Psychometric Evaluation of Self-management Scale for Hemodialysis Patients with Arteriovenous Fistula

Kyungmi Lee; Semi Candidate Lim; Younhee Kang

doi:10.7469/KJAN.2017.29.6.637

Journal List > Korean J Adult Nurs > v.29(6) > 1076496

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Lim, and Kang: Psychometric Evaluation of Self-management Scale for Hemodialysis Patients with Arteriovenous Fistula

Original Research

Korean J Adult Nurs 2017;29(6):637-646.

Published online: 18 December 2017

DOI: https://doi.org/10.7469/KJAN.2017.29.6.637

Psychometric Evaluation of Self-management Scale for Hemodialysis Patients with Arteriovenous Fistula

Kyungmi Lee, APN, Ph.D. Candidate¹, Semi Candidate Lim, Ph.D.¹, Younhee Kang, Ph.D., APRN-ANP^2,

^¹Graduate School of Nursing Science, Ewha Womans University, Seoul, Korea

^²College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Kang, Younhee College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-4483, Fax: +82-2-3277-2850, E-mail: yxk12@ewha.ac.kr

Received 3 September 201714 November 2017 Accepted 17 December 2017

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

The purpose of this study was to develop a Self-Management Scale for Hemodialysis Patients on Arteriovenous Fistula(SMHDP) and to verify its validity and reliability.

Methods

Items for the preliminary instrument of the SMHDP-scale were created through a literature review and in-depth interviews with hemodialysis patients and hemodialysis unit nurses. A convenient sample was utilized for this study. The questionnaire was distributed to 200 hemodialysis patients with arteriovenous fistula. Content validity, construct validity, criterion validity, convergent validity, and discriminative validity were evaluated respectively. Cronbach's ⍺ was used to evaluate the reliability of the SMHDP-scale.

Results

Five factors were identified through factor analysis. The factors included dietary knowledge of hemodialysis (8 items), compliance with hemodialysis (7 items), knowledge of hemodialysis (6 items), dietary compliance of hemodialysis (6 items), and compliance with hemodialysis order (3 items). These five factors explained 58.9% of the total variance. The correlation coefficient between criterion instrument and SMHDP-scale was .66 Reliability analysis showed Cronbach's ⍺ coefficient was .90.

Conclusion

Results show that the SMHDP-scale had good reliability and validity and thus SMHDP-scale may be a useful scale for clinical practices and for research as a measure of self-management of hemodialysis patient on arteriovenous fistula.

Keywords: Arteriovenous fistula, Hemodialysis, Self-management, Reliability and validity

REFERENCES

1.Lee YK., Oh JE. Hemodialysis. The Korean Journal of Medicine. 2014. 86(2):131–7. https://doi.org/10.3904/kjm.2014.86.2.131.

2.The Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul: ESRD Registry Committee;2016. [cited 2017 June 11]. Available from. http://www.ksn.or.kr/rang_board/list.html?code=sinchart.

3.Park HM., Lee HS. Effects of empowerment education program for hemodialysis patients on self-efficacy, self-care agency, self-care activities and physiologic parameters. The Korean Journal of Rehabilitation Nursing. 2010. 13(2):151–60.

4.Park HS., Hong YS., Lee HJ., Ha EH., Sung YA. Individuals with type 2 diabetes and depressive symptoms exhibited lower adherence with self-care. Journal of Clinical Epidemiology. 2004. 57(9):978–84. https://doi.org/10.1016/j.jclinepi.2004.01.015.

5.Lorig KR., Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Annals of Behavioral Medicine. 2003. 26(1):1–7. https://doi.org/10.1207/S15324796ABM2601_01.

6.Sabat'e E. Adherence to long-term therapies: evidence for action [Internet]. Geneva: World Health Organization;2003. [cited 2017 June 11]. Available from. http://www.who.int/chp/knowledge/publications/adherence_report/en/.

7.Song MR. Development and effect of self-efficacy promotion program on self-care of hemodialysis patients [dissertation]. Seoul: Seoul National University;1999. p. 1–118.

8.Kim JH. Understanding and development of measurement instrument. The Korean Academic Society of Adult Nursing. 2008. 6:7–32.

9.DeVellis RF. Scale development: Theory and applications. 4th ed.Thousand Oaks, CA: Sage Publications;2016. p. 111–47.

10.Yevzlin AS., Asif A., Salman L. Interventional nephrology: prin-ciples and practice. New York, NY: Springer Science & Busi-ness Media;2013. p. 101.

11.Ifudu O., Uribarri J., Rajwani I., Vlacich V., Reydel K., Delosreyes G, et al. Relation between interdialytic weight gain, body weight and nutrition in hemodialysis patients. American Journal of Nephrology. 2002. 22(4):363–8. https://doi.org/10.1159/000065228.

12.Ören B., Enç N. Development and psychometric testing of the self-care agency scale for patients undergoing long-term dialy-sis in Turkey. Journal of Renal Care. 2014. 40(4):266–73. https://doi.org/10.1111/jorc.12098.

