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Original Article

A Structural Analysis for Psychosocial Variables related to Sick Role Behavioral Compliance in Hemodialysis Patients

Young-Mun Cho, Ph.D., APN
Korean Journal of Adult Nursing 2016;28(4):415-423.
Published online: August 31, 2016

Assistant Professor, Department of Nursing, Dongshin University, Naju, Korea

Corresponding author: Cho, Young-Mun Department of Nursing, Dongshin University, 185 Geonjae-ro, Naju 58245, Korea. Tel: +82-61-330-3596, Fax: +82-61-330-3580, E-mail: cymun@hanmail.net
• Received: May 6, 2016   • Accepted: August 22, 2016

Copyright © 2016 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
    This study was designed to identify the structural relationships among psychosocial variables related to sick role behavioral compliance among patients undergoing hemodialysis.
  • Methods
    The subjects were 476 patients from seven major hospitals and twelve dialysis centers located in D and P cities. Data were collected using self-report questionnaires. Data analysis was done by using SPSS/WIN 18.0 and AMOS 18.0 programs for structural equation modeling, to estimate the hypothesized model.
  • Results
    This findings support that a modified path model is efficient and appropriate to explain sick role behavioral compliance among hemodialysis patients. These factors account for 80.1% of the variance of sick-role behavioral compliance among hemodialysis patients. The variables having direct effect on sick role behavioral compliance were knowledge related to hemodialysis, social support, attitude, self-efficacy and intention.
  • Conclusion
    The modified model explains the integration process of psychosocial and behavior variables for sick-role behavioral compliance among patients undergoing hemodialysis.
  • Key Words: Sick role; Behavior; Self-determination; Hemodialysis
Figure 1.
Research model.
kjan-28-415f1.jpg
Figure 2.
Structural equation model of sick role behavioral compliance in hemodialysis patients.
kjan-28-415f2.jpg
Table 1.
Descriptive Statistics for Latent Variables and Measured Variables (N=476)
Latent variables Measured variables Range M±SD Min-Max Skewness Kurtosis
KN   0~20 16.47±2.69 7~20 -0.90 0.46
Knowledge 1 0~10 8.34±0.53 3~10 -0.94 0.48
Knowledge 2 0~10 8.12±1.59 2~10 -0.84 0.34
SS   18~90 70.33±12.05 21~90 -0.68 1.06
Medical staff support 8~40 31.82±5.27 8~40 -0.68 1.55
Family support 10~50 38.50±8.47 12~50 -0.77 0.29
BPN   18~90 63.06±9.83 18~90 -0.26 0.63
Autonomy 6~30 22.27±0.96 6~30 -0.28 0.11
Competency 6~30 18.31±4.51 6~30 -0.08 -0.26
Relatedness 6~30 21.96±3.83 6~30 -0.30 0.38
AT   10~70 59.40±10.76 10~70 -0.87 0.40
Behavioral belief 5~35 28.26±5.49 5~35 -1.24 1.79
Outcome evaluation 5~35 30.64±4.80 5~35 -1.46 2.41
SN   10~70 53.52±11.96 10~70 0.13 -0.42
Motivation to comply 5~35 27.06±5.38 5~35 -1.03 1.51
Normative belief 5~35 25.97±0.58 5~35 -0.67 -0.10
SE   9~36 23.90±5.45 9~36 0.09 -0.21
Self-efficacy 1 4~16 10.82±2.70 4~16 -0.06 -0.47
Self-efficacy 2 5~20 13.07±0.30 5~20 0.16 -0.24
INT   10~70 56.92±10.33 12~70 -1.38 2.45
Intention 1 5~35 28.01±0.23 6~35 -1.30 2.12
Intention 2 5~35 28.71±5.30 5~35 -1.44 2.79
BE   16~80 59.65±9.88 30~80 -0.20 -0.05
Behavior 1 8~40 30.78±5.17 11~40 -0.50 0.21
Behavior 2 8~40 28.84±5.66 12~40 -0.20 -0.28

KN=knowledge related to hemodialysis; SS=social support; BPN=basic psychological need; AT=attitude; SN=subjective norm; SE=self-efficacy; INT=intention; BE=sick role behavioral compliance.

