EFFECTS OF SOCIAL SUPPORT TO THE ADHERENCE OF DIALYSIS CIENTS TO

HEMODIALYSIS TREATMENT REGIMENS

A Thesis Proposal
Presented to the
Faculty of the College of Nursing and Allied Health Sciences
Western Leyte College
Ormoc City

In Partial Fulfilment of the

Requirements for the Degree in Bachelor of Science in Nursing

Submitted by:
Baltazar, Mary Grace F.
Eway, Aubrey Mariel D.
Garrido, Arjay P.
Quintana, Marie Grace P.
Santillan, Rice Cindy D.
Sulla, Asielo Estela M.

September 2020
 Acknowledgement

For the past years of our life, people had influenced us in countless of ways.

Inspired by people we never personally seen, the websites and books by authors we never

knew have all contributed to our study.

First, we want to thank God for everything we have. Our knowledge and works are all

worthless without Him in our life. We owe Him the greatest gift we have right now - our life.

Second, we want to use this opportunity to thank our ever-helpful and considerate family

for we will be forever indebted to them.

Third, we want to thank our ever energetic and supportive instructor – Mrs. Ciedelle

Honey Lou D. Gapasin for all the knowledge she imparted to us. She had supported us even

from the time we started this study from scratch.

Fourth, we want to thank the accommodating nurses of our respondents for giving us

time to conduct our data gathering.

Lastly, this study will never come to completion without the participation of our

respondents. They were accommodating to us when we conducted our study.

We thank you all and may God bless us all.

The Researchers
 Abstract

TITLE: EFFECTS OF SOCIAL SUPPORT TO THE ADHERENCE OF

DIALYSIS CIENTS TO HEMODIALYSIS TREATMENT

REGIMENS

RESEARCHERS: Mary Grace F. Baltazar, Aubrey Mariel D. Eway, Arjay P. Garrido,

Marie Grace P. Quintana, Rice Cindy D. Santillan, Asielo Estela

M. Sulla

ADVISER: Ciedelle Honey Lou D. Gapasin RN,MAN,LPT,EDD

YEAR COMPLETED: 2020

           This study investigates the effects of social support on the adherence of dialysis clients
to Hemodialysis Treatment Regimens. Previous research focuses only on the effects of social
support on patients with cardiac illnesses. It has proven that social support has a positive effect
on the recovery of patients with cardiac illnesses. The researchers are seeking to discover
whether social support has the same effect on Hemodialysis clients. The researchers have
gathered data from 20 dialysis clients to which 10 are married and 10 are single. The
respondents are limited to 20 respondents only due to the challenges imposed by the Covid-19
pandemic. The researchers used a questionnaire as the research tool to gather relevant
information from the respondents. Upon collection of data, it was analyzed, and it showed that
social support has effects on dialysis clients adherence to Hemodialysis Treatment Regimens in
the following aspects – that dialysis clients increase compliance to physician prescriptions,
clients increase access to healthcare, and clients decrease depressive affect. This study found
that social support has a positive effect on dialysis clients adhering to their Hemodialysis
Treatment regimens. The social support came from family to which they help in encouraging
dialysis clients to take medications religiously, seek assistance from organizations that offer
financial and emotional aids for dialysis patients, and that they check up on them especially
every after sessions. The researchers have used the descriptive research method to provide
answers to how social support can affect dialysis clients' adherence to Hemodialysis treatment
regimens. The study provides insight into the family and care provider of the hemodialysis
clients the importance of social support to adherence to treatment regimens.
 Chapter I

The Problem and its Background

Chronic Kidney Disease (CKD) as a public health problem is considered endemic

across cultures globally. Hemodialysis patients have many problems resulting from the disease

itself and treatment process, which change their quality of life, cause depression, and

sometimes even lead to suicide and early death. Low adherence to dietary treatment is a

significant health problem that reduces the benefits of routine treatments, exacerbates

symptoms, reduces quality of life for the patient, as well as increasing costs to both the patient

and the health system.

The social support means providing physical and emotional support by family

member and providing professional help or community support group (Leggat, 2005).

Having access to social support, be it from the spouse, family members, friends,

colleagues or the community, has been consistently linked to better health outcomes for

patients with various chronic illnesses (Kara, et.al, 2007). The adherences to dietary and fluid

restrictions as well as medical treatment are important parts of complex and difficult

treatment process in these patients.

Compared with chronic illnesses like cancer or cardiovascular disease, there is a

lack of research addressing the impact of social support to adherences dietary and fluid

restrictions among Hemodialysis patients resulting to conducting this study.

Statement of the Problem

The study aimed to determine the effects of social support to the adherence of dialysis

clients’ adherence to Hemodialysis Treatment Regimens.

Specifically, it sought to answer the following questions:

1. What is the socio-demographic profile of the dialysis clients in terms of:

1.1 Civil Status

2. What are the effects of social support to the adherence of dialysis clients’ adherence to

Hemodialysis Treatment Regimens?

2.1 Compliance to physician prescriptions

2.2 Access to health care

2.3 Affect of the clients

Statement of the Hypothesis:

HO: Social support does not have an effect to the adherence of dialysis clients to Hemodialysis

Treatment regimens.

