Self-management and associated factors among patients with end-stage renal disease undergoing hemodialysis at health facilities in Addis Ababa, Ethiopia

Abstract

IntroductionPatients with end-stage renal disease (ESRD) face multifaceted problems arising from complications of the disease and dialysis that require consistent and, effective self-management from the patients’ side, on top of the management offered by health care professionals. However, little is known about the level of self-management and influencing factors among patients with ESRD undergoing hemodialysis in the study area. Therefore, the aim of this study was to assess self-management and associated factors of patients with ESRD undergoing hemodialysis at health facilities in Addis Ababa, Ethiopia.MethodsAn institution-based cross-sectional survey was used to recruit 169 patients with ESRD undergoing hemodialysis from six private health facilities between March and April 2016. Data were collected using an interviewer-administered structured questionnaire inquiring about patients’ self-management and associated factors. Data were entered into EpiData Version 3.1 and analyzed using the descriptive, correlation, and logistic regression using the SPSS Version 22.0 statistical software.ResultsThe mean age of the patients was 49.86±15.58 years. The majority of the respondents (69.8%) were male, and 65.7% of them were married. Half of the respondents (50.3%) had diploma and above educational level. The great majority of the respondents (93.5%) were on hemodialysis for less than 5 years, and 53.3% of them underwent dialysis twice a week. More than half (57.4%) of the patients had low levels of self-management. There were statistically significant positive associations between self-management and education (adjusted OR [AOR] =6.25, 95% CI =1.40, 27.85), knowledge (AOR =5.5, 95% CI =2.15, 14.03), and self-efficacy (AOR =4.73, 95% CI =1.95, 11.48), while there were statistically significant negative associations between self-management and anxiety (AOR =3.19, 95% CI =1.28, 7.95) and depression (AOR =2.68, 95% CI =1.01, 7.05, P<0.05).ConclusionPatients’ education, knowledge, self-efficacy, anxiety, and depression were found to be independent predictors of self-management.

Factors Influencing Self-Efficacy and Self-Management among Patients with Pre-End-Stage Renal Disease (Pre-ESRD)

“…A higher education level is usually associated with greater knowledge. Knowledge in general has a major impact on self-management, self-efficacy, and the foundations of decision making [ 3 , 10 , 29 ]. Illness-specific knowledge is also significantly positively correlated with self-management and self-efficacy [ 29 ].…”

“…This finding agrees with previous studies demonstrating that self-efficacy has a significant and reciprocal influence on overall self-management [ 3 , 7 , 11 , 19 , 25 , 29 , 30 , 31 ]. Patients with a high level of self-efficacy have better self-management, especially in the category of self-care [ 3 , 10 ]. Self-efficacy can help the patient to engage in self-management behaviours and vice versa [ 3 , 7 , 25 ].…”

“…The literature shows that self-management in such patients is not currently ideal, but the influence of various factors on self-management has not yet been studied in detail [ 3 ]. However, education and knowledge, in addition to depression and anxiety, have been found to affect self-management in these patients [ 10 ]. By studying these related factors, we can suggest interventions to improve their self-management.…”

“…Self-efficacy was found to be an independent predictor of self-management in ESRD patients [ 10 ]. Self-efficacy is defined as a patient’s confidence in their ability to adhere to the treatment and manage their disease [ 11 ].…”

<p>Incidence and Predictors of Congestive Heart Failure Among Hemodialysis Patients at Felege Hiote Referral Hospital, Northwest Ethiopia, 2020: Retrospective Cohort Study</p>

“…A similar study in Ethiopia reported statistically significant positive associations between self-management and education. 23 In addition, our study demonstrated that underweight patients (BMI <18.5) are 1.6 times more likely to develop CHF than those who have normal weight . This finding is in line with a systematic review in Asia, 24 the USA 25,26 , Sweden 25 and Germany.…”