Resilience as a Moderator and Mediator of the Relationship between Symptom Experience and Quality of Life in Hemodialysis Patients

Yeon Hee Cho; Yun Mi Lee

doi:10.7475/kjan.2019.31.1.68

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Cho and Lee: Resilience as a Moderator and Mediator of the Relationship between Symptom Experience and Quality of Life in Hemodialysis Patients

Original Article

Korean J Adult Nurs 2019;31(1):68-77.

Published online: 21 February 2019

DOI: https://doi.org/10.7475/kjan.2019.31.1.68

Resilience as a Moderator and Mediator of the Relationship between Symptom Experience and Quality of Life in Hemodialysis Patients

Yeon Hee Cho¹, Yun Mi Lee^2,

¹MSN, RN, Department of Nursing, College of Medicine, Inje University, Busan, Korea

²Professor, Department of Nursing, College of Medicine, Inje University, Institute of Health Science, Busan, Korea

Corresponding author: Lee, Yun Mi https://orcid.org/0000-0002-3860-0365 Department of Nursing, College of Medicine, Inje University, 75 Bokji-ro, Kaegum-dong, Pusanjin-gu, Busan 47392, Korea. Tel: +82-51-890-6933, Fax: +82-51-896-9840, E-mail: lym312@inje.ac.kr

Received 12 December 20189 January 2019 Accepted 28 January 2019

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 is to identify the moderating and mediating effects of resilience in the relationship between symptom experience and quality of life.

Methods

Participants were recruited from one general hospital and one hospital specialized in hemodialysis located in Busan city. The participants included 105 patients diagnosed with chronic renal failure who had been receiving hemodialysis twice a week or more on a regular basis. Data collection was conducted from December 14, 2017, to January 15, 2018. Collected data were analyzed using the SPSS/WIN 24.0 program.

Results

There were significant correlations between participants'symptom experience and resilience (r=-.36, p<.001), symptom experience and quality of life (r=-.50, p<.001), and resilience and quality of life (r=.67, p<.001), respectively. Resilience had a partial mediating effect (z=-3.48, p<.001) in the relationship between symptom experience and quality of life but did not have moderating effects.

Conclusion

To improve the quality of life among patients on hemodialysis, it is necessary to develop interventions that enhance resilience in addition to providing symptom relief.

Keywords: Renal dialysis, Symptom assesment, Psychological resilience, Quality of life

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Table 1.

Symptom Experience, Resilience and Quality of life according to General Characteristics of Patients (N=105

Characteristics	Categories	n (%)	Symptom experience		Resilience		Quality of life
Characteristics	Categories	n (%)	M± SD	t or F (p)	M± SD	t or F (p)	M± SD	t or F (p)
Age (year)	50	30 (28.6)	1.10±0.78	1.12	2.24±0.57	0.56	2.97±0.53	0.53
	50~59	25 (23.7)	1.24±1.11	(.344)	2.40±0.85	(.646)	3.03±0.58	(.662)
	60~69	28 (26.7)	0.87±0.55		2.13±0.76		2.89±0.70
	≥70	22 (21.0)	0.91±0.78		2.24±0.78		2.83±0.62
Gender	Men	65 (61.9)	0.93±0.79	-1.72	2.19±0.78	-0.88	2.98±0.59	1.02
Gender	Women	40 (38.1)	1.21±0.86	(.088)	2.33±0.78	(.384)	2.86±0.63	(.310)
Religion	Yes	61 (58.1)	1.07±0.83	0.48	2.30±0.89	1.04	2.97±0.63	0.67
Religion	No	44 (41.9)	0.99±0.82	(.631)	2.15±0.60	(.303)	0.89±0.58	(.508)
Marital status	Unmarried ^a	27 (25.7)	1.46±1.04	5.34	2.14±0.75	0.51	2.87±0.64	0.17
	Married ^b	58 (55.2)	0.87±0.60	(.006)	2.31±0.82	(.604)	2.95±0.62	(.844)
	Other ^c	20 (19.1)	0.94±0.90	a＞ b, c^†	2.18±0.71		2.96±0.54
Education	Uneducated	3 (2.9)	0.65±0.30	0.35	2.08±0.57	1.62	2.77±0.33	2.67
	Below middle school	25 (23.8)	0.99±0.80	(.792)	1.99±0.82	(.188)	2.68±0.65	(.051)
	High school	46 (43.8)	1.10±0.95		2.26±0.84		2.96±0.63
	Above college	31 (29.5)	1.01±0.66		2.44±0.65		3.12±0.48
Occupation	Yes	28 (26.7)	1.01±0.71	-0.17	2.46±0.69	1.75	3.06±0.56	1.34
Occupation	No	77 (73.3)	1.04±0.86	(.864)	2.16±0.80	(.082)	2.89±0.62	(.184)
An average monthly income of households (10,000 won)	100 ^a	60 (57.1)	1.08±0.92	0.52	2.05±0.81	2.64	2.81±0.66	1.66
	100~＜200 ^b	16 (15.2)	1.00±0.48	(.723)	2.32±0.63	(.038)	3.00±0.48	(.166)
	200~＜300 ^c	9 (8.6)	1.22±0.85		2.69±0.68	a＜ c, e^†	3.08±0.48
	300~＜400 ^d	7 (6.7)	1.01±1.02		2.43±0.83		3.16±0.54
	≥400 ^e	13 (12.4)	0.76±0.53		2.61±0.64		3.19±0.54
Duration of hemodialysis (year)	5 ^a	44 (41.9)	0.85±0.73	3.40	2.22±0.84	0.28	3.07±0.61	1.62
	5~＜10 ^b	22 (21.0)	1.01±0.68	(.021)	2.25±0.72	(.840)	2.89±0.51	(.190)
	10~＜15 ^c	15 (14.3)	1.61±1.16	a, b, d＜ c^†	2.12±0.97		2.71±0.67
	≥15 ^d	24 (22.8)	1.03±0.75		2.35±0.60		2.87±0.61
Number of hemodialysis per week	2	6 (5.7)	0.43±0.31	1.99	2.60±0.74	1.10	3.38±0.38	1.99
	3	94 (89.5)	1.08±0.84	(.142)	2.20±0.78	(.336)	2.90±0.62	(.141)
	4	5 (4.8)	0.83±0.80		2.54±0.85		3.09±0.36
Monthly hospital expenses (10,000 won)	10	49 (46.7)	0.86±0.72	1.26	2.25±0.72	1.82	2.97±0.54	0.54
	10~＜20	23 (21.9)	1.25±0.94	(.293)	0.93±0.81	(.130)	2.78±0.72	(.707)
	20~＜30	17 (16.2)	1.19±0.97		2.53±0.84		2.93±0.57
	30~＜40	10 (9.5)	0.98±0.86		2.49±0.78		3.08±0.52
	≥40	6 (5.7)	1.28±0.47		2.15±0.83		2.99±0.90
Comorbidity	Yes	83 (79.0)	1.11±0.87	1.84	2.17±0.78	-1.95	2.86±0.61	-2.48
Comorbidity	No	22 (21.0)	0.75±0.55	(.068)	2.53±0.75	(.054)	3.21±0.50	(.015)

