A Causal model of self-management among older persons with chronic kidney disease at predialysis stage

Abstract

The ability of older persons to self-manage chronic kidney disease (CKD) in the earlier predialysis stages needs to be enhanced before entering the end stage of the disease in order to maintain their well-being. Knowledge of factors predicting their self-management is needed for planning self-managing enhancement. This cross- sectional predictive study aimed to examine the causal relationships among physical functions in basic activity of daily living (ADLs) and instrumental ADLs, cognitive function, CKD knowledge, self-efficacy, social support from family and health care stage. The conceptual framework of this study was based on Curtin’s framework forself-management in CKD disease and Bandura’s self-efficacy theory. A total of 216 Thai older persons with stage III-V of CKD at the predialysis stage were randomly selected using multistage random sampling from six outpatient clinics at public primary and secondary hospitals in areas of Chai Nat and Loburi provinces of the central region of Thailand. Eight instruments were used to collect data including the Demographic Data Form, the Self-Management Behavior Questionnaire, the Modified Barthel Activity of Daily Living Index (BAI), the Chula Activity of Daily Living Index (Chula ADLs), the Chula Mental Test (CMT), the Chronic Kidney Disease Knowledge Scale (CKD Knowledge Scale), the Perceived Self-Management Self-Efficacy Questionnaire (PSMSEQ), and the Social Support from Family and Health Care Providers Questionnaire (SSQ). Reliability coefficients of all scales were found acceptable, ranging from 0.77 - 0.97. Data were analyzed using descriptive statistics, Pearson’s product moment correlation coefficient, and structural equation modeling. The results indicated that: 1. Overall self-management behaviors, communication with health care providers, partnership in care, and self-advocacy were at low levels, self-care activities were at moderate levels, and medication adherence was at a high level. 2. Self-efficacy was highly associated with self-management behaviors, while physical function in basic ADLs and instrumental ADLs, cognitive function, CKD knowledge, family support and health care providers support were slightly and moderately positively associated with overall self-management behaviors. 3. In the causal model of self-management, self-efficacy, physical function in instrumental ADLs, CKD knowledge, and family support had a direct positive effect on self-management behaviors (p < .05), while cognitive function and health care provider support had an indirect positive effect on self-management behaviors via self-efficacy (p < .05). Moreover, self-efficacy was also the mediator between other predictors and self-management. These six predictors explained 47.23% of the variance in self-management behaviors. The study results imply that nurses can enhance self-management behaviors of Thai older persons in the predialysis stage by modifying those predictors.