Hypothesized Causal Model of Self-
Management
The hypothesized causal model of selfmanagement
among elderly Thais with pre-dialysis
stage CKD (see Figure 1) was developed based upon
Curtin and Mapes’ framework for self-management
in CKD37 and Bandura’s self-efficacy theory.27 Selfmanagement
was defined as individuals’ positive
attempt to control and participate in health care, in
their daily lives, and to embrace tasks in medical, role
and emotional management in order to optimize their
health, prevent complications, control symptoms,
organize medical resources and minimize intrusion of
the disease into their preferred lifestyles.37 Five
attributes of self-management behavior
(communication with health care providers, partnership
in care, self-care activities, self-advocacy behaviors
and medication adherence behavior)30 were integrated
into the self-management component of the framework.
Seven selected variables (physical function in basic
ADL, physical function in instrumental ADL,
cognitive function, CKD knowledge, self-efficacy,
social support from family members and social support
from health care providers) were included to explain
self-management behavior. Based upon prior research
and a review of the literature, about CKD and other
chronic illnesses, the following hypothesized
relationships were made: a) physical function in basic
ADL will have a direct positive influence on selfmanagement
behavior of older persons with predialysis
CKD; b) physical function in instrumental
ADL will have a direct positive influence on selfmanagement
behavior of older persons with predialysis
CKD; c) cognitive function will have a direct
positive influence on self-management behavior of
older persons with pre-dialysis CKD; d) self-efficacy
will have a direct positive influence on selfmanagement
behavior in older persons with predialysis
CKD; e) knowledge about CKD will have
both a direct positive influence and an indirect positive
influence, through self-efficacy, on self-management
behavior in older persons with pre-dialysis CKD; f)
social support from family members will have both a
direct positive influence and an indirect positive
influence, through self-efficacy, on self-management
behavior in older persons with pre-dialysis CKD; and, g)
social support from health care providers will have
both a direct positive influence and an indirect positive
influence, through self-efficacy, on self-management
behavior in older persons with pre-dialysis CKD.