Factors Related to Self-management Behaviors among Persons with Cirrhosis
Keywords:self-management behavior, knowledge related to disease and treatment, anxiety, social support, person with cirrhosis
Persons with cirrhosis who achieve appropriate and maintained self-management behavior (SMB),
will decelerate complications of the disease, as well as decrease the severity and rate of readmission
to the hospital. This descriptive correlational study aimed to investigate SMB and the factors related
to SMB among persons with cirrhosis. Purposive sampling was applied to recruit 85 persons with
cirrhosis who received service from the outpatient department of the gastrointestinal clinic at a
university hospital. Research instruments consisted of; demographic data record form, the Selfmanagement
Behavior Questionnaire, which was modified from the Self-management Behaviour
Scale for Liver Cirrhosis developed by Wang and colleagues base on Lorig and Holman conceptual
framework, the Knowledge Related to Disease and Treatment Questionnaire developed by researcher
based on the literature review, State-Trait Anxiety Inventory Form Y (STAI form Y) developed by
Spielberger and colleagues, and Social Support Questionnaire (SSQ) developed by Shaefer and
colleagues. Their reliabilities were .73, .72, .96 and .86, respectively. This research project has been
approved by a suitably constituted Research Ethics Committee. Participants were voluntary
participation in this study. Self-administration method was used to collect data. Data were analyzed
using descriptive statistics and Spearman correlation coefficient.
The results revealed that the participants had an inadequate level of overall SMB (82.35%).
There was no association between knowledge related to disease and treatment and overall SMB.
Anxiety was weakly negatively associated with overall SMB (rs = -.26, p <.05), whereas social support
was weakly positively associated with overall SMB at a statistically significant level (rs = .28, p <.01) among
persons with cirrhosis.
The findings of this study shown that enhancing SMB by increasing their knowledge, decreasing
anxiety, and providing social support may not be adequate. Therefore, nurses and healthcare providers
should explore other factors related to SMB, so they are able to perform appropriate SMB.
2. Strategy and Planning Division, Ministry of Public Health (Thailand). Statistical Thailand. 2018. Nonthanuri: Strategy and Planning Division, Ministry of Public Health (Thailand).
3. Polis S, Fernandez R. Impact of physical and psychological factors on health-related quality of life in adult patients with liver cirrhosis: a systemic review protocol. JBI Database of Systematic Reviews Implementation Reports 2015;13(1):39-51.
4. Fagerstrom C, Frisman GH. Living with liver cirrhosis: a vulnerable life. Gastroenterology Nursing 2017;40(1):38-46.
5. Shabanloei R, Ebrahimi H, Ahmadi F, Mohammadi E, Dolatkhah R. Stigma in cirrhotic patients: a qualitative study. Gastroenterology Nursing 2016;39(3):216-26.
6. Sari AA, Karyani AK, Alavian SM, Arab M, Gholmohamadi FR, Rezaei S. The economic burden of liver cirrhosis in Iran: cost of illness study. Iranian Journal of Public Health 2015;44(4):512-21.
7. Volk ML. Hospital readmission of patients with cirrhosis: A canary in a coal mine. Clinical Gastroenterology and Hepatology 2016;14(5):760-1.
8. Lorig KR, Holman HR. Self-management education: History, definition, outcome, and mechanisms. The Society of Behavioral Medicine 2003;26(1):1-7.
9. Dong N, Chen WT, Bao M, Qian Y, Lu H. Self-management behaviors among patients with liver cirrhosis in Shianghai, China: a cross-sectional study. Clinical Nursing Research 2018; 1-25.
10. Hayward KL, Valery PC, Cottrell WN, Irvine KM, Horsfall LU, Tallis CJ, et al. Prevalence of medication discrepancies in patients with cirrhosis: a pilot study. BioMed Central Gastroenterology 2016;16(114):1-9.
11. Lin WJ, Huang HM, Lee, BO, Sun FK. The relationships between uncertainty and coping behaviors of patients with liver cirrhosis. International Journal of Nursing & Clinical Practices 2017;4:1-7.
12. Jansrithong P. Factors predicting self management in older persons with acute coronary syndrome in tertiary hospitals [master’s thesis]. Bangkok: Chulalongkorn University; 2016. (in Thai).