Significance of the Study:

The following are considered to be the benefactors of results and conclusion of the

study:

Family of Dialysis Patient. This study will encourage the respondents to explore their

knowledge in adherence of fluid and diet restrictions while on treatment with hemodialysis. It will
help them understand the relevance of having a support system during their treatment

modalities and how it can affect their well-being.

Healthcare Providers. This study will encourage health care providers to include

social support as part of treatment of the patient undergoing dietary and fluid restriction and,

hemodialysis. Further, assessing adherence among HD patients will allow healthcare providers

to implement interventional methods to minimize health and economic consequences of non-

adherence.

Readers. This research will help them acquire an insight on the importance of social

support to adherence of dietary and fluid restrictions among hemodialysis patients.

Future Researchers. This study will help researchers understand the relationship

between social support and adherence to fluid and dietary restriction among hemodialysis

patients.

Scope of Limitation:

The study is focused only on the effects of social support to the adherence of dialysis

clients to the Hemodialysis Treatment Regimens. The study is limited to 20 respondents only of

which 10 are single and 10 are married.

The researchers have gathered data through an adapted questionnaire that was used to

attain reliable results.

Definition of Terms:

Adherence - This is pertaining to the dialysis patient’s compliance to the prescribed treatment

regiments provided by the doctor.

 Chapter II

Theoretical Background

This study is anchored on the theory of Social Learning of Albert Bandura which

postulates the importance of cognitive processes in changing behavior. Self-efficacy is the

central construct of this model. The health promotion model explained health promoting

behaviors using a wellness orientation. According to the revised model, health promotion entails

activities toward developing resources that maintain or enhance a person’s well-being. Pender’s

framework is used in various research studies aimed at predicting over-all health-promoting

lifestyles and specific behaviors such as exercise, diet, and etc.(Aligood, et al 2010)

The health promotion model identifies cognitive and perceptual factors as major

determinants of health-promoting behavior similar to the assumption of this study where the

researchers identify the effect of social support to the adherence of dialysis clients to

Hemodialysis treatment regimens.

Health care Systems Model

According to theory of Betty Neuman, each person is a complete system and the goal of

nursing is to assist in maintaining system stability.

A study done by Jones-Cannon and Davis (2005) used Neuman’s model as the

framework in their study of the coping strategies of African-American daughters who functioned

as caregivers (Polit, et al 2010). Neuman proposed a healthcare system model that views the

person as a complete system with parts and subparts that interrelate – inter-personal, intra-

personal, and extra-personal. Similar on this research study, the nurses play an active role in

providing social support through promoting activities to the patient undergoing hemodialysis

treatment, whilst considering their social status.

McGill Model of Nursing

Dr. Moyra Allen’s theory explained nursing as the science of health-promoting

interactions. Health promotion is the process of helping people cope and develop; the goal of

nursing is to actively promote patient and family strengths and the achievement of life goals.

(Polit, et al 2012)

This theory provides a significant role in the active participation of nurses to providing

social support to dialysis clients.

Science of Unitary Human Beings

According to the theory of Martha Rogers, the individual is a unified whole in constant

interaction with the environment; nursing helps individuals achieve maximum well-being within

their potential. The relationships are examined among power, uncertainty, self-transcendence,

and quality life among patient with chronic diseases (Polit, et al 2010).

This theory applies to this study in terms of understanding the respondent’s wellbeing

within their potential as they maintain their function to the society while dealing with their

condition.

Adaptation Model

Sr. Callista Roy’s theory implies that humans are adaptive systems that cope with

change through adaptation. Derivation of the Roy Adaption Model for nursing included a citation

of Harry Helson’s work in psychophysics that extended to social and behavioral sciences. In
Helson’s adaption theory, adaptive responses are a function of the incoming stimulus and the

adaptive level (Alligood, et al 2010).

Similar to this study, a previously healthy person would undergo adaptive changes once

they are alarmed with the news of having required hemodialysis treatment regularly until kidney

transplantation is done.

Transpersonal Caring

The theory of Margaret Jean Harman Watson implies that caring is the moral ideal, and

entails mind-body-soul engagement with one another. Watson calls for joining of science with

humanities so that nurses will have a strong liberal arts background and will understand other

cultures as a requisite for caring science and a mind-body-spiritual framework. Watson

described “Transpersonal Caring Relationship” as foundation to her theory. It is a special kind of

human care relationship-a union with another person-high regard for the whole person and their

being-in-the-world (Alligood, et al 2010).

Transpersonal caring may also attribute to how the family, friends, and significant others

provide care to the patient undergoing hemodialysis treatment.

Self-Care Deficit Theory

Dorothea Orem’s theory of self-care appeared in nursing literature in 1959. Her theory

centers on individual and self-care. The nurse provides “wholly compensatory”, “partially

compensatory”, or “supportive-educative care”, according to her assessment of the patient’s

level of functioning. (Venzon, 2010; 33)

 Orem’s theory provides an insight on self-care practices of an individual receiving

varying degree of care from the different sources of social support that would directly affect the

respondent’s self-care practices.

