Medical
Communication
Biosci. Biotech. Res. Comm. 9(4): 666-671 (2016)
On the relationship between motivational and
inhibiting factors and self-ef cacy in patients treated
with hemodialysis from selected hospitals of Tehran
Khadije Alvandi*
1
and Asieh S. Fard
2
Department of Anatomy, Tehran, Medical Science Branch, Islamic Azad University, Tehran, Iran
ABSTRACT
Recentlt, chronic diseases are considered as the greatest challenge to public health and chronic renal failure is a chronic
disease. Patients who have this disease need to have frequent hemodialysis. Both the disease and hemodialysis have neg-
ative effects on self-ef cacy in these patients. Increased self- ef cacy or belief in your abilities can increase the power
of self-care in these patients. The present research aims to examine the relationship between motivational and inhibit-
ing factors and ef cacy in patients treated with hemodialysis referred to selected hospitals in Tehran during 2015-2016.
The present research is a descriptive correlation study. The statistical population consists of the patients treated with
hemodialysis referred to selected hospitals in Tehran during 2015-2016, selected in random; the sample group consists
of 384 patients who had the characteristics of the units under research. Data collection tools include three questionnaires
of demographic characteristics, Sherer General Self-Ef cacyScale and the research-made questionnaire of motivational
and inhibiting factors and ef cacy of patients treated with hemodialysis. To determine validity of questionnaire, content
validity has been sued and Index of internal consistency (Cronbach’s alpha) has been used for reliability of tools. Data
analysis was made using software SPSS Win 21 and the descriptive and inferential methods well suited to the research
goals and questions were used. Findings of research indicated that there is a positive signi cant relationship between
patients’ attitude toward motivational factors and self-ef cacy (P<0.01). Further, there is a negative signi cant relation-
ship between their attitude towards inhibiting factors and self-ef cacy (P<0.01). Average mean of self-ef cacy in these
patients equaled to 51.32, indicating average status of self-ef cacy among patients. Results indicated that the highest
score relates to the physical factor among the motivational factors and the highest relationship relates to the physical
factors and self-ef cacy among the inhibiting factors. Thus, for training programs, increase of self-ef cacy in patients,
attention to prevention and motivation of physical factors should be taken into account.
KEY WORDS: MOTIVATIONAL FACTORS, INHIBITING FACTORS,SELF-EFFICACY, HEMODIALYSIS
666
ARTICLE INFORMATION:
*Corresponding Author: khalvandi12245@gmail.com
Received 10
th
Oct, 2016
Accepted after revision 15
th
Dec, 2016
BBRC Print ISSN: 0974-6455
Online ISSN: 2321-4007
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Online Contents Available at: http//www.bbrc.in/
Khadije and Asieh
INTRODUCTION
Nowadays, chronic diseases are considered as the great-
est challenge to public health and chronic renal failure is
a chronic disease [Bard, 2010]. It is anticipated that about
167 million people will suffer from chronic diseases by
2050. The estimated cost for treating these patients has
been estimated at $ 797 billion [Smeltzer, 2010]. Kidney
failure is among these diseases that it has been reported
with incidence of 242 cases per one million population
and 8% increase to the number of patients who suffer
from these disease per year [Afkand, 2012]. Kidney fail-
ure is one of the largest causes of death and disability
worldwide [Monahan, 2007]; the most common method
of treatment is hemodialysis for these patients [Cohen,
2009]. Mental and social health in hemodialysis patients
depends on stresses on them to a large extent, i.e. stresses
that patients with chronic renal failure face them. It can
refer to the long and continuous treatment with dialysis,
invasive medical procedures, time-consuming treatment
during each dialysis session and the loss of jobs. The
stula or catheter causes food and drug restriction and
on the other hand stress; patients with dialysis have not
enjoyed suitable mental status and faced mental prob-
lems and social withdrawal [Theo lou, 2011].
Abundant physical, mental and social problems for
these patients require attention to the patient’s ability
in making the activities and extent of his self-ef cacy
in obtaining desired quality of life [Curtin et al., 2008].
