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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.

  • 1.The Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul: ESRD Registry Committee, Korean Society of nephrology; 2013. [cited 2016 April 20]. Available from:.http://www.ksn.or.kr/journal/2014/index.html.
  • 2.An GJ. Effects of self-care program using SMS, e-mail, or telephone call on self-care compliance and nutritional status in hemodialysis patients. Journal of Korean Biological Nursing Science. 2009;11(2):157-66.
  • 3.Leggat JE Jr. Adherence with dialysis: a focus on mortality risk. seminars in dialysis. 2005;18(2):137-41. http://dx.doi.org/10.1111/j.1525-139X.2005.18212.x.
  • 4.Baines LS, Jindal RM. Non-compliance in patients receiving haemodialysis: an in-depth review. Nephron. 2000;85:1-7. http://dx.doi.org/10.1159/000045622.
  • 5.Moon ES. A structural analysis of the social-motivational variables influencing adolescents' school dropout behavior. The Korean Journal of Educational Psychology. 2006;20(2):405-23.
  • 6.Choi SB, Ham KS. The relationships between social support, basic needs and quality of life in leisure participation by old adults. Journal of Sport and Leisure Studies. 2009;38:671-82.
  • 7.Cho YM, Choi MS, Sung KW. Factors predicting sick role behavioral compliance in hemodialysis patient. Korean Journal of Adult Nursing. 2011;23(3):235-43.
  • 8.Choe MA, Hah YS, Kim KS, Yi MS, Choi JA. A study on exercise behavior, exercise environment and social support of middle-aged women. Journal of Korean Academy of Nursing. 2008;38(1):101-10.
  • 9.Kim KHA study on influencing factors to the quality of life of the hemodialysis patients.[master's thesis]. Seoul: Kyunghee University; 1996.
  • 10.Na DM, Lee KO, Song ES. Relationship between the knowledge of hemodialysis and the compliance of patient role behavior in hemodialysis patients. The Medical Journal of Chosun University. 2004;29(3):12-20.
  • 11.Tsay SL. Self-efficacy training for patient with end-stage renal disease. Journal of Advanced Nursing. 2003;43(4):370-5.
  • 12.Hong KYA study of the relationships among dialysis related knowledge, self efficacy and compliance of patient role behavior in hemodialysis patients. [master's thesis]. Seoul: Hanyang University; 1999.
  • 13.Cho YM, Sung KW. The association of compliance with sick role behavior with satisfaction of basic psychological needs among hemodialysis patients. Korean Journal of Health Promotion. 2012;12(1):58-65.
  • 14.Lee MR. Testing a motivational sequence integrated self-determination theory and the theory of planned behavior: focused on dieting behavior. Korean Journal of Health Psychology. 2014;19(1):443-51.
  • 15.Hagger MS, Chatzisarantis NLDThe trans-contextual model of motivation. In: Hagger MS, Chatzisarantis NLD, editors. Intrinsic motivation and self-determination in exercise and sports. Champaign, IL: Human Kinetics; 2007. p. 53-70.
  • 16.Hagger MS, Chatzisarantis NLD, Harris J. From psychological need satisfaction to intentional behavior: testing a motivational sequence in two behavioral contexts. Personality and Social Psychological Bulletin. 2006;32:131-8. http://dx.doi.org/10.1177/0146167205279905.
  • 17.Hagger MS, Chatzisarantis NLD, Hein V, Soos I, Karsai I, Lintunen T, et al. Teacher, peer and parent autonomy support in physical education and leisure-time physical activity: a trans-contextual model of motivation in four nations. Psychology and Health. 2009;24(6):689-711. http://dx.doi.org/10.1080/08870440801956192.
  • 18.Moon SBBasic concepts and application of structural equation modeling with AMOS 17.0. Seoul: Hakjisa; 2009.
  • 19.Ryan RM, Deci ELAn overview of self-determination theory. In: Deci EL, Ryan RM, editors. Handbook of self determination research. Rochester, NY: University of Rochester Press; 2002. p. 3-33.
  • 20.Ajzen I. Constructing a TpB questionnaire: conceptual and methodological considerations. Revised January 2006;[cited 2016 April 16]. Available from:.http://www.uni-bielefeld.de/ikg/zick/ajzen%20construction%20a%20tpb%20questionnaire.pdf.
  • 21.Jee YO. Instrument development for the application of the theory of planned behavior. Korean Journal of Nursing Query. 1994;2(2):102-15.
  • 22.Kim JHAn effect of guided imagery applied to hemodialysis patients. [dissertation]. Seoul: Seoul National University; 1995.
  • 23.Lee GH. The relationships between game knowledge, basic needs for physical education classes, and behavioral regulation among middle and high school students. Korean Journal of Sport Psychology. 2010;21(1):99-110.
  • 24.Kim MJ. A structural equation model explaining contraception behaviors of married Korean women. Korean Journal of Women Health Nursing. 2001;7(2):141-56.
  • 25.Park JK. Predicting adolescent´s intention for physical activity and behavior using the theory of planned behavior: The roles of family support and personality. Korean Journal of Sport Psychology. 2011;22(1):129-44.
  • 26.Hagger MS, Chatzisarantis NLDSelf-determination theory and the promotion and maintenance of sport, exercise, and health. In: Hagger MS, Chatzisarantis NLD, editors. Intrinsic motivation and self-determination in exercise and sports. Champaign, IL: Human Kinetics; 2007. p. 1-19.
  • 27.Austin GS, David RM. Association of patient autonomy with increased transplantation and survival among new dialysis patient in the United States. American Journal of Kidney Diseases. 2005;45(4):730-42. http://dx.doi.org/10.1053/j.ajkd.2004.12.016.
  • 28.Kim SH, Lee SH. Influences of knowledge, self-efficacy, and social support on sick role behavior in patients with coronary artery disease. Journal of Korean Public Health Nursing. 2014;28(2):228-40. http://dx.doi.org/10.5932/JKPHN.2014.28.2.228.

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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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