Theory of Human Becoming

According to Rosemarie Rizzo parse, the proponent of the theory of human becoming,

health and meaning are co-created by indivisible humans and their environment; nursing

involves having clients share views and meanings. (Polit, et al, 2010)

A patient with CKD stage 5 undergoing hemodialysis treatments may require time-on-

time assessment on their view over what their purpose in life might be. It is within nursing

responsibility to provide time in listening to their concerns and offering available resources in

dealing with their crisis. Support groups may contribute to their current state and would help

them realize their meaning in life and their purpose.

Heath as Expanding Consciousness

Margaret Newman viewed health as an expansion of consciousness with health and

disease as parts of the same whole; health is seen in an evolving pattern of the whole in time,

space, and movement. (Polit and Beck, 2012; 133)

The basic assumptions of the theory are focused on pattern. Pattern refers to

“information that depicts the whole, understanding of the meaning of all the relationships at

once.” Wholeness is identified in pattern. Pattern is constantly evolving. Each observable

pattern is time specific and contains information that was enfolded and will unfold. The evolution

and transformation of pattern occurs through the patient–environment interaction, that is, the
manner in which the patient relates with the environment. A pattern can be demonstrated

retrospectively as sequential patterns over time. Sometimes, a patient's life is orderly; other

times, the patient goes through a difficult life passage that is seen as chaos. Order and disorder

in the patient's life are part of expansion of consciousness.

A nurse enters this process with the patient, particularly at a time when the patient is

experiencing chaos. The key is that the nurse and the patient can engage in the mutual process

of pattern recognition. Thus, both of them will evolve to higher levels of consciousness.

The Theory of Planned Behavior

This provides a framework for understanding people’s behavior and its psychological

determinants. Theory of planned behavior consists of the following proposition: (1) Behavior that

is volitional is determined by people’s intention to perform that behavior. (2) Intention to perform

or not perform a behavior is determined by three factors: (1) Attitudes toward the behavior,

subjective norms, and behavioral control. The relative importance of the three factors in

influencing intention varies across behavior in influencing intention varies across behavior and

situation. Example of using the Theory of Planned Behavior: Peddle and colleagues (2009)

used the Theory of Planned Behavior to predict adherence to a presurgical exercise training

intervention in patients awaiting surgery for suspected malignant lung lesions. Perceived

behavioral control and subjective norms were found to predict adherence. (Ajzen, 2005)

Social Support

Social support, as a viable psychological construct, has been linked empirically to

several state measures of psychological factors, including low levels of anxiety and depressive

symptoms, and enhanced levels in areas of physical health and emotional well-being (e.g.,
Decker et al., 2007; Vilchinsky et al., 2011). Schaefer, Coyne, and Lazarus (1981) described

five types of social support, namely: emotional support, esteem support, network support,

information support, and tangible support.

Emotional support refers to communication that meets an individual’s emotional or

affective needs. These are expressions of care and concern, such as telling someone, I feel bad

for you” or “I just want you to know how much you mean to me.” In this type of support

expressions of emotional support do not try to directly solve a problem but serve to elevate an

individual’s mood.

Esteem support is communication that bolsters an individual’s self-esteem or beliefs

in their ability to handle a problem or perform a needed task. This type of support refers to

encouraging individuals to take needed actions and convincing them that they have the ability

to confront difficult problems.

Network support does not focus on emotions or self-concept, but instead refers to

communication that affirms individual’s belonging to a network or reminds them of support

available from the network. It refers to communication that reminds people that they are not

alone in whatever situation individuals are facing. Members of the network may offer many

types of support but the concept of network support emphasizes that a network is available to

provide social support.

Information support refers to communication that provides useful or needed information.

When facing any challenging situation, often information is needed in order to make decisions.

Not knowing the details of what one is facing or about the different options available can be a

source of upset and stress. An individual just diagnosed with an illness or health problem often
needs more information about their condition and treatment options and can be supported by

those who provide useful information.

Tangible support is any physical assistance provided by others. This can range from

making a meal for someone who is sick to driving that person to a doctor’s appointment. In

some situations, individuals need material goods or action to help them in challenging

situations.

Past studies have revealed that construct of social support was associated with several

areas of adaptive functioning, including mental health, interpersonal satisfaction, and physical

well-being (Flannery, et al., 1989; Vilchinsky et al., 2011). Some studies have reported positive

and significant relationships between perceived social support and treatment outcomes such as

adequate academic adjustment and performance (Decker, et al., 2007), increased use of

emotion-focused coping strategies (Hudek- ne zevi c Kardum, 2000), and enhanced feelings

of social safeness (Kelly, et al., 2012). Research has also shown negative and significant

correlations between low levels of social support and some psychopathological conditions, such

as severity of posttraumatic stress disorder symptoms (Wilcox, 2010), frequency of suicidal

ideation (Zhang, et al., 2010), severity of depressive symptoms (Williams, et al., 2002), and

frequency of self-blame (Beck, et al., 2004).

Results from most of the studies just noted underscore the importance of using

contemporary psychometric methods to enhance further our understanding of the complex

dimensions and impact of the social support construct.

The most influential theoretical perspective on support hypothesizes that support

reduces the effects of stressful life events on health through either the supportive actions of

others like advice and reassurance or the belief that support is available. Supportive actions are

thought to enhance coping performance, while perceptions of available support lead to

appraising potentially threatening situations as less stressful. This perspective is linked closely

with research and theory on stress and coping (Thoits, 1986).

