Abstract
-
Purpose
This study aimed to examine the relationship between stigma and self-management among patients undergoing hemodialysis and to identify the key factors influencing their self-management practices.
-
Methods
A convenience sample of 139 hemodialysis patients, aged 18 years or older with an arteriovenous fistula, was recruited from online websites designed for patients undergoing hemodialysis in South Korea. Data were collected using a self-reported questionnaire that assessed demographic and clinical characteristics, self-management behavior, and stigma. Data analysis included descriptive statistics, the independent t-test, one-way analysis of variance, Pearson r correlations, and hierarchical regression analysis to evaluate the influence of stigma on self-management.
-
Results
Hierarchical regression analysis showed that demographic and clinical characteristics accounted for 25.1% of the variance in self-management, and the inclusion of stigma increased the explained variance to 31.4%. Significant predictors included the number of hemodialysis sessions per week (≥3) (β=–.38, p<.001), stigma (β=–.27, p<.001), monthly household income (≥4 million won) (β=.24, p=.014), and marital status (single) (β=–.18, p=.028).
-
Conclusion
The findings highlight the substantial impact of stigma and treatment burden on self-management, while socioeconomic status and marital support serve as protective factors. Targeted interventions that reduce stigma and strengthen support systems are warranted.
-
Key Words: Chronic disease; Renal dialysis; Social stigma; Self-management
INTRODUCTION
The prevalence of chronic kidney disease continues to rise, making it the seventh leading cause of death worldwide [
1]. By 2040, kidney disease is projected to become the fifth most common cause of mortality [
1]. In line with this trend, the number of patients undergoing hemodialysis has steadily increased, with a six-fold rise in the Korean population between 2002 and 2017 [
2]. Hemodialysis patients must engage in multiple aspects of self-management to preserve their health [
3]. These include adhering to dietary and fluid restrictions, taking medications as prescribed, maintaining dialysis schedules, managing comorbid conditions, and caring for the arteriovenous (AV) fistula [
3].
Stigma is defined as a stereotypical attribute that distinguishes individuals from others and fosters discrimination [
4]. Patients with chronic illness often experience diminished social standing as a result of their conditions, leading to social exclusion and internalized stigma [
4]. Previous research has demonstrated that stigma undermines treatment adherence and health outcomes by discouraging medical utilization, reducing motivation, and worsening disease progression [
5]. Stigma has been identified as a major barrier to self-management in chronic illnesses such as epilepsy [
6], diabetes [
7], and hypertension [
8]. These findings suggest that stigma is not only a social problem but also an important behavioral determinant in chronic disease management.
Among patients undergoing hemodialysis, stigma may be particularly evident due to the visible aspects of treatment, such as the AV fistula, changes in skin tone, and altered physical appearance, as well as the restrictions imposed by strict treatment schedules [
9]. Prior studies have shown that some patients conceal their condition to avoid discomforting others, which can lead to non-adherence to dietary restrictions and even alcohol use [
10]. Stigma has also been associated with poor adherence to potassium, phosphorus, and salt restrictions [
11]. However, self-management in hemodialysis extends beyond dietary and fluid control, encompassing medication adherence, fistula care, and consistent communication with healthcare providers [
3]. Although stigma has been studied in relation to dietary and fluid adherence, limited research has addressed its relationship with overall self-management among hemodialysis patients.
This study was guided by social cognitive theory [
12], which emphasizes the continuous interaction of personal factors (such as demographic and clinical characteristics) and environmental factors (such as stigma) in shaping self-management behaviors. The objectives were to (1) assess the levels of stigma and self-management among hemodialysis patients; (2) examine differences in stigma and self-management according to general and clinical characteristics; (3) investigate correlations between stigma and self-management; and (4) identify factors influencing self-management among patients undergoing hemodialysis.
METHODS
1.Study design
This study employed a cross-sectional correlational design.
2. Setting and Samples
We collected data through an online survey. Participants were patients undergoing hemodialysis with an AV fistula, aged ≥18 years. Inclusion criteria required patients to have an AV fistula, be aged ≥18 years, and possess the ability to read and complete online surveys. AV fistula patients were selected because this type of vascular access is the most common among hemodialysis patients and is regarded as the gold standard for long-term treatment [
13]. In addition, prior qualitative research reported that hemodialysis patients felt stigmatized when exposing their AV fistula [
14]. Exclusion criteria included cognitive impairment or severe psychiatric disorders that could interfere with comprehension of the questionnaire. The required sample size was estimated at 118 using G*Power 3.1.9.7, with an effect size of 0.15, an alpha level of .05, a power of .80, and 10 predictors. To account for potential dropout, 20% was added, yielding a target sample size of 142. After excluding three participants with incomplete survey responses, 139 participants were included in the final analysis.