13.Curtin RB., Sitter DC., Schatell D., Chewning BA. Self-manage-ment, knowledge, and functioning and well-being of patients on hemodialysis. Nephrology Nursing Journal. 2004. 31(4):378–86.

14.Kim YM., Evangelista LS., Phillips LR., Pavlish C., Kopple JD. The End-Stage Renal Disease Adherence Questionnaire (ESRDAQ): testing the psychometric properties in patients receiving in- center hemodialysis. Nephrology Nursing Journal. 2010. 37(4):377–93.

15.Song YC., Lin CC. The development and testing of a new hemodialysis self-management instrument (HD-SMI). Journal of Nursing Healthcare & Research. 2009. 51(9):51–9.

16.National Kidney Foundation Kidney Dialysis Outcome Qual-ity Initiative. Clinical practice guidelines and clinical practice recommendations: guideline 2. Selection and placement of hemodialysis access [Internet]. New York: National Kidney Foundation;2006. [cited 2015 May 29]. Available from. http://www2.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/va_guide2.htm.

17.The Korean Society for Dialysis Access. Clinical practice guideline for dialysis access [Internet]. Seoul: The Korean Society for Dialysis Access;2014. [cited 2017 June 11]. Available from. http://www.guideline.or.kr/guideline/guide/guide_renew.php.

18.Hair JF., Black WC., Babin BJ., Anderson RE. Multivariate data analysis. 7th ed.Upper Saddle River, NJ: Prentice Hall;2010. p. 109–36.

19.Ware JE., Snow KK., Kosinski M., Gandek B. SF-36 health survey: manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Center;1993. p. 1–238.

20.Feizalahzadeh H., Tafreshi MZ., Moqhaddasi H., Farahani MA., Khosrovshahi HT., Zareg Z, et al. Development and validation of a theory-based multimedia application for educating Persian patients on hemodialysis. CIN: Computers, Informatics, Nursing. 2014. 32(5):242–7. https://doi.org/10.1097/CIN.0000000000000052.

21.Palmer SC., Hanson CS., Craiq JC., Strippoli GF., Ruospo M., Campbell K, et al. Dietary and fluid restrictions in CKD: a the-matic synthesis of patient views from qualitative studies. American Journal of Kidney Diseases. 2015. 65(4):559–73. https://doi.org/10.1053/j.ajkd.2014.09.012.

22.The Korean Society for Dialysis Therapy. About hemodialysis [Internet]. Seoul: The Korean Society for Dialysis Therapy;2013. [cited 2017 June 11]. Available from. http://www.e-kda.org/blood/sub01_6.html.

23.Lee YB., Park HN., Kim SY., Kim JE., Choi SJ., Won YD, et al. A case of severe arterial steal syndrome with skin necrosis developing after percutaneous angioplasty. Korean Journal of Medicine. 2015. 88(1):83–8. https://doi.org/10.3904/kjm.2015.88.1.83.

24.Cha JE. Relationships between compliance and health-related quality of life in patients with hemodialysis. Journal of the Korea Academia-Industrial cooperation Society. 2015. 16(10):6495–503. https://doi.org/10.5762/KAIS.2015.16.10.6495.

25.Seo YH., Lim SO., Hyeon EH., Kim HW., Eom MR. Factors influ-encing medication adherence in hemodialysis patients: focusing on primary and secondary medical care. Perspectives in Nursing Science. 2015. 12(1):60–70. https://doi.org/10.16952/pns.2015.12.1.60.

26.Berger D., Takala J. Hypotension and hypovolemia during he-modialysis: is the usual suspect innocent? Critical Care. 2016. 20:140. https://doi.org/10.1186/s13054-016-1307-4.

27.Litwin MS. How to measure survey reliability and validity. Thousand Oaks, CA: SAGE Publication;1995. p. 21–6.

28.Park HA. Problems and issues in developing measurement scales in nursing. Journal of Nursing Query. 2005. 14(1):46–72.

Table 1.

General Characteristics of Participants (N=200)

Characteristics	Categories	n (%) or M± SD
Gender	Male	130 (65.0)
Gender	Female	70 (35.0)
Age (year)		56.01±13.95
	20~39	27 (13.5)
	40~49	33 (16.5)
	50~59	60 (30.0)
	60~69	41 (20.5)
	≥70	39 (19.5)
Level of education completed	≤ Elementary school	25 (12.5)
	Junior high school	31 (15.5)
	High school	62 (31.0)
	≥ College	82 (41.0)
Spouse	Present	139 (69.5)
Spouse	None	61 (30.5)
Underlying disease	Diabetes mellitus	73 (36.5)
	Hypertension	33 (16.5)
	Glomerulonephritis	31 (15.5)
	Others	30 (15.0)
	Unknown	33 (16.5)
Comorbidity	Present	165 (82.5)
Comorbidity	None	35 (17.5)
Period of hemodialysis (month)		72.98±75.24
Frequency of hemodialysis	Four times a week	5 (2.5)
	Three times a week	176 (88.0)
	Twice a week	17 (8.5)
	Once a week	2 (1.0)
History of kidney transplantation		15 (7.5)
Registered for kidney transplantation		100 (50.0)

Table 2.