The stress-support matching hypothesis (Cutrona, et al., 1990) is perhaps the most

explicit statement of how supportive action should promote coping. The hypothesis is that social

support will be effective in promoting coping and reducing the effects of a stressor, insofar as

the form of assistance matches the demands of the stressor. According to this view, each

stressful circumstances places specifics demands on the affected individual.

Social cognition and symbolic interactionism provide an alternative perspective on social

support. Although these two views differ in their recent intellectual tradition and methods, they

share common origins in pragmatist philosophy and thereby share many assumptions (Barone,

et al., 1997). Social constructions refer to the assumption that people’s perceptions about the

world that reflect their social context (Dewey, 1997). However, because there is frequently no

clear social consensus, there are important individual and group differences in how people

interpret their worlds (Kelly, 1969).

In explaining the mechanism by which social support is related to health social cognitive

views of social support draw from cognitive models of emotional disorders (Beck, et.al., 1979).

Negative thoughts about social relations are thought to overlap with and stimulate negative

thoughts about the self, which, in turn, overlap with and stimulate emotional distress (Sarason,

et al., 1990).
Conceptual Framework

Family
Adherence to
Social Support Hemodialysis
Treatment Regimens
Health care
provider
Compliance to physician
prescriptions

Access to health care

Affect of clients

Figure 1. Conceptual Framework of the Study

Figure 1 shows the conceptual framework of the study. As seen in the figure, social

support are sourced from the family and health care provider of the client, and is the

independent variable. The adherence to Hemodialysis Treatment Regimens is the dependent

variable. The adherence to Hemodialysis Treatment Regimens can be measured by the social

support given.
 Chapter III

Review of Related Literature

Social support is a concept recognizing patients exist to varying degrees in

networks through which they can receive and give aid, and in which they engage in interactions.

Social support can be obtained from family, friends, co-workers, spiritual advisors, health care

personnel, or members of one's community or neighborhood. Several studies have

demonstrated that social support is associated with improved outcomes and improved survival

in several chronic illnesses, including cancer and end-stage renal disease (ESRD). The

mechanism by which social support exerts its salutary effects are unknown, but practical aid in

achieving compliance, better access to health care, improved psychosocial and nutritional

status and immune function, and decreased levels of stress may all play key roles. Few data

exist regarding social support in patients with ESRD and chronic renal insufficiency, but links

between social support and depressive affect and quality of life have been established.

Interventions that enhance social support in ESRD patients should be evaluated (Patel et al.,

2005; p 98-102).

According to Patel, support improves quality of life through various mechanisms such as

increasing patients satisfaction from the provided care, enhancing adherence to the therapeutic

regimen including diet and fluid restrictions, thus improving laboratory results (lower phosphorus

and potassium) or leading to better clinical outcomes. High social support is also associated

with approximately 15% decreased risk for hospital admission. Most hospitalizations of

hemodialysis patients could have been avoided or treated in clinical out settings if they were

early recognized by a supportive social network that enhances treatment-seeking behavior. In

the light of these results, increasing support is obviously one of the most effective ways to

decrease hospitalization-associated costs Another significant area related to this association is

that a supportive environment provides a frame within patients may express their feelings and
find solutions to the stressful treatment aspects. Indeed, an encouraging environment will help

hemodialysis patients to adopt a more positive attitude towards the disease including

improvement in their coping mechanisms (Alexopouou, Margarita et al., 2016; p 338-342).

Social support may improve patient outcomes through at least five mechanisms in

patients with chronic disease, including increased access to health care, increased compliance

with physician prescriptions, improvements in nutritional status and overall sense of quality of

life, modulation of the immune system, and a decrease in depressive affect. Study showed that

increased spirituality, defined as importance of faith, as measured by a particular tool, was

associated with improved survival in a hemodialysis population with end stage renal disease

(ESRD) at a single medical center. Whereas increased “spirituality” was associated with

survival, “religion as a coping mechanism” and “religious involvement” were not associated with

decreased mortality in this relatively small study, suggesting that the instruments used may

have been able to discriminate between an overall sense of “spirituality” and other factors that

are associated with religious experience. (Spinale, Joann et al., 2008; p1620-1627).

Hemodialysis patients experience tremendous psychosocial burden, mainly attributed to

the limitations imposed by the disease including fluid and diet restrictions. Additionally, other

stressors that contribute to this burden are physical and cognitive impairment, failure of

adherence to the therapeutic regimen, dependency upon treatment and health professionals

and the fear of death. Though several advances have been made in understanding

hemodialysis treatment however, the beneficial role of social support to hemodialysis patients is

slowly being acknowledged. Social support is obviously one of the most effective ways to

facilitate the long-term treatment success and patients adjustment to illness. High social support

is also associated with more effective disease management. This beneficial effect of social

support is may be achieved through psychological, medical, and biochemical factors

(Theodoritsi, et al., 2016).

 Following recommended treatments by the patient is one of the most important issue.

The social support means providing physical and emotional support by the family member and

providing professional help or community support group (Arahan et al., 2010; p45).

According to the study of Kimmel in 1995 and Moran in 1997, there is no significant

relation between the social support and adherence to recommended dietary treatment.

