1 * * 141 SPSS end stage renal disease, ESRD , ,447 Wu, Wu, Shih, Hsu, & Taiwan Society of Nephrology, 2011 * * 102

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1 1 * ** *** 141 SPSS end stage renal disease, ESRD , ,447 Wu, Wu, Shih, Hsu, & Taiwan Society of Nephrology, 2011 * ** *** (037) A20186@weigong.org.tw DOI /

2 Qunibi, 2004; Qunibi et al., mg/dl mg/dl 27 Qunibi, National Kidney Foundation-Kidney / Disease Outcomes Quality Initiative, NKF-K/DOQI Kalantar-Zadeh et al., 2006 Sun, Chang, Chen, Chang, & Wu, 2008 García-Llana, Remor, & Selgas, Durose Holdsworth Watson Przygrodzka 2004 Karamanidou Clatworthy Weinman Horne / Qunibi et al., 2004 Qunibi Nolan Sun 2008

3 3 Conn Takaki et al., 2003; Karamanidou et al., Lee Molassiotis Takaki et al., 2003; Theofilou, Takaki et al., 2003 Theofilou House Klainin & Ounnapiruk, 2010 O Brien Karamanidou 2008

4 4 Rotter 1966 locus of control health locus of control Wallston Wallston De Vellis Takaki & Yano, 2006 Theofilou 2013 self-efficacy Bandura 1977 Bandura efficacy expectation outcome expectation 2004 Takaki et al., 2003; Zrinyi et al., 2003; Takaki & Yano, purposive sampling

5 5 20 CVI content validity index House 1981 Cronbach s α Likert Wallston Wallston Devellis 1978 multidimensional health locus of control, MHLC Wallston 1978 MHLC Cronbach s α Wallston, et al., Cronbach s α

6 Likert Cronbach s α Likert Likert Cronbach s α Bandura 1977 Expectancy-Value Theory Wigfield & Eccles, 2000 Rodgers Brawley Rodgers & Brawley, 1991 Cronbach s α Likert NO SPSS 16.0 t

7 (multilinearily)

8 8 n N 141 M SD AVON M SD AVON M SD AVON t t t F * F * F * b b F *** F *** F * a a a F * F F a F F F F F F c F F F t * t t * a Scheffe s mothod b Honestly significant difference c welch *p.05. ***p.001 AVON Scheffe s mothod Honestly significant difference, HSD

9 9 N

10 10 N **.234 **.280 **.329 **.269 **.300 ** **.278 **.321 ** **.220 *.321 ** * 212 * **.187 *.204 * **.705 **.627 **.271 **.276 **.234 ** *p.05. **p Takaki 2003 Karamanidou

11 11 N 141 t * * *** *** *** F value *** *** *** R ***p

12 O Brien, 1990; Karamanidou et al., 2008 r.318, p.01 r.166, p Takaki Yano 2006 Lin Liang Takaki et al., 2003; Zrinyi et al., 2003 Bandura

13 13

14 doi: /JN

15 Bandura, A. (1977). Self-efficacy: Toward a unifying theroy of behavioral change. Psychological Review, 84(2), doi: // X Conn, V. S., Hafdahl, A. R., Cooper, P. S., Ruppar, T. M., Mehr, D. R., & Russell, C. L. (2009). Interventions to improve medication adherence among older adults: meta-analysis of adherence outcomes among randomized controlled trials. The Gerontologist, 49(4), doi: /geront/ gnp037 Durose, C. L., Holdsworth, M., Watson, V., & Przygrodzka, F. (2004). Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. Journal of The American Dietetic Association, 104(1), doi: /j.jada García-Llana H., Remor, E., & Selgas, R. (2013). Adherence to treatment, emotional state and quality of life in patients with end-stage renal disease undergoing dialysis. Psicothema, 25(1), doi: / psicothema House, J. S. (1981). Work stress and social support. Reading, Mass: Addison- Wesley. Kalantar-Zadeh, K., Kuwae, N., Regidor, D. L., Kovesdy, C. P., Kilpatrick, R. D., Shinaberger, C. S.,... Kopple, J. D. (2006). Survival predictability of timevarying indicators of bone disease in maintenance hemodialysis patients. Kidney International, 70, doi: /sj.ki Karamanidou, C., Clatworthy, J., Weinman, J., & Horne, R. (2008, January 31). A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease. BMC Nephrology, 9: 2. Retrieved from content/pdf/ pdf. doi: / Klainin, P., & Ounnapiruk, L. (2010). A meta-analysis of self-care behavior research on elders in Thailand: an update. Nursing Science Quarterly, 23(2), doi: / Lin, C. C., & Liang, C. C. (1997). The relationship between health locus of control and compliance of hemodialysis patients. Kaohsiung Journal Medical Sciences, 13, Lee, S. H., & Molassiotis, A. (2002). Dietary and fluid compliance in Chinese hemodialysis patient. International Journal of Nursing Studies, 39(7),

