Purpose
This descriptive correlational study aimed to evaluate the impact of patient activation on self-management and explore the mediating role of shared decision-making (SDM) among patients on hemodialysis.
Methods
A cohort of 136 participants was recruited from hemodialysis units in Gwangju, South Korea, between August 9 and 22, 2024. Patient activation, self-management, and SDM were assessed using the Patient Activation Measure (PAM-13), the Hemodialysis Self-Management Instrument (HDMI-K), and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), respectively. Descriptive statistics, Pearson’s correlation analysis, and mediation analysis using the PROCESS macro were conducted to analyze the data.
Results
Patient activation, SDM, and self-management were positively correlated with one another. Mediation analysis showed that patient activation significantly predicted both SDM and self-management. SDM also significantly predicted self-management, confirming its partial mediating effect. The final model explained 54.5% of the variance in self-management. The indirect effect of patient activation on self-management through SDM was statistically significant (indirect effect=0.05, 95% confidence interval [CI]=0.02–0.10). The indirect effect of patient activation on self-management through SDM was statistically significant (indirect effect=0.05, 95% CI=0.02–0.10).
Conclusion
Patient activation directly and indirectly enhances self-management through SDM, verifying the partial mediating role of SDM. Integrating SDM into nursing interventions is essential for effectively supporting self-management in patients undergoing hemodialysis.

Purpose
This study was conducted to develop a conceptual framework for understanding non-adherence to self-management among patients with Chronic Obstructive Pulmonary Disease (COPD). This was accomplished through a literature review, in-depth interviews with patients, and a survey of healthcare professionals featuring semi-structured open-ended questions.
Methods
First, a systematic literature review was conducted across five databases. Next, 25 patients with COPD participated in detailed interviews that included seven semi-structured questions. Subsequently, 15 healthcare professionals completed a survey about factor categories and specific factors associated with non-adherence to COPD self-management. Categories and factors identified at least once across these three methods were documented. Finally, two researchers conducted preliminary mapping of the relationships between factor categories and individual factors, which was assessed for face validity by a third researcher. All processes were conducted from March 28, 2022, and January 30, 2023.
Results
The research revealed eight factor categories and 53 individual factors associated with non-adherence to COPD self-management. The categories encompassed personal, socioeconomic, disease-related, functional, treatment- related, health system-related, and environmental characteristics. The literature review, patient interviews, and survey of healthcare professionals yielded 35, 19, and 44 factors, respectively. Twelve factors were identified using all three sources. All processes were conducted from March 28, 2022, and January 30, 2023.
Conclusion
In this study, quantitative and qualitative methods were employed to develop a conceptual framework for non-adherence to COPD self-management. The findings indicate that effective self-management of this condition requires not only patient effort but also adaptations to complex treatment regimens, societal perceptions, and workplace environments.

Citations

• Development of a deep learning model to predict smoking status in patients with chronic obstructive pulmonary disease: A secondary analysis of cross-sectional national survey
  Sudarshan Pant, Hyung Jeong Yang, Sehyun Cho, EuiJeong Ryu, Ja Yun Choi
  DIGITAL HEALTH.2025;[Epub]     CrossRef
• Factors Associated with Non-Adherence to Self-Management Among Patients with Chronic Obstructive Pulmonary Disease: A Survey Using the Delphi Technique and Analytic Hierarchy Process
  Ja Yun Choi, Eui Jeong Ryu
  International Journal of Chronic Obstructive Pulmonary Disease.2024; Volume 19: 1247.     CrossRef

PURPOSE
This study compares the characteristics of patients with Chronic Obstructive Pulmonary Disease (COPD) according to hospitalization frequency due to Acute Exacerbation (AE) using a retrospective medical records review.
METHODS
From August to October 2017, COPD patients who had visited the chonnam national university hospital were classified into three groups: (1) not hospitalization (n=115), (2) hospitalized once owing to AE (n=79) and (3) hospitalized twice or more owing to AE (n=47), and their medical records were reviewed. Data were analyzed using χ2, Kruskal Wallis, and Mann-Whitney tests, and logistic regression.
RESULTS
Home oxygen therapy, metered dose inhaler use, long-acting beta2-agonist, and Inhaled Corticosteroids (ICS) were used most in patients who were hospitalized twice or more. Symptoms of dyspnea and fever, prescription of phosphodiesterase-4 and oral corticosteroid were the least frequent in the patients who were not hospitalized, and they had the best pulmonary function test results. Home oxygen therapy (Odds Ratio [OR]=9.59, 95% Confidence Interval [CI]=2.53~36.46), and prescribed ICS (OR=2.77, 95% CI=1.14~6.77) and phosphodiesterase-4 (OR=5.35, 95% CI=1.69~16.93) were significantly associated with COPD readmission. For patients who were hospitalized once, SpO2 (p=.016), the frequency of positive pressure ventilation therapy (p=.023) and monitoring of oxygen saturation in nursing activities (p=.022) were higher than that of patients who were hospitalized twice or more. There was no significant difference in discharge education between the two hospitalized groups.
CONCLUSION
Regardless of the severity of illness, presence of respiratory symptoms, drug prescribed, or admission frequency, there were no differences in nursing activities and discharge education.

Citations

• COPD Prevalence and Risk Factors in Korean Older Adults
  Do-Youn Lee
  The Journal of Korean Physical Therapy.2025; 37(1): 31.     CrossRef
• Development of a smartphone application for Korean patients with chronic obstructive pulmonary disease: Self-monitoring based action plans
  Ja Yun Choi, Maureen George, So Young Yun
  Applied Nursing Research.2021; 61: 151475.     CrossRef