Ativação de pacientes em hemodiálise: fatores associados e qualidade de vida relacionada à saúde

Abstract

Introduction: Hemodialysis treatment imposes changes in the individual's daily life and demands effective self-management of health in order to achieve therapeutic goals and, consequently, a better quality of life related to health. In this context, there is evidence that people with high levels of activation have healthier behaviors and better clinical outcomes when compared to people with low levels of activation. In this way, measuring the activation of the patient on hemodialysis allows the identification of the degree of self-management of these and enables health interventions directed to the individual considering their beliefs, skills and motivations. Objective: To evaluate the level of activation of hemodialysis patients and their associated factors. Methodology: Study with a quantitative approach and cross-sectional study carried out with 162 people undergoing hemodialysis, from a substitute renal therapy unit, based in the city of Juiz de Fora, Minas Gerais. Participants answered two questionnaires, one for sociodemographic and clinical assessment and another for economic classification, and also two scales, one to measure the level of activation (Patient Activation Measure-13) and the other to assess quality of life (Kidney Disease Quality of life short form). Secondary data were collected, referring to the results of laboratory tests and ultrafiltration values, to assess health results. Descriptive analysis of the data was performed to characterize the population, Poisson regression with robust variance to verify the association between the activation score and the sociodemographic, socioeconomic and clinical data and Logistic regression in order to establish the relationship between the activation levels with health-related quality of life. SPSS version 23.0 and STATA software were used. Results: Two articles were created entitled "Factors associated with the activation of patients on hemodialysis" and "Level of activation and quality of life related to the health of people on hemodialysis". It is noteworthy that of the participants, 63% were men, the average age was 59.23+ 15 years and 74.1% had undergone treatment for less than five years. The average activation score of the patient's activation measure was 60.85 +15.57, with a median of 53.2 (confidence interval: 58.4 - 63.3). They were associated with a higher prevalence of high activation having a higher education level and not needing a caregiver, and the lower prevalence of high activation having the household classified as B2 or D-E and not having previously undergone other renal replacement therapy. Regarding activation and quality of life, the level of activation was associated with the domains symptoms, physical functioning, general health, emotional well-being, energy / fatigue and the mental component of health-related quality of life. Conclusion: Most people on hemodialysis do not have enough skills, knowledge and motivations to be responsible for self-managing their health, which reinforces the relevance of professional performance in carrying out health interventions aimed at improving the activation levels of this population.