Table 2.
Fitness Statistics of Hypothetical Structural and Modified Model (N=476)
Goodness χ² p df χ²/df GFI NNFI SRMR CFI RMSEA (LO90/HI90) CAIC
Criteria       2~3 ≥.9 ≥.9 ＜1.0 ≥.9 .05~.08  
Hypothetical model 307.36 ＜.001 94 3.27 .92 .91 .04 .93 .07 (.06/.08) 730.12
Modified model 313.99 ＜.001 98 3.20 .92 .91 .04 .93 .07 (.60/.08) 708.09

GFI=goodness-of-fit index, NNFI=nonnormed fit index, SRMR=standardized root mean square residual; CFI=comparative fit index, RMSEA=root mean square error of approximation.

Table 3.
Modifie d Model wi ith Param meter Estim ate (N=476)
Path B β SE* CR (p)† SMC‡ Direct effect (p) In ndirect effect (p) Total effect (p)
BPN .409      
   KN→BPN 0.46 .15 .20 2.28 (.023) .15 (.035) - .15 (.035)
   SS→BPN 0.28 .57 .04 7.56 (＜.001) .57 (.010) - .57 (.010)
AT .467      
   KN→AT 1.13 .25 .27 4.12 (＜.001) .25 (.010) .04 (.095) .30 (.010)
   SS→AT         - .33 (.010) .33 (.010)
   SN→AT 0.50 .49 .08 6.67 (＜.001) .49 (.010) - .49 (.010)
   SE→AT - - - - - .08 (.020) .08 (.020)
   BPN→AT 0.21 .15 .10 2.20 (.028) .15 (.029) .13 (.010) .27 (.010)
SN .328      
   SE→SN 0.23 .17 .10 2.66 (.008) .17 (.020) - .17 (.020)
   SS→SN 0.22 .31 .06 3.48 (＜.001) .31 (.010) .19 (.010) .50 (.010)
   KN→SN - - - - - .04 (.097) .04 (.097)
   BPN→SN 0.30 .21 .12 2.44 (.015) .21 (.031) .06 (.020) .26 (.010)
SE .239      
   KN→SE - - - - - .05 (.095) .05 (.095)
   SS→SE 0.10 .21 .04 2.48 (.013) .21 (.019) .19 (.010) .40 (.010)
   BPN→SE 0.30 .33 .08 3.92 (＜.001) .33 (.010) - .33 (.010)
INT .705      
   KN→INT -0.65 -.13 .28 -2.32 (.020) -.13 (.062) .11 (.010) -.02 (.858)
   SS→INT -0.16 -.19 .06 -2.84 (.005) -.19 (.010) .51 (.010) .32 (.010)
   AT→INT 0.27 .23 .08 3.38 (＜.001) .23 (.021) - .23 (.021)
   SN→INT 0.61 .52 .11 5.76 (＜.001) .52 (.010) .11 (.021) .63 (.010)
   SE→INT 0.81 .45 .10 7.84 (＜.001) .45 (.010) .11 (.021) .55 (.010)
   BPN→INT - - - - - .35 (.010) .35 (.010)
BE .801      
   KN→BE 0.84 .22 .23 3.73 (＜.001) .22 (.010) -.04 (.452) .17 (.023)
   SS→BE 0.12 .19 .04 3.32 (＜.001) .19 (.010) .26 (.010) .45 (.010)
   AT→BE -0.13 -.14 .06 -2.20 (.028) -.14 (.023) .16 (.021) .01 (.900)
   SN→BE SE→BE - 0.32 - .23 - .09 - 3.58 (＜.001) - .23 (.010) .36 (.010) .36 (.010) .35 (.010) .59 (.010)
   SE→BE BPN BE 0.32 - .23 - .09 - 3.58 (＜.001) - .23 (.010) - .36 (.010) .27 (.010) .59 (.010) .27 (.010)
   BPN→BE - - - - - .27 (.010) .27 (.010)
   INT→BE 0.52 .67 .06 8.59 (＜.001) .67 (.010) - .67 (.010)

SE=standard error; KN=knowledge related to hemodialysis; BPN=basic psychological need; SS=social support; AT=attitude; SN=subjective norm; SE=self-efficacy; INT=intention; BE=sick role behavioral compliance;

†Critical ratio;

‡Squared multiple correlation.

