Do personal resources influence health-related quality of life for people receiving hemodialysis treatment in Latin America?
These negatively affect different areas of life, including physical and psychological health, especially at the emotional, cognitive, and social levels, considerably impairing health-related quality of life (HRQOL; Contreras, Esguerra, Espinosa, & Gomez, 2007; Urzua, Pavlov, Cortes, & Pino, 2011). HRQOL is used in a patient-reported evaluation of quality of life changes resulting from medical intervention (Urzua, 2010).
Measuring HRQOL of patients with chronic diseases, such as ESRD, is increasingly important, because, inter alia, it helps in assessing the quality of care and the efficacy of medical intervention, improves clinical decision making and the estimation of health care needs in communities (Schwartzmann, 2003; Urzua, 2010), and facilitates the identification of the risk of mortality (Contreras et al., 2007; Joyce et al., 2012). Therefore, in the assessment of health care policy, it is worth considering decisions that affect HRQOL self-reporting in the hemodialysis population (Gorodetskaya et al., 2005).
In general, people who are undergoing hemodialysis have significantly lower HRQOL compared with both the general population and individuals with transplants, with small variations because of differences in cultural factors (Merkus et al., 1997; Spiegel, Melmed, Robbins, & Esrailian, 2008). Various researchers have reported that HRQOL of individuals undergoing hemodialysis is related to factors such as sex (Alvarez-Ude et al., 2001; Germin-Petrovic et al., 2011; Vazquez et al., 2004; Wehbe, Salazar, Vaccaro, Wehbe, & Guerrero, 2004), age (Germin-Petrovic et al., 2011; Moreno Nunez et al., 2004; Patel, Peterson, & Kimmel, 2005; Wehbe et al., 2004), duration of treatment (Munoz Sancho, Oto Royo, Barrio Alonso, & Fernandez, 2006), level of social activities (Kao et al., 2009), family support and expectations (Bayat et al., 2012; Symister, 2011), self-esteem (Wolcott, Nissenson, & Landsverk, 1988), hostility towards others (Tovbin, Gidron, Jean, Granovsky, & Schnieder, 2003), and religious beliefs (Kimmel, Emont, Newmann, Danko, & Moss, 2003; Patel, Shah, Peterson, & Kimmel, 2002). Further, clinical factors, such as the type of dialysis, disease severity, medical compliance, hemoglobin levels, dialysis adequacy, and nutrition, explain a small percentage of the variability in HRQOL. Similarly, hemodialysis patients have shown lower levels of HRQOL compared to peritoneal dialysis patients (Atencio et al., 2004; Leaf & Goldfarb, 2009; Merkus et al., 1997; Morales-Jaimes, Salazar-Martmez, Flores-Villegas, Bochicchio-Riccardelli, & Lopez-Caudana, 2008; Moreno Nunez et al., 2004; Ross et al., 2003; Urzua et al., 2011). In addition, Spiegel et al. (2008) demonstrated that nutritional biomarkers (e.g., albumin, creatinine, body mass index) had moderate to strong relationships with HRQOL.
In the context of this study, personal resources are defined as an individual's support for disease management-related behavior, ranging from proximal support (i.e., family and friends) to distal support (i.e., neighborhood or community; Glasgow, Strycker, Toobert, & Eakin, 2000).
Participation of patients in chronic disease treatment is necessary to prevent specific complications and improve HRQOL (Heidarzadeh, Atashpeika, & Jalilazar, 2010). This includes adherence to a diet, appropriate administration of medication, physical exercise, monitoring of disease symptoms, maintaining regular contact with physicians, searching for information about one's health, and good emotional and social management in interpersonal relationships (Eakin, Bull et al., 2007; Glasgow, Toobert, Barrera, & Strycker, 2005). To support chronic disease self-management, Glasgow et al. (2000) developed the Chronic Illness Resources Survey (CIRS), using a multilevel social-ecological model to assess the support and resources on which people with chronic diseases rely, in terms of family, friends, medical-care teams, and neighborhood/community. Using this survey instrument, various studies have been carried out with samples of patients with nontransmittable chronic diseases, the results of which emphasize the importance of healthy behavior in managing chronic diseases (Glasgow et al., 2000, 2005; Manit, Tuicomepee, Jiamjarasrangsi, & Taneepanichskul, 2011; O'Dell & O'Dell, 2006).
Despite these findings, there have been few studies conducted in Latin America, in which the role that personal resources may have in HRQOL, as perceived by the patient at the time of assessment, has been examined. Our aims in the study were to assess the relationship between personal resources (measured using the CIRS) and HRQOL with a group of patients undergoing hemodialysis in Chile, and to determine which resources influenced the perceptions of these people about their HRQOL. We hypothesized that the personal resources would be positive predictors of the domains of HRQOL that we assessed.
In this observational, cross-sectional study, we recruited a group of individuals with ESRD who were receiving outpatient hemodialysis in Antofagasta, Chile. Of all the people who were receiving hemodialysis in the city, we evaluated 95% of the patients in a private dialysis center and 76% of the patients receiving hemodialysis at the public hospital. Of the 128 people we evaluated, 68% were receiving treatment at the private health center (n = 87) and 32% at the public hospital (n = 41), 50.8% were men and 49.2% were women, and the age range was between 18 and 81 years (M = 56; SD = 13.80). Mean hemodialysis treatment time was 49 months (SD = 46 months, min. = 1, max. = 205). In the period during which data were collected, only 34 of the 128 participants were in paid employment.
Kidney Disease Quality of Life Survey (KDQOL-36[TM]; Hays et al., 1997).