However, other study by including that of Kara et al., in 2007 have confirmed the relation

between social support and adherence to dietary treatment.

Hemodialysis patients have a weak adherence to dietary and fluid restriction (Koglar et

al., 2005; p78). Sayers et al., studied in 2008 that family member should play a greater part in

improving self-care behaviors.

Social support in diabetic patients can reduce the negative effect of depression on

adherence to treatment regimen (Obsborn et al., 2012; p4). Patients with higher social support

level had significantly higher quality of life, lower depressions level, and higher acceptance of

life with psoriasis (Janowski et al., 2016;p 56). Gallagher et al., have concluded that heart failure

patients with high score of social support had more adherence to self- care behaviors

compared to patients with moderate and low social support. Song et al., have also found that

social support is an important factor in self-care behaviors in patients with type 2 diabetes.

Advances in medicine, improved general hygiene practices in particular, and the

development of effective preventive and curative measures, such as vaccines and antibiotics,

have made it possible to win the battle against most infectious disease. However, these

changes have increased the number of people with long term illnesses, functional limitations,

and physical and psychological disabilities (Smith et al., 2015; p16).

Adherence to medical recommendations is vital to patients with a chronic illness. Once a

patient has been diagnosed as having a chronic illness, major lifestyle changes need to be
implemented. Such patients need to follow a strict drug regimen, take medications several times

a day, or even self-administer daily in insulin injections in the case of diabetic patients (Gross et

al., 2003; p.62).

The attitude, social influences, and self-efficacy psychosocial model suggest that an

adherent patient should have a positive attitude toward drug compliance, social influences that

encourage adherence to perceived himself or herself as being able to take the medication as

prescribed (Lopez, et al., 2002;p43).

The well-known Health Belief Model (Becker and Rosenstock et al.,1974;p52) also

incorporates the construct of perceived self-efficacy to explain health protective or preventive

behavior.

Nevertheless, Banndura’s self-efficacy theory, set within social cognitive theory, provides

the greatest support for the relationship between self-efficacy and health behaviors.

A large number of studies have shown that interpersonal relationship have a direct

significant impact on health and well-being (Cohen et al., 2011;p32). Hence, health problems

are more likely to occur and are more pronounced among people who lack this relationship or

social support (Hoth et al., 2007;p21).

Low levels of social support may lead to the failure to adopt a healthy lifestyle and to

poorer compliance with medical recommendations (Kara et al., 2007;p11). Whereas perceived

social support has a positive association with treatment adherence in various conditions and

diseases (Bosworth et al., 2006;p 48). In other words, social support can buffer the stress of

chronic disease and enable the individual to engage in more adoptive and healthier behavior

leading to improve treatment adherence.

Chronic kidney disease (CKD) as a public health problem is considered endemic across

cultures globally. Hemodialysis patients have many problems resulting from the disease itself
and treatment process, which change their quality of life, cause depression, and sometimes

even lead to suicide and early death. The prevalence of CKD stages 1 to 4 increased from

10.0% in 1988-1994 to 13.1% in 1999-2004 in the USA. Chronic renal failure involves the

patients and their families due to the extensive lifestyle changes, as well as fluid and dietary

restriction. The successful treatment of patient with end stage renal failure requires adherence

to complex, whole of lifestyle changes, and lack of compliance with diet and fluid restriction nay

lead to accumulation of metabolic by products and excess fluid in the circulatory system, leading

to increased morbidity and mortality for renal failure patients. Low adherence to dietary

treatment is a significant health problem that reduces the benefits of routine treatment,

exacerbates symptoms, reduces quality of life for the patients, as well as increasing costs to

both the patients and the health system. Poor compliance has been estimated to cost between

100 to 300 billion dollars in the United States.

Identity factors influencing adherence to treatment regimens are one of the goals of public

health, which it has been declared an as objectives of the healthy people 2010. Adherence to

diet and fluids and dialysis in the cornerstone of renal failure treatment. Following recommend

treatment by the patients is one of the most important issues in the health care programs. We

suggest our hemodialysis patients to be educated to follow a proper schedule for their

adherence to dietary and fluids restriction, as well as necessary medications. The social support

means providing physical and emotional support by family member and providing professional

help or community support group. Having access to social support, be it from the spouse, family

members, friends, colleagues, or the community, has been consistently linked to better health

outcomes for patients with various chronic illnesses. The adherence to dietary and fluid

restriction as well as medical treatment are important parts of complex and difficult treatment

process is these patients. Compared with chronic illnesses like cancer or cardiovascular

disease, there is a paucity or research addressing the association between social support and
mortality rates and adherence to dietary and fluid restriction is dialysis patients. (Kimmel et al.,

in 1995 and Moran et al., in 1997).

Treatment adherence is a key health behavior in chronic patients. It enables them to more

likely be successful in any medical treatments. The study investigates the mediating role of

perceived social support in connection between self-efficacy and adherence to treatment. All

throughout the years, adherence to health treatment has been an issue of social concerns. The

patient’s adherence behavior plays a vital role in his way to the success of his treatment.

However, there are factors that trigger the delay and some on the other hand, motivate

and enable the patient to have a positive visualization regarding the health recommendation

prescribed by the health professionals. One of these factors is the patient’s behaviour towards

the medical treatment. It may be on how he takes the medication, follows a diet plan, and even

on how the patient handles hid lifestyle.