^† LSD test.

Table 2.

Level of Symptom Experience, Resilience and Quality of Life of Patients (N=105)

Variables	M± SD	Range	Min	Max
Symptom experience	1.03±0.82	0~5	0.03	4.06
Physical symptoms	1.01±0.79	0~5	0.04	4.00
Emotional symptoms	1.10±1.08	0~5	0.00	4.22
Resilience	2.24±0.78	0~4	0.08	4.00
Quality of life	2.93±0.61	1~5	1.31	4.35

Table 3.

Correlation among Symptom Experience, Resilience, and Quality of Life of Patients (N=105)

Variables	Symptom experience	Resilience	Quality of life
Variables	r (p)	r (p)	r (p)
Symptom experience	1
Resilience	-.36 (＜.001)	1
Quality of life	-.50 (＜.001)	.67 (＜.001)	1

Table 4.

Moderating Effect of Resilience between the Symptom Experience and Quality of life of Patients (N=145)

Variables	Model 1					Model 2					Model 3					Model 4
Variables	B	SE	β	t	p	B	SE	β	t	p	B	SE	β	t	p	B	SE	β	t	p
Associated disease	9.14	3.70	.24	2.48	.015	5.85	3.30	.15	1.77	.079	3.13	2.69	.08	1.17	.247	3.13	2.70	.08	1.16	.249
Symptom experience						-0.29	0.05	-.48	-5.58 ＜	.001	-0.18	0.04	-.29	-3.98	.001	-0.17	0.05	-.29	-3.64 ＜	.001
Resilience											0.44	0.06	.55	7.45	.001	0.44	0.06	.55	7.40 ＜	.001
Symptom experience × Resilience																3.98	0.00	.00	0.02	.985
R²			.06					.28					.53					.53
Adjusted R²			.05					.26					.52					.52
F (p)		6.13 (.015)					19.50 (＜.001)					38.47 (＜.001)					28.56 (＜.001)

Table 5.

Mediating Effect of Resilience between the Symptom Experience and Quality of life of Patients (N=105)

Step	Independent variables	Dependent variables	β	t (p)	Adjusted R²	F (p)
1	Symptom experience	Resilience	-.36	-3.93 (＜.001)	.122	15.40 (＜.001)
2	Symptom experience	Quality of life	-.48	-5.58 (＜.001)	.262	19.50 (＜.001)
3	Symptom experience Resilience	Quality of life	-.29.55	-3.98 (＜.001)7.45 (＜.001)	.519	38.47 (＜.001)
				Sobel test: z=-3.48, p＜.001

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