This questionnaire was designed for patients with renal disease undergoing hemodialysis, and was translated and approved in Spain by Alonso (2008). We (The Kidney Disease Quality of Life Working Group) gained permission to use the questionnaire from the authors of the KDQOL, and made grammatical modifications to include the Chilean Spanish terms. The questionnaire contains 36 items organized in two sections comprising (a) a generic module (Items 1 to 12): questionnaire SF-12 (functional health and well-being from the respondent's point of view), and (b) three specific renal disease modules (Items 13 to 36), composed of symptoms of renal disease (12 items), effects of renal disease (eight items), and the burden of renal disease (four items). Items 13-16 are rated using the following response options: completely true (1), fairly certain (2), do not know (3), quite lacking (4), and totally false (5). Items 17-36 are rated using the following response categories: nothing (1), a little (2), fair (3), long (4), and very much (5). These response options are used to assess intensity or frequency.
The SF-12 questionnaire is widely used in population studies (Cunillera et al., 2010; Gandek et al., 1998). It has been validated for the Chilean population and used in surveys of quality of life (QOL) conducted by the Ministry of Health in Chile (Hoffmeister, 2007). Four of the SF-12 items have dichotomous responses (i.e., 0 = no, 1 = yes). Each question is coded numerically and the resulting points are converted into a scale from 0 to 100 points, with higher values reflecting better HRQOL (Morales-Jaimes et al., 2008). Cronbach's alpha reliability for this study was .87 for the overall scale (.72 for SF-12, physical health; .35 for SF-12, mental health; .77 for burden of renal disease; .76 for symptoms of renal disease; and .77 for the effects of renal disease).
Chronic Illness Resources Survey (CIRS; Glasgow et al., 2000). The CIRS contains 22 items grouped into seven categories: personal resources (helpful things that the individual does for him/herself), family and friends (if the individual is accompanied or aided by them in different areas such as diet, monitoring of treatment, physical exercise), healthcare team (medical support), neighbors and community (if the patient shares activities with others), community organizations (national or local organizations, church, volunteer programs), work (if the individual's job is flexible and has available facilities, such as an individual having permission to go to the physician during working hours), and health information (how the individual receives information about his/her illness, e.g., through the media, Internet, or newspapers). The 22 items are rated using ordinal Likert scales with responses ranging from 1 (not at all) to 5 (often).
The reliability and validity of the CIRS was reported by Eakin, Reeves et al. (2007). The internal consistency reliability in this study via Cronbach's alpha was .83 for the overall scale (.65, personal resources; .63, family and friends; .64, healthcare team; .58, neighbors and the community; .55, community organizations; .66, place of work; .52, health information). The CIRS was used to obtain overall indicators of resources, that is, one for individuals in work and another for those out of work, including or excluding the mean for the work condition.
Once permission was obtained from the Ethics Committee of the Universidad Catolica del Norte (Catholic University of the North) and the healthcare institutions involved, information was gathered on patients admitted for kidney hemodialysis treatment. Inclusion criteria were as follows: with a clinical diagnosis of ESRD, having completed at least one month of hemodialysis, aged 18 years or older, and of adequate physical and psychological condition to complete the questionnaires. All participants were informed of the study objectives and signed a consent form. The participants answered the questionnaire individually while the hemodialysis procedure continued, with the mean duration of completion being 45 minutes. The collected data were entered into a database (SPSS version 17.0).
To perform the statistical analyses, Cronbach's alpha was used for reliability analysis. At the descriptive level, frequencies and means were calculated as measures of the central trend. To evaluate differences between participants grouped by various characteristics and responses, student's t test was used. Pearson's r test was used to assess the relationship between ESRD fields and personal resources, and between time undergoing hemodialysis, age, and HRQOL. To determine the relative weight of each type of resource in overcoming the effects of renal disease in each HRQOL field, a multiple regression analysis was performed using the overall points of the scale as a dependent variable and each of the three fields as independent variables. To confirm adequate adjustment of variables to the regression model, F values were obtained to contrast with the null hypothesis, for which the R value is zero, and, therefore, to decide if there was a significant lineal relationship between the assessed resources and the HRQOL fields. If the p value is less than .05, the null hypothesis is rejected and it is confirmed that there is a significant lineal relationship. Our data were, therefore, adjusted to the regression model.
Analysis of HRQOL
Table 1 shows the means reported for the fields assessed using the KDQOL-36[TM], according to sex, type of establishment where the individual was receiving treatment, and overall sample. Statistically significant gender differences were found only for symptoms, for which the mean for women was significantly lower than that for men (t(126) = 2.809, p < .05). No statistically significant differences were found for type of establishment.
No relationship was found between time undergoing hemodialysis and point totals of the fields of HRQOL. The only field that had a significant correlation with age was physical health in SF-12 (r = -.279, p < .01), indicating that older participants reported worse physical health.
Personal Resources and HRQOL
It is evident from the results shows in Table 2 that perceived resources from one's neighbors and community were positively and significantly correlated with each HRQOL field, and personal resources were positively correlated with each HRQOL field, except for mental health in SF-12. Similarly, the perceived resources from community organizations had a positive correlation with the HRQOL field effects of renal disease. The remaining evaluated resources had no statistically significant relationship with the HRQOL fields reported by KDQOL-36[TM].
When incorporating the work field, it became evident that among those who were in paid employment there was a directly proportional relationship between the effects of renal disease, burden of renal disease, and physical health in SF-12 and all resources. This was because the instrument contains a module that is used
to measure effects at work, and was thus completed only by those respondents who were in paid employment. This module further allowed for substratification of those who were, and those who were not, in paid employment, whereby we found that in those who not in paid employment, the total score of the scale of resources was positively correlated with three domains of HRQOL that we assessed (effects of renal disease, burden of renal disease, and physical health).
