Association of Empowerment-Oriented Self-Care Education with Quality of Life Among Hemodialysis Patients in a Resource-Limited Setting: A Quasi-Experimental Study

Nunung Liawati, Ady Waluya

Abstract


Introduction: Chronic kidney disease (CKD) is a major global health problem, and many patients with end-stage kidney disease require maintenance hemodialysis. Although life-sustaining, hemodialysis is associated with persistent symptoms, psychosocial distress, and lifestyle restrictions that reduce health-related quality of life (HRQoL), particularly in resource-limited settings. Empowerment-oriented self-care education may strengthen patients’ ability to manage dialysis-related demands and improve HRQoL, yet evidence from district-level services remains limited.

Objective: To evaluate the effect of an empowerment-oriented self-care education program on HRQoL among patients receiving maintenance hemodialysis.

Methods: A quasi-experimental, two-arm pretest–posttest study with a control group was conducted in 2022 in a public district hospital hemodialysis unit in Sukabumi, West Java, Indonesia. Eligible adults receiving maintenance hemodialysis were recruited using consecutive sampling and allocated to either an intervention group (empowerment-oriented self-care education) or a usual-care control group. The intervention consisted of structured nurse-led self-care education integrated into routine dialysis visits and focused on guided problem-solving, collaborative goal setting, self-management skills, and coping strategies related to dialysis care. Health-related quality of life (HRQoL) was assessed at baseline and after completion of the intervention using the Kidney Disease Quality of Life 36-item survey (KDQOL-36). Data were analyzed using descriptive statistics and multivariable linear mixed-effects models to estimate group, time, and group × time effects, adjusting for baseline covariates.

Results: Of 68 screened patients, 62 were enrolled and 58 completed primary analyses. Compared with usual care, the intervention group showed greater improvements in Burden of Kidney Disease, Symptoms/Problems, Effects of Kidney Disease, and SF-12 physical and mental components.

Conclusion: Empowerment-oriented self-care education was associated with meaningful improvements in HRQoL among hemodialysis patients in a resource-limited setting. Integrating structured empowerment-based self-care education into routine hemodialysis nursing practice may help reduce perceived disease burden and improve patient well-being

Keywords


chronic kidney disease; hemodialysis; self-care education; patient empowerment; quality of life; KDQOL-36.

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DOI: https://doi.org/10.17509/jpki.v12i1.96944

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