مدل‌ يابي معادلات ساختاري پيروي از درمان بر اساس ويژگي‌هاي شخصيتي، حمايت اجتماعي و ادراك بيماري در بيماران تحت همودياليز

Structural Modeling of Treatment Adherence Based on Personality Traits, Social Support, and Disease Perception in Hemodialysis Patients

زمينه و هدف: همودياليز به‌عنوان شايع‌ترين روش درمان جايگزين كليه در بيماران كليوي، منجربه انواع مشكلات فيزيكي و روان‌شناختي مي‌شود؛ لذا هدف پژوهش حاضر، مدل‌يابي معادلات ساختاري پيروي از درمان براساس ويژگي‌هاي شخصيتي، حمايت اجتماعي و ادراك بيماري در بيماران تحت همودياليز بود. روش‌ بررسي: روش پژوهش توصيفي و طرح پژوهش همبستگي از نوع مدل معادلات ساختاري بود. جامعه‌ٔ آماري را تمامي بيماران كليوي مزمن تحت همودياليز شهر تهران در سال 1397 تشكيل دادند كه از بين آن‌ها، 200 نفر به‌روش نمونه‌گيري دردسترس انتخاب شدند. داده‌ها با استفاده از مقياس پيروي كلي (هيز، 1994)، پرسشنامهٔ شخصيت پنج‌عاملي نئو (كاستا و مك‌كري، 1992)، پرسشــنامهٔ حمايــت اجتماعــي (واكس و همكاران، 1986) و پرسشنامهٔ ادراك بيماري (واينمن و همكاران، 1996) جمع‌آوري شد. تحليل داده‌هاي پژوهش با استفاده از ضريب همبستگي‌ پيرسون و تحليل مسير با نرم‌افزارهاي SPSS نسخهٔ 22 و AMOS نسخهٔ 22 در سطح معناداري 0٫05 صورت گرفت. يافته‌ها: در بيماران تحت همودياليز حمايت اجتماعي رابطهٔ بين عامل روان‌رنجورخويي شخصيت و پيروي از درمان را به‌صورت منفي (0٫001=p، 0٫087-=β) و رابطهٔ بين گشودگي (0٫002=p، 0٫056=β)، توافق‌پذيري (0٫013=p، 0٫046=β) و برون‌گرايي (0٫001=p، 0٫103=β) با پيروي از درمان را به‌صورت مثبت و معنادار ميانجيگري مي‌كند. ادراك منفي از بيماري در بين بيماران تحت همودياليز رابطه بين عامل روان‌رنجورخويي شخصيت و پيروي از درمان را به‌صورت منفي (0٫009=p، 0٫093-=β) و ادراك مثبت از بيماري رابطه بين وظيفه‌شناسي (0٫001=p، 0٫099=β) و توافق‌پذيري را (0٫024=p، 0٫058=β) با پيروي از درمان را به‌صورت مثبت و معنادار ميانجيگري مي‌كند. نتيجه‌گيري: براساس يافته‌هاي پژوهش، ويژگي‌هاي شخصيتي با نقش ميانجي حمايت اجتماعي و ادراك از بيماري مي‌تواند مدل خوبي براي تبيين پيروي از درمان در بيماران تحت همودياليز باشد.

Background & Objectives: Treatment adherence is an essential issue in the field of health that saves numerous lives. Cooperation with pharmacotherapy is vital, especially in chronic diseases. Besides, the patient should properly cooperate in drug use to control the disease and prevent its progression. Stress, anxiety, depression, pain perception, perceived threatening variables, and emotional dysregulation are related to adherence to treatment. All of the mentioned characteristics are concerned with personality traits; thus, personality traits impact adherence to treatment. Social support also affects the treatment and control of chronic diseases. Furthermore, disease perception is effective in increasing the hope of hemodialysis patients and consequently on self–care behaviors and treatment adherence. To increase treatment adherence, health adherence models are required. Therefore, the present study aimed to model the treatment follow–up based on personality traits, social support, and disease perception in patients undergoing hemodialysis. Methods: In terms of correlation, this was structural equation modeling research. The statistical population consisted of all patients with chronic kidney disease in Tehran City, Iran, who underwent hemodialysis, in 2018. To determine the number of samples, the modeling nature of the research was considered. Accordingly, 10 to 15 subjects were required per obvious variable; based on the available variables, 200 individuals were required. Therefore, in this study, 200 patients undergoing hemodialysis in Tehran City, Iran were selected by convenience sampling method from two medical centers in Tehran. The inclusion criteria of the present research were as follows: having chronic kidney disease (as per medical records); undergoing hemodialysis (as per medical records), and having a minimum secondary school of education to understand the questionnaires. The exclusion criterion of the study included not completing the study questionnaires. The required data were collected using the General Adherence Scale (Hayes, 1994), NEO–Five Factor Inventory (NEO–FFI) (Costa and McCare, 1992), Social Support Questionnaire (Vaux et al., 1986), and Illness Perception Questionnaire (Weinman et al., 1996). To analyze the research data, Pearson correlation coefficient and structural equation modeling were used in SPSS and AMOS. The significance level in this study was considered at 0.05. Results: The present study results suggested the negative effect of neuroticism on treatment adherence (β=–0.186, p=0.029). Moreover, the pathway coefficients of openness factors (β=0.120, p=0.031), responsibility (β=0.274, p=0.003), and social support (β=0.292, p=0.002) were positive for treatment adherence. The direct path coefficient between the negative perception of the disease and adherence to treatment was negative and significant (β=–0.235, p=0.005). Besides, social support among hemodialysis patients negatively mediated the relationship between personality neuroticism and adherence to treatment (β=–0.087, p=0.001), and the relationship between openness (β=0.056, p=0.002), agreeableness (β=0.046, p=0.013), and extraversion (β=0.103, p=0.001) by following the treatment was positive and significant. Negative disease perception among hemodialysis patients negatively mediated the relationship between personality neuroticism and adherence to treatment (β=– 0.093, p=0.009), and the relationship between responsibility (β=0.099, p=0.001) and agreeableness (β=0.058, p=0.024) by following the treatment was positive and significant. The goodness of suitability indices also revealed that social support played a mediating role in the relationship between personality traits and treatment adherence (AGFI=0.994, RMSEA=0.006). Moreover, The goodness of suitability indices demonstrated that disease perception played a mediating role in the relationship between personality traits and treatment adherence (AGFI=0.989, RMSEA=0.009). Conclusion: Based on the present study findings, personality traits with the mediating role of social support and illness perception can be a good model for explaining adherence to treatment in hemodialysis patients.