Representaciones de la insuficiencia renal crónicaafrontamiento y adherencia al tratamiento
- Vélez Vélez, Esperanza
- Ricardo José Bosch Martínez Director
- M. Pilar Lacasa Díaz Co-director
Defence university: Universidad de Alcalá
Fecha de defensa: 29 June 2010
- Eladio Montoya Melgar Chair
- María Luisa Rodríguez Hernández Secretary
- Azucena Pedraz Marcos Committee member
- Gema Martín Seoane Committee member
- Juan José Plaza Pérez Committee member
Type: Thesis
Abstract
Introduction: Integral care of end-stage renal disease patients requires the disease to be understood not only as organic damage but also as an illness and the way in which patients suffer from it. Many authors from different disciplinary approaches defend the benefits for patient care derived from the incorporation of patient illness representations in the professional field of health care. Research on intuitive ideas related to illness and the patient’s individual perception of their disease, can contribute to the understanding of the way in which a patient perceives and reinterprets the situation they are experiencing, and hence to explain illness-related behavior. This knowledge should be included in patient-oriented educational programs if we want them to be minimally successful. An individual´s personal view of illness is determined by a variety of factors including the cause of the illness, its consequences, chronicity, related symptoms, and the potential for recovery. The study has an overall double aim: to identify intuitive ideas about the renal system and the end-stage chronic disease among a sample of patients and general population, and to explore the relationship among illness perceptions, the way patients cope with it and their adherence to treatment in a sample of patients suffering from chronic kidney disease and receiving hemodialysis replacement therapy. Methods: Using a quantitative research methodology, a two- phase cross-sectional research design was used for this study. Identification and analysis of individual´s ideas and perceptions about the kidney and the disease was approached in the first phase of the study. A non probabilistic sample of 120 participants was recruited. The participants were divided into five groups according to the interaction level they had with the disease. Two tasks which implied answering questionnaires were designed to identify and analyze their intuitive ideas. An ad hoc questionnaire was then designed to identify intuitive ideas, and the second questionnaire used in this phase was the Cuestionario de Creencias Sobre la Enfermedad (CCSE). The main goal of the second phase of the study was therefore to explore the relationships among illness representations, coping and adherence to treatment. A consecutive case sampling method was used for patient recruitment; finally 111 patients in hemodialysis treatment formed the sample. Data were collected using self report information obtained from a demographic data form, the Illness Perception Questionnairerevised (Spanish version), the Cuestionario de Afrontamiento del Estrés and the Morisky Green test, all widely used to study illness representations, coping and adherence. Multiple regression analysis was then used to determine the predictive ability of the dimensions of illness representation and other sociodemographic variables on the dependent variables: the different ways of coping and adherence to treatment. Results.: On a first level of analysis, ideas about renal disease and the renal system seem to respond according to the scientific model; a more profound analysis of these answers revealed the everyday models supporting these superficial and context-based answers. Discrepancies were found among intuitive ideas and perceptions held among the different groups of participants. The regression analysis carried out in the second phase of the study offers the different models found to predict coping strategies and adherence to treatment. Variability proportion of adherence, proactive coping and avoidance coping explained for the regression models is 56,5%, 24,8% and 26,7%, respectively; all of them can be improved, indicating that more accurate predictions of the dependent variables are possible. Further research using a larger sample and longitudinal designs is suggested. Conclusions: As opposed to what scientific models defend, patients and general population share the idea that chronic renal disease is a curable condition, that its appearance depends mainly on chance and behavioral patterns, and that it is a less serious condition than what experts in renal care state. Suffering the disease offers more information about it (not necessarily knowledge) and this information is recalled according to its usefulness in feeling better and in achieving an improvement in health care. The nature and the level of knowledge patients have about their disease is an important predictor of their adherence to treatment. The perception of control over the disease, the illness coherence (degree to which patients identify with it) and the perception of a chronic course of illness are dimensions of the illness representations which determine the use of the different coping strategies analyzed.