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    • Development and Evaluation of an Online Self-Management Program in Patients with Chronic Kidney Failure Undergoing Hemodialysis
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      Journal of Korean Academy of Fundamentals of Nursing.2022; 29(4): 531.     CrossRef

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    Korean J Adult Nurs. 2016;28(4):415-423.   Published online August 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.4.415
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    A Structural Analysis for Psychosocial Variables related to Sick Role Behavioral Compliance in Hemodialysis Patients
    Korean J Adult Nurs. 2016;28(4):415-423.   Published online August 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.4.415
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    A Structural Analysis for Psychosocial Variables related to Sick Role Behavioral Compliance in Hemodialysis Patients
    Image Image
    Figure 1. Research model.
    Figure 2. Structural equation model of sick role behavioral compliance in hemodialysis patients.

    Figure 1.

    Figure 2.

    A Structural Analysis for Psychosocial Variables related to Sick Role Behavioral Compliance in Hemodialysis Patients

    Descriptive Statistics for Latent Variables and Measured Variables (N=476)

    Latent variables Measured variables Range M±SD Min-Max Skewness Kurtosis
    KN   0~20 16.47±2.69 7~20 -0.90 0.46
    Knowledge 1 0~10 8.34±0.53 3~10 -0.94 0.48
    Knowledge 2 0~10 8.12±1.59 2~10 -0.84 0.34
    SS   18~90 70.33±12.05 21~90 -0.68 1.06
    Medical staff support 8~40 31.82±5.27 8~40 -0.68 1.55
    Family support 10~50 38.50±8.47 12~50 -0.77 0.29
    BPN   18~90 63.06±9.83 18~90 -0.26 0.63
    Autonomy 6~30 22.27±0.96 6~30 -0.28 0.11
    Competency 6~30 18.31±4.51 6~30 -0.08 -0.26
    Relatedness 6~30 21.96±3.83 6~30 -0.30 0.38
    AT   10~70 59.40±10.76 10~70 -0.87 0.40
    Behavioral belief 5~35 28.26±5.49 5~35 -1.24 1.79
    Outcome evaluation 5~35 30.64±4.80 5~35 -1.46 2.41
    SN   10~70 53.52±11.96 10~70 0.13 -0.42
    Motivation to comply 5~35 27.06±5.38 5~35 -1.03 1.51
    Normative belief 5~35 25.97±0.58 5~35 -0.67 -0.10
    SE   9~36 23.90±5.45 9~36 0.09 -0.21
    Self-efficacy 1 4~16 10.82±2.70 4~16 -0.06 -0.47
    Self-efficacy 2 5~20 13.07±0.30 5~20 0.16 -0.24
    INT   10~70 56.92±10.33 12~70 -1.38 2.45
    Intention 1 5~35 28.01±0.23 6~35 -1.30 2.12
    Intention 2 5~35 28.71±5.30 5~35 -1.44 2.79
    BE   16~80 59.65±9.88 30~80 -0.20 -0.05
    Behavior 1 8~40 30.78±5.17 11~40 -0.50 0.21
    Behavior 2 8~40 28.84±5.66 12~40 -0.20 -0.28

    KN=knowledge related to hemodialysis; SS=social support; BPN=basic psychological need; AT=attitude; SN=subjective norm; SE=self-efficacy; INT=intention; BE=sick role behavioral compliance.

    Fitness Statistics of Hypothetical Structural and Modified Model (N=476)

    Goodness χ² p df χ²/df GFI NNFI SRMR CFI RMSEA (LO90/HI90) CAIC
    Criteria       2~3 ≥.9 ≥.9 ＜1.0 ≥.9 .05~.08  
    Hypothetical model 307.36 ＜.001 94 3.27 .92 .91 .04 .93 .07 (.06/.08) 730.12
    Modified model 313.99 ＜.001 98 3.20 .92 .91 .04 .93 .07 (.60/.08) 708.09

    GFI=goodness-of-fit index, NNFI=nonnormed fit index, SRMR=standardized root mean square residual; CFI=comparative fit index, RMSEA=root mean square error of approximation.

