Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

A Structural Equation Model on Quality of Life in Hemodialysis Patients

혈액투석환자의 삶의 질 구조모형

  • Received : 2019.05.08
  • Accepted : 2019.07.05
  • Published : 2019.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

This study was conducted to build a structural equation model explaining factors that affect hemodialysis patients' quality of life to test the goodness of fit of the model and identify directly and indirectly significant paths. To accomplish this, 230 patients receiving hemodialysis registered at study hospitals in G Metropolitan City and M City were randomly selected, and 201 were used in the final analysis. Data were collected using a self reporting questionnaire from February 1 to March 31, 2014. SPSS WIN 18.0 was used for descriptive statistics and correlation analysis of the general characteristics and for reliability analysis of the research tools. In addition, AMOS 18.0 was used for confirmatory factor analysis of latent variables, to determine the goodness of fit of the hypothetic model, and hypotheses testing. The results of this study were as follows: the fit of the modified model was 41.32, GFI = .96, AGFI = .92, RMR = .04, NFI = .96, CFI = .91 and TLI = .95. Twelve out of the 22 research hypotheses that were improved and improved were statistically significant. The results indicated that hemodialysis patients' quality of life was influenced directly by self-efficacy, depression, and self-care behavior, and indirectly by sleep disturbance, stress, fatigue, and family support. These variables explained 58.6% of the variation in quality of life. Overall, these findings suggest that nursing interventions for hemodialysis patients require strategies for managing patient depression and for increasing self-efficacy and self-care behavior to improve quality of life.

본 연구의 목적은 혈액투석환자의 삶의 질에 영향을 미치는 요인들을 직접 및 간접적으로 유의한 경로를 파악하고자 하는 구조방정식 모형구축 연구이다. 연구방법으로 대상자는 G광역시와 M시 지역에 소재한 혈액투석 전문센터에서 치료를 받고 있는 환자 230명을 선정하였고, 최종적으로 분석에 이용한 대상자 수는 201명이었다. 자료수집 기간은 2014년 2월 1일부터 3월 31일까지였으며, 자가보고식 설문지로 구성된 연구도구를 사용하여 수집하였다. 자료분석은 SPSS WIN 18.0을 이용하여 대상자의 일반적 특성, 변수에 대한 서술적 통계, 상관관계 및 연구도구의 신뢰도를 분석하였고, AMOS 18.0 프로그램을 이용하여 잠재변수의 확인적 요인분석, 가설적 모형의 적합도 및 가설을 검증하였다. 연구결과 수정모형의 적합도는 카이제곱 = 41.32, GFI = .96, AGFI = .92, RMR = .04, NFI = .96, CFI = .91, TLI = .95로 나타나 가설적 모형보다 적합도가 크게 개선되어 설정한 22개의 연구가설 중 12개가 통계적으로 유의하게 지지되었다. 본 연구에서 결론은 자기효능감, 우울, 자가간호행위가 혈액투석환자의 삶의 질에 직접적인 영향을 주었으며, 수면장애, 스트레스, 피로, 가족지지는 간접적으로 영향을 미치는 것으로 나타났다. 이들 변수들의 삶의 질에 대한 설명력은 58.6%였다. 혈액투석환자의 삶의 질을 향상시키기 위해서는 대상자의 우울을 우선적으로 관리하고 자기효능감의 증진을 통해 자가간호행위를 실천할 수 있는 간호중재가 이루어져야 할 것이다.