The patient’s adherence to treatment largely contributes a great importance for the success

of his treatment. Treatment adherence refers to the increased involvement and voluntary

collaboration of the patient in a course of behavior accepted by mutual agreement with the

health provider to produce a desired preventive or therapeutic result. Meaning, the positive

results of the treatment, for some reason, depends on the patient’s interest and willingness to

cooperate with the health professional in-charge. In this manner, perceived social support, as

one of the factors that contribute to the success of the treatment, also plays part in connection

with the patient’s attitude towards the health recommendation. It has been stated that the self-

efficacy of the patient helps him to be more subject successful medical treatment. Self-efficacy

refers to the beliefs a person holds in terms of their own ability to successfully perform the

behavior required to produce certain outcomes (Bandura, 1999). If the patient thinks that he can

manage to follow the medical recommendations given by the doctor, the more that he is likely to
perform the required medical behavior by the health professionals. However, self-efficacy can

be affected by some factors such as interpersonal relationship and social support.

The patient’s social relatedness can both be positive and negative when it comes to

developing self-efficacy of the patient. It can be a great help but can sometimes hinder the

patient’s positive behavior towards the treatment. An example of this is when a patient lacks

support from his families and relatives. On the other hand, social supports from them such as

motivational and inspiring factors (encouragements and advice), enables the patient to be more

collaborative. It therefore states that the patient’s self-efficacy largely depends and relies on

their satisfactory level with their perceived social support. In conclusion, patients with higher

level of self-efficacy have more social resources available and satisfied with them. Their

interpersonal relationship with others (families, friends, relatives, etc.), positively influence the

patients, enabling them to willingly comply with the recommended treatment, thus allowing them

to feel more efficacious. (Journal of behavior, health and social issues vol.7 num.2)

The deterioration of kidney function requires considerable dietary adaptations to reduce

the risk for increased morbidity and mortality, including changes in the intake of energy,

macronutrients, certain minerals and fluids. In the case of potassium and phosphorus intake,

dietary adherence is estimated at 2 to 39% and 19 to 57% respectively. Non-adherence to

medication ranges between 19 to 99%, whereas appointment non-adherence varies between 0

to 35%. Nonadherence is most common for fluid restrictions and somewhat less common for

other dietary restrictions and medication. Several research reports concluded that there is little

or no evidence supporting an association between patient characteristics and adherence to

treatment guidelines in chronic diseases. Indeed, there are many factors that may contribute to

non-adherence in patients with CKD, in addition to personal characteristics. Various theoretical

approaches have been used to achieve or explain dietary adherence.

 The health belief model explains adherence to health prescriptions by patient’s perception

of the severity of the condition, the benefits and costs of treatment. The transtheoretical model

explains behavior changes as a process that focuses on the individual’s decision to change.

They found that in patients with end stage renal disease, a more vigilant style of coping was

associated with improved adherence only for patients undergoing home-based dialysis

treatment that is highly patient-directed. (Dirks JH, et al). Prevention of chronic kidney and

vascular disease: toward global health equity-the Bellagio 2004 declaration. Kidney int Suppl

2005; 98:S1-S6).

Psychological factors in End-Stage renal disease: An emerging context for behavioral

medicine research. Patient non-adherence and psychological distress are highly prevalent

among ESRD patients and both have been found to contribute to greater morbidity and earlier

mortality in this population. A Range of factors have been examined as potential determinants

of adherence and adjustment. Evidence suggests that adherence and adjustment are

maximized when a patient’s preferred style of coping is consistent with the contextual features

or demands of the renal intervention the patient is undergoing. (Alan J, et al 2002).

Compliance with dietary, fluid and medication instruction is a critically significant factor in

the continued health and well-being of the patient undergoing chronic hemodialysis. The most

compliant patients tend to be married, skilled professionals with a high level of self-concept.

Compliance in hemodialysis patients is most often measured by monitoring levels of blood urea

nitrogen, potassium, and phosphorus and by observing the amount of weight gained between

dialysis treatments. To improve compliance, health professionals need to assess fully the

education level and understanding of the patients.

In regimens requiring alterations of critical behaviour, such as diet, changes should be

made one at a time, with the next objective being added only after the patient has demonstrated

adequate knowledge of the preceding steps. The problem of noncompliance is

multidimensional. Intervention to alter health behaviors must involve considerations of the

issues of greatest concern to the patients. Simplifying the treatment plan, including family

support, and making sure that the patient has a clear understanding of what is expected of him

or her are some of the techniques reported. (Journal of the American dietetic association 89

(7):957-9.august 1989).

An important part of patients‟ dietary restrictions is their fluid intake. Since hemodialysis

patients cannot excrete excess fluid from their bodies, careful attention is given to the amount of

fluids they intake. Fluids are considered anything that is liquid at room temperature, including

foods such as Jell-O™ and ice cream, and patients are typically recommended to keep intake

to 1 liter a day (Cvengros et al., 2004; Faris, 1994). Research suggests that 30 to 60 percent of

patients fail to adhere to recommended fluid restrictions (Christensen, et al., 2002; Christensen

et al., 1996; Wolcott, et al., 1986).

