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Original Article
- The Effect of an Educational Program Based on Orem’s Self-care Model on Treatment Adherence, Self-care Behaviors, and Quality of Life in Hemodialysis Patients in Iran: A Randomized Controlled Clinical Trial
- Samira Rezaei, Mostafa Bijani, Azizallah Dehghan, Zhila Fereidouni
- J Prev Med Public Health. 2026;59(3):249-257. Published online December 12, 2025
- DOI: https://doi.org/10.3961/jpmph.25.727
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Abstract
Summary
PDF - Objectives
Patients undergoing hemodialysis encounter a wide range of complex challenges, underscoring the essential role of self-care in disease management. The present study aimed to examine the effectiveness of an educational intervention grounded in Orem’s self-care model for enhancing treatment adherence, self-care behaviors, and quality of life among hemodialysis patients in southern Iran.
Methods
This single-blind randomized controlled trial included 120 hemodialysis patients who met the predetermined eligibility criteria. Data were collected between April 2023 and August 2023 at 2 university-affiliated teaching hospitals located in southern Iran. After providing informed consent, participants were randomly allocated to either the intervention group (n=60) or the control group (n=60) through a simple randomization procedure. Three psychometrically robust instruments were used to collect data: the End-Stage Renal Disease Adherence Questionnaire, the Kidney Disease Quality of Life Short Form, and the Self-Management Behavior Scale. Statistical analyses were performed using SPSS version 23, and p-values<0.05 were considered statistically significant.
Results
At baseline, no statistically significant differences were observed between the intervention and control groups in the mean scores of the measured variables. However, immediately following the intervention and at the 3-month follow-up, the intervention group demonstrated statistically significant improvements across all 3 variables.
Conclusions
The findings underscore the effectiveness of an educational program based on Orem’s self-care model in significantly improving self-care behaviors, treatment adherence, and quality of life among hemodialysis patients. -
SummaryKey Message
Patients undergoing hemodialysis encounter a wide range of complex challenges, underscoring the essential role of self-care in disease management. The findings underscore the effectiveness of an educational program based on Orem’s self-care model in significantly improving self-care behaviors, treatment adherence, and quality of life among hemodialysis patients. The results of this trial carry implications for clinical practice and health policy. It is recommended that contemporary educational methodologies—particularly those grounded in well-established nursing theories such as Orem’s model—be systematically integrated into nursing curricula. Additionally, structured training workshops emphasizing the clinical utility and outcomes of Orem-based self-care education should be incorporated into hospital-based educational programs.English Abstract- Impact of Health Insurance Type on the Quality of Hemodialysis Services: A Multilevel Analysis.
- Jin Hee Jung, Soon Man Kwon, Kyoung Hoon Kim, Seon Kyoung Lee, Dong Sook Kim
- J Prev Med Public Health. 2010;43(3):245-256.
- DOI: https://doi.org/10.3961/jpmph.2010.43.3.245
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- 5 Crossref
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Abstract
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- OBJECTIVES
This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. METHODS: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). RESULTS: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb> or =11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate< or =55 g2/dL2 and albumin> or =4 g/dL were not significantly different between the groups. CONCLUSIONS: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis. -
Summary
Citations
Citations to this article as recorded by
- Impact of health insurance status on hospitalization and mortality from emergency department admission in patients with end-stage kidney disease: a Korean nationwide registry analysis
AJin Cho, Kyung Don Yoo, Hye Eun Yoon, Seon A Jeong, Wookjin Choi, Dai Hai Choi, Jungeon Kim, Hayne Cho Park, Young-Ki Lee
Kidney Research and Clinical Practice.2026; 45(3): 383. CrossRef - A comparative study of epidemiological characteristics, treatment outcomes, and mortality among patients undergoing hemodialysis by health insurance types: data from the Korean Renal Data System
Kyeong Min Kim, Soyoung Lee, Jong Ho Shin, Mira Park
Kidney Research and Clinical Practice.2025; 44(1): 164. CrossRef - A Study of Effect on the Smoking Status using Multilevel Logistic Model
Ji Hye Lee, Tae-Young Heo
Korean Journal of Applied Statistics.2014; 27(1): 89. CrossRef - Multilevel Analysis on Factors Influencing Death and Transfer in Inpatient with Severe Injury
Young Eun Choi, Kang Suk Lee
Health Policy and Management.2013; 23(3): 233. CrossRef - Factors Affecting Diabetic Screening Behavior of Korean Adults: A Multilevel Analysis
Hyeongsu Kim, Minjung Lee, Haejoon Kim, Kunsei Lee, Sounghoon Chang, Vitna Kim, Jun Pyo Myong, Soyoun Jeon
Asian Nursing Research.2013; 7(2): 67. CrossRef
Original Article- Impacts of Implementing Case Payment System to Medical Aid Hemodialysis Patients on Dialysis Frequencies and Expenditure.
- Sunhee Lee, Hanjoong Kim, Seungho Shin, Woohyun Cho, Hye Young Kang
- J Prev Med Public Health. 2004;37(3):260-266.
- 2,804 View
- 42 Download
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Abstract
PDF
- OBJECTIVES
To assess the impacts of implementing case payment system (CPS) to Medical Aid (MA) hemodialysis patients on the frequencies and expenditure of dialysis. METHODS: Fifty-eight clinics and 35 tertiary care hospitals were identified as having a minimum of 10 hemodialysis patients for each of the MA and Medical Insurance (MI) programs, who received hemodialysis from the same dialysis facilities for both periods of July 2001 and July 2002. From these facilities, a total of 2, 167 MA and 2, 928 MI patients were identified as the study subjects. Using electronic claims data, the changes in the total number of monthly treatments and charges for outpatient hemodialysis treatments for each patient after the introduction of the CPS were compared between the MA and MI patients. Multiple regression analyses were performed to examine the independent impact of the CPS on the utilization and expenditure of dialysis treatments among the MA patients. RESULTS: There was a significant decrease in the total charges for the hemodialysis treatments of the MA patients, 3.4% (p< 0.05), whereas a significant increase was observed for the MI patients, 2.5% (p< 0.05). For both the MA and MI patients, the frequency of the monthly hemodialysis treatments were significantly increased, 5.5 (from 12.1 to 12.7) and 7.8% (from 11.6 to 12.5), for the MA and MI patients, respectively. However, a multivariate regression analysis showed no significant difference in the changes in the total number of monthly hemodialysis treatments between the MA and MI patients after implementation of the CPS. Another regression model, regressing on the changes in the monthly claims of dialysis treatments, showed a significant negative coefficient for the MA ( (=-70725, p< 0.05). CONCLUSION: The significant decrease in the total charges for hemodialysis treatments among MA as compared to MI patients suggests that there was a cost reduction in the MA program following the introduction of the CPS. -
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