In Table 3 the results show the level of significance for each independent variable as well as the relative weight of each variable in the regression model, for each HRQOL field.
As is shown in Table 3, only personal resources in the symptoms of renal disease field, neighbor resources in the effects of renal disease field, personal and neighbor resources in the burden of renal disease field, and neighbor resources in physical health had significant lineal correlations with HRQOL, and significantly influenced the model.
Resources that are significant have a relative weight in the regression model, similar to those in the specific renal disease fields, but unlike the general physical health field, in which the neighbor resources acquire a relatively higher weight. It is in the latter field that the variation is explained mainly by factors included in the model; hence, the 23.1% of variance explained by the physical health variable.
In this study we analyzed the relationship between personal resources and perceived HRQOL in individuals undergoing hemodialysis. Our results are
not consistent with those of the majority of researchers, who found differences between men and women in terms of HRQOL (Alvares et al., 2012; Arenas et al., 2004; Bayoumi et al., 2013; Germin-Petrovic et al., 2011; Jofre, 1999; Rodriguez Zamora, 2008; Vazquez et al., 2004). Several researchers have suggested that when people reach adulthood or later stages of life, they achieve higher levels of well-being and satisfaction with life, and are better able to manage chronic disease emotionally as they have become more experienced in coping with stressful events. Further, as health problems are a common type of stressor, such issues are, therefore, expected or predicted by people and it is easier for them to adapt (Yanguas Lezaun, 2006). In our study, the only significant differences we found were in the symptoms field, that is, men reported more symptoms than did women. This result does not agree with that of Vazquez et al. (2004), who found no differences between men and women in severity of disease symptoms.
Therefore, we recommend that researchers develop systematic studies with representative population samples to analyze mean factors and coordinate the perception of HRQOL in men and women being treated for ESRD because of the importance of this relationship with clinical care, for example, emotional status (Alvarez-Ude et al., 2001), associated diseases (Alvares et al., 2012; Arenas et al., 2004; Germin-Petrovic et al., 2011), impaired touch, sight, or hearing (Rodriguez Zamora, 2008), sociocultural context (Rambod & Rafii, 2010; Untas et al., 2011), social and marital status, (Alvares et al., 2012; Weisbord et al., 2008), style of coping, especially spiritual/religious (Saffari et al., 2013), and any type of instrument used that could mask HRQOL results if the instrument does not specify nonclinical depression (Jofre, 1999).
We found that the duration of hemodialysis was not related to HRQOL. This is possibly because patients receive four years of treatment, during which there is ample opportunity for them to understand what hemodialysis involves and what its effects are, and control these effects (Ryan & Brown, 2003). Nevertheless, other researchers have revealed that hemodialysis duration predicts lower HRQOL. For example, the treatment duration was found to be positively correlated with mental health, the number of hours in hemodialysis was also found to be negatively correlated with physical health (Guerra-Guerrero, Sanhueza-Alvarado, & Caceres-Espina, 2012), and it has also been reported that a shorter duration of hemodialysis led to higher HRQOL (Bohlke et al., 2008; Germin-Petrovic et al., 2011; Martins & Cesarino, 2005; Morsch, Gongalves, & Barros, 2006). In contrast, Arenas et al. (2004) reported that a longer duration resulted in worse HRQOL. This suggests that it would be valuable to develop studies in which other variables, such as age and perceived quality of care with HRQOL, are analyzed over different hemodialysis durations.
However, we found that aging had an impact on physical health (SF-12), but not on the other HRQOL fields, which corroborates the findings of previous researchers (Anees, Hameed, Mumtaz, Ibrahim, & Saeed Kahn, 2011; Bayoumi et al., 2013; Botero de Mejia & Pico Merchan, 2007; Rodriguez Zamora, 2008). In elderly patients undergoing hemodialysis, higher mental HRQOL was found along with a lower quality of physical health (Alvares et al., 2012). This is in part because normal physical deterioration is linked with gradual decline caused by renal disease (Yanguas Lezaun, 2006). Because hemodialysis requires four hours of treatment for each session, plus traveling time, as well as eight hours spent in medical consultation, it is understandable that the patient feels exhausted (Rodriguez Zamora, 2008).
It is also noteworthy that the dimension of effects of renal disease in HRQOL was the only one with a positive correlation with resources offered by community organizations. Although the correlation was weak, the result indicated that the participation of people undergoing hemodialysis treatment in gatherings and social meetings held locally or in the community, such as a church, health center, or recreation facility may be a useful treatment option. We suggest that future researchers conduct an analysis of the relationship between informational social support and HRQOL of people receiving hemodialysis treatment. HRQOL has been reported to improve as a result of access to information (Germin-Petrovic et al., 2011). In addition, information received by patients being treated for ESRD promotes treatment compliance, frequent guidance helps patients in adapting their lifestyle to reduce comorbidity (Abraham, Venu, Ramachandran, Chandran, & Raman, 2012), and advice helps to delay the progression of renal insufficiency (Abraham & Ramachandran, 2012).
Similarly, the personal resources of people receiving hemodialysis treatment, such as personal goals and projects, and organizing time and daily routines to do more to address health problems, as well as neighbors and community resources, such as recreation, sport, information, safety, and websites that offer healthy food options positively associated with improvement in symptoms of renal disease, the burden and effects of renal disease, and physical health. In this study, personal resources had a positive influence on the symptoms and burden of renal disease on HRQOL. In addition, of all the resources named in the CIRS questionnaire, neighbors and community resources were the only type found to have a positive influence on physical health and on the burden and effects of renal disease in HRQOL. It has been found that for individuals receiving treatment for ESRD, physical exercise improves their general health status and levels of energy, and reduces hemodialysis time owing to reduced fluid retention, leading to improvement in HRQOL (Fayad Saeta, Escalona Labaceno, & Feraud Temo, 2005). Greater variety in recreational activities and daily routine is also associated with a positive assessment of HRQOL and with more social relationships (Rodriguez Zamora, 2008).
