Asadizaker Behnaz, Gheibizadeh Mahin, Ghanbari Saeed, Araban Marzieh
Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Biostatistics and Epidemiology, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Med J Islam Repub Iran. 2022 Mar 19;36:23. doi: 10.47176/mjiri.36.23. eCollection 2022.
Non-compliance to the treatment is a major problem in hemodialysis patients. This study aimed to determine factors predicting adherence to treatment in hemodialysis patients in selected cities of Khuzestan province, Iran. This cross-sectional study was conducted on 500 patients undergoing hemodialysis in Ahvaz, Shush, Shushtar, and Dezful cities. The data collection tools were ESRD-AQ, perceived health, perceived social support, Beck Depression, self-efficacy, and demographic and clinical factors questionnaires. Data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson's correlation coefficient. Structural equation modeling (SEM) was employed to analyze the relationship between various exogenous and endogenous or mediating variables. The results showed that all predicting variables of perceived social support, depression, self-efficacy, and perceived health had been associated with the variable of adherence to treatment. Accordingly, there was a reverse correlation between social support and depression (p< 0.001, r= -0.94), as well as depression and self-efficacy (p< 0.001, r= -0.87). There was a direct correlation between self-efficacy and perceived health (p< 0.001, r= 0.79), perceived health and adherence to treatment (p< 0.001, r= 0.72). Fitness indices also indicate the adequacy of the proposed model (X2/df= 4.94, CD=0.937, SRMR=0.076, TLI= 0.870, CFI= 0.873, RMSEA= 0.071). The results showed that high social support, low level of depression, high perceived self-efficacy, and high perceived health predicted better compliance with the treatment in hemodialysis patients. The proposed model can be used as a framework to improve adherence to treatment regimens in hemodialysis patients.
不遵守治疗方案是血液透析患者面临的一个主要问题。本研究旨在确定伊朗胡齐斯坦省部分城市血液透析患者坚持治疗的预测因素。这项横断面研究对阿瓦士、舒什、舒什塔尔和迪兹富勒市的500名接受血液透析的患者进行。数据收集工具包括终末期肾病-生活质量量表、感知健康、感知社会支持、贝克抑郁量表、自我效能感以及人口统计学和临床因素问卷。数据采用描述性统计、t检验、方差分析和皮尔逊相关系数进行分析。采用结构方程模型（SEM）分析各种外生变量、内生变量或中介变量之间的关系。结果表明，感知社会支持、抑郁、自我效能感和感知健康的所有预测变量均与治疗依从性变量相关。因此，社会支持与抑郁之间呈负相关（p<0.001，r = -0.94），抑郁与自我效能感之间也呈负相关（p<0.001，r = -0.87）。自我效能感与感知健康之间呈正相关（p<0.001，r = 0.79），感知健康与治疗依从性之间呈正相关（p<0.001，r = 0.72）。拟合指数也表明所提出模型的适宜性（卡方/自由度 = 4.94，比较拟合指数 = 0.937，标准化残差均方根 = 0.076，塔克-刘易斯指数 = 0.870，比较拟合指数 = 0.873，近似误差均方根 = 0.071）。结果表明，高社会支持、低抑郁水平、高自我效能感和高感知健康预示着血液透析患者对治疗的依从性更好。所提出的模型可作为一个框架，用于提高血液透析患者对治疗方案的依从性。