1) Demographic and clinical characteristics
Demographic data included age, sex, marital status, and monthly household income. Clinical data included hemodialysis duration (years), number of hemodialysis sessions per week, number and types of comorbidities, number and types of medications, perceived difficulty with hemodialysis, support from medical staff (doctors and nurses), and support from family.
2) Self-care behavior measurement scale
Self-care behavior was assessed using the scale originally developed by Song [
15] and revised by Cho [
16]. The revised version contains 35 items covering eight domains: diet and hydration control, AV fistula care, exercise and rest, medication adherence, blood pressure and weight control, post-hemodialysis care, physical and mental management, and social activity. Each item is rated on a 5-point Likert scale (1=complete inability, 5=exceptional proficiency), with total scores ranging from 35 to 175. Higher scores indicate greater engagement in self-care behaviors. The Cronbach’s α of the revised version was .88 [
16]; in this study, Cronbach’s α was .91.
3) Stigma scale for chronic illness
Stigma was measured using the 8-item stigma scale for chronic illness (SSCI-8), originally developed for patients with neurological disorders [
17] and applied here in its Korean version [
18]. Although initially designed for neurological disorders [
17], the scale has demonstrated reliability and validity across various chronic conditions, including chronic pain [
19] and breast cancer [
20], supporting its applicability to hemodialysis patients. The SSCI-8 comprises two domains—internalized and experienced stigma—scored on a 5-point Likert scale (1=never, 5=always). Total scores range from 8 to 40, with higher scores reflecting greater stigma. The Cronbach’s α of the original version was .89 [
17], and the translated version was .90 [
18]; in this study, Cronbach’s α was .93.
Participants were recruited through online hemodialysis support groups identified via Naver Band (NAVER, Seongnam, Korea) and KakaoTalk (Kakao, Seongnam, Korea), private social networking platforms for group communication. Study flyers were also posted on online communities for individuals with end-stage renal disease. Interested participants accessed the survey via a URL link, which provided study information and a consent form. Only those who provided informed consent were able to proceed. Each participant could respond only once. Recruitment was conducted from November 7, 2022, to December 20, 2022.
5. Ethical Considerations
Participants were provided with study information and a consent form before beginning the survey. Only those who provided consent were allowed to complete the questionnaire. They were informed that participation was voluntary, withdrawal was permitted at any time without penalty, and incomplete responses would not be included in the analysis. The consent form described the study’s purpose, methods, duration, potential risks and benefits, and measures for data privacy. Research data and consent forms were securely stored for the legally required period and scheduled for safe disposal afterward. The institutional review board of Seoul National University approved the data collection process before the start of the study (Date of approval: 2022/10/25, IRB No. 2211/001-001).
6. Data Analysis
Statistical analyses were performed using IBM SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (frequency, percentage, mean, and standard deviation [SD]) were used to summarize demographic and clinical characteristics, as well as self-management and stigma scores. Independent t-tests, one-way analysis of variance, and post-hoc analyses were conducted to examine differences in self-management and stigma by demographic and clinical factors. Pearson’s correlations were calculated to explore associations among continuous variables. Hierarchical regression analysis was performed with self-management as the dependent variable. Demographic and clinical characteristics were entered in the first step, and stigma was entered in the second step to assess its additional contribution.
RESULTS
1. Demographic and Clinical Characteristics of the Participants
The mean age of the participants was 48.17 years (SD=10.20). Of the 139 participants, 63 (45.3%) were male and 76 (54.7%) were female, with the majority (61.2%) being married (
Table 1). Clinical characteristics are summarized in
Table 1. On average, participants had been receiving hemodialysis for 4.60 years (SD=5.10), with a mean of 2.19 sessions per week (SD=0.91), and reported 1.31 comorbidities (SD=0.99). Hypertension and diabetes mellitus were the most prevalent comorbid conditions. Participants took an average of three medications (SD=1.53), with anti-hypertensive agents being the most common (51.1%). In terms of perceived challenges, participants identified maintaining a healthy lifestyle as the most difficult aspect of managing hemodialysis, followed by psychological stress, managing physical symptoms, financial difficulties, forming social relationships, and other issues related to AV fistula care. Regarding support, participants reported most often receiving assistance from medical staff (50.4%) and family (42.4%).
