مدل‌یابی معادلات ساختاری پیروی از درمان براساس ویژگی‌های شخصیتی، حمایت اجتماعی و ادراک بیماری در بیماران تحت همودیالیز

زمینه و هدف: همودیالیز به‌عنوان شایع‌ترین روش درمان جایگزین کلیه در بیماران کلیوی، منجربه انواع مشکلات فیزیکی و روان‌شناختی می‌شود؛ لذا هدف پژوهش حاضر، مدل‌یابی معادلات ساختاری پیروی از درمان براساس ویژگی‌های شخصیتی، حمایت اجتماعی و ادراک بیماری در بیماران تحت همودیالیز بود.روش‌بررسی: روش پژوهش توصیفی و طرح پژوهش همبستگی از نوع مدل معادلات ساختاری بود. جامعه‌ٔ آماری را تمامی بیماران کلیوی مزمن تحت همودیالیز شهر تهران در سال 1397 تشکیل دادند که از بین آن‌ها، 200 نفر به‌روش نمونه‌گیری دردسترس انتخاب شدند. داده‌ها با استفاده از مقیاس پیروی کلی (هیز، 1994)، پرسشنامهٔ شخصیت پنج‌عاملی نئو (کاستا و مک‌کری، 1992)، پرسشنامهٔ حمایت اجتماعی (واکس و همکاران، 1986) و پرسشنامهٔ ادراک بیماری (واینمن و همکاران، 1996) جمع‌آوری شد. تحلیل داده‌های پژوهش با استفاده از ضریب همبستگی‌ پیرسون و تحلیل مسیر با نرم‌افزارهای spss نسخهٔ 22 و amos نسخهٔ 22 در سطح معناداری 0٫05 صورت گرفت.یافته‌ها: در بیماران تحت همودیالیز حمایت اجتماعی رابطهٔ بین عامل روان‌رنجورخویی شخصیت و پیروی از درمان را به‌صورت منفی (0٫001=p، 0٫087-=β) و رابطهٔ بین گشودگی (0٫002=p، 0٫056=β)، توافق‌پذیری (0٫013=p، 0٫046=β) و برون‌گرایی (0٫001=p، 0٫103=β) با پیروی از درمان را به‌صورت مثبت و معنادار میانجیگری می‌کند. ادراک منفی از بیماری در بین بیماران تحت همودیالیز رابطه بین عامل روان‌رنجورخویی شخصیت و پیروی از درمان را به‌صورت منفی (0٫009=p، 0٫093-=β) و ادراک مثبت از بیماری رابطه بین وظیفه‌شناسی (0٫001=p، 0٫099=β)  و توافق‌پذیری را (0٫024=p، 0٫058=β) با پیروی از درمان را به‌صورت مثبت و معنادار میانجیگری می‌کند.نتیجه‌گیری: براساس یافته‌های پژوهش، ویژگی‌های شخصیتی با نقش میانجی حمایت اجتماعی و ادراک از بیماری می‌تواند مدل خوبی برای تبیین پیروی از درمان در بیماران تحت همودیالیز باشد.

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

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.