With regard to social-environmental and personal support related to self-management of renal disease in patients who are not in paid employment, there is a better perception of HRQOL in terms of physical health, and the effects and burden of renal disease. It has been found that unemployment negatively affects QOL in hemodialysis patients (Bayoumi et al., 2013), and being employed promotes a better QOL (Alvarez-Ude, 2011). It is, therefore, important that the focus in a patient's health care during hemodialysis is on assisting the individual in the identification and use of resources on which they rely in their social, community, and environmental surroundings, to promote HRQOL in times of unemployment.
Finally, the burden of the disease in HRQOL was influenced by personal resources, neighbors, and community resources. Neighbors and the community had a greater correlation with, and influence on, both physical health and mental health in SF-12, and none of the chronic illness resources had weight on mental health in SF-12, only for correlation. It should be noted that the group of people receiving hemodialysis is composed of individuals who are approaching old age, with a longer recommended hemodialysis time, deterioration due to renal disease, and possibly decreased mobility. Among patients undergoing hemodialysis, a negative HRQOL value has been found in the fields of environmental and family surroundings, and social relationships. These people perceive less support from the community with regard to the quality and availability of health care services, transport, recreation, finances, and opportunities to acquire knowledge and learn customs (Theofilou, 2011). This may explain why mental health was not affected by personal resources, regardless of how the respondent felt emotionally. Physical functioning took precedence, with physical activity being the greatest difficulty for elderly patients (Li, Li, & Fan, 2010). Future researchers could analyze the effects of mobility and travel on physical and mental health in HRQOL in different age brackets among those being treated for ESRD.
The results in this study show the importance of the availability and use of measures required for the community to make people's life more bearable when renal disease is a time-consuming burden, and also the importance of protecting their physical health. QOL is determined not only by assessing physical and functional status, but also by social and community surroundings (Yeung & Towers, 2014). Patients' support system and integration in the community promote a higher perception of independence (Lenci & Campbell, 2012) and capacity for self-care (Heidarzadeh et al., 2010). This suggests the need for better planning of health care by supporting resources that people receiving hemodialysis treatment rely on, and by developing intervention programs closely adapted to the needs of older persons, especially with regard to physical needs (Klinkmann & Vienken, 2008), and for those who are unemployed, to promote HRQOL in general. The data presented here, though preliminary, indicate the need to continue systematic study of the influence of personal resources in HRQOL, by controlling for more sociodemographic and clinical variables in various types of population samples of people with ESRD who are receiving hemodialysis treatment.
There are some limitations in this study. First, as the study design was cross-sectional, our results cannot imply causality. Longitudinal research on personal resources and HRQOL of people undergoing hemodialysis is needed. Second, the sample may not be representative of the entire Latin American population of people who are receiving hemodialysis. Therefore, further confirmation is required, using more diverse and larger groups of people with ESRD who are receiving hemodialysis treatment.
Abraham, S., & Ramachandran, A. (2012). Estimation of quality of life in haemodialysis patients. Indian Journal of Pharmaceutical Sciences, 74, 583-587. http://doi.org/xbg
Abraham, S., Venu, A., Ramachandran, A., Chandran, P. M., & Raman, S. (2012). Assessment of quality of life in patients on hemodialysis and the impact of counseling. Saudi Journal of Kidney Diseases and Transplantation, 23, 953-957. http://doi.org/xbh
Alonso, J. (2008). Kidney disease quality of life--SF-36 M--Spanish version. Unpublished questionnaire.
Alvares, J., Cesar, C. C., de Assis Acurcio, F., Andrade, E. I., & Cherchiglia, M. L. (2012). Quality of life of patients in renal replacement therapy in Brazil: Comparison of treatment modalities. Quality of Life Research, 21, 983-991. http://doi.org/c97j75
Alvarez-Ude, F. (2011). Factores asociados al estado de salud percibido (calidad de vida relacionada con la salud) de los pacientes en hemodialisis cronica [Factors associated with perceived health status (quality of life related to health) of patients on chronic hemodialysis]. Revista de la Sociedad Espahola de Enfermeria Nefrologica, 14, 64-68.
Alvarez-Ude, F., Fernandez-Reyes, M., Vazquez, A., Mon, C., Sanchez, R., & Rebollo, P. (2001). Sintomas fisicos y trastornos emocionales en pacientes en programa de hemodialisis periodicas [Physical symptoms and emotional disorders in patients on a regular hemodialysis program]. Nefrologia, 21, 191-199.
Anees, M., Hameed, F., Mumtaz, A., Ibrahim, M., & Saeed Khan, M. N. (2011). Dialysis-related factors affecting quality of life in patients on hemodialysis. Iranian Journal of Kidney Diseases, 5, 9-14.
Arenas, M. D., Moreno, E., Reig, A., Millan, I., Egea, J. J., Amoedo, M. L., ... Sirvent, A. E. (2004). Evaluacion de salud calidad de vida (CVRS) en base a informacion de Coop/Wonca en pacientes de hemodialysis [Evaluation of health-related quality of life (HRQOL) based on information from Coop/Wonca sheets in hemodialysis patients]. Nefrologia, 24, 470-479.
