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Psychometric Evaluation of Self-management Scale for Hemodialysis Patients with Arteriovenous Fistula

Kyungmi Lee, APN, Ph.D. Candidate1, Semi Candidate Lim, Ph.D.1, Younhee Kang, Ph.D., APRN-ANP2
Korean Journal of Adult Nursing 2017;29(6):637-646.
Published online: December 18, 2017

1Graduate School of Nursing Science, Ewha Womans University, Seoul, Korea

2College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Kang, Younhee College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-4483, Fax: +82-2-3277-2850, E-mail: yxk12@ewha.ac.kr
• Received: September 3, 2017   • Accepted: December 17, 2017

© 2017 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to develop a Self-Management Scale for Hemodialysis Patients on Arteriovenous Fistula(SMHDP) and to verify its validity and reliability.
  • Methods
    Items for the preliminary instrument of the SMHDP-scale were created through a literature review and in-depth interviews with hemodialysis patients and hemodialysis unit nurses. A convenient sample was utilized for this study. The questionnaire was distributed to 200 hemodialysis patients with arteriovenous fistula. Content validity, construct validity, criterion validity, convergent validity, and discriminative validity were evaluated respectively. Cronbach's ⍺ was used to evaluate the reliability of the SMHDP-scale.
  • Results
    Five factors were identified through factor analysis. The factors included dietary knowledge of hemodialysis (8 items), compliance with hemodialysis (7 items), knowledge of hemodialysis (6 items), dietary compliance of hemodialysis (6 items), and compliance with hemodialysis order (3 items). These five factors explained 58.9% of the total variance. The correlation coefficient between criterion instrument and SMHDP-scale was .66 Reliability analysis showed Cronbach's ⍺ coefficient was .90.
  • Conclusion
    Results show that the SMHDP-scale had good reliability and validity and thus SMHDP-scale may be a useful scale for clinical practices and for research as a measure of self-management of hemodialysis patient on arteriovenous fistula.
  • Key Words: Arteriovenous fistula; Hemodialysis; Self-management; Reliability and validity
Table 1.
General Characteristics of Participants (N=200)
Characteristics Categories n (%) or M± SD
Gender Male 130 (65.0)
Female 70 (35.0)
Age (year)   56.01±13.95
20~39 27 (13.5)
40~49 33 (16.5)
50~59 60 (30.0)
60~69 41 (20.5)
≥70 39 (19.5)
Level of education completed ≤ Elementary school 25 (12.5)
Junior high school 31 (15.5)
High school 62 (31.0)
≥ College 82 (41.0)
Spouse Present 139 (69.5)
None 61 (30.5)
Underlying disease Diabetes mellitus 73 (36.5)
Hypertension 33 (16.5)
Glomerulonephritis 31 (15.5)
Others 30 (15.0)
Unknown 33 (16.5)
Comorbidity Present 165 (82.5)
None 35 (17.5)
Period of hemodialysis (month) 72.98±75.24
Frequency of hemodialysis Four times a week 5 (2.5)
Three times a week 176 (88.0)
Twice a week 17 (8.5)
Once a week 2 (1.0)
History of kidney transplantation 15 (7.5)
Registered for kidney transplantation 100 (50.0)
Table 2.
Exploratory Factor Analysis (N=200)
Items Factors
1 2 3 4 5
39. I know foods that contain lots of potassium. .80        
40. I know foods that contain lots of phosphate. .76        
41. I know that banana and tomato contain a lot of potassium, and grapes and apples contain less potassium. .76        
42. I know that spinach and leek contain a lot of potassium, and napa cabbage and cucumber contain less potassium. .69        
50. I know blood test results to be checked monthly. .67        
37. I know that soup, ice cream, watery kimchi, coffee and porridge also include the water. .62        
43. I know that phosphate binder should be taken during meals or just after meals. .61        
38. I know that edema or dyspnea occurs when fluid are accumulated. .60        
12. Do not wear jewelries (rings, bracelets, watches) on your arm with arteriovenous fistula (AVF).   .80      
20. Do not take folk remedies (acupuncture, herbal medicines, medicinal water)   .78      
14. On your arm with AVF, do nothing such as blood sampling, taking blood pressuret, except for hemodialysis (HD).   .78      
26. Do not drink.   .76      
25. Do not smoke.   .74      
16. Do not take medication not prescribed by your doctor.   .72      
10. When you sleep, do not lay on your arm with AVF.   .52      
49. I know how to cope with hypotension during HD.     .75    
44. I know names of medication I take.     .74    
48. I know symptoms of hypotension during HD.     .66    
47. I know I should be careful because of anticoagulant used during HD.     .63    
45. I know about the kinds and effects of medications I take.     .62    
46. I know about use of anticoagulant during HD.     .61    
1. I eat a limited amount of potassium (vegetables, fruits, sweet potatoes, beans).       .73  
2. When eating vegetables, dip them in water or eat them in order to reduce potassium.       .73  
6. Take the amount of water allowed per day (daily urine output+ 500~800mL)       .71  
3. I eat a limited amount of phosphate (milk, dairy products, cereals, nuts).       .71  
4. I restrict salty foods and eat low salt diet.       .64  
7. I try to reduce the amount of water intake.       .60  
19. I receive whole HD without reducing HD duration.         .74
18. I receive HD as scheduled without skipping.         .63
23. If treatments that may cause bleeding, such as surgery or tooth extraction, are scheduled, I should inform medical staff before starting HD.         .56
Initial eigenvalue 8.04 4.48 4.30 3.76 2.71
Explained variance (%) 15.8 14.2 11.1 10.6 7.1
Accumulative variance (%) 15.8 30.0 41.1 51.8 58.9
Kaiser-Meyer-Olkin (KMO)     .83    
Bartlett's test of sphericity 3 3,293. 66 (p＜ ＜.001 1)
Table 3.
Convergent and Discriminant Validity (N=200)
Factor Items Factor 1 Factor 2 Factor 3 Factor 4 Factor 5
Factor 1 39 .82 .23 .52 .16 .18
40 .79 .24 .53 .17 .10
41 .77 .27 .44 .27 .11
42 .74 .23 .45 .22 .07
50 .71 .26 .43 .13 .20
37 .69 .16 .42 .16 .12
43 .69 .23 .46 .13 .19
38 .67 .20 .46 .13 .13
Factor 2 12 .19 .83 .15 .32 .36
20 .25 .83 .23 .32 .41
14 .29 .81 .21 .22 .41
26 .23 .77 .24 .23 .21
25 .27 .75 .29 .23 .20
16 .21 .77 .20 .29 .40
10 .26 .66 .21 .41 .35
Factor 3 49 .46 .16 .77 .02 .05
44 .41 .19 .79 .14 .00
48 .51 .24 .73 .08 .04
47 .43 .19 .77 .10 -.03
45 .54 .27 .77 .15 -.02
46 .56 .27 .78 .05 .06
Factor 4 1 .27 .26 .12 .75 .06
2 .20 .25 .05 .76 .13
6 .07 .22 .07 .71 .15
3 .16 .29 .04 .72 .11
4 .09 .28 .10 .66 .25
7 .24 .28 .13 .67 .28
Factor 5 19 .06 .32 -.07 .24 .83
18 .13 .27 -.02 .12 .73
23 .22 .36 .12 .15 .74
Table 4.
Correlation between the SMHDP-scale and Song's Scale (N=200)
Variables SMHDP-scale Factor 1 Factor 2 Factor 3 Factor 4 Factor 5
r (p) r (p) r (p) r (p) r (p) r (p)
Song's scale .66 (＜.001) .52 (＜.001) .42 (＜.001) .45 (＜.001) .47 (＜.001) .32 (＜.001)
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    • Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis
      Haegyeong Lee, Gyuli Baek, Eunju Lee
      Osong Public Health and Research Perspectives.2023; 14(4): 279.     CrossRef

