Relationship Between Self-management And Fear Of Progression And Adult Attachment In Maintenance Hemodialysis Patients

ObjectiveThe purpose of this study was to understand the status quo of self-management,fear of progression and adult attachment in maintenance hemodialysis patients,and to further analyze the correlation between the three.To explore whether adult attachment has a mediating effect on fear of progression and self-management;It provides a new reference for medical personnel to improve the self-management level of patients by improving the fear of progression and adult attachment in maintenance hemodialysis patients in the future.MethodsUsing convenience sampling method,207 patients with maintenance hemodialysis in a tertiary hospital in Dalian from November 2019 to January 2020 were selected as the research objects.The general information questionnaire,the Hemodialysis SelfManagement Instrument(HDSMI),Fear of Progression Questionnaire-Short Form(Fo PQ-SF)and Experiencesin Close Relationships Inventory(ECR)were used for investigation.The data were input by Excel,and the data were analyzed by SPSS 25.0.The structural equation model was established by AMOS 21.0,and the process plug-in was used to verify the difference of parallel mediating effect.Descriptive analysis,t-test,one-way ANOVA,Pearson correlation analysis,multiple linear regression,mediating effect and path analysis were used to analyze the data.Results1.The total score of self-management of maintenance hemodialysis patients was(47.16±7.95).According to the average score of each dimension,the dimension with the highest average score was the partnership dimension(2.74±0.48),and the dimension with the lowest average score was the emotional processing dimension(2.15±0.50).2.The total score of fear of progression in maintenance hemodialysis patients was(30.53±4.77),among which 54 patients(27.27%)were in the high group(total score ≥34),and 144 patients(72.73%)were in the low group(total score<34).Adult attachment had two dimensions: attachment anxiety(63.79±12.41)and attachment avoidance(65.72±19.32).3.The results of correlation analysis showed that self-management was negatively correlated with the fear of progression and adult attachment(r=-0.606,P<0.01),and negatively correlated with attachment anxiety(r=-0.506,P<0.01),and also negatively correlated with attachment avoidance(r=-0.517,P<0.01).4.The results of univariate analysis showed that there were significant differences in self-management among maintenance hemodialysis patients with different education levels,payment methods of medical expenses,dialysis years and interests(P<0.05).5.According to the results of multiple linear regression analysis,dialysis years,hobbies,fear of progression and adult attachment were the influencing factors of selfmanagement of maintenance hemodialysis patients,which jointly explained 56.3% of the variation.6.The results of mediating effect analysis showed that adult attachment had a parallel mediating effect between fear of progression and self-management in maintenance hemodialysis patients,and the mediating effect accounted for 53.46% of the total effect.Through Amos to construct the structural equation,the final fitness index of the model is: CMIF/ DF=2.052,GFI=0.963,CFI=0.963,AGFI=0.918,IFI=0.964,RMSEA=0.073.All indicators are within the acceptable standard range,indicating that the model has good fitting degree and the structural equation model is established.Bootstrap method was used to further verify the mediating effect.The results showed that the 95%confidence interval of the total effect,direct effect and indirect effect fear of progression on self-management did not include 0,indicating that adult attachment has a mediating effect between fear of progression and self-management.The process plug-in was used to further analyze the mediating effects of attachment anxiety and attachment avoidance.It was found that the 95% confidence interval of the difference between the two parallel mediating effects included 0(-0.103,0.076),indicating that there should be no difference in the mediating effects between the two dimensions of adult attachment between fear of progression and self-management.Conclusion1.The self-management of maintenance hemodialysis patients is in the middle level,which needs to be improved.In addition,fear of progression and adult attachment need to be alleviated.Maintenance hemodialysis patients’ self-management is affected by dialysis years and interests.We should strengthen guidance and support for patients with longer dialysis years and less interests and hobbies.2.The lower the level of fear of progression and adult attachment in maintenance hemodialysis patients,the higher the level of self-management,and fear of progression and adult attachment are also predictors of self-management.3.Adult attachment has a parallel mediating effect between fear of progression and self-management in maintenance hemodialysis patients,and fear of progression can indirectly affect the self-management level of maintenance hemodialysis patients through adult attachment.