13. Aramsin R, Kerdkul P, Jarujit S, Prachanno W. Self-management behaviors among patients with hypertension in Mueang District, Chonburi Province. Journal of Phrapokklao Nursing College 2018;29(1):68-77. (in Thai).
14. Jandeekaewsakul P, Watthayu N, Suwonnaroop N. Factors predicting self-management behavior among patients with uncontrolled essential hypertension. Journal of Nursing Science 2018;36(1): 31-43. (in Thai).
15. Bai YL, Chiou CP, Chang YY. Self-care behavior and related factors in older people with type 2 diabetes. Journal of Clinical Nursing 2009;18(23):3308-15.
16. Huang M, Zhao R, Li S, Jiang X. Self-management behavior in patients with type 2 diabetes: a cross-sectional survey in western urban China. Public Library of Science ONE 2014;9(4):1-7.
17. Troung PV, Jullamate P, Piphatvanitcha N. Factor related to self-management behaviours in hypertensive older adults in Haiduong Province, Vietnam. Journal of Nursing and Health Sciences 2016;10(3):56-64.
18. Li H, Jiang YF, Lin CC. Factors associated with self-management by people undergoing hemodialysis: A descriptive study. International Journal of Nursing Studies 2014;51(2):208-16.
19. Cohen J. Statistic power analysis. Psychological Bulletin 1992;122(1):33-2909.
20. Polit DF. Statistic and data analysis for nursing research. Canada: Pearson. 2010.
21. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society 1975;23:433-41.
22. Intarasombat P. Health assessment for the elderly. Ramathibodi Nursing Journal 1996;2(3):44-56. (in Thai).
23. Wang Q, Wang Y, Gao J, Han JT, Li YP. Development of self-management behavior scale for liver cirrhosis. International Journal of Nursing Sciences 2015;2(1):73-9.
24. Spielberger CD, Gorsuch RL, Lushene R, Vagg P, Jacobs GA. Manual for the stat-trait anxiety inventory STAI (From Y), self-evaluation questionnaire. Palo alto, CA: consulting Psychologist Press; 1983.
25. Thapinta D. Reduction of anxiety of staff nurses working with aids patient through cognitive reconstructuring and mindfulness training [doctoral’s thesis]. Bangkok: Chulalongkorn University;1992. (in Thai).
26. Schaefer C, Coyne JC, Lazarus RS. The health-related function of social support. Journal of Behavioral Medicine 1981;4(4):381-406.
27. Hanuchcharurnkul S. Social support, self-care, and quality of life in cancer patients receiving radiotherapy in Thailand [doctoral’s thesis]. Detroit, MI: Wayne State University; 1988.
28. Hornung-Praehauser V, Ploessnig M, Zauchner-Studnicka S, Kautzky-Willer A, Leuther M. Better insight into gender-specific diabetes self-management for more effective diabetes services. European Journal of Public Health 2016;26(1):378-9.
29. Phua SH, Taha NA, Pau KB, Kong WY. Evaluation of self-management behavior of chronic kidney disease patients. Journal of Pharmacy and Pharmacology 2017;5:179-188.
30. Park SK. Factors affecting self-care behavior in Koreans with COPD. Applied Nursing Research 2017;38:29-37.
31. Popovic DD, Culafic DM, Tepaccevic DBK, Kovacevic NV, Spuran MM, Djuranovic SP, et al. Assessment
of depression and anxiety in patients with chronic liver disease. Vojnosanitetski Pregled 2015;72(5):414-20.
32. Bettoni LC, Ottaviani AC, Orlandi FS. Relationship between self-care and depression and anxiety symptoms in individuals undergoing hemodialysis. Northeast Network Nursing Journal 2017;18(2);181-6.
33. Kitreerawutiwong K, Kingnetr G, Saengpak C, Wongsawang N. Factor influencing diabetes self-management behavior among type 2 diabetes mellitus patients. Journal of The Royal Thai Army Nurses 2017;18(3):192-200. (in Thai).
How to Cite
Article published Is the copyright of the Journal of Health and Nursing Research (Boromarajonani College of Nursing, Bangkok) Cannot be republished in other journals