Failure to adhere to fluid restrictions can lead to complications such as hypertension,

congestive heart failure, pulmonary edema, and increased risk of mortality (Wolcott et al., 1986).

The amount of fluid ingested between sessions is measured by the patient’s Interdialytic Weight

Gain (IWG; Cvengros et al., 2004). The IWG is considered to be a valid and reliable measure of

fluid adherence, and is utilized in both clinical and research settings (Cvengros et al., 2004;

Wolcott et al., 1986). Patients are routinely weighed at the start and after completing each

dialysis session, therefore IWG is calculated based on the individual’s postdialysis weight or dry

weight of the previous session subtracted from the predialysis weight for the subsequent

session (Khechane & Mwaba, 2004; Cvengros et al., 2004).

Adherence can be evaluated based on the average weight gain over a 12-session period, with

IWG values over 2.5kg interpreted as poor or problematic fluid adherence. (Christensen, et al.,

1995; Cvengros et al., 2004).

 Schneider et al. (1991) assessed cognitive variables such as locus of control, self-

evaluation of compliance and self-efficacy, as well as the emotional variables of depression,

anger, and anxiety in fluid adherence. Schneider et al. (1991) found that the cognitive variables

accounted for past and future fluid adherence. Emotional variables such as depression were not

related to adherence, but patients reporting high negative emotions were significantly more

symptomatic and distressed.

Christensen, Smith, Turner, Holman, and Gregory (1992) measured patients‟ perception of

familial social support and adherence. Patients‟ who perceived a more cohesive, expressive,

and lower intra-family conflict had significantly more favorable adherence to fluid intake

restrictions in both center base and home hemodialysis programs. Sensky, Leger, and Gilmour

(1996) also examined social support and fluid adherence with similar findings to Christensen et

al. 1992; namely, good social support was related too much lower levels of interdialytic weight

gain.

The presence of an intimate partner can directly or indirectly influence patient health

behavior, thereby facilitating adherence through the internalization of norms and the provision of

sanction when behavior is not conducive to health (social control hypothesis: Lewis, et al.,

1999;p87).

Social network composed of individuals who do not offer support to the chronic patient

may be a hindrance to practicing healthy habit, limit the time and energy available to engage in

a healthy behavior, or lead to stressful situations that compromise to attitude and behavior

needed to achieve treatment adherence in this patient (Revecky, et al., 1985;p76).

Related Studies

Social support is a concept recognizing patients exist to varying degrees in networks

through which they can receive and give aid, and in which they engage in interactions. Social

support can be obtained from family, friends, co-workers, spiritual advisors, health care

personnel, or members of one's community or neighborhood. Several studies have

demonstrated that social support is associated with improved outcomes and improved survival

in several chronic illnesses, including cancer and end-stage renal disease (ESRD). The

mechanism by which social support exerts its salutary effects are unknown, but practical aid in

achieving compliance, better access to health care, improved psychosocial and nutritional

status and immune function, and decreased levels of stress may all play key roles. Few data

exist regarding social support in patients with ESRD and chronic renal insufficiency, but links

between social support and depressive affect and quality of life have been established.

Interventions that enhance social support in ESRD patients should be evaluated (Patel et al.,

2005; p 98-102).

Possibly in direct way, social support improves quality of life through various

mechanisms such as increasing patients‟ satisfaction from the provided care, enhancing

adherence to the therapeutic regimen including diet and fluid restrictions, thus improving

laboratory results (lower phosphorus and potassium) or leading to better clinical outcomes. Also

of importance is the acknowledgement that high social support is associated with approximately

15% decreased risk for hospital admission. Interestingly, many hospitalizations of hemodialysis

patients could have been avoided or treated in clinical out settings if they were early recognized

by a supportive social network that enhances treatment-seeking behavior. In the light of these

results, increasing support is obviously one of the most effective ways to decrease

hospitalization-associated costs . Another significant area related to this association is that a

supportive environment provides a frame within patients may express their feelings and find

solutions to the stressful treatment aspects. Indeed, an encouraging environment will help

hemodialysis patients to adopt a more positive attitude towards the disease including

improvement in their coping mechanisms (Alexopouou, et al., 2016; p 338-342).

Social support may improve patient outcomes through at least five mechanisms in

patients with chronic disease, including increased access to health care, increased compliance

with physician prescriptions, improvements in nutritional status and overall sense of quality of

life, modulation of the immune system, and a decrease in depressive affect. Study showed that

increased spirituality, defined as importance of faith, as measured by a particular tool, was

associated with improved survival in a hemodialysis population with end stage renal disease

(ESRD) at a single medical center. Whereas increased “spirituality” was associated with

survival, “religion as a coping mechanism” and “religious involvement” were not associated with

decreased mortality in this relatively small study, suggesting that the instruments used may

have been able to discriminate between an overall sense of “spirituality” and other factors that

are associated with religious experience. (Spinale, et al., 2008; p1620-1627).