Table 2 presents differences in self-management and stigma according to demographic and clinical characteristics. Married participants reported significantly higher levels of self-management compared to single participants (
p<.001). Regarding income, participants with monthly household earnings ≥4 million Korean won demonstrated higher self-management compared to those earning <2.5 million Korean won (
p=.003). Patients undergoing fewer than three hemodialysis sessions per week reported better self-management (
p<.001) and higher stigma (
p=.045) compared with those undergoing three or more sessions weekly. Participants without hypertension exhibited significantly higher stigma compared to those with hypertension (
p=.002). In addition, patients with diabetes mellitus reported significantly higher self-management compared to those without diabetes (
p=.031).
Table 3 summarizes stigma and self-management scores. The mean self-management score was 132 (SD=17.98), with a mean item score of 3.77 (SD=0.51), indicating generally good self-management. Subscale mean item scores, from highest to lowest, were: medication (4.20, SD=0.62), AV fistula care (4.08, SD=0.49), social activity (4.04, SD=0.70), care after hemodialysis (3.78, SD=0.76), physical and mental management (3.69, SD=0.59), blood pressure and weight control (3.65, SD=0.80), exercise and rest (3.57, SD=0.82), and diet and hydration control (3.49, SD=0.74). The mean stigma score was 16.67 (SD=6.22), with a mean item score of 2.08 (SD=0.78), indicating that participants generally reported low levels of stigma. Among the stigma domains, internalized stigma was higher than enacted stigma.
3. Correlations among Variables
Pearson’s correlations are presented in
Table 4. Self-management was positively associated with age (r=.20,
p=.017) and number of comorbidities (r=.21,
p=.013). Conversely, self-management was negatively correlated with the number of medications (r=–.20,
p=.020) and stigma (r=–.22,
p=.008).
Multiple linear regression was conducted to examine the association between stigma and self-management, controlling for demographic and clinical characteristics. A two-step hierarchical regression model was used, with self-management as the dependent variable. In Model 1, demographic and clinical characteristics—including marital status, monthly household income, diabetes mellitus, difficulty in managing physical symptoms, and number of hemodialysis sessions per week—explained 25.1% of the variance in self-management (F=7.62, adjusted R²=.251) (
Table 5). When stigma was added in Model 2, the variance explained increased to 31.4% (F=8.88, adjusted R²=.314). In the final model, four of eight predictors were statistically significant: number of hemodialysis sessions per week (≥3) (β=–.38,
p<.001), stigma (β=–.27,
p<.001), monthly household income (≥4 million won) (β=.24,
p=.014), and marital status (single) (β=–.18,
p=.028).
DISCUSSION
This study examined the relationship between stigma and self-management among patients undergoing hemodialysis and identified factors influencing self-management. Overall, patients demonstrated a relatively high level of self-management, with an average score of 3.77±0.51 on a 5-point scale, and reported experiencing stigma only rarely, with an average score of 2.08±0.78. Several factors may account for these findings. Many participants reported receiving strong support from family members and healthcare providers, which likely served as a protective buffer against stigma [
21,
22]. A qualitative study of patients undergoing hemodialysis found that trust in doctors and nurses helped patients better manage dialysis sessions and physical symptoms [
23]. Similarly, family support has been shown to enhance treatment adherence and strengthen emotional resilience [
24]. Recruitment through online platforms and patient support groups may also have fostered a sense of community, enabling participants to share experiences and provide mutual support [
25]. The online nature of this study may have further influenced the findings. The mean age of participants was 48.17 years, which is younger than the national average of 62 years among Korean hemodialysis patients [
2]. Younger patients are more likely to have higher levels of digital health literacy [
26], which can facilitate engagement in online communication and peer networks, ultimately reducing stigma and promoting self-management. Digital proficiency may thus have contributed to the development of peer support systems that enhanced social connectedness, reduced stigma, and strengthened self-management [
26]. In this study, stigma was assessed using a scale that measured internalized and enacted stigma [
17]. However, anticipated stigma is also an important factor that may hinder self-management in chronic illness [
27]. Anticipated stigma may mediate the effects of internalized and experienced stigma on access to care [
27]. Future research should therefore examine its impact on self-management among patients undergoing hemodialysis.
