| Summary: | 碩士 === 國立成功大學 === 護理學系 === 104 === Background: A great deal of self-management behaviors are necessary for patients undergoing hemodialysis. Self-management behaviors can increase patients’ active participation in managing their disease and has been shown to improve fluid adherence, which remains a major problem with patients undergoing hemodialysis.
Despite the fact that hemodialysis is the most frequently used treatment for chronic kidney disease in Indonesia, and the reported level of poor fluid adherence is still quite high, the concept of self-management remains little known. More understanding of what influences self-management behaviors and an exploration of factors which affect the clinical outcomes due to self-management behaviors is thus required before effective self-management programs can be implemented.
Purpose: The purpose of this study was to understand the influence demographic and psychological factors have on self-management behaviors and Inter Dialysis Weight Gain (IDWG) as a fluid adherence marker among patients undergoing hemodialysis in Indonesia.
Method: A cross-sectional study was conducted. A convenience sample of 145 patients undergoing hemodialysis was recruited from the dialysis units in two hospitals in Jakarta from September to December 2015. Questionnaires were used to examine the following variables: self-management behaviour indices, and the Depression, Anxiety and Stress Scale-Short Form (DASS-SF). Data analysis involved descriptive statistics, Pearson correlations, and hierarchical multiple linear regression was used for identifying the predictors of Self-Management Behaviour and Inter-dialytic weight gain.
Results: The overall score of the self-management behavior indices was 74.11 ± 10.72 (median = 75; range= 48-104), and the average of IDWG was 4% (mean= 3.97; SD= 2.17). The average item score for each of the five dimension of self-management behaviors were 3.4 in partnership, 2.34 for self-care, 2.09 for communication, 2.06 for partnership in care, and 1.39 for self-advocacy. Hierarchical linear regression analyses were used to model the relationship between each dimension of self-management behavior and the psychological factors. This analysis indicated that anxiety was the only one of the psychological factors which had positive and significant associations with the self-advocacy dimension. The final model of hierarchical linear regression analyses for each dimension of self-management behavior explained 18% of the variance in IDWG and indicated that the partnership in care dimension was a predictor of IDWG.
Conclusion: With regard to the dimensions of self-management behavior, the medication adherence dimension is the most performed by patients undergoing hemodialysis, followed by self-care, communication, partnership in care and self-advocacy. Self-management behaviors, especially the partnership in care dimension, are potential predictors that can be modified by nephrology nurses in order to enhance clinical outcomes, with the specific outcome being IDWG in this context.
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