Perceived autonomy and self-esteem in Dutch dialysis patients: The importance of illness and treatment perceptions

Abstract

Compared to healthy people, end-stage renal disease (ESRD) patients participate less in paid jobs and social activities. This study explored the perceived autonomy, state self-esteem and labour participation in ESRD patients on dialysis, and the role illness and treatment perceptions play in these concepts. Patients completed questionnaires at home or in the dialysis centre (N = 166). Data were analysed using bivariate and multivariate analyses. Labour participation among dialysis patients was low, the average autonomy levels were only moderate, and the average self-esteem level was rather high. On the whole, positive illness and treatment perceptions were associated with higher autonomy and self-esteem, but not with labour participation. Multiple regression analyses demonstrated that illness and treatment perceptions explained 18 to 27% of the variance in autonomy and self-esteem. Perceptions of personal control, less impact of the illness and treatment, and less concern were important predictors. Our results indicate that dialysis patients’ beliefs about their illness and treatment play an important role in their perceived autonomy and self-esteem. Stimulating positive (realistic) beliefs and altering maladaptive beliefs might contribute to a greater sense of autonomy and self-esteem, and to social participation in general. Interventions focusing on these beliefs may assist patients to adjust to ESRD.

Keywords:

• autonomy
• dialysis
• employment
• illness perceptions
• self-esteem
• treatment perceptions

Acknowledgements

This study was supported by a grant from the Dutch Kidney Foundation and the Institute Gak Foundation, Netherlands. The nursing staffs of the participating dialysis centres are gratefully acknowledged for collecting most of the clinical data. The authors also wish to thank the staff of the NECOSAD trial office and the trial nurses and data managers of the Hans Mak Institute for their assistance in the logistics of this study.

Notes

†For the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group.

Note

1. These data were derived from the last regular survey carried out under NECOSAD-2.

Additional information

Notes on contributors

Elisabeth W. Boeschoten†

†For the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group.