Patients receiving dialysis treatment also need to implement many practices within the scope of self-management, such as taking medications regularly, complying with diet and fluid restrictions, monitoring weight, managing accompanying conditions, and observing complications.Reference Bonilla-Félix and Suárez-Rivera 1 , Reference Ma, Liu and Lin 2
The earthquakes that occurred in Türkiye on February 6, which were described as the “disaster of the century,” caused people to struggle with serious health problems and 11 provinces, including the city of Adıyaman, were affected by this disaster. 3 , Reference Murakami, Siktel and Lucido 4 Therefore, this study was conducted to determine the self-management of dialysis patients affected by the earthquake and the affecting factors. It is believed that the study will contribute to both patients in the earthquake region and the literature.
Methods
The study was conducted descriptively with 125 patients who applied to a public hospital in Adıyaman province, which was significantly affected by the earthquake, for dialysis treatment between April 2024-May 2024, who were conscious, verbally communicative, over the age of 18, and volunteered to participate in the study.
Data Collection Tools
The data of the study were collected using the Personal Information Form and the Chronic Illness Self-Management Scale.Reference Murakami, Siktel and Lucido 4 , Reference Bektas and Uysal 5
Data Analysis
In the study, Spearman Correlation tests and Linear Regression analysis was used to determine the predictors of the scale scores.
Ethics
To conduct the study, written permission was obtained from the Adıyaman University Non-Interventional Clinical Research Ethics Committee (dated May 21, 2024, numbered 05-18), as well as informed consent from the authors who adapted the scale for Turkish society, the hospital where the study was conducted, and the patients. The research was conducted in accordance with the Declaration of Helsinki.
Results
There were negative and statistically significant correlations between the subscales of self-stigma and coping with stigma and treatment adherence, and weak, positive, and statistically significant correlations between coping with stigma and health maintenance efficacy, treatment adherence, and income (P < 0.05). There was a positive and statistically significant correlation between health maintenance efficacy and treatment adherence, a negative and statistically significant correlation between health maintenance efficacy and age (P < 0.05), and there were positive and statistically significant correlations between treatment adherence and HD entry weight and HD exit weight (P < 0.05).
According to the multiple linear regression analysis, self-stigma score was predicted by coping with stigma (β = -0.388, P < 0.05) and treatment adherence (β = -0.265, P < 0.05) while coping with stigma score was predicted by self-stigma (β = -0.124, P < 0.05), health maintenance efficacy (β = -0.228, P < 0.05), gender (β = 1.755, p < 0.05) and dialysis type (β = -2.571, P < 0.05). The health maintenance efficacy was predicted by coping with stigma (β=.191, P < 0.05), treatment adherence (β = .339, P < 0.001), educational level (β = 2.816, P < 0.05), dialysis access route (β = -2.764, P = 0.001), and age (β = -.099, P = 0.001), while the treatment adherence score was predicted by self-stigma (β = -.195, P < 0.05), health maintenance efficacy (β = .397, P < 0.001), and marital status (β = 2.993, P < 0.05).
Discussion
In this study, it is thought that the destructions that occurred after the earthquake, the losses experienced, the change of the familiar environment, and the daily life that is trying to continue in difficult conditions in the container, may increase the fragility of women from fragile and sensitive groups even more, and may cause them to postpone or push their professional health care and health-seeking behaviors to the background, and this situation may negatively affect their self-management. In addition, it was determined that the mean score of coping with stigma of patients receiving peritoneal dialysis treatment was low and predicted coping with stigma. During the study, female peritoneal dialysis patients stated that they could not perform peritoneal dialysis because they could not protect their privacy while staying in crowded environments such as shared houses, gyms, or guesthouses. For this reason, it is seen that especially female peritoneal dialysis patients are inadequate in coping with stigma. However, in different studies, the level of self-management of women was found to be higher than that of men.Reference Bektas and Uysal 5 , Reference Gela and Mengistu 6 In this study, it is thought that the priorities of female patients have changed due to the changing conditions during the disaster period.
As in this study, studies examining self-management in HD patients have also found a relationship between self-management and education level, and a higher education level has a positive effect on self-management.Reference Ma, Liu and Lin 2 , Reference Bektas and Uysal 5 -Reference Bonomini, Stuard and Canton 7 The idea that a high level of education is effective in coping with stigma, which is a subscale of patients’ self-management, and in increasing their health care activities is also supported by the literature.Reference Bektas and Uysal 5
In the study, the health maintenance efficacy mean scores of patients who did not receive assistance when going to HD sessions, those with vascular access catheters, those with chronic diseases other than renal failure, and those who lost their relatives in the earthquake were found to be significantly lower (P < 0.05). In the study of Gale and Mengistu (2018), it was determined that there was a strong positive relationship between social support and patients’ self-management and that HD patients who received social support had high self-management.Reference Bonomini, Stuard and Canton 7
Studies found that chronic diseases are common in HD patients and that the self-management of HD patients with chronic illnesses is low.Reference Ma, Liu and Lin 2 , Reference Gela and Mengistu 6 , Reference Lee, Lu and Wu 8 In this study, the health maintenance efficacy of patients with another chronic illness was found to be significantly low (P < 0.05). In their study after Hurricane Maria, Bonilla-Félix and Suárez-Rivera (2019) determined that patients with chronic kidney disease could not have routine laboratory tests and could not meet their health care needs adequately.Reference Bonilla-Félix and Suárez-Rivera 1 The study found that some patients changed their dialysis centers after the earthquake, missed dialysis sessions, and temporarily moved out of the province. The study results are consistent with the findings of many studies.Reference Bonilla-Félix and Suárez-Rivera 1 , Reference Murakami, Siktel and Lucido 4 , Reference Bonomini, Stuard and Canton 7 , Reference Sever, Erek and Vanholder 9 For example, it was reported that HD patients had difficulty accessing health care after Hurricane Sandy.Reference Murakami, Siktel and Lucido 4 According to the research findings, the mean score of the CISMS’s subscale of treatment adherence of patients who were compliant with the diet was found to be significantly high (P < 0.05) because the participants stated that they anticipated that dialysis sessions might be disrupted, and, therefore, they tried to adapt to fluid and diet restrictions.
Author contribution
SG, NO, and RG established the study, implemented statistical analysis, and processed the manuscript. TS contributed to the design of the study. SG, NO, and RV examined the data and assisted in manuscript revision. NO also reanalyzed and interpreted the data according to the supervisions, guidance, and suggestions of SG, TS, and RG in every aspect of this study. All authors have read and approved the final manuscript.
Competing interests
The authors declare none.