Interestingly, patients receiving fewer than three hemodialysis sessions per week reported higher stigma but better self-management compared with those undergoing three or more sessions. The frequency of dialysis can vary depending on residual kidney function or clinical recommendations [
28], and may also be influenced by patients’ dietary control and fluid management [
28]. Compared with thrice-weekly dialysis, twice-weekly sessions may help preserve residual kidney function, reduce infection risk, and lessen complications of the AV fistula, while potentially improving quality of life [
29]. In this study, 52.5% of participants had been receiving hemodialysis for less than three years, suggesting that many were in the early stages of treatment. Patients in this phase often experience psychosocial burdens, uncertainty, and reduced acceptance of their condition [
25]. Prior research similarly indicates that individuals within the first three years of dialysis frequently report hopelessness, uncertainty, and emotional instability [
25]. At the same time, these patients may adhere more rigorously to dietary and fluid restrictions, reducing the need for more frequent dialysis [
28]. Longitudinal studies are needed to clarify whether stigma decreases as patients progress through the adaptation process and undergo longer-term treatment.
Another noteworthy finding was that patients without hypertension reported higher stigma compared to those with hypertension, despite hypertension being the most common comorbidity (63.1%). This may reflect the complexity of comorbidity profiles: 29.5% of participants had two or more comorbidities, with 44.3% having diabetes mellitus and 32.0% affected by conditions such as liver disease, lung disease, eye disease, cerebrovascular disease, or osteoarthritis. These overlapping conditions may have shaped participants’ perceptions of stigma in nuanced ways [
20].
Although this study found only a weak negative correlation between stigma and self-management, stigma nonetheless emerged as an important influencing factor, alongside the number of hemodialysis sessions per week, marital status, and household income. These findings highlight stigma as a significant barrier to effective self-management. Accordingly, strategies to address stigma are critical. Interventions should aim to strengthen patient motivation and empower individuals to take an active role in their care [
30]. Because patients undergoing hemodialysis require lifelong therapy until transplantation, programs that cultivate a positive mindset, enhance personal empowerment, and reduce stigma are essential [
31]. Healthcare providers should be trained to identify and minimize stigma-related barriers [
31], and peer support groups should be promoted as a means of fostering patient-centered care [
32]. Finally, public campaigns are needed to reduce stigma more broadly. Educational initiatives, such as posters in hospitals and informational content on social media, can raise awareness that successful self-management in hemodialysis is achievable and encourage positive health behaviors [
33].
This study has several limitations. First, this study recruited hemodialysis patients from online, which may have led to the underrepresentation of the target population-patients undergoing hemodialysis. Specifically, potential participants with limited access to online resources or low digital literacy may not have had the opportunity to participate, thereby limiting the generalizability of the findings. Second, collecting self-reported data through online surveys may have resulted in misinterpretations of the survey questions, as participants did not have access to real-time assistance from researchers. Therefore, future research should consider combining online surveys with on-site, community-based recruitment to minimize underrepresentation and enhance the generalizability of the results. Third, the mean age of the study sample was approximately 48 years, which is considerably lower than the national average age of hemodialysis patients in South Korea [
2]. This discrepancy may also limit the generalizability of the findings, as younger patients may differ from older patients in terms of stigma perception and self-management behaviors.
CONCLUSION
Self-management is a dynamic and ongoing process that requires continuous attention and practice in daily life. The findings of this study indicate that stigma is an important influencing factor in the self-management of patients undergoing hemodialysis, with a negative correlation between stigma and self-management. Marital status, monthly household income, and number of weekly hemodialysis sessions, along with stigma, were identified as the strongest predictors of self-management. These results verify the necessity of developing and implementing programs aimed at reducing stigma and enhancing self-management among patients undergoing hemodialysis.
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CONFLICTS OF INTEREST
The authors declared no conflict of interest.
-
AUTHORSHIP
Study conception and design acquisition - SR and YHP; data collection - SR; analysis - SR and YHP; interpretation of the data - SR and YHP; and drafting or critical revision of the manuscript for important intellectual content - SR and YHP.
-
FUNDING
None.
-
ACKNOWLEDGEMENT
This article is a condensed form of the Seulgi Ryu’s master’s thesis from Seoul National University.