Keywords

SHGSCZ_2019_v20n7_589_f0001.png 이미지

Fig. 1. The Conceptual Framework

SHGSCZ_2019_v20n7_589_f0002.png 이미지

Fig. 2. Path Diagram for Modified Model

Table 1. General Characteristics of Subjects

SHGSCZ_2019_v20n7_589_t0001.png 이미지

Table 2. Descriptive Statistics of Variable

SHGSCZ_2019_v20n7_589_t0002.png 이미지

Table 3. Model Fit of Confirmatory Factor Analysis

SHGSCZ_2019_v20n7_589_t0003.png 이미지

Table 4. Model Fit for the Hypothetical Model

SHGSCZ_2019_v20n7_589_t0004.png 이미지

Table 5. Regression Weights of the Modified Model

SHGSCZ_2019_v20n7_589_t0005.png 이미지

References

  1. Horigan, A. E., "Fatigue in Hemodialysis Patients: a Review of Current Knowledge", Journal of Pain and Symptom Management, Vol.44, No.5, pp.715-724, 2012. DOI:http://dx.doi.org/10.1016/j.jpainsymman.2011.10.015
  2. End Stage Renal Disease Registry Committee, Current Renal Replacement Therapy in Korea-Insan Memorial Dialysis Registry, Korean Journal Nephrology, Vol.31, pp.531-557, 2012. DOI: https://doi.org/10.1016/j.krcp.2014.01.002
  3. P. L. Kimmel, S. D. Cohen, S. D. Weisbord, Quality of Life in Patients with End-stage Renal Disease Treated with Hemodialysis : Survival is not Enough, Journal of Nephrology, Vol.21, pp.54-58, 2008. DOI: https://doi.org/10.5527/wjn.v3.i4.308
  4. O. F. Fredric, W. F. Daine, H. F. Susan, Health Related Quality of Life and the CKD Patient, International Society of Nephrology, Vol.76, pp.946-952, 2009. DOI: https://doi.org/10.1038/ki.2009.307
  5. S. N. Davison, G. S. Jhangri, Impact of Pain and Symptom Burden on the Health-related Quality of Life of Hemodialysis Patients, Journal of Pain and Symptom Management, Vol.39, No.3, pp.477-485, 2010. DOI:https://doi.org/10.1016/j.jpainsymman.2009.08.008
  6. R. B. Curtin, D. L. Mapes, Health Care Management Strategies of Long-term Dialysis Survivors, Journal of the American Nephrology Nurses' Association, Vol.28, No.4, pp.385-392, 2001. DOI: https://www.researchgate.net/publication/8046816
  7. S. L. Tsay, Self-efficacy Training for Patients with Endstage Renal Disease, Journal of Advanced Nursing, Vol.43, No.4, pp.370-375, 2004. DOI: https://doi.org/10.1046/j.1365-2648.2003.02725.x
  8. J. Chilcot, D. Wellsted, M. Da Silva-Gane, K. Farrington, Depression on Dialysis, Nephron Clinical Practice, Vol. 108, No.4, pp.c256-c264, 2008. DOI: https://doi.org/10.1093/ndt/15.12.1911
  9. S. D.Weisbord, L. F. Fried, R. M. Arnold, M. J. Fine, D. J. Levenson, R. A. Peterson, Prevalence Severity and Importance of Physical and Emotional Symptoms in Chronic Hemodialysis Patients, Journal of the American Society of Nephrology, Vol.16, No.8, pp.2487-2494, 2005. DOI: https://doi.org/10.1681/ASN.2005020157
  10. I. Vazquez, F. Valderrabano, J. Fort, R. Jofre, J. M. Lopez-Gomez, F. Moreno, D. Sanz-Guajardo, Psychosocial Factors and Health-related Quality of Life in Hemodialysis Patients: Spanish Cooperative Renal Patients Quality of Life Study Group, Quality of Life Research, Vol.14, No.1, pp.179-190, 2005. DOI: https://doi.org/10.1016/j.trsl.2011.09.004
  11. E. Y. Choi, H. R. Lee, The Relationship between Fatigue, Self-efficacy, Family Support and Sleep Factors in Hemodialysis Patients. Journal of Korean Academy of Nursing, Vol.17, No.3, pp.435-443, 2005. DOI:https://doi.org/10.17547/kjsr.2017.25.4.246
  12. B. L. Bae, Structural Equation Modeling: Principles and Practice. Seoul: Chulam Publishing Company, 2011. https://doi.org/10.4324/9781315757421
  13. H. S. Lee, J. H. Lim, Structural Equation Model Analysis and AMOS 16.0. Gyeonggi Province: Hwamwonsa Temple, 2009.
