Study On Adherence, Quality Of Life And Influencing Factors Among Kidney Transplantation Recipients

BackgroundKidney transplantation is recognized as the best altemative for end-stage renal disease(ESRD).Kidney transplantation recipients must maintain on a strict immunosuppressive regimen to precaution rejection episodes for the rest of life and accept life habits' changes accompanied with kidney transplantation which all referred to adherence.There were lots of researches about medication adherence,however life habits adherence,self-monitoring adherence,follow-up adherence were rarely involved in researches.The majority of researches about quality of life among kidney transplantation recipients tended to compare quality of life between kidney transplantation recipients and dialysis patients or the general population,using Short Form Health Survey Questionnare(SF-36).SF-36 is a common scale for evaluating people's quality of life,not specialized for kidney transplantation recipients; Therefore,this study investigated kidney transplantation recipients' adherence, including medication adherence,life habits adherence,self-monitoring adherence and follow-up adherence,used quality of life scale specialized for kidney transplantation recipients to investigate recipients' quality of life,and put recipients' demographic, transplantation-related variables and adherence as independent variables,to explore the influencing factors of quality of life,and provide evidence for improving kidney transplantation recipients' quality of life.ObjectiveTo describe the adherence and quality of life,and to analyze the influencing factors of adherence and quality of life among kidney transplantation recipients.MethodsA cross-sectional,descriptive study was carried out from April to August 2008.A total of 805 kidney transplantation recipients were recruited from 6 organ transplantation centers in Shanghai with convenience sampling.The instruments used were "Socio-demographic Questionnaire","Kidney Transplantation Recipients Adherence Inventory" and "The Scale of Quality of Life of Kidney Transplantation Recipients".Results1.The retest reliabity was 0.85,Cronbach'sαcoefficient was 0.84;content validity index was 0.98,exploratory factor analysis(EFA)was conducted to form the four-factor model,and confirmatory factor analysis(CFA) was cross-validated the result of EFA to examine the performance of this four-factor model,and the chi-square value was 838.228(df =246,P＜0.001),the root mean squared error of approximation,RMSEA=0.055,the Incremental Fit Index,IFI=0.88,the Normed Fit Index,NFI=0.84,the Comparative Fit Index,CFI=0.88o2.The total score of adherence was 79.86±9.44(49.00～100.00);The scores of the four adherence subscales respectively were:medication adherence,15.80±0.72: life habits adherence,20.81±4.64;self-monitoring adherence,13.53±4.74;follow-up adherence,25.95±2.64.3.Multivariate regression analysis(age,gender,marital status,educational status, family type,occupational status,payment type,economic burden,dialysis modality before transplantation,type of transplantation,time since transplantation,number of transplantation,immunosuppressive drug) of kidney transplantation recipients' medication adherence showed negative association with FK506(P＜0.01),economic burden(P＜0.05).There was a positive association with gender(femal;P＜0.05).The standard regression coefficient of immunosuppressive drug was -0.101 and immunosuppressive drug was the biggest influencing factor of medication adherence; Multivariate regression analysis of life habits adherence showed positive association with age(P＜0.01),type of transplantation(living transplantation;P＜0.01).There was a negative association with time since transplantation(P＜0.01),economic burden (P＜0.05).Age and time since transplantation were the 2 biggest influencing factors; Multivariate regression analysis of self-monitoring adherence showed negative association with time since transplantation(P＜0.01),occupational status(P＜0.01). There was a positive association with type of transplantation(P＜0.05).The standard regression coefficient of time since transplantation was -0.258 and time since transplantation was the biggest influencing factor of self-monitoring adherence;Multivariate regression analysis of follow-up adherence showed negative association with payment type(P＜0.01).There was a positive association with type of transplantation(living transplantation;P＜0.01),gender(female;P＜0.05).The standard regression coefficient of payment type was -0.149 and payment type was the biggest influencing factor of follow-up adherence.4.The total score of quality of life was 137.5±13.2(84.0～168.0);96.9%of the kidney transplantation recipients never regretted accepting kidney transplantation surgery;90.1%of the kidney transplantation recipients were satisfied with quality of life after transplantation and 87.5%of recipients were satisfied with their health status.However,35%of recipients thought that kidney transplantation affect their interpersonal relationship,22.4%of recipients thought kidney transplantation not resolve their health problems;Among kidney transplantation recipients'physiological function subscale,the biggest problem was satisfaction with sexual function.Among the psychological function subscale,the biggest problem was anxiety.Among the social function subscale,the biggest problem was participation with recreation. Among the treatment subscale,the biggest problem was that recipients were worried about adverse effects accompanied with immunosuprressive drugs.5.Multivariate regression analysis(adherence,age,gender,marital status, educational status,family type,occupational status,payment type,economic burden, type of transplantation,time since transplantation,immunosuppressive drug) of kidney transplantation recipients' overall quality of life showed positive association with adherence(P＜0.01),marital status(married;P＜0.05).There was a negative association with economic burden(P＜0.01),payment type(P＜0.05).The standard regression coefficient of adherence was 0.227 and adherence was the biggest influencing factor of quality of life.Conclusion1.The self-developed " Kidney Transplantation Recipients Adherence Inventory" has good reliability and validity and could be used to measure kidney transplantation recipients's adherence.2.Among kidney transplantation recipients' adherence,the medication adherence was the best,followed by follow-up adherence,life habits adherence,and self-monitoring was the worst.In recipients' follow up,nurses should emphasize on the immunosupression adherence and meanwhile emphasize on self-monitoring adherence.3.Overally,kidney transplantation recipients were satisfied with their quality of life,but there were a series of problems in physiological,psychological,social function and treatment.The influencing factors of quality of life were:adherence, economic burden,marital status,financial status.And adherence was the biggest influencing factor.Focusing on these problems and integrating the influencing factors, nurses should take targeted measures,especially strengthen health education,to improve quality of life among kidney transplantation recipients.