The Relationship Between Social Support And Self-Management In Patients With Chronic Kidney Disease:The Mediating Role Of Health Literacy And Self-Efficacy

ObjectiveTo investigate the status quo of self-management in patients with chronic kidney disease and the relationship between social support and self-management,to explore the mediating role of health literacy and self-efficacy in social support and self-management,so as to provide theoretical basis for the development of self-management level intervention measures in patients with chronic kidney disease.MethodsThis study is a cross-sectional descriptive study.From April to December 2021,332 inpatients with chronic kidney disease in a class A hospital in Shandong Province were selected as the research objects by convenient sampling method.The research tools include:General data questionnaire,Social Support Scale,Health literacy scale for chronic disease patients,chronic disease self-efficacy Scale and self-management scale for chronic kidney disease patients.SPSS23.0 statistical software was used for data collation and analysis,including descriptive statistical analysis,independent samplet t est,analysis of variance,Pearson correlation analysis and multiple linear step-up regression analysis.AMOS23.0 statistical software was used to establish the structural equation model,and the mediation effect was tested by Bootstrap program in Process plug-in.Results1.Sociodemographic and disease-related data of patients with chronic kidney diseaseIn this study,332 patients with CKD were selected,ranging in age from 21 to 88 years old,with an average age of 51.91±14.84 years old.The majority of chronic kidney disease stage 5 patients were 140 cases,accounting for 42.2%.2.Self-management of patients with chronic kidney diseaseThe self-management score of CKD patients was(86.63±11.31),and the scores of each dimension from high to low were:treatment management(26.36±4.42),psychosocial management(14.31±2.02),physical activity management(14.16±1.96),diet management(31.80±5.04).3.Univariate analysis of self-management in patients with chronic kidney diseaseAge,occupation,education level,permanent residence,source of medical expenses,monthly family income and course of disease had statistical differences on the self-management of patients with CKD(P<0.05).4.Social support,health literacy and self-efficacy in patients with chronic kidney diseaseThe social support score of CKD patients was(40.14±6.63);The score of health literacy was(105.42±14.38);The score of self-efficacy was(6.62±1.83).5.Correlation analysis of social support,health literacy,self-efficacy and self-management in patients with chronic kidney diseasePearson correlation analysis showed that social support,health literacy,self-efficacy and self-management were positively correlated(p<0.01).6.Multiple linear stepwise regression analysis resultsThe results of multiple linear step-up regression analysis showed that patients’ age,sources of medical expenses,course of disease,symptom management,communication and interaction ability,utilization of support,and willingness to improve health were included in the regression equation,with statistical significance(p<0.05),which could explain 45.9%of self-management.7.Mediating effects of health literacy and self-efficacy on social support and self-managementThe structural equation model was established:χ2/df=2.707,RMSEA=0.072,GFI=0.936,AGFI=0.931,NFI=0.926,CFI=0.951,IFI=0.952,and the model fitting was acceptable.The total effect of social support on self-management was 0.436(p<0.001,95%CI:0.283～0.584),the direct effect was 0.083(p<0.05,95%CI:0.039～0.132),and the indirect effect was 0.353(p<0.001,95%CI:0.254～0.489),the mediating effect accounted for 80.96%of the total effect value.Indirect path 1:social support→health literacy→self-management,95%CI is(0.123～0.491),excluding 0,indicating that health literacy has a partial mediating effect between social support and self-management,and the indirect effect value is 0.165(0.461*0.359).Indirect path 2:Social support→self-efficacy→self-management,95%CI is(0.098～0.205),excluding 0,indicating that self-efficacy has a partial mediating effect between social support and self-management,and the indirect effect value is 0.110(0.328*0.333).Indirect path 3:social support→health literacy→self-efficacy→self-management.95%CI is(0.022～0.571),excluding 0,indicating that health literacy and self-efficacy have a chain mediating effect between social support and self-management,and the indirect effect value is 0.078(0.461*0.511*0.333).Conclusions:1.The self-management of patients with chronic kidney disease is at a lower level and needs to be further improved.2.The level of self-management is different in age,occupation,education level,permanent residence,marital status,source of medical expenses,family monthly income,course of disease,etc.It is necessary to focus on these aspects and take targeted intervention measures to improve their self-management ability.3.Social support of patients with chronic kidney disease can directly affect self-management,and indirectly affect self-management through the mediating effects of health literacy and self-efficacy.Therefore,medical staff should pay attention to patients’social support,improve patients’ health literacy and self-efficacy to improve patients’self-management ability.