Structural Equation Modeling of Self-Care Behaviors in Kidney Transplant Patients Based on Self-Determination Theory

Hye Won Jeong; Hyang Sook So

doi:10.4040/jkan.2018.48.6.731

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Jeong and So: Structural Equation Modeling of Self-Care Behaviors in Kidney Transplant Patients Based on Self-Determination Theory

Original Article

J Korean Acad Nurs 2018;48(6):731-742.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.6.731

Structural Equation Modeling of Self-Care Behaviors in Kidney Transplant Patients Based on Self-Determination Theory

Hye Won Jeong¹, Hyang Sook So^2,

¹Department of Nursing, Chonnam National University Hospital, Gwangju

²College of Nursing · Research Institute of Nursing Science, Chonnam National University, Gwangju, Korea

Address reprint requests to : So, Hyang Sook College of Nursing · Research Institute of Nursing Science, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-530-4952 Fax: +82-62-220-4544 E-mail: hsso0075@jnu.ac.kr

Received 12 July 2018 Revised 10 December 2018 Accepted 10 December 2018

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 test a hypothesis explaining direct and indirect relationships among the factors affecting self-care behaviors of kidney transplant patients, based on self-determination theory.

Methods

Data were collected from 222 outpatients with kidney transplantation. The endogenous and exogenous variables of the hypothetical model consisted of healthcare provider's autonomy support, duration after kidney transplantation, basic psychological need satisfaction, autonomous and controlled motivation, depression, and self-care behaviors. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0.

Results

The hypothetical model demonstrated a good fit: RMSEA=.06, SRMR=.04, TLI=.94, CFI=.97. Statistically significant explanatory variables for the self-care behaviors of kidney transplant patients were duration after transplantation and basic psychological need satisfaction. Healthcare provider's autonomy support was indirectly significant, while autonomous motivation, controlled motivation and depression were not statistically significant for self-care behaviors. The variables accounted for 59.5% of the self-care behaviors of kidney transplant patients.

Conclusion

It is necessary to develop an autonomy support program for healthcare providers to enhance the self-care behaviors of kidney transplant patients. Preventing the deterioration of self-care behaviors will be possible by conducting this program at one year and six years post-transplantation. In addition, the results suggest the need to developing personalized autonomy support programs for healthcare providers that can meet the basic psychological need satisfaction of kidney transplant patients.

Keywords: Kidney Transplantation, Self-Care, Health Behavior, Motivation

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Figure 1.

The conceptual framework of this study.

Figure 2.

Path diagram for the final model.

Table 1-1.

Demographic and Transplant-Related Characteristics of Participants (N=222)

Variables	Categories	n (%)
Age (yr)	23~39	38 (17.1)
(M±SD 50.36±10.62)	40~49	58 (26.1)
	50~59	80 (36.0)
	60~71	46 (20.8)
Sex	Men	139 (62.6)
	Women	83 (37.4)
Marital status	Single	44 (19.8)
	Living with spouse	144 (64.9)
	Others (divorced, widowed, separated)	34 (15.3)
Education level	Below middle school	33 (14.9)
	High school	89 (40.1)
	College & over	100 (45.0)
Job status	Have	106 (47.7)
	Have not	116 (52.3)
Monthly household income (10,000 won)	<100	69 (31.1)
	100~<300	76 (34.2)
	≧300	73 (32.9)
	No response	4 (1.8)
Types of religion	Protestantism	55 (24.8)
	Buddhism	34 (15.3)
	Catholicism	26 (11.7)
	None	100 (45.0)
	Others	7 (3.2)
Duration after KT (yr) (M±SD 5.86±5.30)	<1	33 (14.9)
	1~<6	105 (47.3)
	≧6	84 (37.8)
Type of donor	Deceased	124 (55.9)
	Living	98 (44.1)
Co-morbidity^†	Diabetes mellitus	69 (23.5)
	Hypertension	108 (36.9)
	Heart disease	26 (8.9)
	Others	14 (4.8)
	None	76 (25.9)

KT=Kidney transplantation.

^† Multi response.

Table 1-2.

