Factors associated with self-care behavior in patients with pre-dialysis or dialysis-dependent chronic kidney disease

Factors associated with self-care behavior in patients with chronic kidney disease: a systematic review

BACKGROUND

Chronic kidney disease (CKD) is a significant global health issue associated with cardiovascular risk, elevated morbidity and mortality rates, reduced quality of life, and high medical costs. Self-care behavior (SCB) is an effective strategy for mitigating the negative impacts of CKD. Identifying factors that influence SCB in CKD patients is essential for improving clinical outcomes. This study analyzes the factors affecting self-care behavior in patients with CKD.

METHODS

A structured search was conducted on PubMed and EBSCO up to June 10th, 2024. This review was not limited by publication year, published in English, and only full-text articles were included.

RESULTS

A total of 510 articles were identified from both databases. After removing 109 duplicates, 401 articles remained. Sixteen articles met the inclusion criteria. The results showed that several factors were associated with SCB, including health literacy (HL), social support, disease knowledge (DK), age, occupation, income, marital status, place of residence, gender, education, comorbidities, smoking habits, body mass index, participation in CKD programs, duration since CKD diagnosis, CKD stage, psychological factors, therapy compliance, self-efficacy, and laboratory results (triglyceride, PCR urine, hemoglobin, phosphor, and albumin levels).

CONCLUSIONS

The findings indicated that multiple factors can influence SCB in patients with CKD. The most factors that showed a significant association with SCB were age and education in 5 studies, respectively. These findings underscore the importance of addressing patient-specific factors to improve patient SBC through education and counseling from healthcare providers.

Psychometric testing of the cross-culturally adapted Thai version of the Self-Care Self-Efficacy Scale version 3.0 in individuals with chronic illnesses

Objective

To assess the psychometric properties of the Thai version of the Self-Care Self-Efficacy Scale version 3.0 (SCSES-v3.0) in individuals with chronic illnesses. Although originally developed and tested in a Western context, its applicability in Asian populations, including Thailand, remains inadequately explored.

Methods

Psychometric tests were guided by COSMIN principles. This included the translation of the English version into Thai based on the ISPOR framework. Nine nursing experts evaluated the content validity. Data were obtained from a multicenter cross-sectional study conducted between July and November 2022. This study included individuals with chronic conditions from 16 primary care centers in Thailand. We tested the structural validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and concurrent validity in relation to the Self-Care of Chronic Illness Inventory version 4.c (SC-CII-v4.c). We tested the scale's reliability with McDonald's ω, Cronbach's α, and the intraclass correlation coefficient (ICC).

Results

The Thai SCSES-v3.0 demonstrated excellent content validity (k = 1.00). The final analysis included a total of 385 participants. The EFA with the first split-half subsample (n = 193) extracted a two-factor structure. One reflected SCSES for maintenance and monitoring behaviors and another captured SCSES for management behaviors (item 6-10). CFA with the second split-half subsample (n = 192) and the overall sample (n = 385) supported the scale's two-factor model with high factor loadings. Each dimension and the overall SCSES-v3.0 positively correlated with each scale and the overall SC-CII-v4.c. McDonald's ω and Cronbach's α (both ranged 0.91-0.94) and ICC (ranged 0.95-0.96), indicated excellent internal reliability and test-retest reliability, respectively.

Conclusions

The identification of a valid and reliable two-factor model for the Thai SCSES-v3.0 renders it a valuable tool for clinicians and investigators, facilitating the assessment of self-efficacy in self-care across diverse contexts.

Effectiveness of teach-back for chronic kidney disease patient education: A systematic review

BACKGROUND

Education is an essential component in optimising chronic disease self-management. Teach-back is a robust approach in patient education, which is suitable for varying health literacy although its effectiveness in chronic kidney disease patient education is unknown.

OBJECTIVE

To evaluate the impact of teach-back method in health education for improving self-management and adherence to treatment regimens in chronic kidney disease.

DESIGN

Systematic review.

PARTICIPANTS

Adults with any chronic kidney disease grade or treatment modality.

MEASUREMENTS

A comprehensive search was undertaken in MEDLINE, CINHAL, EMBASE, Cochrane library, PsychINFO, Web of Science, ERIC, JBI library and WHO International Clinical Trial Registry to identify published studies from September 2013 to December 2022. The methodological quality of studies was assessed using Joanna Briggs Institute guidelines.

RESULTS

Six studies involving 520 participants were retrieved for this review. A meta-analysis could not be conducted due to substantial heterogeneity between studies. Nevertheless, there was some evidence that teach-back could improve self-management, self-efficacy and knowledge. There was limited evidence on improvement in psychological outcomes or health-related quality of life.

CONCLUSION

Teach-back seems to improve both objective and patient-reported outcomes, although further studies are needed. Using teach-back can improve both understanding of health information and the development of skills. Kidney care teams could use teach-back for all patients as it takes account of varying patient health literacy abilities. Teach-back assists with communicating important health information to improve patients' knowledge, confidence and skills in self-managing this disease and its treatment.