Atencio, B., Nucette, E., Colina, J., Sumalave, H., Gomez, F., & Hinestroza, D. (2004). Evaluacion de la depresion y ansiedad en pacientes con insuficiencia renal cronica sometidos a hemodialisis [Evaluation of depression and anxiety in patients with chronic renal failure undergoing hemodialysis]. Archivos Venezolanos de Psiquiatria y Neurologia, 50, 35-40.
Australian Institute of Health and Welfare. (2010). Chronic kidney disease hospitalisations in Australia 2000-01 to 2007-08. Canberra, Australia: Author. Retrieved from
Bayat, A., Kazemi, R., Mohebi, B., Toghiani, A., Tabatabaee, M., & Adibi, N. (2012). Psychological evaluation in hemodialysis patients. Journal of the Pakistan Medical Association, 62, 1-5.
Bayoumi, M., Al Harbi, A., Al Suwaida, A., Al Ghonaim, M., Al Wakeel, J., & Mishkiry, A. (2013). Predictors of quality of life in hemodialysis patients. Saudi Journal of Kidney Diseases and Transplantation, 24, 254-259. http://doi.org/xbj
Bohlke, M., Nunes, D. L., Marini, S. S., Kitamura, C., Andrade, M., & Ost Von-Gysel, M. (2008). Predictors of quality of life among patients on dialysis in southern Brazil. Sao Paulo Medical Journal, 126, 252-256. http://doi.org/bd9vd3
Botero de Mejia, B. E., & Pico Merchan, M. E. (2007). Calidad de vida relacionada con la salud (CVRS) en adultos mayores de 60 anos: Una aproximacion teorica [Quality of life related to health (QLRH) in seniors over 60 years old: A theoretical approach]. Revista Hacia la Promocion de la Salud, 12, 11-24.
Contreras, F., Esguerra, G., Espinosa, J. C., & Gomez, V. (2007). Estilos de afrontamiento y calidad de vida en pacientes con insuficiencia renal cronica (IRC) en tratamiento de hemodialisis [Coping styles and quality of life in patients with chronic kidney disease (CKD) in treatment with haemodialysis]. Acta Colombiana de Psicologta, 10, 169-179.
Cunillera, O., Tresserras, R., Rajmil, L., Vilagut, G., Brugulat, P., Herdman, M., ... Ferrer, M. (2010). Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey. Quality of Life Research, 19, 853-864. http://doi.org/bb26q3
Eakin, E., Bull, S., Riley, K., Reeves, M., McLaughlin, P., & Gutierrez, S. (2007). Resources for health: A primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions. Health Psychology, 26, 392-400. http://doi.org/bstsw5
Eakin, E., Reeves, M., Bull, S., Floyd, S., Riley, K., & Glasgow, R. (2007). Validation of the Spanish-language version of the Chronic Illness Resources Survey. International Journal of Behavioral Medicine, 14, 76-85. http://doi.org/b4s68v
Fayad Saeta, S., Escalona Labaceno, R., & Feraud Temo, G. (2005). El ejercicio fisico en el tratamiento del enfermo con insuficiencia renal cronica (IRC) [Physical exercise and the treatment of patients with chronic renal failure (CRF)]. Cuadernos de Psicologta del Deporte, 5, 1-16.
Gandek, B., Ware, J. E., Aaronson, N., Apolone, G., Bjorner, J., Brazier, J., ... Sullivan, M. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. Journal of Clinical Epidemiology, 51, 1171-1178. http:// doi.org/dj2z69
Germin-Petrovic, D., Mesaros-Devcic, I., Lesac, A., Mandic, M., Soldatic, M., Vezmar, D., ... Racki, S. (2011). Health-related quality of life in the patients on maintenance hemodialysis: The analysis of demographic and clinical factors. Collegium Antropologicum, 35, 687-693.
Glasgow, R. E., Strycker, L. A., Toobert, D. J., & Eakin, E. (2000). A social-ecologic approach to assessing support for disease self-management: The Chronic Illness Resources Survey. Journal of Behavioral Medicine, 23, 559-583. http://doi.org/fgh8wp
Glasgow, R. E., Toobert, D. J., Barrera, M., Jr., & Strycker, L. A. (2005). The Chronic Illness Resources Survey: Cross-validation and sensitivity to intervention. Health Education Research, 20, 402-409. http://doi.org/cbrx58
Gorodetskaya, I., Zenios, S., McCulloch, C. E., Bostrom, A., Hsu, C.-Y., Bindman, A. B., ... Chertow, G. M. (2005). Health-related quality of life and estimates of utility in chronic kidney disease. Kidney International, 68, 2801-2808. http://doi.org/dd7696
Guerra-Guerrero, V., Sanhueza-Alvarado, O., & Caceres-Espina, M. (2012). Calidad de vida de personas en hemodialisis cronica: Relacion con variables sociodemograficas, medico-clinicas y de laboratorio [Quality of life of people with chronic hemodialysis: Association with sociodemographic, medical-clinical and laboratory variables]. Revista Latino-Americana de Enfermagem, 20, 234-345. http://doi.org/xbk
Hays, R., Kallich, J., Mapes, D., Coons, S., Amin, N., Carter, W., & Kamberg, C. (1997). Kidney Disease Quality of Life Short Form (KDQOL-SFTM]), version 1.3: A manual for use and scoring. Retrieved from http://bit.ly/lC6jg2Z
Heidarzadeh, M., Atashpeikar, S., & Jalilazar, T. (2010). Relationship between quality of life and self-care ability in patients receiving hemodialysis. Iranian Journal of Nursing and Midwifery Research, 15, 71-76.