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    Psychometric Evaluation of Self-management Scale for Hemodialysis Patients with Arteriovenous Fistula
    Korean J Adult Nurs. 2017;29(6):637-646.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.637
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    Psychometric Evaluation of Self-management Scale for Hemodialysis Patients with Arteriovenous Fistula
    Korean J Adult Nurs. 2017;29(6):637-646.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.637
    Close
    Psychometric Evaluation of Self-management Scale for Hemodialysis Patients with Arteriovenous Fistula
    Psychometric Evaluation of Self-management Scale for Hemodialysis Patients with Arteriovenous Fistula

    General Characteristics of Participants (N=200)

    Characteristics Categories n (%) or M± SD
    Gender Male 130 (65.0)
    Female 70 (35.0)
    Age (year)   56.01±13.95
    20~39 27 (13.5)
    40~49 33 (16.5)
    50~59 60 (30.0)
    60~69 41 (20.5)
    ≥70 39 (19.5)
    Level of education completed ≤ Elementary school 25 (12.5)
    Junior high school 31 (15.5)
    High school 62 (31.0)
    ≥ College 82 (41.0)
    Spouse Present 139 (69.5)
    None 61 (30.5)
    Underlying disease Diabetes mellitus 73 (36.5)
    Hypertension 33 (16.5)
    Glomerulonephritis 31 (15.5)
    Others 30 (15.0)
    Unknown 33 (16.5)
    Comorbidity Present 165 (82.5)
    None 35 (17.5)
    Period of hemodialysis (month) 72.98±75.24
    Frequency of hemodialysis Four times a week 5 (2.5)
    Three times a week 176 (88.0)
    Twice a week 17 (8.5)
    Once a week 2 (1.0)
    History of kidney transplantation 15 (7.5)
    Registered for kidney transplantation 100 (50.0)

    Exploratory Factor Analysis (N=200)