Assessment of Knowledge on Dietary Management of Chronic Kidney Disease Among Patients Undergoing Hemodialysis at a Tertiary Care Hospital in South India: A Cross-Sectional Analytical Study

Background This cross-sectional analytical study aimed to assess the level of knowledge on dietary management of chronic kidney disease (CKD) among patients undergoing hemodialysis in a tertiary care hospital in Puducherry, South India. Methodology The study was conducted among 86 inpatients diagnosed with CKD and undergoing hemodialysis in the dialysis unit. They were selected by simple random sampling. The self-administered, validated, self-structured questionnaire was used to collect the data. The study was conducted from May to September 2019. Descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (chi-square) were used to find out the relationship between the level of knowledge and background variables using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). Results The findings indicated that the majority of patients were in the 20-30 age range (36, 41.9%), male (58, 67.4%), from nuclear families (58, 66.3%), with mixed dietary habits (60, 69.8%), and undergoing thrice-weekly hemodialysis (34, 53.5%). Additionally, 59 (68.6%) were hypertensive and 14 (16.3%) were diabetic. Most patients exhibited a moderate level of knowledge (74, 86%), while a small percentage had inadequate (6, 7%) and adequate (6, 7%) knowledge, with a mean (SD) value of 2.00 (0.376). The study identified statistically significant associations between knowledge levels and age, occupation, food habits, duration of dialysis, pre-existing co-morbid illnesses, and treatment of hemodialysis with a p-value <0.05. Conclusions In conclusion, this study highlights that the majority of the CKD patients undergoing hemodialysis exhibit moderately adequate knowledge of dietary management. However, a notable need remains for further education and support in this area. Addressing these knowledge gaps is crucial, as it can empower nursing students and healthcare professionals to educate these patients on their dietary needs effectively. By providing comprehensive education and support, we can enhance the quality of care and improve outcomes for hemodialysis patients.

Patient engagement during the transition from nondialysis-dependent chronic kidney disease to dialysis: A meta-ethnography

INTRODUCTION

Patient engagement, encompassing both patient experience and opportunities for involvement in care, has been associated with increased patient satisfaction and the overall quality of care. Despite its importance, there is limited knowledge regarding patient engagement in the transition from nondialysis-dependent chronic kidney disease (CKD) to dialysis-dependent treatment. This systematic review employs meta-ethnography to synthesize findings from qualitative studies examining patients' experiences of engagement during this transition, with the aim of developing a comprehensive theoretical understanding of patient engagement in the transition from nondialysis-dependent CKD to dialysis.

METHODS

A systematic search of six databases, namely the Cochrane Library, PsycINFO, Scopus, Embase, PubMed and Web of Science was conducted to identify eligible articles published between 1990 and 2022. Meta-ethnography was utilized to translate and synthesize the findings and develop a novel theoretical interpretation of 'patient engagement' during the transition to dialysis.

RESULTS

A total of 24 articles were deemed eligible for review, representing 21 studies. Patient engagement during a transition to dialysis was found to encompass three major domains: psychosocial adjustment, decision-making and engagement in self-care. These three domains could be experienced as an iterative and mutually reinforcing process, guiding patients toward achieving control and proficiency in their lives as they adapt to dialysis. Additionally, patient engagement could be facilitated by factors including patients' basic capability to engage, the provision of appropriate education, the establishment of supportive relationships and the alignment with values and resources.

CONCLUSIONS

The findings of this review underscore the necessity of involving patients in transitional dialysis care, emphasizing the need to foster their engagement across multiple domains. Recommendations for future interventions include the provision of comprehensive support to enhance patient engagement during this critical transition phase. Additional research is warranted to explore the effects of various facilitators at different levels.

PATIENT OR PUBLIC CONTRIBUTION

The studies included in our review involved 633 participants (547 patients, 14 family members, 63 healthcare providers and 9 managers). Based on their experiences, views and beliefs, we developed a deeper understanding of patient engagement and how to foster it in the future.

The factors of perceived disease knowledge and self-care behavior in type 2 diabetic patients with chronic kidney disease: A cross-sectional study

Chronic kidney diseases (CKD) is an important public health issue worldwide, and diabetes mellitus is the main cause of CKD. Having sufficient disease knowledge and good self-care behavior both help to prevent the progression of diabetes mellitus and CKD. This cross-sectional study enrolled 181 type 2 diabetic patients with CKD from July 2017 to October 2017. Perceived Kidney Knowledge survey and structured questionnaires of self-care behavior were used to measure perceived disease knowledge and CKD Self-Care (CKDSC) scales respectively with the determinants analyzed by linear regression. Meanwhile, socio-demographic information, kidney function and laboratory data were collected. Of 181 enrolled patients, the mean age was 66.8 ± 9.7 years, 59.1% were male and the mean estimated glomerular filtration rate was 33.1 ± 23.1 mL/min/1.73 m2. The mean scores of CKDSC and perceived disease knowledge were 63.2 and 22.4, respectively. High scores of disease knowledge were significantly correlated with low glycated hemoglobin (P = .03) and high scores of overall self-care behavior (P = .03) and aspects of self-care behavior, including diet (P = .003), exercise (P = .02), and home blood pressure monitoring (P = .04). The relationship between young age and high scores of disease knowledge was found (P = .001); however, old age was significantly associated with high scores of overall self-care behavior (P < .001) while additionally, married patients had high scores of regular medication behavior (P = .03). Our findings identified the significant factors correlated with disease knowledge and self-care behavior in type 2 diabetic patients with CKD. Healthcare givers should establish personalized health education plans to improve perceived disease knowledge and self-care behavior.