Factors Influencing Self-management Behaviors In Patients Receiving Maintenance Hemodialysis

ObjectiveTo describe self-management behaviors in patients with Chronic Renal Failure (CRF) undergoing maintenance hemodialysis and determine factors which influence self-management behaviors.MethodsA descriptive survey was conducted. Participants were recruited by convenient sampling from a hemodialysis clinic in Tianjin First Center Hospital between July2012and June2013. The self-report questionnaires were used to measure key variables including self-management behaviors, self-efficacy, anxiety, depression and social support. Socio-demographic and clinical characteristics were obtained from medical records. The data were collected with Self-management Behaviors Questionnaire of hemodialysis Patients, Self-efficacy scale for managing chronic disease, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Social Support Rating Scale (SSDS). The association between these variables and self-management behaviors were examined by T-Test, ANOVA, Nonparametric Test and Spearman correlation. A multiple linear regression analysis was performed to identify potential factors influencing self-management behaviors in patients receiving maintenance hemodialysis.Results1. A total of175patients receiving hemodialysis were enrolled. The mean score of self-management behaviors was64.93±9.498(range40to86). The mean score of four subscales were23.72±5.769for fluid restriction,9.46±2.693for dietary management,15.49±2.832for physical activity, and16.25±3.281for physical sign and psychosocial behavior management. The average item scores of subscales were2.68for fluid restriction,1.95for dietary management,2.97for physical activity, and2.74for physical sign and psychosocial behavior management.2. Multiple liner regression analysis for overall self-management behaviors revealed self-efficacy (β=0.511, P=0.000), educational level (β=0.458, P=0.000), sex (β=0.302, P=0.013) and depression (β=-0.081, P=0.038) were independent predictors which together explained33.9%of the variance in self-management behaviors.Regression analysis for four dimensions respectively indicated:sex β=0.391, P=0.005), self-efficacy (β=0.319, P=0.029), residual renal function (β=-0.252, P=0.047) were significant predictors which explained24.0%of the variance in fluid restriction; self-efficacy (β=0.306, P=0.014) and social support (β=0.293, P=0.043) were predicting factors which explained12.9%of the variance in dietary adherence; self-efficacy (β=0.344, P=0.003), social support (β=0.312, P=0.019), depression (β=-0.110, P=0.032) were predictive factors which explained31.70%of the variance in physical activity; self-efficacy (β=0.492,P=0.000), depression (β=-0.352, P=0.042), sex (β=0.338, P=0.004) were independent predictors which explained28.0%of the variance in physical sign and psychosocial behavior management.ConclusionsThe level of self-management behaviors in hemodialysis patients was suboptimal. In the average item scores of four dimensions, the highest one was physical activity, and the lowest was dietary management. The predictors of four dimensions were diverse but self-efficacy, social support, depression and sex were the main influencing factors of self-management behaviors in maintenance hemodialysis patients. Therefore, the healthcare professionals should recognize the factors hindering self-management behaviors from the patients’ perspective while assisting them with appropriate skills in making behavior changes possible.