The Mediating Role Of Spiritual Health In The Perceived Social Support And Quality Of Life In Maintenance Hemodialysis Patients

Purpose:This study aims to understand the status quo of social support,spiritual health and quality of life in maintenance hemodialysis patients,analyze the influencing factors of quality of life in maintenance hemodialysis patients,and clarify the relationship among social support,spiritual health and quality of life.To explore the effect of social support on quality of life in maintenance hemodialysis patients.Methods:In this cross-sectional study,363 patients with MHD who met the inclusion and exclusion criteria were selected from hemodialysis centers of 5 Grade A hospitals in Chengdu from March to September 2022 by convenience sampling method.Research tools include the General Information Questionnaire,the disease-related Information Questionnaire,and the Perceived Social Support Scale(PSSS),Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale(FACIT-Sp-12)and the Kidney Disease Questionnaire(KDQ).The questionnaire is issued,filled in and withdrawn on the spot;Epidata3.1 software was used to input and verify the data,IBM SPSS23.0software and Process V3.3 plug-in were used for statistical analysis of the data,in which the basic characteristics of the research object were analyzed statistically and descriptively.The inter-group differences of social support,spiritual health and quality of life in MHD patients in general data and disease-related data were analyzed by independent sample t test and variance analysis.Pearson correlation analysis was used to clarify the correlation between social support,spiritual health and quality of life in MHD patients.Multiple regression analysis was used to identify the influencing factors of quality of life in MHD patients,and the mediating role of spiritual health in social support and quality of life in MHD patients was analyzed by IBM SPSS Process V3.3 plug-in.Result:1.The total score of PSSS for MHD patients was 62.27±6.69,family endogenous support score was 23.11±3.43,and family exogenous support score was 39.16±4.78.Univariate analysis showed that there were statistically significant differences in the total score of social support among MHD patients with different age groups,marital status,education level,residence,main caregiver,type of medical insurance,alcohol consumption,other underlying diseases and current medication types(P < 0.05).2.The total score of FACIT-Sp-12 of MHD patients was 22.68±4.79,and the scores of peace,meaning and faith were 8.62±1.77,7.88±1.79 and 6.17±2.50,respectively.Univariate analysis showed that the spiritual health scores of MHD patients with different age groups,marital status,educational status,occupational status,per capita monthly family income,place of residence,main caregiver,type of medical insurance and current medication were statistically significant(P < 0.05).3.The total score of KDQ of MHD patients was 134.79±17.12,and the scores of physical symptoms,fatigue,depression,relationship with others and frustration dimension were 30.38±4.32,37.60±6.15,22.70±3.98,26.36±5.81 and 17.74±2.48,respectively.Univariate analysis showed that there were statistically significant differences in the KDQ of MHD patients with different gender,age,marital status,education level,residence,main caregiver,smoking status,alcohol consumption status,current medication type and the presence of other complications(P < 0.05).The results of multivariate analysis showed that age,current medication type,other complications,perceived social support and spiritual health level accounted for 47.3% of the total variation in the quality of life of hemodialysis patients(P < 0.05).4.There was a significant positive correlation among social support,spiritual health and quality of life(r=0.526,0.574,0.758;P < 0.01).5.The results of mediating effect analysis showed that the direct effect of social support on quality of life was 0.831,the indirect effect of spiritual health level on quality of life was 0.384,and the total effect was 1.215.The mediating effect of spiritual health level on the influence of social support on quality of life was 31.6% of the total effect,which played a partial mediating role.Conclusion:1.The FACIT-Sp-12 of MHD patients is at a low level,the level of PSSS and the KDQ of MHD patients are at a medium level,which need to be further improved.Among them,MHD patients who are 75 years old and above,have no education,live in rural areas,are in divorce/widowhood and other marital status,the main caregivers are children,are unemployed or retired,have lower per capita family income,use the new rural cooperative medical insurance to reimburse medical expenses,and take more kinds of medication have lower spiritual health level.MHD patients aged 59 and below,who were married,whose primary caregiver was their spouse,who had received some education,who lived in urban areas,who used urban health insurance for medical expenses,who did not have other underlying conditions,and who took fewer medications had higher levels of social support;MHD patients who were female,75 years of age and above,had other marital status such as divorce/widowhood,had no education,lived in rural areas,had no smoking/drinking habits,had a wide variety of medications,and had complications after dialysis treatment had a relatively poor quality of life.2.The main factors influencing the quality of life of MHD patients were age,current medication type,complication,social support level and spiritual health level.3.There was a positive correlation between social support,spiritual health and quality of life in MHD patients.Social support and spiritual health were positive predictors of quality of life respectively.Spiritual health plays a mediating role in understanding the impact of social support on quality of life.