Factors associated with patient activation among patients with diabetes on hemodialysis: a multicenter cross-sectional study from a developing country

• Published in: BMC nephrology Vol. 25; no. 1; pp. 232 - 16
• Main Authors: Zeidalkilani, Jehad M, Milhem, Yazan A, Shorafa, Reem N, Taha, Sari, Koni, Amer A, Al-Jabi, Samah W, Zyoud, Sa'ed H
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.07.2024; BioMed Central; BMC
• Subjects: Adult; Aged; Blood pressure; Care and treatment; Chronic illnesses; Chronic kidney disease; Cross-Sectional Studies; Developing Countries; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetic nephropathies; Evaluation; Female; Glucose monitoring; Health aspects; Health-related quality of life; Hemodialysis; Hemodialysis patients; HRQOL; Humans; Kidney diseases; Male; Middle Aged; Middle East - epidemiology; Morbidity; Mortality; Multiple regression analysis; Patient activation; Patient outcomes; Patient Participation; Patients; Population; Population studies; Public health; Quality of Life; Questionnaires; Renal Dialysis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - therapy; Sample size; Surveys and Questionnaires; Middle East; Palestinian Territories; West Bank; Health-related quality of life; HRQOL; Patient activation; Chronic kidney disease; Hemodialysis; Diabetes mellitus
• DOI: 10.1186/s12882-024-03674-z
• ISSN: 1471-2369

Diabetes mellitus (DM) is a major public health concern with considerable morbidity and mortality. DM affects patients' quality of life and can lead to multiple complications, including chronic kidney disease (CKD) and the need for dialysis. Higher patient activation can improve health outcomes in hemodialysis patients with DM. This study aimed to explore the factors associated with higher patient activation and health-related quality of life (HRQoL) among hemodialysis patients with DM. This was a cross-sectional, questionnaire-based study conducted on hemodialysis patients with DM in Palestine. The quota sampling method was utilized to draw samples from six dialysis centers. The questionnaire consists of three sections. The first section includes demographic, socioeconomic and clinical questions. The second section utilizes the patient activation measure-13 (PAM-13) to measure patient activation, while the third section assesses HRQoL using the EQ-5D-5 L tool and the visual analog scale (VAS). Mann‒Whitney and Kruskal‒Wallis tests were employed to examine the relationships between variables at the bivariate level, and multiple regression analysis was employed at the multivariate level. Of the 200 patients who were approached, 158 were included. The median PAM, EQ-5D index, and VAS score were low at 51.0, 0.58, and 60.0, respectively. A higher PAM score was independently associated with a higher household income level and taking medications independently. A higher EQ-5D index was associated with taking more than eight medications, taking medications independently, living with fewer than three comorbid conditions, and having a higher PAM. A higher VAS score was associated with being married, and receiving less than 3.5 hours of hemodialysis. A higher patient activation level was associated with a higher income level and independence in taking medications. Interventions designed to improve patient activation, such as medication management programs, should address these factors among the target population. Longitudinal studies are needed to assess the time effect and direction of causation between health status and patient activation.