Treatment regimen adherence and life-satisfaction in hemodialysis patients: A covariance structure analysis

Background. The purpose of this study was to clarify the causal relationship among factors related to treatment regimen adherence and life- satisfaction in hemodialysis patients by a covariance structure analysis. Methods. Self- administered questionnaires were obtained from 209 patients. The variables were as follows (with η representing endogenous latent variables, ξ, exogenous latent variables; and x, observed variables): treatment regimen adherence (η 1), dietary management behavior (x 1); life- satisfaction (η 2), life-satisfaction in hemodialysis patients (x 2); self- determination (η 3), self-determination factor concerning self-care (x 3) and self-determination factor concerning patient-medical staff relationship (x 4); self-efficacy (η 4), self-efficacy for dietary management (x 5); emotional support from medical staff (ξ 1), emotional support from medical doctors (x 6), and emotional support from nurses (x 7). Results. Treatment regimen adherence was directly influenced by self-efficacy (β = 0.978; P < 0.05), and was indirectly influenced by emotional support from medical staff (γ = -0.266; P < 0.05) and self-determination (β = 0.101; P < 0.05). Life- satisfaction was directly influenced by emotional support from medical staff (γ = 0.412; P < 0.05) and self-determination (β = 0.337; P < 0.05), and was indirectly influenced by emotional support from medical staff (γ = -0.266; P < 0.05). The goodness-of-fit-index of this model was 0.93, and the adjusted goodness-of-fit-index was 0.84. Conclusions. (1) The only patient characteristic which had a significant relation with adherence was age over 65 years, and the characteristics which had a significant relation with life- satisfaction were those of living with family and having an occupation. (2) Good adherence regarding dietary behavior was directly influenced by the level of self-efficacy. Less emotional support from medical staff resulted in greater self-determination, leading to higher self-efficacy, which indirectly induced high adherence. (3) The degree of life-satisfaction was directly influenced by the level of emotional support from medical staff and by the degree of self-determination. Less emotional support from medical staff indirectly enhanced self-determination, leading to higher life-satisfaction.