Differences of Self-Care Behaviors according to Duration after KT (N=222)

Variables	Categories	n (%)	Self-care behaviors	F (p)
Variables	Categories	n (%)	M±SD	F (p)
Duration	＜1^a	33 (14.9)	77.30±8.58	17.35
after KT	1~＜6^b	105 (47.3)	72.22±9.93	(<.001)
(yr)	≧6^c	84 (37.8)	65.86±11.21	(a>b>c)

M=Mean; SD=Standard deviation; KT=Kidney transplantation.

Table 2.

Descriptive Statistics of Research Variables (N=222)

	Min	Max	Range	M±SD	Skewness	Kurtosis	Standardized F.L.	C.R (p)	AVE	CCR
Healthcare providers’ autonomy support	36.00	98.00	14∼98	82.28±12.66	-0.99	0.79			.57	.95
Duration after KT (yr)	0.08	25.00	0.1∼25	5.86±5.25	1.38	1.76
BPNS	43.00	85.00	3∼85	66.11±9.73	-0.25	-0.42			.44	.70
Autonomy	3.00	18.00	3∼18	15.43±2.68	-1.33	-1.97	.51
Competence	8.00	42.00	6∼42	31.11±6.56	-0.34	0.00	.67	6.69 (<.001)
Relatedness	10.00	25.00	5∼25	19.57±3.16	-0.27	-0.09	.65	6.54 (<.001)
Autonomous motivation	14.00	49.00	7∼49	41.19±7.08	-1.16	1.27			.59	.91
Controlled motivation	7.00	49.00	7∼49	24.68±10.79	0.01	-0.83			.52	.88
Depression	0.00	14.00	0∼15	4.77±2.59	0.43	0.86			.64	.90
Self-care behaviors	38.00	90.00	18∼90	70.56±10.99	-0.50	0.19			.78	.91
Daily life management	12.00	35.00	7∼35	26.88±4.80	-0.51	0.38	.84
Complication management	11.00	35.00	7∼35	27.82±4.65	-0.71	0.58	.75	10.50 (<.001)
Medication	8.00	20.00	4∼20	15.87±2.84	-0.33	-0.65	.82	14.42 (<.001)

KT=Kidney transplantation; BPNS=Basic psychological need satisfaction; M=Mean; SD=Standard deviation; F.L.=Factor loading; C.R.=Critical ratio; AVE=Average variance extracted; CCR=Composite construct reliability.

Table 3.

Standardized Direct, Indirect, and Total Effects of the Final Model (N=222)

Endogenous variables	Exogenous variables	Standardized estimates (β)	C.R. (p)	SMC	Standardized direct effect (p)	Standardized indirect effect (p)	) Standardized total effect (p)
BPNS	Healthcare providers’ autonomy support	.47	5.25 (<.001)	.26	.47 (.001)		.47 (.001)
	Duration after KT	-.17	-2.45 (.014)		-.17 (.012)		-.17 (.012)
Autonomous motivation	Healthcare providers’ autonomy support	-.02	-0.30 (.767)	.53	-.19 (.819)	.34 (.001)	.32 (.001)
	BPNS	.73	5.99 (<.001)		.73 (.002)		.73 (.002)
Controlled motivation	BPNS	.15	1.88 (.060)	.02	.15 (.074)		.15 (.074)
Depression	BPNS	-.97	-5.02 (<.001)	.50	-.97 (.001)	.33 (.001)	-.63 (.001)
	Autonomous motivation	.44	3.28 (.001)		.44 (.001)		.44 (.001)
	Controlled motivation	.07	1.17 (.242)		.07 (.348)		.07 (.348)
Self-care behaviors	Healthcare providers’ autonomy support	.04	0.60 (.548)	.60	.04 (.612)	.28 (.001)	.32 (.001)
	Duration after KT	-.27	-4.92 (<.001)		-.27 (.001)	-.10 (.010)	-.38 (.001)
	BPNS	.56	2.29 (.022)		.56 (.042)	.06 (.705)	.62 (.002)
	Autonomous motivation	.19	1.30 (.192)		.19 (.304)	.06 (.242)	.25 (.065)
	Controlled motivation	.05	0.92 (.356)		.05 (.364)	.01 (.300)	.06 (.299)
	Depression	.14	1.17 (.243)		.14 (.318)		.14 (.318)

BPNS: Basic psychological need satisfaction; KT: Kidney transplantation; C.R.: Critical ratio; SMC: Squared Multiple Correlation.

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