title: Prediction of self-care behaviour on the basis of knowledge about chronic kidney disease using self-efficacy as a mediator.
abstract: OBJECTIVE
  This study was to investigate: (1) the important factors in the self-care of chronic kidney disease (CKD) patients and (2) the mediating effects of self-efficacy on knowledge and self-care.
  
  
  BACKGROUND
  Chronic kidney disease has become a major global health issue and is one of the top 10 leading causes of death in Taiwan where the dialysis population ranks first in the world. The number of patients with poor self-care behaviours continues to rise despite ongoing health education. Knowledge and self-efficacy are important factors that influence self-care behaviour; however, very few articles have examined the relationships among them.
  
  
  METHODS
  Cross-sectional and correlational design.
  
  
  METHODS
  Subject recruitment was conducted by purposive sampling in the renal outpatient clinics and dialysis centres of two teaching hospitals in northern Taiwan. A total of 247 patients with chronic kidney disease (stages 1-5) were enrolled.
  
  
  RESULTS
  (1) Knowledge was positively correlated with self-efficacy (r = 0·41, p < 0·01) and with self-care (r = 0·18, p < 0·01). Self-efficacy (r = 0·44, p < 0·01) as well as age (r = 0·15, p < 0·01) were positively correlated with self-care. (2) The relationship between knowledge and self-care was fully mediated by self-efficacy (z = 4·82, p < 0·001) and the effect was 50%.
  
  
  CONCLUSIONS
  The results showed that self-efficacy was a crucial mediator between knowledge and self-care. In addition to providing knowledge to chronic kidney disease patients, healthcare professionals should also offer strategies that can enhance self-efficacy to increase self-care behaviours in chronic kidney disease patients and implement effective disease management.
  
  
  CONCLUSIONS
  Incorporate self-efficacy strategies into the process of health education to improve knowledge and the effectiveness of self-care. The findings of this study provide evidence of effectiveness of the use of group activity through self-management and self-efficacy enhancement programmes and may influence the policy makers to consider adding or modifying the reimbursement criteria.
authors.affiliation: School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. shufang@ntunhs.edu.tw.
authors.forename: Shu-Fang Vivienne
authors.initials: SF
authors.lastname: Wu
authors.affiliation: Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
authors.forename: Nan-Chen
authors.initials: NC
authors.lastname: Hsieh
authors.affiliation: National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
authors.forename: Li-Ju
authors.initials: LJ
authors.lastname: Lin
authors.affiliation: Department of Long-TermCare, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
authors.forename: Juin-Ming
authors.initials: JM
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D010353:Patient Education as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000451:nursing / Q000523:psychology* / Q000628:therapy; D012648:Self Care; D011795:Surveys and Questionnaires; D013624:Taiwan; D055815:Young Adult
keywords: chronic kidney disease; knowledge; mediation; nursing; self-care; self-efficacy