Journal List > Korean J Adult Nurs > v.28(4) > 1076407

Korean J Adult Nurs. 2016 Aug;28(4):415-423. Korean.
Published online August 31, 2016.
© 2016 Korean Society of Adult Nursing
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, Email:
Received May 06, 2016; Revised June 22, 2016; Accepted August 22, 2016.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



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


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.


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.


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


Figure 2
Structural equation model of sick role behavioral compliance in hemodialysis patients.
Click for larger image


Table 1
Descriptive Statistics for Latent Variables and Measured Variables (N=476)
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Table 2
Fitness Statistics of Hypothetical Structural and Modified Model (N=476)
Click for larger image

Table 3
Modified Model with Parameter Estimate (N=476)
Click for larger image


This manuscript is a revision of the author's doctoral dissertation from Catholic University of Daegu.

1. The Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul: ESRD Registry Committee, Korean Society of nephrology; 2013 [cited 2016 April 20].
2. An GJ. Effects of self-care program using SMS, e-mail, or telephone call on self-care compliance and nutritional status in hemodialysis patients. J Korean Biol Nurs Sci 2009;11(2):157–166.
3. Leggat JE Jr. Adherence with dialysis: a focus on mortality risk. Semin Dial 2005;18(2):137–141. [doi: 10.1111/j.1525-139X.2005.18212.x]
4. Baines LS, Jindal RM. Non-compliance in patients receiving haemodialysis: an in-depth review. Nephron 2000;85:1–7. [doi: 10.1159/000045622]
5. Moon ES. A structural analysis of the social-motivational variables influencing adolescents' school dropout behavior. Korean J Educ Psychol 2006;20(2):405–423.
6. Choi SB, Ham KS. The relationships between social support, basic needs and quality of life in leisure participation by old adults. J Sport Leis Stud 2009;38:671–682.
7. Cho YM, Choi MS, Sung KW. Factors predicting sick role behavioral compliance in hemodialysis patient. Korean J Adult Nurs 2011;23(3):235–243.
8. Choe MA, Hah YS, Kim KS, Yi MS, Choi JA. A study on exercise behavior, exercise environment and social support of middle-aged women. J Korean Acad Nurs 2008;38(1):101–110.
9. Kim KH. In: A study on influencing factors to the quality of life of the hemodialysis patients.[master's thesis]. Seoul: Kyunghee University; 1996.
10. Na DM, Lee KO, Song ES. Relationship between the knowledge of hemodialysis and the compliance of patient role behavior in hemodialysis patients. Med J Chosun Univ 2004;29(3):12–20.
11. Tsay SL. Self-efficacy training for patient with end-stage renal disease. J Adv Nurs 2003;43(4):370–375.
12. Hong KY. In: A study of the relationships among dialysis related knowledge, self efficacy and compliance of patient role behavior in hemodialysis patients. [master's thesis]. Seoul: Hanyang University; 1999.
13. Cho YM, Sung KW. The association of compliance with sick role behavior with satisfaction of basic psychological needs among hemodialysis patients. Korean J Health Promot 2012;12(1):58–65.
14. Lee MR. Testing a motivational sequence integrated self-determination theory and the theory of planned behavior: focused on dieting behavior. Korean J Health Psychol 2014;19(1):443–451.
15. Hagger MS, Chatzisarantis NLD. The trans-contextual model of motivation. In: Hagger MS, Chatzisarantis NLD, editors. Intrinsic motivation and self-determination in exercise and sports. Champaign, IL: Human Kinetics; 2007. pp. 53-70.
16. Hagger MS, Chatzisarantis NLD, Harris J. From psychological need satisfaction to intentional behavior: testing a motivational sequence in two behavioral contexts. Pers Soc Psychol Bull 2006;32:131–148. [doi: 10.1177/0146167205279905]
17. Hagger MS, Chatzisarantis NLD, Hein V, Soos I, Karsai I, Lintunen T, et al. Teacher, peer and parent autonomy support in physical education and leisure-time physical activity: a transcontextual model of motivation in four nations. Psychol Health 2009;24(6):689–711. [doi: 10.1080/08870440801956192]
18. Moon SB. In: Basic concepts and application of structural equation modeling with AMOS 17.0. Seoul: Hakjisa; 2009.
19. Ryan RM, Deci EL. An overview of self-determination theory. In: Deci EL, Ryan RM, editors. Handbook of self determination research. Rochester, NY: University of Rochester Press; 2002. pp. 3-33.
20. Ajzen I. Constructing a TpB questionnaire: conceptual and methodological considerations. [Revised January, 2006]. [cited 2016 April 16].
21. Jee YO. Instrument development for the application of the theory of planned behavior. Korean J Nurs Query 1994;2(2):102–115.
22. Kim JH. In: An effect of guided imagery applied to hemodialysis patients. [dissertation]. Seoul: Seoul National University; 1995.
23. Lee GH. The relationships between game knowledge, basic needs for physical education classes, and behavioral regulation among middle and high school students. Korean J Sport Psychol 2010;21(1):99–110.
24. Kim MJ. A structural equation model explaining contraception behaviors of married Korean women. J Korean Acad Womens Health Nurs 2001;7(2):141–156.
25. Park JK. Predicting adolescent´s intention for physical activity and behavior using the theory of planned behavior: The roles of family support and personality. Korean J Sport Psychol 2011;22(1):129–144.
26. Hagger MS, Chatzisarantis NLD. Self-determination theory and the promotion and maintenance of sport, exercise, and health. In: Hagger MS, Chatzisarantis NLD, editors. Intrinsic motivation and self-determination in exercise and sports. Champaign, IL: Human Kinetics; 2007. pp. 1-19.
27. Stack AG, Martin DR. Association of patient autonomy with increased transplantation and survival among new dialysis patients in the United States. Am J Kidney Dis 2005;45(4):730–742. [doi: 10.1053/j.ajkd.2004.12.016]
28. Kim SH, Lee SH. Influences of knowledge, self-efficacy, and social support on sick role behavior in patients with coronary artery disease. J Korean Public Health Nurs 2014;28(2):228–240. [doi: 10.5932/JKPHN.2014.28.2.228]