	Motivation to comply	5~35	27.06±5.38	5~35	-1.03	1.51
	Normative belief	5~35	25.97±0.58	5~35	-0.67	-0.10
SE		9~36	23.90±5.45	9~36	0.09	-0.21
	Self-efficacy 1	4~16	10.82±2.70	4~16	-0.06	-0.47
	Self-efficacy 2	5~20	13.07±0.30	5~20	0.16	-0.24
INT		10~70	56.92±10.33	12~70	-1.38	2.45
	Intention 1	5~35	28.01±0.23	6~35	-1.30	2.12
	Intention 2	5~35	28.71±5.30	5~35	-1.44	2.79
BE		16~80	59.65±9.88	30~80	-0.20	-0.05
	Behavior 1	8~40	30.78±5.17	11~40	-0.50	0.21
	Behavior 2	8~40	28.84±5.66	12~40	-0.20	-0.28

KN=knowledge related to hemodialysis; SS=social support; BPN=basic psychological need; AT=attitude; SN=subjective norm; SE=self-efficacy; INT=intention; BE=sick role behavioral compliance.

Table 2.

Fitness Statistics of Hypothetical Structural and Modified Model (N=476)

Goodness	χ²	p	df	χ²/df	GFI	NNFI	SRMR	CFI	RMSEA (LO90/HI90)	CAIC
Criteria				2~3	≥.9	≥.9	＜1.0	≥.9	.05~.08
Hypothetical model	307.36	＜.001	94	3.27	.92	.91	.04	.93	.07 (.06/.08)	730.12
Modified model	313.99	＜.001	98	3.20	.92	.91	.04	.93	.07 (.60/.08)	708.09

GFI=goodness-of-fit index, NNFI=nonnormed fit index, SRMR=standardized root mean square residual; CFI=comparative fit index, RMSEA=root mean square error of approximation.

Table 3.

Modifie d Model wi ith Param meter Estim ate (N=476)

Path	B	β	SE	CR (p)^†	SMC^‡	Direct effect (p) In	ndirect effect (p)	Total effect (p)
BPN					.409
KN→BPN	0.46	.15	.20	2.28 (.023)		.15 (.035)	-	.15 (.035)
SS→BPN	0.28	.57	.04	7.56 (＜.001)		.57 (.010)	-	.57 (.010)
AT					.467
KN→AT	1.13	.25	.27	4.12 (＜.001)		.25 (.010)	.04 (.095)	.30 (.010)
SS→AT						-	.33 (.010)	.33 (.010)
SN→AT	0.50	.49	.08	6.67 (＜.001)		.49 (.010)	-	.49 (.010)
SE→AT	-	-	-	-		-	.08 (.020)	.08 (.020)
BPN→AT	0.21	.15	.10	2.20 (.028)		.15 (.029)	.13 (.010)	.27 (.010)
SN					.328
SE→SN	0.23	.17	.10	2.66 (.008)		.17 (.020)	-	.17 (.020)
SS→SN	0.22	.31	.06	3.48 (＜.001)		.31 (.010)	.19 (.010)	.50 (.010)
KN→SN	-	-	-	-		-	.04 (.097)	.04 (.097)
BPN→SN	0.30	.21	.12	2.44 (.015)		.21 (.031)	.06 (.020)	.26 (.010)
SE					.239
KN→SE	-	-	-	-		-	.05 (.095)	.05 (.095)
SS→SE	0.10	.21	.04	2.48 (.013)		.21 (.019)	.19 (.010)	.40 (.010)
BPN→SE	0.30	.33	.08	3.92 (＜.001)		.33 (.010)	-	.33 (.010)
INT					.705
KN→INT	-0.65	-.13	.28	-2.32 (.020)		-.13 (.062)	.11 (.010)	-.02 (.858)
SS→INT	-0.16	-.19	.06	-2.84 (.005)		-.19 (.010)	.51 (.010)	.32 (.010)
AT→INT	0.27	.23	.08	3.38 (＜.001)		.23 (.021)	-	.23 (.021)
SN→INT	0.61	.52	.11	5.76 (＜.001)		.52 (.010)	.11 (.021)	.63 (.010)
SE→INT	0.81	.45	.10	7.84 (＜.001)		.45 (.010)	.11 (.021)	.55 (.010)
BPN→INT	-	-	-	-		-	.35 (.010)	.35 (.010)
BE					.801
KN→BE	0.84	.22	.23	3.73 (＜.001)		.22 (.010)	-.04 (.452)	.17 (.023)
SS→BE	0.12	.19	.04	3.32 (＜.001)		.19 (.010)	.26 (.010)	.45 (.010)
AT→BE	-0.13	-.14	.06	-2.20 (.028)		-.14 (.023)	.16 (.021)	.01 (.900)
SN→BE SE→BE	- 0.32	- .23	- .09	- 3.58 (＜.001)		- .23 (.010)	.36 (.010) .36 (.010)	.35 (.010) .59 (.010)
SE→BE BPN BE	0.32 -	.23 -	.09 -	3.58 (＜.001) -		.23 (.010) -	.36 (.010) .27 (.010)	.59 (.010) .27 (.010)
BPN→BE	-	-	-	-		-	.27 (.010)	.27 (.010)
INT→BE	0.52	.67	.06	8.59 (＜.001)		.67 (.010)	-	.67 (.010)

SE=standard error; KN=knowledge related to hemodialysis; BPN=basic psychological need; SS=social support; AT=attitude; SN=subjective norm; SE=self-efficacy; INT=intention; BE=sick role behavioral compliance;

^† Critical ratio;

^‡ Squared multiple correlation.

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