    Modifie d Model wi ith Param meter Estim ate (N=476)

    Path B β SE* CR (p)† SMC‡ Direct effect (p) In ndirect effect (p) Total effect (p)
    BPN .409      
       KN→BPN 0.46 .15 .20 2.28 (.023) .15 (.035) - .15 (.035)
       SS→BPN 0.28 .57 .04 7.56 (＜.001) .57 (.010) - .57 (.010)
    AT .467      
       KN→AT 1.13 .25 .27 4.12 (＜.001) .25 (.010) .04 (.095) .30 (.010)
       SS→AT         - .33 (.010) .33 (.010)
       SN→AT 0.50 .49 .08 6.67 (＜.001) .49 (.010) - .49 (.010)
       SE→AT - - - - - .08 (.020) .08 (.020)
       BPN→AT 0.21 .15 .10 2.20 (.028) .15 (.029) .13 (.010) .27 (.010)
    SN .328      
       SE→SN 0.23 .17 .10 2.66 (.008) .17 (.020) - .17 (.020)
       SS→SN 0.22 .31 .06 3.48 (＜.001) .31 (.010) .19 (.010) .50 (.010)
       KN→SN - - - - - .04 (.097) .04 (.097)
       BPN→SN 0.30 .21 .12 2.44 (.015) .21 (.031) .06 (.020) .26 (.010)
    SE .239      
       KN→SE - - - - - .05 (.095) .05 (.095)
       SS→SE 0.10 .21 .04 2.48 (.013) .21 (.019) .19 (.010) .40 (.010)
       BPN→SE 0.30 .33 .08 3.92 (＜.001) .33 (.010) - .33 (.010)
    INT .705      
       KN→INT -0.65 -.13 .28 -2.32 (.020) -.13 (.062) .11 (.010) -.02 (.858)
       SS→INT -0.16 -.19 .06 -2.84 (.005) -.19 (.010) .51 (.010) .32 (.010)
       AT→INT 0.27 .23 .08 3.38 (＜.001) .23 (.021) - .23 (.021)
       SN→INT 0.61 .52 .11 5.76 (＜.001) .52 (.010) .11 (.021) .63 (.010)
       SE→INT 0.81 .45 .10 7.84 (＜.001) .45 (.010) .11 (.021) .55 (.010)
       BPN→INT - - - - - .35 (.010) .35 (.010)
    BE .801      
       KN→BE 0.84 .22 .23 3.73 (＜.001) .22 (.010) -.04 (.452) .17 (.023)
       SS→BE 0.12 .19 .04 3.32 (＜.001) .19 (.010) .26 (.010) .45 (.010)
       AT→BE -0.13 -.14 .06 -2.20 (.028) -.14 (.023) .16 (.021) .01 (.900)
       SN→BE SE→BE - 0.32 - .23 - .09 - 3.58 (＜.001) - .23 (.010) .36 (.010) .36 (.010) .35 (.010) .59 (.010)
       SE→BE BPN BE 0.32 - .23 - .09 - 3.58 (＜.001) - .23 (.010) - .36 (.010) .27 (.010) .59 (.010) .27 (.010)
       BPN→BE - - - - - .27 (.010) .27 (.010)
       INT→BE 0.52 .67 .06 8.59 (＜.001) .67 (.010) - .67 (.010)

    SE=standard error; KN=knowledge related to hemodialysis; BPN=basic psychological need; SS=social support; AT=attitude; SN=subjective norm; SE=self-efficacy; INT=intention; BE=sick role behavioral compliance;

    †Critical ratio;

    ‡Squared multiple correlation.
    Table 1. Descriptive Statistics for Latent Variables and Measured Variables (N=476)

    KN=knowledge related to hemodialysis; SS=social support; BPN=basic psychological need; AT=attitude; SN=subjective norm; SE=self-efficacy; INT=intention; BE=sick role behavioral compliance.

    Table 2. Fitness Statistics of Hypothetical Structural and Modified Model (N=476)

    GFI=goodness-of-fit index, NNFI=nonnormed fit index, SRMR=standardized root mean square residual; CFI=comparative fit index, RMSEA=root mean square error of approximation.

    Table 3. Modifie d Model wi ith Param meter Estim ate (N=476)

    SE=standard error; KN=knowledge related to hemodialysis; BPN=basic psychological need; SS=social support; AT=attitude; SN=subjective norm; SE=self-efficacy; INT=intention; BE=sick role behavioral compliance;

    Critical ratio;

    Squared multiple correlation.

    Table 1.

    Table 2.

    Table 3.

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