Hoffmeister, L. (2007). Normas poblacionales del Cuestionario de Calidad de Vida Relacionada a la Salud, SF-12 para poblacion chilena adulta, 2007 [Population standards of the Quality of Life Questionnaire in relation to health, SF-12 for adult Chilean population, 2007]. Ministerio de Salud de Chile. Encuesta de Calidad de vida 2006. Retrieved from http://www.minsal.cl/
Jofre, R. (1999). Factores que afectan a la calidad de vida en pacientes en predialisis, dialisis y trasplante renal [Factors affecting the quality of life in patients on predialysis, dialysis and renal transplantation]. Nefrologia, 19, S84-S90.
Joyce, V. R., Smith, M. W., Johansen, K. L., Unruh, M. L., Siroka, A. M., O'Connor, T. Z., ... Veteran Affairs/National Institutes of Health Acute Renal Failure Trial Network. (2012). Health-related quality of life as a predictor of mortality among survivors of AKI. Clinical Journal of the American Society of Nephrology, 7, 1063-1070. http://doi.org/xbn
Kao, T.-W., Lai, M.-S., Tsai, T.-J., Jan, C.-F., Chie, W.-C., & Chen, W.-Y. (2009). Economic, social, and psychological factors associated with health-related quality of life of chronic hemodialysis patients in Northern Taiwan: A multicenter study. Artificial Organs, 33, 61-68. http://doi.org/ fsw83t
Kimmel, P. L., Emont, S. L., Newmann, J. M., Danko, H., & Moss, A. H. (2003). ESRD patient quality of life: Symptoms, spiritual beliefs, psychosocial factors, and ethnicity. American Journal of Kidney Diseases, 42, 713-721. http://doi.org/bz6htw
Klinkmann, H., & Vienken, J. (2008). Health is wealth! Is wealth health? Prilozi, 29, 13-23.
Leaf, D. E., & Goldfarb, D. S. (2009). Interpretation and review of health-related quality of life data in CKD patients receiving treatment for anemia. Kidney International, 75, 15-24. http://doi.org/ dzhswz
Lenci, L. T., & Campbell, J. D. (2012). Peritoneal dialysis in elderly patients. Advances in Peritoneal Dialysis, 28, 79-83.
Li, M., Li, L., & Fan, X. (2010). Patients having haemodialysis: Physical activity and associated factors. Journal of Advanced Nursing, 66, 1338-1345. http://doi.org/bkk3vn
Lorenzo Sellares, V., Torres Ramfrez, A., & Hernandez Marrero, D., & Ayus, J. (Eds.). (1997). Manual de nefrologia clinica, dialisis y trasplante renal [Manual of clinical nephrology, dialysis, and kidney transplantation] (2nd ed.). Madrid, Spain: Harcourt Brace.
Manit, A., Tuicomepee, A., Jiamjarasrangsi, W., & Taneepanichskul, S. (2011). Development of needs and resources for self-management assessment instrument in Thais with type 2 diabetes: Cross-cultural adaptation. Journal of the Medical Association of Thailand, 94, 1304-1313.
Martins, M. R. I., & Cesarino, C. B. (2005). Qualidade de vida de pessoas com doenga renal cronica em tratamento hemodialitico [Quality of life in chronic kidney failure patients receiving hemodialysis treatment]. Revista Latino-Americana de Enfermagem, 13, 670-676. http:// doi.org/ccxx75
Merkus, M. P., Jager, K. J., Dekker, F. W., Boeschoten, E., Stevens, P., Krediet, R. T., & The Necosad Study Group. (1997). Quality of life in patients on chronic dialysis: Self-assessment 3 months after the start of treatment. American Journal of Kidney Diseases, 29, 584-592. http://doi.org/ cwfc5f
Morales-Jaimes, R., Salazar-Martinez, E., Flores-Villegas, F., Bochicchio-Riccardelli, T., & Lopez-Caudana, A. (2008). Calidad de vida relacionada con la salud en los pacientes con tratamiento sustitutivo renal: El papel de la depresion [Quality of life related to health in patients with renal replacement therapy: The role of depression]. Gaceta Medica de Mexico, 144, 91-98.
Moreno Nunez, E., Arenas Jimenez, M., Porta Bellmar, E., Escalant Calpena, L., Canto Garcia, M., Castell Garcia, G., ... Cases Iborra, J. (2004). Estudio de la prevalencia de trastornos ansiosos y depresivos en pacientes en hemodialisis [A study of the prevalence of anxious and depressive disorders in patients receiving haemodialysis]. Revista de la Sociedad Espanola de Enfermerta Nefrologica, 7, 225-233. http://doi.org/dzgpxq
Morsch, C., Gonsalves, L., & Barros, E. (2006). Health-related quality of life among haemodialysis patients--Relationship with clinical indicators, morbidity and mortality. Journal of Clinical Nursing, 15, 498-504. http://doi.org/ftrwpm
Munoz Sancho, R., Oto Royo, A., Barrio Alonso, R., & Fernandez, M. (2006). Evolucion de la calidad de vida en pacientes en hemodialisis: Estudio prospectivo a un ano [Evolution of the quality of life in patients on haemodialysis: One-year prospective study]. Revista de la Sociedad Espanola de Enfermerta Nefrologica, 9, 55-58. http://doi.org/fbpxp4
O'Dell, K., & O'Dell, M. (2006). Socio-ecological resources for diabetes self-management. Journal of the Mississippi State Medical Association, 47, 99-103.