    Items Factors
    1 2 3 4 5
    39. I know foods that contain lots of potassium. .80        
    40. I know foods that contain lots of phosphate. .76        
    41. I know that banana and tomato contain a lot of potassium, and grapes and apples contain less potassium. .76        
    42. I know that spinach and leek contain a lot of potassium, and napa cabbage and cucumber contain less potassium. .69        
    50. I know blood test results to be checked monthly. .67        
    37. I know that soup, ice cream, watery kimchi, coffee and porridge also include the water. .62        
    43. I know that phosphate binder should be taken during meals or just after meals. .61        
    38. I know that edema or dyspnea occurs when fluid are accumulated. .60        
    12. Do not wear jewelries (rings, bracelets, watches) on your arm with arteriovenous fistula (AVF).   .80      
    20. Do not take folk remedies (acupuncture, herbal medicines, medicinal water)   .78      
    14. On your arm with AVF, do nothing such as blood sampling, taking blood pressuret, except for hemodialysis (HD).   .78      
    26. Do not drink.   .76      
    25. Do not smoke.   .74      
    16. Do not take medication not prescribed by your doctor.   .72      
    10. When you sleep, do not lay on your arm with AVF.   .52      
    49. I know how to cope with hypotension during HD.     .75    
    44. I know names of medication I take.     .74    
    48. I know symptoms of hypotension during HD.     .66    
    47. I know I should be careful because of anticoagulant used during HD.     .63    
    45. I know about the kinds and effects of medications I take.     .62    
    46. I know about use of anticoagulant during HD.     .61    
    1. I eat a limited amount of potassium (vegetables, fruits, sweet potatoes, beans).       .73  
    2. When eating vegetables, dip them in water or eat them in order to reduce potassium.       .73  
    6. Take the amount of water allowed per day (daily urine output+ 500~800mL)       .71  
    3. I eat a limited amount of phosphate (milk, dairy products, cereals, nuts).       .71  
    4. I restrict salty foods and eat low salt diet.       .64  
    7. I try to reduce the amount of water intake.       .60  
    19. I receive whole HD without reducing HD duration.         .74
    18. I receive HD as scheduled without skipping.         .63
    23. If treatments that may cause bleeding, such as surgery or tooth extraction, are scheduled, I should inform medical staff before starting HD.         .56
    Initial eigenvalue 8.04 4.48 4.30 3.76 2.71
    Explained variance (%) 15.8 14.2 11.1 10.6 7.1
    Accumulative variance (%) 15.8 30.0 41.1 51.8 58.9
    Kaiser-Meyer-Olkin (KMO)     .83    
    Bartlett's test of sphericity 3 3,293. 66 (p＜ ＜.001 1)

    Convergent and Discriminant Validity (N=200)

    Factor Items Factor 1 Factor 2 Factor 3 Factor 4 Factor 5
    Factor 1 39 .82 .23 .52 .16 .18
    40 .79 .24 .53 .17 .10
    41 .77 .27 .44 .27 .11
    42 .74 .23 .45 .22 .07
    50 .71 .26 .43 .13 .20
    37 .69 .16 .42 .16 .12
    43 .69 .23 .46 .13 .19
    38 .67 .20 .46 .13 .13
    Factor 2 12 .19 .83 .15 .32 .36
    20 .25 .83 .23 .32 .41
    14 .29 .81 .21 .22 .41
    26 .23 .77 .24 .23 .21
    25 .27 .75 .29 .23 .20
    16 .21 .77 .20 .29 .40
    10 .26 .66 .21 .41 .35
    Factor 3 49 .46 .16 .77 .02 .05
    44 .41 .19 .79 .14 .00
    48 .51 .24 .73 .08 .04
    47 .43 .19 .77 .10 -.03
    45 .54 .27 .77 .15 -.02
    46 .56 .27 .78 .05 .06
    Factor 4 1 .27 .26 .12 .75 .06
    2 .20 .25 .05 .76 .13
    6 .07 .22 .07 .71 .15
    3 .16 .29 .04 .72 .11
    4 .09 .28 .10 .66 .25
    7 .24 .28 .13 .67 .28
    Factor 5 19 .06 .32 -.07 .24 .83
    18 .13 .27 -.02 .12 .73
    23 .22 .36 .12 .15 .74

    Correlation between the SMHDP-scale and Song's Scale (N=200)

    Variables SMHDP-scale Factor 1 Factor 2 Factor 3 Factor 4 Factor 5
    r (p) r (p) r (p) r (p) r (p) r (p)
    Song's scale .66 (＜.001) .52 (＜.001) .42 (＜.001) .45 (＜.001) .47 (＜.001) .32 (＜.001)
    Table 1. General Characteristics of Participants (N=200)

    Table 2. Exploratory Factor Analysis (N=200)

    Table 3. Convergent and Discriminant Validity (N=200)

    Table 4. Correlation between the SMHDP-scale and Song's Scale (N=200)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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