-
DATA AVAILABILITY STATEMENT
The data can be obtained from the corresponding author.
Table 1.Demographic and Clinical characteristics of the Participants (N=139)
|
Variables |
Categories |
M±SD or n (%) |
|
Demographic characteristics |
|
Age (year) |
|
48.17±10.20 |
|
22–39 |
28 (20.1) |
|
40–49 |
49 (35.3) |
|
50–59 |
42 (30.2) |
|
60–67 |
20 (14.4) |
|
Sex |
Male |
63 (45.3) |
|
Female |
76 (54.7) |
|
Marital status |
Married |
85 (61.2) |
|
Single |
45 (32.4) |
|
Other |
9 (6.4) |
|
Monthly household income (million Korean won) |
≥4 |
54 (38.9) |
|
≥2.5 to <4 |
47 (33.8) |
|
<2.5 |
38 (27.3) |
|
Clinical characteristics |
|
|
|
Hemodialysis period (year) |
|
4.60±5.10 |
|
<1 |
11 (7.9) |
|
≥1 to <3 |
63 (45.3) |
|
≥3 to <5 |
27 (19.4) |
|
≥5 to <10 |
24 (17.3) |
|
≥10 |
14 (10.1) |
|
No. of hemodialysis sessions per week |
|
2.19±0.91 |
|
<3 |
73 (52.5) |
|
≥3 |
66 (47.5) |
|
No. of comorbidities |
|
1.31±0.99 |
|
0 |
22 (15.8) |
|
1 |
76 (54.7) |
|
2 |
41 (29.5) |
|
Comorbidities†
|
HTN (yes) |
77 (55.4) |
|
DM (yes) |
54 (38.8) |
|
Cardiovascular disease (yes) |
15 (10.8) |
|
Others (yes) |
39 (28.1) |
|
No. of medications |
|
3.00±1.53 |
|
1 |
19 (13.7) |
|
2 |
42 (30.2) |
|
3 |
34 (24.5) |
|
4 |
26 (18.7) |
|
≥5 |
18 (12.9) |
|
Medications†
|
Anti-hypertensive agent |
71 (51.1) |
|
Vitamin supplement |
63 (45.3) |
|
Phosphate binder |
57 (41.0) |
|
Iron supplement |
56 (40.3) |
|
Hypoglycemic agent |
52 (37.4) |
|
Antiplatelet agent |
31 (22.3) |
|
Potassium lowering agent |
28 (20.1) |
|
Calcium supplement |
27 (19.4) |
|
Sodium bicarbonate |
6 (4.3) |
|
Others |
10 (7.2) |
|
Difficulties regarding hemodialysis†
|
Maintain healthy lifestyle (yes) |
93 (66.9) |
|
Psychological stress (yes) |
81 (58.3) |
|
Manage physical symptoms (yes) |
75 (54.0) |
|
Financial difficulty (yes) |
55 (39.6) |
|
Social relationship formation (yes) |
41 (29.5) |
|
Others (related to arteriovenous fistula care) (yes) |
6 (4.3) |
|
Support from medical staff (doctors, nurses) |
Always |
30 (21.6) |
|
Often |
70 (50.4) |
|
Sometimes |
30 (21.6) |
|
Rarely |
3 (2.1) |
|
Never |
6 (4.3) |
|
Support from family |
Always |
53 (38.1) |
|
Often |
59 (42.5) |
|
Sometimes |
16 (11.5) |
|
Rarely |
9 (6.5) |
|
Never |
2 (1.4) |
Table 2.Difference in Stigma and Self-Management by Demographic and Clinical Characteristics of the Participants (N=139)
|
Variable |
n (%) |
Stigma |
Self-management |
|
Mean |
SD |
t or F |
p
|
Mean |
SD |
t or F |
p (Scheffe) |
|
Age (year) |
|
|
|
0.95 |
.346 |
|
|
–1.76 |
.081 |
|
<50 |
77 (55.4) |
17.12 |
6.51 |
|