16 16 O Brien, M. E. (1990). Compliance behavior and long-term maintenance dialysis. American Journal of Kidney Diseases, 15(3), Qunibi, W. Y. (2004). Consequences of hyperphosphatemia in patients with end-stage renal disease (ESRD). Kidney International, 66, S8-S12. doi: /j x Qunibi, W. Y., & Nolan, C. R. (2004). Treatment of hyperphosphatemia in patients with chronic kidney disease on maintenance hemodialysis: Results of the care study. Kidney International, 66, S33-S38. doi: /j x Qunibi, W. Y., Hootkins, R. E., McDowell, L. L., Meyer, M. S., Simon, M., Garza, R. O.,... Nolan, C. R. (2004). Treatment of hyperphosphatemia in hemodialysis patients: The calcium acetate renagel evaluation (care study). Kidney International, 65, doi: /j x Rotter, J. B. (1966). Generalized expectancies for internal and external control of reinforcement. Psychological Monographs: General and Applied, 80, doi: / h Rogers, W. M., & Brawley, L. R. (1991). The outcome expectancies in participation motivation. Journal of Sport and Exercise Psychology, 13, Sun, C. Y., Chang, K. C., Chen, S. H., Chang, C. T., & Wu, M. S. (2008). Patient education: An efficient adjuvant therapy for hyperphosphatemia in hemodialysis patients. Renal Failure, 30(1), doi: / Takaki, J., Nishi, T., Shimoyama, H., Inada, T., Matsuyama, N., Sasaki, T.,... Kuboki, T. (2003). Possible variances of blood urea nitrogen, serum potassium and phosphorus levels and interdialytic weight gain accounted for compliance of hemodialysis patients. Journal of Psychosomatic Research, 55(6), doi: /S (03) Takaki, J., & Yano, E. (2006). Possible gender differences in the relationships of self-efficacy and the internal locus of control with compliance in hemodialysis patients. Behavioral Medicine, 32(1), doi: / BMED Theofilou, P. (2013). Medication adherence in Greek hemodialysis patients: The contribution of depression and health cognitions. International Journal of Behavioral Medicine, 20(2), doi: /s Wallston, K. A., Wallston, B. S., & De Vellis, R. (1978). Development of the multidimensional health locus of control (MHLC) scales. Health Education Monographs, 6(2), doi: /

17 17 Wigfield, A., & Eccles, J. S. (2000). Expectancy-value theory of achievement motivation. Contemporary Educational Psychology, 25, doi: / ceps Wu, M. S., Wu, I. W., Shih, C. P., Hsu, K. H., & Taiwan Society of Nephrology (2011). Establishing a platform for battling end-stage renal disease and continuing quality improvement in dialysis therapy in Taiwan Taiwan renal registry data system (TWRDS). Acta Nephrologica, 6(2), Zrinyi, M., Juhasz, M., Balla, J., Katona, E., Ben, T., Kakuk, G., & Pall, D. (2003). Dietary self-efficacy: Determinant of compliance behaviours and biochemical outcomes in haemodialysis patients. Nephrology Dialysis Transplantation, 18, doi: /ndt/gfg307

18 18 A Study on the Adherence Behavior of Phosphate Control by Long-term Hemodialysis Patient and its Related Factors Ya-Fang Ho Mou-Tzu Yang * Giien-Shuen Chen ** Fen-Hsiang Hu *** Abstract Purpose: The aim of this study was to explore the phosphate control adherence behavior of hemodialysis patients and its related factors. Methods: This study used a cross-sectional design and structured questionnaire. A total of 141 hemodialysis patients from the two hospital hemodialysis centers were recruited as participants. Statistical analyses consisted of descriptive and inferential statistics using SPSS 16.0 statistical software. Results: We found that younger patients, singles, patients who live with their parents, and patients with high self awareness on the symptoms of hyperphospthemia had comparatively poor phosphate control adherence behavior. Hemodialysis patients with higher social support, better self efficacy, more positive outcome expectations and a tendency towards internal health locus of control tended to exhibit better phosphate control adherence behavior. Age, marital status, living conditions, self awareness symptoms of hyperphospthemia, social support, internal control, self efficacy, and outcome expectations explained 56.4% of the variance in the phosphate control adherence behavior of hemodialysis patients. Self efficacy was the main predictor among these variables. Conclusions: The results of this study can be used by healthcare workers as a reference during the performance of health education. Key words: adherence, self-efficacy, health locus of control, social support, hemodialysis MS, RN, Nephrology Education Nurse, Wei Gong Memorial Hospital PhD, President, University of Kang Ning * PhD, MD, Director, Department of Nephrology, Tri-Service General Hospital ** EMBA, MD, Director, Peritoneal Dialysis Center, Department of Nephrology, Wei Gong Memorial Hospital *** Received: Sep. 14, 2013 Revised: Jul. 8, 2014 Accepted for publication: Jul. 9, 2014 Correspondence: Ya-Fang Ho No. 128, Xinyi Rd., Toufen Township, Miaoli County, Taiwan (ROC) Telephone: (037) ext A20186@weigong.org.tw DOI: /

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