혈액투석환자에서 식이관련 자기효능감 설문지의 타당도 평가
A Validation of Dietary Self-Efficacy Questionnaire in Hemodialysis Patients
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연구배경: 본 연구는 국내 혈액투석환자들에게 적합한식이 관련 자기효능감 설문문항을 개발하고, 개발한 식이관련 자기효능감을 환자의 임상검사 지표와 건강관련 삶의 질 예측인자로서 활용하고자 하였다. 방법: 본 연구의 연구 대상자는 2개 대학병원에서 연구당시 혈액 투석 관리를 받고 있는 환자 중 6개월이 경과된172명이었고, 환자들에게 직접 면접 설문조사하였다. 결과: 연구 결과 전체 문항의 내적신뢰도인 크론바흐알파는 0.944이었으며, 요인분석 결과 2개 성분이 추출되었으며, ‘요인1’은 상황별 식이지침준수 자기효능감, ‘요인2’는 음식선택 시 자기효능감으로 명명하였다. 편상관분석 결과 임상검사지표 중 혈중 칼륨(K)농도와 상황별 식이지침준수 자기효능감이 유의하였으며 신장질환 특이건강관련 삶의 질(kidney disease quality of life [KDQOL]-36)과의 분석결과 대부분 영역에서 식이관련자기효능감이 유의하였다. 식이관련 자기효능감 중 상황별 식이지침준수 자기효능감은 3.52±0.72점이었으며 음식선택 시 자기조절 자기효능감 점수는 3.61±0.71점이었다. 성별, 연령, 직업유무, 교육수준, 투석기간, 신부전의 원인질환 등으로 보정한 뒤 실시한 다중회귀분석 결과, 상황별 식이지침준수 자기효능감은 혈중 칼륨 농도(95% confidence interval [CI], -0.340~-0.002), 육체적 영역(95% CI,3.236~12.988), 정신적 영역(95% CI, 1.886~11.962), 증상(95% CI, 2.165~9.390), 질병 영향(95% CI, 2.927~11.480) 등의 영역에 유의한 관련성이 있었다. 음식 선택 시 자기효능감은 건강관련 삶의 질의 육체적 영역(95% CI, 0.584~8.449),정신적 영역(95% CI, 0.196~8.257), 증상(95% CI, 1.331~7.084), 질환의 영향(95% CI, 1.287~8.142), 질병의 부담(95% CI, 0.174~9.584) 등 다섯 가지 전 영역과 유의한 관련성이 있었다. 결론: 이상의 연구결과를 바탕으로 본 연구에서 개발된식이관련 자기효능감 설문 도구는 국내 혈액 투석환자들에게 적합하다고 할 수 있으며, 환자의 임상검사 지표와건강관련 삶의 질을 예측할 수 있는 것으로 볼 수 있다. 혈액 투석환자들 진료 시 식이에 대한 단순한 지식전달이 아닌 환자들의 자기효능감을 높일 수 있는 개입이 필요할 것이다.
Abstract
Background: This study was performed to develop a dietary self-efficacy questionnaire and to determine how dietary self-efficacy is related to selected biochemical markers and health-related quality of life in hemodialysis patients. Methods: Participants included 172 patients who had been participating in a dialysis program for at least 6months at two teaching hospitals. A questionnaire was used to assess socio-demographic factors, dialysis-related factors, dietary self-efficacy, and kidney disease quality of life (KDQOL). Serum levels of potassium and phosphorus and interdialytic weight gain were also measured. Results: The internal reliability of dietary self-efficacy was 0.944 (Cronbach's alpha). Principal component analysis resulted in two factors, situational self-efficacy of compliance with dietary guidelines and self-efficacy of food choice. The correlation analysis showed a significant association between situational self-efficacy of compliance with dietary guidelines and serum potassium and KIDQOL. The average scores of situational self-efficacy of compliance with dietary guidelines and self-efficacy of food choice in the participants were 3.52±0.72and 3.61±0.71 respectively. Multiple linear regression analysis showed that the situational self-efficacy of compliance with dietary guidelines was significantly associated with serum potassium level and KDQOL and self-efficacy of food choice was significantly associated with KDQOL. Conclusions: Based on our results, the developed dietary self-efficacy questionnaire may be a suitable survey tool for hemodialysis patients, which can play a role in predicting clinical indicators of patient and health-related quality of life. We recommend further research into clarifying whether the positive effects of increased dietary self-efficacy is maintained in long-term dialysis patients.
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