Patel, S., Peterson, R., & Kimmel, P. (2005). Psychosocial factors in patients with chronic kidney disease: The impact of social support on end-stage renal disease. Seminars in Dialysis, 18, 98-102. http://doi.org/fjcxt3
Patel, S., Shah, V., Peterson, R., & Kimmel, P. (2002). Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis. American Journal of Kidney Diseases, 40, 1013-1022. http://doi.org/fj9src
Rambod, M., & Rafii, F. (2010). Perceived social support and quality of life in Iranian hemodialysis patients. Journal of Nursing Scholarship, 42, 242-249. http://doi.org/dkgw7h
Rodriguez Zamora, M. C. (2008). Calidad de vida en pacientes nefropatas con terapia dialitica [Quality of life in renal patients with dialytic therapy]. Revista CONAMED, 13, 15-22.
Ross, S., Fahrbach, K., Frame, D., Scheye, R., Connelly, J., & Glaspy, J. (2003). The effect of anemia treatment on selected health-related quality-of-life domains: A systematic review. Clinical Therapeutics, 25, 1786-1805. http://doi.org/bm6fbn
Ryan, R., & Brown, K. (2003). Why we don't need self-esteem: On fundamental needs, contingent love, and mindfulness. Psychological Inquiry, 14, 71-76.
Saffari, M., Pakpour, A., Naderi, M., Koenig, H., Baldacchino, D., & Piper, C. (2013). Spiritual coping, religiosity and quality of life: A study on Muslim patients undergoing haemodialysis. Nephrology, 18, 269-275. http://doi.org/xbp
Schwartzmann, L. (2003). Calidad de vida relacionada con la salud: Aspectos conceptuales [Health-related quality of life: Conceptual aspects]. Ciencia y Enfermerta, 9, 9-21. http://doi.org/fqbhf7
Spiegel, B., Melmed, G., Robbins, S., & Esrailian, E. (2008). Biomarkers and health-related quality of life in end-stage renal disease: A systematic review. Clinical Journal of the American Society of Nephrology, 3, 1759-1768. http://doi.org/dn9s6w
Symister, P. (2011). Beyond social support: Using family expectations to predict psychological adjustment in end-stage renal disease patients. Journal of Health Psychology, 16, 1015-1026. http://doi.org/fnbf6j
Theofilou, P. (2011). Quality of life in patients undergoing hemodialysis or peritoneal dialysis treatment. Journal of Clinical Medicine Research, 3, 132-138. http://doi.org/fnjtmp
Tovbin, D., Gidron, Y., Jean, T., Granovsky, R., & Schnieder, A. (2003). Relative importance and interrelations between psychosocial factors and individualized quality of life of hemodialysis patients. Quality of Life Research, 12, 709-717. http://doi.org/cjvcgr
Untas, A., Thumma, J., Rascle, N., Rayner, H., Mapes, D., Lopes, A., ... Combe, C. (2011). The associations of social support and other psychosocial factors with mortality and quality of life in the dialysis outcomes and practice patterns study. Clinical Journal of the American Society of Nephrology, 6, 142-152. http://doi.org/fq6tfk
Urzua, A. (2010). Calidad de vida relacionada con la salud: Elementos conceptuales [Health related quality of life: Conceptual elements]. Revista Medica de Chile, 138, 358-365. http://doi.org/ b6fw2v
Urzua, A., Pavlov, N., Cortes, R., & Pino, V. (2011). Factores psicosociales relacionados con la calidad de vida en salud en pacientes hemodializados [Psychosocial factors linked to health-related quality of life in hemodialysis patients]. Terapia Psicologica, 29, 135-140. http://doi.org/c43dfp
Vazquez, I., Valderrabano, F., Fort, J., Jofre, R., Lopez-Gomez, J., Moreno, F., & Sanz-Guajardo, D. (2004). Diferencias en la calidad de vida relacionada con la salud entre hombres y mujeres en tratamiento en hemodialisis [Gender differences in health-related quality of life in hemodialysis patients]. Nefrologia, 24, 167-178.
Wehbe, J., Salazar, J., Vaccaro, Y., Wehbe, I., & Guerrero, R. (2004). Dialisis y calidad de vida [Dialysis and quality of life]. Archivos Venezolanos de Psiquiatria y Neurologia, 50, 27-32.
Weisbord, S., Bossola, M., Fried, L., Giungi, S., Tazza, L., Palevsky, P., ... Kimmel, P. (2008). Cultural comparison of symptoms in patients on maintenance hemodialysis. Hemodialysis International, 12, 434-440. http://doi.org/b9msr2
Wolcott, D., Nissenson, A., & Landsverk, J. (1988). Quality of life in chronic dialysis patients: Factors unrelated to dialysis modality. General Hospital Psychiatry, 10, 267-277. http://doi.org/ dv4pqr
Yanguas Lezaun, J. (2006). Analisis de la calidad de vida relacionada con la salud en la vejez desde una perspectiva multidimensional [Analysis of quality of life associated with health in old age from a multidimensional perspective]. Madrid, Spain: Instituto de Mayores y Servicios Sociales (IMSERSO).
Yeung, P., & Towers, A. (2014). An exploratory study examining the relationships between the personal, environmental and activity participation variables and quality of life among young adults with disabilities. Disability and Rehabilitation, 36, 63-73. http://doi.org/xbq
Universidad Catolica del Norte
Universidad de Tarapaca
JAPCY MARGARITA QUICENO
Universidad de San Buenaventura Bogota
STEFANO VINACCIA ALPI
Universidad Santo Tomas
Universidad Catolica del Norte
Alfonso Urzua, School of Psychology, Universidad Catolica del Norte; Alejandra Caqueo-Urizar, Department of Philosophy and Psychology, Universidad de Tarapaca; Japcy Margarita Quiceno, Department of Psychology, Universidad de San Buenaventura Bogota; Stefano Vinaccia Alpi, School of Psychology, Universidad Santo Tomas; Nicole Pavlov, School of Psychology, Universidad Catolica del Norte.
