Health-literacy, self-efficacy and health-outcomes of patients undergoing haemodialysis: Mediating role of self-management

Shu-Hua Hsu; Yu-Li Lin; Malcolm Koo; Debra K Creedy; Ying Tsao

doi:10.1111/jorc.12493

Health-literacy, self-efficacy and health-outcomes of patients undergoing haemodialysis: Mediating role of self-management

J Ren Care. 2024 Mar 24. doi: 10.1111/jorc.12493. Online ahead of print.

Authors

Shu-Hua Hsu¹, Yu-Li Lin¹, Malcolm Koo², Debra K Creedy³, Ying Tsao⁴

Affiliations

¹ Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
² Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan.
³ School of Nursing & Midwifery, Griffith University, Griffith, Australia.
⁴ Department of Nursing, Tzu-Chi University, Hualien, Taiwan.

PMID: 38522017
DOI: 10.1111/jorc.12493

Abstract

Background: Health literacy, self-efficacy and self-management are known to influence health-related well-being. However, the precise influence of self-management, health literacy and self-efficacy on health outcomes in Asian countries is under-researched.

Objectives: To examine the impact of health literacy and self-efficacy (independent variables) and self-management (mediator) on patients' health outcomes (dependent variable).

Design: An observational, cross-sectional design was conducted between 1 March 2022 and 31 August 2022.

Participants: Outpatients receiving haemodialysis (n = 200) at a Taiwanese medical centre were assessed.

Measurements: The survey included demographic questions and standardised scales: the 3-item Brief Health Literacy Screen, the 8-item Perceived Kidney/Dialysis Self-Management Scale as a measure of self-efficacy, and the 20-item Haemodialyses Self-Management Instrument. Health outcomes were responses on the 12-item Short-Form Health Survey version 2 and clinical blood results from the past 3 months.

Results: Participants aged over 60 exhibited common comorbidities, with 34% showing low health literacy. Biochemical markers (e.g., haemoglobin and albumin) significantly correlated with physical and mental health scores. Mediating coefficients revealed that self-management significantly influenced associations between health outcomes, health literacy (β = 0.31; p < 0.01), and self-efficacy (β = 0.19; p < 0.01).

Implications for practice: Self-management can modify the overall influence of health literacy and self-efficacy on patients' quality of physical and emotional health. When managing a chronic condition, 'knowing' how to self-manage does not always result in 'doing so' by the patient. Continuous monitoring and promoting self-management behaviours and support by nurses are crucial to enhance health outcomes.

Keywords: haemodialysis; health literacy; quality of life; self‐efficacy; self‐management.