Study On The Influence Of Hemodialysis Patients' Self-management On Their Functioning And Well-being

Objectives:(1) To identify the level of self-management in hemodialysis (HD)patients and the related factors of self-management in hemodialysis patients; (2) To identify the functioning and well-being of patients undergoing hemodialysis and the related factors of functioning and well-being in hemodialysis patients; (3) To examine the relationship beteen self-management and functioning and well-being in patients undergoing hemodialysis; (4) To explore the influence of improving self-management of these patients on their functioning and well-being; (5) To initially explore the effective measure to improve the level of self-management of patients undergoing hemodialysis.Methods:A descriptive and correlation design and a quasi-experiment design were used in this study. From July 2006 to December 2006, 103 patients received the therapy of hemodialysis in the hemodialysis centers of General Hospital and 2nd Hospital of Tianjin Medical University. All subjects completed the Common Information Questionnaire, Self-Management Behavior Questionaire of HD Patients and the Chinese version of the Short-Form Health Survey (SF-36). At the same time, the value of interdialysis weight gain in kg (IWG%), and concentrations of predialysis serum potassium (SK), phosphorus (SPO4), calcium (SCa), calcium×phosphate(Ca×PO₄) product tested in the same month was collected. All the data collected were evaluated; the levels of self-management, functioning and well-being were described, together with their related factors. The correlation between self-management and functioning and well-being was analyzed. In the part of quasi-experiment, all subjects were randomly selected into intervention group and control group by there date of receiving hemodialysis in a week. Patients in intervention group were given "self-efficacy training" oriented intervention by the researcher and routine education by dialysis center. Patients in control group only received routine education. The duration of intervention was 12 weeks. Questionnaires and values of SK, SPO4, SCa and Ca×PO₄ were collected again just after intervention. Paired t-test was used in comparing the levels of self-management, functioning and well-being before and after intervention. Statistical analysis was performed with SPSS 13.0.Results:(1) The general level of self-management in HD patients is at a medium level, with imbalance among all the factors of self-management. Among these factors, "adherence of taking drug" and "trying to maintain excellence style of life" showed high level, while "restriction behavior of liquid" and "seeking interest of life" were at low level. (2) Multiple stepwise regression analyses revealed that, in the related factors of self-management, HD patients with lower education level, heavier economic burden and shorter history of HD had lower levels of self-management. (3) 24.3% of HD patients reported higher levels of SK than the ideally controlled level concerned; 73.8% of HD patients had lower levels of SCa than the ideally controlled level concerned and had higher level of SPO₄ than the ideally controlled level concerned. 58.3% of HD patients reported higher levels than the ideally controlled level concerned. 50.8% of HD reported higher levels of interdialysis gain in kg than the ideally controlled level concerned. (4) On average, HD patients reported a relatively low level in quality of life by SF-36. HD patients scored significantly worst on the dimension of general health perception. (5) Multiple stepwise regression analyses revealed that, patients with more kinds of complications or less urine scored lower on physical function scale; and patients with more kinds of complications or patients without even a child had lower score on mental function scale. (6) Negative associations were found between the total score of self-management and the levels of SK, SPO₄, Ca X PO₄ (r=-0.217,-0.204 and -0.286 respectively, p＜0.05). both score of "behavior of sodium and protein intaking" and score of "restriction behavior of liquid" showed negative associations with the value of IWG% (r=-0.214 and -0.273 respectively, p＜0.05). There were negative associations between the score of "restriction behavior of iron" and the level of SK, SP₄, Ca×PO₄ (r=-0.251,-0.216 and -0.341 respectively, p＜0.05). The level of SCa showed a negative association with the score of "restriction behavior of iron" (r=-0.262, p＜0.01), and a positive association with the score of "adherence to dug taking" (r=0.252, p＜0.05). (7) Scores of total self-management, "behavior of sodium and protein intaking", "restriction behavior of liquid", "restriction behavior of iron", "protection of access" and "trying to maintain health" in the patients in intervention group significantly increased after intervention. The levels of SK, SPO₄ and value of IWG% of these patients significantly decreased after intervention, while the level of SCa was promoted. Patients in intervention group also scored higher both on the scale of physical function and scale of mental function after invention than before intervention. There also were increases in the scores of the dimensions of Physical Functioning, Vitality, Social functioning by invention. (8) In the patients of control group, no significant change was found in the scores of total self-management and all the factors, the values of SK, SPO₄, SCa and Ca×PO₄, as well as the scores on the scale of physical function and scale of mental function. While there were significant deceases in the scores on Physical Functioning and General Health.Conclusions:There were associations between some aspects of self-management and functioning and well-being among HD patients. Functioning and well-being of HD patients can be maintained or improved by promoting their levels of self-management.