The person’s self-ef cacy beliefs affect incidence of
various diseases and recovery process through affect-
ing the behaviors related to well-being and biological
function [Naja , 2007]. Moattari et al. in their study
entitled “study on effect of empowerment on self-ef -
cacy, quality of life and clinical indices in the patients
treated with hemodialysis” indicated that there is a
large difference on extent of self-ef cacy, reduction of
stress, power of decision making and all dimensions of
quality of life mentioned in the questionnaire before
and after intervention in two groups [Moattari et al.,
2012].
Nowadays, it is stated that the best outcomes of
health care come to realize when the patients involve
in their care. The active participation of the patient in
the care process such as tracking the treatment progress,
monitoring symptoms, side effects, tracking positive
behaviors related to health such as having a healthy
diet, regular exercise and improvement in patient’s gen-
eral health will be followed by reduction of treatment
costs [Longo et al., 2012]. In the study by Khoshnazar. it
has been concluded that self-ef cacy of patients treated
with hemodialysis has been at average level, so that
there has been 70% desired general self-ef cacy [Kho-
shnazar, 2014].
The research by Christiaan, quoted from Karimi
et al, indicated that self-ef cacy depends on the physi-
cal and mental health in the patients with Rheumatism
and arthritis, i.e. the patients with low self-ef cacy com-
pared to the patients with high self-ef cacy feel dis-
ability, fatigue and pain as well as depression and anxi-
ety [Karimi et al., 2011]. With regard to what mentioned
above and the fact that the ef cacy is considered as the
effective factor in achieving the outcomes expected by
patients and increase of self-ef cacy in patients can
cause increase of self-care ability, and on the other hand
due to the constant involvement of patients with chronic
renal failure with their disease symptoms, necessity of
study on factors affecting self-ef cacy in these patients
obliged the researcher to conduct a study in this con-
text with the title of study on the relationship between
motivational and inhibiting factors and self-ef cacy of
patients treated with hemodialysis.
MATERIALS AND METHODS
The present research has been a descriptive correlation
conducted on the patients treated with hemodialysis
referred to selected hospitals in Tehran during 2015-
2016. Data collection tools included: 1-demographic
information questionnaire for the units under research
including age, gender, education, marital status, job and
insurance status, number of family members who live
with patient, status of house and Comorbidities, number
of dialysis sessions in week and income.
SHERER GENERAL SELF-EFFICACY SCALE
(SGSES):
Maddox and Scherrer (1982) argue that self-ef cacy
theory is a model of cognitive processes and they rst
built a scale to measure public opinion; the Scale con-
sists of 17 items. Maddox and Scherrer, without specify-
ing items, believe that the scale measures an aspect of
behavior including desire to behavior boot, the desire
to complete the task and deal with obstacles. The scor-
ing is made in this way that score 1-5 is given to each
item and high score indicates higher self-ef cacy. Score
17-39, 40-64 and 65 to above indicate low, average and
high self-ef cacy.
Questionnaire of motivation and inhibiting factors is
a self-ef cacy prepared via related works and interview
with a number of patients. This questionnaire was given
to a number of faculty members of Islamic Azad uni-
versity and Baqiyatallah University of Medical Sciences
to con rm the validity of questionnaire; ultimately a
research-made questionnaire consisted of 50 questions
was developed, consisted of 26 questions related to
motivational factors and 24 questions related to inhibit-
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS ON THE RELATIONSHIP BETWEEN MOTIVATIONAL AND INHIBITING FACTORS 667
Khadije and Asieh
ing factors. Questions are in multi-item form; the views
were measured via Likret scoring scale (totally agree,
agree, no idea, disagree, totally disagree); the score to
these responses is considered from 1-5, i.e. score 5 indi-
cates maximum agree and score 1 indicates maximum
disagree. Reliability coef cient of self-ef cacy scale has
been obtained equal to 0.76 and 0.79 via Gutman half-
split test and Cronbach’s alpha coef cient, respectively
(Shamaei Zade & Abedi, 2005). Further, Cronbach’s alpha
equaled to 0.85 to examine reliability of self-ef cacy in
the research by Vaghari (1998).
