Study On The Relationship Between Health Literacy,Social Support,Psychological Resilience And Frailty Of Maintenance Hemodialysis Patients

Purpose:1.To understand the current status of health literacy,social support,psychological resilience and frailty in maintenance hemodialysis patients;2.To analyze the correlation between health literacy,social support,psychological resilience and frailty in maintenance hemodialysis patients;3.To explore the factors influencing the frailty of maintenance hemodialysis patients;4.To explore the mediating role of social support and psychological resilience between health literacy and frailty in maintenance hemodialysis patients.Methods:The study was a cross-sectional study in which questionnaires were administered to 395 patients who were on maintenance hemodialysis treatment and met the inclusion and exclusion criteria from October 2021 to May 2022 in hemodialysis centers of four tertiary care general hospitals in Chengdu using a convenience sampling method.The survey instruments included general information questionnaires,Health Literacy Scale for Patients with Chronic Diseases,Social Support Rating Scale,Psychological Resilience Scale and Tilburg Frailty Scale.Data were entered and subjected to descriptive analysis,Mann-Whitney U test,Kruskal-Wallis H test,correlation analysis and multiple stepwise linear regression analysis using SPSS23.0 software.Structural equation modeling of factors influencing frailty in maintenance hemodialysis patients was constructed using AMOS23.0 software.Results:1.Descriptive analysis:A total of 395 valid questionnaires were collected in this study.The health literacy score of maintenance hemodialysis patients was(94.14±11.40);social support score was(35.10±7.87);psychological resilience score was(62.97±14.20);frailty score was 3.00(2.00,7.00),among which 157 maintenance hemodialysis patients had a total score of≥5 on the frailty scale,accounting for a total of 39.7%.2.Single factor analysis:Regarding demographic characteristics,there were significant differences in frailty scores among maintenance hemodialysis patients with different age,gender,work status,presence of spouse,education level,per capita monthly household income,and smoking status(P<0.05).Regarding disease-related data,there were significant differences in frailty scores among maintenance hemodialysis patients with different vascular access,parathyroid hormone levels,and medication status(P<0.05).3.Correlation analysis:Health literacy,social support,and psychological resilience were all negatively correlated with frailtyin maintenance hemodialysis patients(r_s=-0.385,P<0.01;r_s=-0.397,P<0.01;r_s=-0.317,P<0.01);health literacy was positively correlated with social support and psychological resilience(r_s=0.319,P<0.01;r_s=0.298,P<0.01);social support and psychological resilience were positively correlated(r_s=0.354,P<0.01).4.Multiplestepwise linearregressionanalysis:The main influencing factors of frailty in maintenance hemodialysis patients were health literacy,social support,psychological resilience,medication status,education level and smoking status,which together explained 47.9%of the variance.5.Mediatingeffectanalysis:Healthliteracycannotonlydirectlyaffectthe frailty ofmaintenancehemodialysispatients,but also indirectly affect their frailty through themediatingandchainmediatingeffectsof social support and psychological resilience.The mediating effect value of social support between health literacy and frailty was-0.145,accounting for 33.03%of the total effect;the mediating effect value of psychological resilience between health literacy and frailty was-0.034,accounting for7.74%of the total effect;the chain mediating effect value of social support and psychological resilience between health literacy and frailty was-0.029,accounting for6.61%of the total effect.Conclisions:1.Maintenance hemodialysis patients had a low level of health literacy,an intermediate level of social support and psychological resilience,and a high prevalence of frailty at 39.7%(157/395).2.Health literacy of maintenance hemodialysis patients was negatively correlated with frailty;social support of maintenance hemodialysis patientswas negatively correlated with frailty;psychological resilience of maintenance hemodialysis patients was negatively correlated with frailty;health literacy,social support and psychological resilience of maintenance hemodialysis patients were positively correlated with each other.3.Health literacy,social support,psychological resilience,medication status,education level and smoking status,were the main influencing factors for frailty symptoms in patients with maintenance hemodialysis.4.Social support partially mediated the relationship between health literacy and frailty in maintenance hemodialysis patients;psychological resilience partially mediated the relationship between health literacy and frailty in maintenance hemodialysis patients;social support and psychological resilience played a chain mediating role between health literacy and frailty in maintenance hemodialysis patients.