Exploratory Factor Analysis (N=200)

Items	Factors
Items	1	2	3	4	5
39. I know foods that contain lots of potassium.	.80
40. I know foods that contain lots of phosphate.	.76
41. I know that banana and tomato contain a lot of potassium, and grapes and apples contain less potassium.	.76
42. I know that spinach and leek contain a lot of potassium, and napa cabbage and cucumber contain less potassium.	.69
50. I know blood test results to be checked monthly.	.67
37. I know that soup, ice cream, watery kimchi, coffee and porridge also include the water.	.62
43. I know that phosphate binder should be taken during meals or just after meals.	.61
38. I know that edema or dyspnea occurs when fluid are accumulated.	.60
12. Do not wear jewelries (rings, bracelets, watches) on your arm with arteriovenous fistula (AVF).		.80
20. Do not take folk remedies (acupuncture, herbal medicines, medicinal water)		.78
14. On your arm with AVF, do nothing such as blood sampling, taking blood pressuret, except for hemodialysis (HD).		.78
26. Do not drink.		.76
25. Do not smoke.		.74
16. Do not take medication not prescribed by your doctor.		.72
10. When you sleep, do not lay on your arm with AVF.		.52
49. I know how to cope with hypotension during HD.			.75
44. I know names of medication I take.			.74
48. I know symptoms of hypotension during HD.			.66
47. I know I should be careful because of anticoagulant used during HD.			.63
45. I know about the kinds and effects of medications I take.			.62
46. I know about use of anticoagulant during HD.			.61
1. I eat a limited amount of potassium (vegetables, fruits, sweet potatoes, beans).				.73
2. When eating vegetables, dip them in water or eat them in order to reduce potassium.				.73
6. Take the amount of water allowed per day (daily urine output+ 500~800mL)				.71
3. I eat a limited amount of phosphate (milk, dairy products, cereals, nuts).				.71
4. I restrict salty foods and eat low salt diet.				.64
7. I try to reduce the amount of water intake.				.60
19. I receive whole HD without reducing HD duration.					.74
18. I receive HD as scheduled without skipping.					.63
23. If treatments that may cause bleeding, such as surgery or tooth extraction, are scheduled, I should inform medical staff before starting HD.					.56
Initial eigenvalue	8.04	4.48	4.30	3.76	2.71
Explained variance (%)	15.8	14.2	11.1	10.6	7.1
Accumulative variance (%)	15.8	30.0	41.1	51.8	58.9
Kaiser-Meyer-Olkin (KMO)			.83
Bartlett's test of sphericity	3	3,293.	66 (p＜	＜.001	1)

Table 3.

Convergent and Discriminant Validity (N=200)

Factor	Items	Factor 1	Factor 2	Factor 3	Factor 4	Factor 5
Factor 1	39	.82	.23	.52	.16	.18
	40	.79	.24	.53	.17	.10
	41	.77	.27	.44	.27	.11
	42	.74	.23	.45	.22	.07
	50	.71	.26	.43	.13	.20
	37	.69	.16	.42	.16	.12
	43	.69	.23	.46	.13	.19
	38	.67	.20	.46	.13	.13
Factor 2	12	.19	.83	.15	.32	.36
	20	.25	.83	.23	.32	.41
	14	.29	.81	.21	.22	.41
	26	.23	.77	.24	.23	.21
	25	.27	.75	.29	.23	.20
	16	.21	.77	.20	.29	.40
	10	.26	.66	.21	.41	.35
Factor 3	49	.46	.16	.77	.02	.05
	44	.41	.19	.79	.14	.00
	48	.51	.24	.73	.08	.04
	47	.43	.19	.77	.10	-.03
	45	.54	.27	.77	.15	-.02
	46	.56	.27	.78	.05	.06
Factor 4	1	.27	.26	.12	.75	.06
	2	.20	.25	.05	.76	.13
	6	.07	.22	.07	.71	.15
	3	.16	.29	.04	.72	.11
	4	.09	.28	.10	.66	.25
	7	.24	.28	.13	.67	.28
Factor 5	19	.06	.32	-.07	.24	.83
	18	.13	.27	-.02	.12	.73
	23	.22	.36	.12	.15	.74

Table 4.

Correlation between the SMHDP-scale and Song's Scale (N=200)

Variables	SMHDP-scale	Factor 1	Factor 2	Factor 3	Factor 4	Factor 5
Variables	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Song's scale	.66 (＜.001)	.52 (＜.001)	.42 (＜.001)	.45 (＜.001)	.47 (＜.001)	.32 (＜.001)

TOOLS

Similar articles