|
129.61 |
18.67 |
|
|
|
≥50 |
62 (44.6) |
16.11 |
5.86 |
|
|
134.97 |
16.76 |
|
|
|
Sex |
|
|
|
–0.41 |
.680 |
|
|
–1.21 |
.230 |
|
Female |
76 (54.7) |
16.87 |
6.50 |
|
|
133.68 |
17.30 |
|
|
|
Male |
63 (45.3) |
16.43 |
5.92 |
|
|
129.97 |
18.70 |
|
|
|
Marital status |
|
|
|
1.93 |
.149 |
|
|
8.86 |
<.001 |
|
Marrieda
|
85 (61.2) |
15.86 |
5.81 |
|
|
136.66 |
16.31 |
|
a>b |
|
Singleb
|
45 (32.4) |
18.07 |
6.83 |
|
|
123.47 |
17.01 |
|
|
|
Othersc
|
9 (6.5) |
17.33 |
6.25 |
|
|
130.67 |
23.43 |
|
|
|
Monthly household income (million Korean won) |
|
|
|
0.22 |
.802 |
|
|
6.21 |
.003 |
|
≥4a
|
54 (38.8) |
17.07 |
6.92 |
|
|
137.52 |
15.88 |
|
a>c |
|
≥2.5 to <4b
|
47 (33.8) |
16.57 |
5.84 |
|
|
131.64 |
18.06 |
|
|
|
<2.5c
|
38 (27.3) |
16.22 |
5.75 |
|
|
124.61 |
18.37 |
|
|
|
Number of hemodialysis sessions per week |
|
|
|
2.02 |
.045 |
|
|
5.14 |
<.001 |
|
<3 |
73 (52.5) |
17.67 |
5.57 |
|
|
138.85 |
15.83 |
|
|
|
≥3 |
66 (47.5) |
15.56 |
6.74 |
|
|
124.42 |
17.24 |
|
|
|
Hemodialysis period |
|
|
|
1.96 |
.052 |
|
|
1.77 |
.079 |
|
<5 |
100 (71.9) |
17.31 |
6.12 |
|
|
133.67 |
17.51 |
|
|
|
≥5 |
39 (28.1) |
15.03 |
6.26 |
|
|
127.72 |
18.67 |
|
|
|
HTN |
|
|
|
3.19 |
.002 |
|
|
–1.75 |
.082 |
|
Yes |
77 (55.3) |
15.21 |
5.43 |
|
|
134.38 |
18.40 |
|
|
|
No |
62 (44.7) |
18.48 |
6.69 |
|
|
129.05 |
17.12 |
|
|
|
DM |
|
|
|
0.73 |
.467 |
|
|
–2.18 |
.031 |
|
Yes |
54 (38.8) |
16.19 |
6.01 |
|
|
136.11 |
17.82 |
|
|
|
No |
85 (61.2) |
16.98 |
6.37 |
|
|
129.39 |
17.68 |
|
|
|
Difficulty in maintaining healthy lifestyle |
|
|
|
–2.26 |
.026 |
|
|
1.73 |
.086 |
|
Yes |
93 (66.9) |
17.49 |
6.49 |
|
|
130.16 |
18.38 |
|
|
|
No |
46 (33.1) |
15.00 |
5.34 |
|
|
135.72 |
16.70 |
|
|
|
Psychological stress |
|
|
|
0.06 |
.952 |
|
|
–1.40 |
.163 |
|
Yes |
81 (58.3) |
16.64 |
6.50 |
|
|
133.80 |
17.83 |
|
|
|
No |
58 (41.7) |
16.71 |
5.87 |
|
|
129.48 |
18.03 |
|
|
|
Difficulty in managing physical symptoms |
|
|
|
0.63 |
.528 |
|
|
–2.84 |
.005 |
|
Yes |
75 (53.9) |
16.36 |
6.59 |
|
|
135.91 |
16.98 |
|
|
|
No |
64 (46.1) |
17.03 |
5.80 |
|
|
127.42 |
18.16 |
|
|
|
Financial difficulty |
|
|
|
–0.76 |
.450 |
|
|
–0.50 |
.615 |
|
Yes |
55 (39.6) |
17.16 |
6.19 |
|
|
132.98 |
19.59 |
|
|
|
No |
84 (60.4) |
16.35 |
6.26 |
|
|
131.36 |
16.93 |
|
|
|
Difficulty in forming social relationship |
|
|
|
–1.67 |
.097 |
|
|
0.84 |
.404 |
|
Yes |
41 (29.5) |
18.02 |
6.83 |
|
|
130.02 |
17.95 |
|
|
|
No |
98 (70.5) |
16.10 |
5.90 |
|
|
132.83 |
18.05 |
|
|
Table 3.Stigma and Self-Management of the Participants (N=139)
|
Item |
Possible range |