Naja (2003) separated 30 participants in random
and performed self-ef cacy test for them and the Cron-
bach’s alpha was obtained equal to 0.83. In the research
by Ganji & Farahani (2009), reliability coef cient was
obtained equal to 0.81 via Cronbach’s alpha. In this
research, 10% of samples were tested for reliability of
questionnaire and reliability of two questionnaires was
measured via re-test using Cronbach’s alpha. Three gen-
eral scales of motivational factors, inhibiting factors and
Scherrer self-ef cacy enjoyed Cronbach’s alpha coef-
cient above 0.7. The sample size (384) was estimated
using the statistical formula. Then the patients treated
with hemodialysis referred to selected hospitals in Teh-
ran during 2015-2016 were included in the study regard-
ing the inclusion criteria. By compliance with code of
ethics in the research, the participants were included in
the study after informed of the goal of research with
informed consent and privacy of information as well as
liberty of patients whether to participate in the research
or not.
RESULTS
With regard to the results, majority of participants in the
study developed from men (54.7%) and 85.9% of patients
have been married. Average age of patients under study
has been 55.51years old and most of patients (28.1%)
have been illiterate and 44% of patients have been
treated with hemodialysis for 1 to 4 years and most per-
cent of patients were treated with hemodialysis for three
sessions per week (table 1). Findings related to deter-
mination of relationship between various dimensions of
motivational and inhibiting factors and self-ef cacy of
patients have been represented in table 2. With regard
Table 1: Frequency distribution of the units under research in terms of demographic
characteristics in the study on the relationship between motivational and inhibiting factors and
ef cacy in patients treated with hemodialysis referred to selected hospitals in Tehran during
2015-2016
Demographic variables
Highest class
Frequency Percent Lowest class Frequency Percent
Gender male 210 54.7 women 174 45.3
Age 41-54 178 46.4 25-40 36 9.4
Marital status
married
330 85.9 single 14 3.6
Education
illiterate
108 28.1 diploma 53 13.8
Employment
unemployed
99 25.8 Unemployed 3 0.8
Monthly income under500
000
133 34.6 1000000-1500000T 63 16.4
Treatment duration
1-4 years
169 44 More than 12y 32 8.3
Status of living with
spouse and children
190 49.5 with parents 4 1.0
Diseases(4 diseases) 75 19.5 1 disease 1 0.3
Numberof sessions
3 sessions
190 49.5 One session 3 0.8
Insurance status have it 338 88 no 46 12
668 ON THE RELATIONSHIP BETWEEN MOTIVATIONAL AND INHIBITING FACTORS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
Khadije and Asieh
Table 3: Frequency distribution of patients in terms of self-ef cacy in the study on the relationship
between motivational and inhibiting factors and self- ef cacy in patients treated with hemodialysis
referred to selected hospitals in Tehran during 2015-2016
Frequency
self-ef cacy
No
Relative
percent
Accumulative
percent
Low(17-39) 81 1/21 1/21
Average(40-64) 224 3/58 4/79
High(65 and above) 79 6/20 0/100
Sum 384 0/100
Mean: 51.32; standard deviation: 12.47; minimum: 34; maximum: 79
Table 2: The relationship between patients’ attitude towards motivational
and inhibiting factors to separation of dimensions with self-ef cacy
variable in the patients treated with hemodialysis referred to selected
hospitals in Tehran during 2015-2016
Self-ef cacy
Attitude towards physical motivational factors
Correlation level(r) **620/0
Sig.(sig) 000/0
Attitude towards mental motivational factors
Correlation level(r) **578/0
Sig.(sig) 000/0
Attitude towards social motivational factors
Correlation level(r) **490/0
Sig.(sig) 000/0
Attitude towards physical inhibiting factors
Correlation level(r) **641/0-
Sig.(sig) 000/0
Attitude towards mental inhibiting factors
Correlation level(r) **635/0-
Sig.(sig) 000/0
Attitude towards social inhibiting factors
Correlation level® **467/0-
Sig.(sig) 000/0
to the obtained results, there is a signi cant relation-
ship between physical, mental and social dimensions
of motivational and inhibiting factors and self-ef cacy
of patients. There is a positive signi cant relationship
between patients’ attitude toward motivational factors
and self-ef cacy (P<0.01). Intension of relationship in
these three sub-scales reduces from physical inhibit-
ing factors to mental and social inhibiting factors, thus
the highest inverse relationship was observed between
physical factors and self-ef cacy and the lowest inverse
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS ON THE RELATIONSHIP BETWEEN MOTIVATIONAL AND INHIBITING FACTORS 669
Khadije and Asieh
relationship was observed between social factors and
self-ef cacy. On the other hand, results indicate that there
is a negative signi cant relationship between patients’
attitude towards inhibiting factors and self-ef cacy
(P<0.01). Thus the more patients’ attitude towards phys-
ical, mental and social inhibiting factors, self-ef cacy
reduces in patients. Intension of relationship in these
three sub-scales reduces from physical inhibiting factors
to social and mental inhibiting factors, thus the high-
est inverse relationship was observed between physical
factors and self-ef cacy and the lowest inverse relation-
ship was observed between social factors and self-ef -
cacy. Further, ndings related to self-ef cacy indicated
that 58.3% of patients reported average self-ef cacy.