This work was supported by the Proyecto Mayor de Investigacion Cientifica y Tecnologica Universidad de Tarapaca 3730-14 and Convenio de Desempeno UTA-MINEDUC.
Correspondence concerning this article should be addressed to: Alfonso Urzua, School of Psychology, Universidad Catolica del Norte, Avda. Angamos 0610, Antofagasta, Chile. Email: email@example.com
Table 1. Means and Standard Deviations of Number of Points for Fields of the KDQOL-36[TM] According to Sex and Type of Healthcare Institution HRQOL Men Women (n = 63) (n = 65) Symptoms 77.11 [+ or -] 14.60 * 69.16 [+ or -] 17.25 Disease effects 59.17 [+ or -] 23.35 56.54 [+ or -] 23.57 Disease weight 43.94 [+ or -] 29.20 56.54 [+ or -] 23.57 SF-12 physical 38.71 [+ or -] 10.63 35.25 [+ or -] 9.41 SF-12 mental 48.87 [+ or -] 11.17 45.18 [+ or -] 11.88 HRQOL Hospital Private center (n = 41) (n = 87) Symptoms 70.62 [+ or -] 19.12 74.23 [+ or -] 14.98 Disease effects 58.31 [+ or -] 25.20 57.61 [+ or -] 22.67 Disease weight 42.53 [+ or -] 34.29 43.39 [+ or -] 27.24 SF-12 physical 38.33 [+ or -] 9.81 36.31 [+ or -] 10.28 SF-12 mental 45.59 [+ or -] 11.65 47.65 [+ or -] 11.64 HRQOL Total (N = 128) Symptoms 73.07 [+ or -] 16.43 Disease effects 57.83 [+ or -] 23.41 Disease weight 43.11 [+ or -] 29.55 SF-12 physical 36.95 [+ or -] 10.14 SF-12 mental 46.99 [+ or -] 11.64 Note. * significantly higher than average woman. p < .05. Table 2. Correlations Between Fields of the CIRS and HRQOL Scales HRQOL CIRS Symptoms Effects Burden SF-12 SF-12 of renal of renal physical mental disease disease Healthcare .011 .165 .145 .113 .018 team Family and .045 .074 .041 .116 .141 friends Personal .226 * .208 * .227 ** .243 ** .141 resources Neighbors .194 * .268 ** .237 ** .447 ** .200 * and community Health .129 .158 .081 .094 .06 information Community .048 .189 * .085 .11 .085 organizations Total personal .171 .270 ** .210 * .284 ** .166 resources for nonworkers (n = 94) Total personal -.013 .095 .217 .29 .084 resources for workers (n = 34) Note. * p < .05 (two-tailed), ** p < .01 (two-tailed). Table 3. Analysis of Regression for Each HRQOL Field Dependent Independent Nonstandardized Standardized variable variable coefficients coefficients B SD Symptoms (Constant) 60.465 6.991 Team -1.342 1.471 Famfriends -1.628 1.501 Personal 3.499 1.690 Neighbors 4.007 2.042 Information 0.829 1.450 Commorg -0.990 2.253 Disease (Constant) 27.225 9.813 effects Team 1.537 2.065 Famfriends -2.651 2.107 Personal 2.817 2.372 Neighbors 5.977 2.866 Information 1.473 2.035 Commorg 3.416 3.163 Disease (Constant) 10.429 12.474 burden Team 2.020 2.625 Famfriends -3.759 2.678 Personal 6.346 3.016 Neighbors 7.818 3.643 Information -0.929 2.586 Commorg -0.673 4.021 Physical (Constant) 24.769 3.961 health Team -0.218 0.833 Famfriends -1.131 0.850 Personal 1.757 0.958 Neighbors 5.921 1.157 Information -0.238 0.821 Commorg -1.071 1.277 Mental (Constant) 40.193 5.050 health Team -0.663 1.063 Famfriends 0.512 1.084 Personal 0.925 1.221 Neighbors 2.447 1.475 Information 0.013 1.047 Commorg -0.146 1.628 Dependent Independent Nonstandardized Standardized variable variable coefficients coefficients [beta] t p [R.sup.2] Symptoms 8.649 <.001* .087 -.085 -0.912 .364 -.111 -1.085 .280 .216 2.070 .041* .202 1.962 .052 .056 0.572 .568 -.042 -0.439 .661 Disease 2.774 .006 .114 effects .069 0.745 .458 -.127 -1.258 .211 .122 1.187 .237 .211 2.085 .039* .070 0.724 .471 .102 1.080 .282 Disease 0.836 .405 .102 burden .071 0.770 .443 -.143 -1.404 .163 .218 2.104 .037* .219 2.146 .034* -.035 -0.359 .720 -.016 -0.167 .867 Physical 6.253 <.001* .231 health -.022 -0.262 .794 -.125 -1.330 .186 .176 1.835 .069 .483 5.118 <.001* -.026 -0.290 .773 -.074 -0.839 .403 Mental 7.959 <.001* .051 health -.060 -0.624 .534 .049 0.472 .638 .081 0.757 .450 .174 1.659 .100 .001 0.012 .990 -.009 -0.090 .929 Note. Famfriends = family and friends; Commorg = community organizations.
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|Author:||Urzua, Alfonso; Caqueo-Urizar, Alejandra; Quiceno, Japcy Margarita; Alpi, Stefano Vinaccia; Pavlov,|
|Publication:||Social Behavior and Personality: An International Journal|
|Date:||Apr 1, 2015|
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