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Do personal resources influence health-related quality of life for people receiving hemodialysis treatment in Latin America?

There are currently more than 1.2 million people worldwide who are living with end-stage renal disease (ESRD) because of hemodialysis (Australian Institute of Health and Welfare, 2010). However, hemodialysis may lead to secondary effects, such as low blood pressure, fatigue, leg cramps, chest pain, and headaches (Lorenzo Sellares, Torres Ramirez, Hernandez Marrero, & Ayus, 1997).

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.

Method

Participants

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.

Measures

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.

Procedure

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.

Results

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.

Discussion

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.

http://dx.doi.org/10.2224/sbp.2015.43.3.367

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ALFONSO URZUA

Universidad Catolica del Norte

ALEJANDRA CAQUEO-URIZAR

Universidad de Tarapaca

JAPCY MARGARITA QUICENO

Universidad de San Buenaventura Bogota

STEFANO VINACCIA ALPI

Universidad Santo Tomas

NICOLE PAVLOV

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: alurzua@ucn.cl
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
Article Type:Report
Geographic Code:3CHIL
Date:Apr 1, 2015
Words:6960
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