Min |
Max |
Mean±SD |
Items |
|
Mean±SD |
|
Self-management |
35–175 |
86 |
164 |
132±17.98 |
3.77±0.51 |
|
Medication |
2–10 |
5 |
10 |
8.40±1.24 |
4.20±0.62 |
|
Arteriovenous fistula care |
6–30 |
16 |
30 |
24.50±2.95 |
4.08±0.49 |
|
Social activity |
3–15 |
5 |
15 |
12.12±2.11 |
4.04±0.70 |
|
Care after hemodialysis |
2–10 |
4 |
10 |
7.56±1.51 |
3.78±0.76 |
|
Physical and mental management |
9–45 |
19 |
45 |
33.23±5.30 |
3.69±0.59 |
|
Blood pressure and weight control |
3–15 |
3 |
15 |
10.95±2.41 |
3.65±0.80 |
|
Exercise and rest |
4–20 |
6 |
20 |
14.28±3.29 |
3.57±0.82 |
|
Diet and hydration control |
6–30 |
7 |
30 |
20.96±4.47 |
3.49±0.74 |
|
Stigma |
8–40 |
8 |
31 |
16.67±6.22 |
2.08±0.78 |
|
Internalized |
3–15 |
3 |
14 |
6.71±2.82 |
2.24±0.94 |
|
Enacted (experienced) |
5–25 |
5 |
19 |
9.96±3.79 |
1.99±0.76 |
Table 4.Correlations between Demographic and Clinical Characteristics, Stigma, and Self-Management (N=139)
|
Variables |
r (p) |
|
1 |
2 |
3 |
4 |
5 |
6 |
|
1. Age |
1 |
|
|
|
|
|
|
2. Hemodialysis period |
.03 (.704) |
1 |
|
|
|
|
|
3. Number of medications |
.03 (.748) |
.49 (<.001) |
1 |
|
|
|
|
4. Number of comorbidities |
.45 (<.001) |
.01 (.951) |
.18 (.033)* |
1 |
|
|
|
5. Stigma |
–.26 (.002) |
–.14 (.111) |
–.24 (.005) |
–.36 (<.001) |
1 |
|
|
6. Self-management |
.20 (.017) |
–.13 (.122) |
–.20 (.020) |
.21 (.013) |
–.22 (.008) |
1 |
Table 5.Summary of Hierarchical Regression Analysis for Variables Associated with Self-Management
|
Independent variables |
Model 1 |
Model 2 |
|
B |
SE |
β |
t |
p
|
B |
SE |
β |
t |
p
|
|
Marital status (single) |
–9.27 |
3.08 |
–.24 |
–3.00 |
.003 |
–6.76 |
3.03 |
–.18 |
–2.23 |
.028 |
|
Marital status (others) |
–0.44 |
5.70 |
–.01 |
–0.08 |
.939 |
1.67 |
5.49 |
.02 |
0.31 |
.761 |
|
Monthly household income (≥2.5 to <4 million Korean won) |
2.00 |
3.59 |
.05 |
0.56 |
.579 |
2.78 |
3.45 |
.07 |
0.81 |
.422 |
|
Monthly household income (≥4 million Korean won) |
6.98 |
3.64 |
.19 |
1.92 |
.057 |
8.77 |
3.52 |
.24 |
2.49 |
.014 |
|
DM (no) |
–1.76 |
2.87 |
–.05 |
–0.62 |
.540 |
–0.41 |
2.77 |
–.01 |
–0.15 |
.883 |
|
Difficulty in managing physical symptoms (no) |
–4.49 |
2.77 |
–.13 |
–1.62 |
.108 |
–3.56 |
2.66 |
–.10 |
–1.34 |
.184 |
|
Number of hemodialysis sessions per week (≥3) |
–11.18 |
2.86 |
–.31 |
–3.91 |
<.001 |
–13.61 |
2.82 |
–.38 |
–4.83 |
<.001 |
|
Stigma |
|
|
|
|
|
-0.77 |
0.22 |
–.27 |
–3.59 |
<.001 |
|
R2
|
.289 |
.353 |
|
Adjusted R2
|
.251 |
.314 |
|
F |
7.62 |
8.88 |
|
p
|
<.001 |
<.001 |
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