The lowest and highest self-ef cacy in these patients
equaled to 34 and 79, respectively. Further, among 384
patients, 81 patients had the low self-ef cacy and 224
and 79 patients described self-ef cacy at low and high
level, respectively. Thus, majority of patients had aver-
age self-ef cacy (table 3).
DISCUSSION
The study by Nejad et al is consistent with the results
of this study, indicating that the patients treated with
hemodialysis enjoyed an average self-ef cacy before
holding training sessions Nejad et al,2013]. Ismaeili et
al [2005] and Tsay and Hung [2004] reported extent of
self-ef cacy in patients at average level. Feeling of self-
ef cacy motivated the person and enabled him to make
great tasks in dealing with obstacles using the skills. In
the study by Ismaeili et al [2005], the patients treated
with hemodialysis enjoyed average self-ef cacy, which
this has been consistent with the results from the present
research.
Contrary to the present study, the study by Khosh
Nazar et al[2014]. indicated that patients treated with
hemodialysis enjoyed proper self-ef cacy. The study by
Ismaeili et al [2015] on patients after coronary artery
bypass surgery, most of patients enjoyed proper and
average general self-ef cacy and just 2% of patients had
poor self-ef cacy. The study by Manani et al indicated
that there is a direct signi cant relationship between self-
ef cacy and self-concept of patients treated with hemo-
dialysis, so that the self-ef cacy of patients increase by
increasing their self-con dence(P<0.05). in the present
research, there is a direct relationship between mental
motivational factors and self-ef cacy of patients treated
with hemodialysis and there is a negative signi cant
relationship between mental inhibiting factors and self-
ef cacy of patients (P<0.05) (Manani et al. 2015).
In the study by Naseh et al, half of samples gained the
total score of self-ef cacy. In this study, there is a direct
signi cant relationship between self-ef cacy and physi-
cal, mental and social dimensions which this is same as
the present research. In this study, there is a signi cant
relationship between motivational and inhibiting fac-
tors and self-ef cacy (Naseh et al. 2012). In the study
by Sadeghi, there is a linear signi cant relationship
between self-ef cacy and various dimensions of qual-
ity of life. In the study by Sadeghi, the patients with
diabetes gained the highest score in social dimension
and the least score in physical dimension. In the pre-
sent research, the intension of relationship has been wit-
nessed in physical factors, mental motivational factors
and social motivational factors. The inverse relationship
sets between self-ef cacy and inhibiting factors (Sad-
eghi, 2014).
In the study by Emdadi et al. conducted among stu-
dents, there existed a signi cant relationship between
self-ef cacy, social support and depression, so that the
students who enjoyed higher self-ef cacy and social
support had less depression. Findings of this research
indicated that the social, physical and mental motiva-
tional factors involve in the self-ef cacy. Thus, the more
it can improve factors affecting improvement in self-
ef cacy in patients and reduce the inhibiting factors, it
can assist the patients to have greater self-ef cacy. On
the other hand, physical factor was recognized as the
most important inhibiting factor in the process of self-
ef cacy in patients, indicating that feeling of chronic
pains is the most important inhibiting factor in the pro-
cess of self-ef cacy.
Thus it should assist the patients to pay more atten-
tion to their physical health and invoke to sports and
healthy nutrition. The nancial aids by government
and facilities can play a major role in the process of
self-ef cacy facilitation for patients. With regard to the
results from this research, it is suggested to conduct a
study on the relationship between self-ef cacy and vari-
ous dimensions of quality of life to compare it with the
results from this study.
ACKNOWLEDGEMENT
It is a great thank to all the patients, nurses, research
deputy of Shahid Beheshti University and all the profes-
sors who assisted us to conduct this research.
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