  14. S. G. Min, G. I. Kim, D. K.. Kim, S. Y. Seon, Development of the Korean Version of the World Health Organization Quality of Life Scale (WHOQOL-BREF), Neuropsychology, Vol.39, No.3, pp.571-579, 2000. DOI:http://dx.doi.org/10.1023/A:1016351406336
  15. M. R. Song, M. J. Kim, M. E. Lee, I. B. Lee, M. R. Shu, A Study on Self-efficacy and Self-care of Hemodialysis Patients. Journal of Korean Academy of Nursing, Vol.29, No.3, pp.563-575, 2009.
  16. A. T. Beck, R. A. Steer, G. K. Brown, An Inventory for Measuring Depression, Archives of General Psychiatry, Vol.4, pp.561-571, 1961. DOI: https://doi.org/10.1159/000066239
  17. H. M. Han, T. H. Yeom, Y. O. Shin, G. H. Kim, D. J. Yun, G. J. Jeong, A Study on Standardization of Korean Version of Beck Depression Inventory: Focused on Normal Group Beck Depression Inventory, Neuropsychology, Vol.25, No.3, pp.487-500, 1986. DOI:https://doi.org/10.7599/hmr.2014.34.2.91
  18. J. J. Oh, M. S. Song, S. M. Kim, Research for Development of Sleep Measurement Tool. Korean Journal of Nursing. Vol.28, No.3, pp.563-572, 1998. DOI:https://doi.org/10.1177/136140969900400109
  19. J. H. Kim, The Effect of Indirect Imaging Therapy on Hemodialysis Patients. Nursing Research Institute Seoul National University, 1995.
  20. E. Y. Choi, Fatigue Prediction Model for Hemodialysis Patients. Kyung Hee University Graduate School Doctoral Dissertation, 2005.
  21. A, K. Lee, G. Hicks, G. Nino-Mucria, Validity and Reliability of a Scale to Assess Fatigue. Psychiatry Research, Vol.36, pp.291-298, 1991. https://doi.org/10.1016/0165-1781(91)90027-M
  22. H. R. Kim, A Study on Fatigue and Related Factors in Hemodialysis Patients. Korean Journal of Nursing, Vol.26, No.1, pp.53-71, 1996. DOI: http://doi.org/10.4040/jnas.1996.26.1.53
  23. H. S. Kang, Experimental Study of the Effects of Reinforcement Education for Rehabilitation on Hemiplegia Patients' Self-care Activities, Yonsei University Graduate School Doctoral Thesis, 1984. DOI: https://ir.ymlib.yonsei.ac.kr/handle/22282913/115192
  24. S. Cobb, Social Support as a Moderator of Life Stress. Psychosomatic Medicine, Vol.38, No.5, pp.300-314, 1976. DOI: http://dx.doi.org/10.1097/00006842-197609000-00003
  25. H. W. Kim, Structural Equation Modeling on Quality of Life in Pre-dialysis Patients with Chronic Kidney Disease, Seoul National University Graduate School Doctoral Thesis, 2012. DOI: https://doi.org/10.4040/jkan.2012.42.5.699
  26. M. R. Song, M. J. Kim, M. E. Lee, M. R. Seo, A Study on the Correlation between Self-efficacy and Self-care in Hemodialysis. Korean Journal of Nursing, 29(3). pp.563-575, 1999. DOI: https://doi.org/10.4040/jkan.1999.29.3.563
  27. M. Y. Jo, M. A. Choe, Self-care Behaviors in Patients with Hemodialysis. Basic Nursing Science, Vol.9, No.2, pp.105-117, 2007. DOI: http://hdl.handle.net/10371/9641
  28. H. M. Lee, S. A. Ryu, E. A. Kim, G. S. Jang, Factors Influencing Sleep Disorder in Hemodialysis Patients. Journal of Korean Academy of Medical Sciences, Vol.16, No.2, pp.190-199, 2009. DOI: https://doi.org/10.7739/jkafn.2019.26.1.23
  29. E. H. Kim, G. Y. Lee, Health-related Quality of Life Factors of the Elderly Using Welfare Centers, Korea Society for Advanced Studies, Vol.29, No.2, pp.425-440, 2009. DOI: http://dx.doi.org/10.14257.ilbsbt.2015.7.6.08
  30. N. S. Seo, S. J. Kang, Its Relationship with Symptom Index, Self Efficacy and Family Support in Hemodialysis Patients, Journal of the Korea Acsdemia-Industrial, Vol.16, No.10, pp.6483-6494, 2015. DOI:http://dx.doi.org/10.5762/KAIS.2015.16.10.6483