Hemodialysis patients experience tremendous psychosocial burden, mainly attributed to

the limitations imposed by the disease including fluid and diet restrictions. Additionally, other

stressors that contribute to this burden are physical and cognitive impairment, failure of

adherence to the therapeutic regimen, dependency upon treatment and health professionals

and the fear of death. Though several advances have been made in understanding

hemodialysis treatment however, the beneficial role of social support to hemodialysis patients is

slowly being acknowledged. Social support is obviously one of the most effective ways to

facilitate the long-term treatment success and patients‟ adjustment to illness. More in detail,

high social support is associated with more effective disease management. This beneficial effect
of social support is may be achieved through psychological, medical, and biochemical factors.

(Theodoritsi, Anastasia et al.,2016; p 1261-1269).

Synthesis

Studies show that social support has significant effect on patient’s adherence to

treatments and overall well-being. With positive social support, patients are inclined to comply to

prescribed treatment regimens from the physician, improve diet and nutrition, and decrease

depression affect.
 Chapter III

Research Methodology

Research Design

The researchers used descriptive quantitative design which requires gathering of

relevant data and compiling of information about the effect of social support to dialysis clients

adherence to their Hemodialysis treatment regimen.

Research Respondents

There were 20 respondents participated in this study. Purposive sampling method

was used in selecting the respondents. The dialysis clients acquired treatment from both

clinics and hospitals. The respondents voluntarily participated in the study.

Research Instrument

The research instrument used is an modified questionnaire based on the collected ideas

from relevant theories and related studies. It was modified to adapt the local setting fit to the

situation of the respondents. The questionnaire is arranged in order of the effects of social

support to the adherence of dialysis clients to Hemodialysis treatment regiments. Three

statements are made to support each factor and are arranged chronologically.

During the conduct of the study, the researchers have distributed the questionnaires to

the respondents and were readily available for questions asked.

Locale of the Study

The study was conducted in dialysis clinics and hospitals located in North Western

Leyte, specifically Ormoc City and Albuera. Respondents from the dialysis centers located in

Maasin City have answered the questionnaire through an online platform.

Validation of the Research Instrument

The research instructor is involved in analyzing and reviewing the contents of our study

regarding the “ social support and adherence of dialysis clients to hemodialysis treatment

regimens. The instructor accepts inquires and concerns, and gives us recommendations and

feedbacks. We are given enough time to prepare and analyze our research study. A thorough

analysis was made to come up an accurate and relevant content.

Data Gathering Procedure

Once the proposal was approved, a transmittal letter was given to the Dean of the

College of Nursing of Western Leyte College requesting permission to conduct the study. Upon

the approval, the schedule for research activity was made. A survey took place as soon as

possible with the convenience of the respondents' schedules. The respondents were

approached and were be given questionnaires to complete. Data collection was done for one

month, after which the gathered data were collated, summarized, and categorized.
Statistical Treatment

The researchers have used weighted mean as the statistical treatment to find the effects

of social support to dialysis clients adherence to Hemodialysis treatment regimens. The

weighted mean is solved with the equation below.

x́=
∑x
n

The equation is then applied by dividing the sum of the data by the total number of

respondents.
 Chapter IV

Presentation, Analysis, and Data Interpretation

This chapter presents, analyzes, and interprets the results of the field survey through the

adapted questionnaire provided to the respondents.

Table 1. Sociodemographic profile of Dialysis Clients

Civil Status No. of Respondents

Single 10
Married 10
TOTAL: 20

Table 1 shows that 10 of the respondents are single and 10 of the respondents are married,

totaling to 20.

Table 2. Effects of Social Support to Dialysis Clients Adherence to Hemodialysis

Treatment Regimens
 Mean per Total
Statements
statement Mean
Statement 1 3.85
Statement 2 3.75 3.67
Statement 3 3.4
Statement 4 2.8
Statement 5 2.6 3.08
Statement 6 3.85
Statement 7 4
Statement 8 3.95 3.98
Statement 9 4

Table 2 shows that statements one to three supporting “Compliance to physician prescriptions”

has a weighted mean of 3.67 which means always. Statements four to give “Access to health

care” has a weighted mean of 3.08 which means often. Statements seven to nine supporting

“Affect of the clients” has a weighted mean of 3.98 which means always.

Table 3. Compliance to physician prescriptions

 Responden Statement
t 1 Statement 2 Statement 3
1 4 2 2
2 1 1 1
3 4 4 1
4 4 4 1
5 4 4 4
6 4 4 4
7 4 4 4
8 4 4 4
9 4 4 4
10 4 4 3
11 4 4 4
12 4 4 4
13 4 4 4
14 4 4 4
15 4 4 4
16 4 4 4
17 4 4 4
18 4 4 4
19 4 4 4
20 4 4 4
Mean 3.85 3.75 3.4

Table 3 shows the first statement has a weighted mean of 3.85 which means always. The

second statement has a weighted mean of 3.75 which means always. The third statement has a

weighted mean of 3.4 which means often.

Table 4. Access to health care

 Responden Statement Statemen
t 4 Statement 5 t6
1 2 4 2
2 2 1 4
3 4 2 4
4 4 2 4
5 4 1 4
6 4 2 4
7 4 1 4
8 4 1 4
9 4 2 4
10 4 1 4
11 4 1 4
12 3 2 3
13 2 4 4
14 2 4 4
15 1 4 4
16 2 4 4
17 1 4 4
18 2 4 4
19 1 4 4
20 2 4 4
Mean 2.8 2.6 3.85

Table 3 shows the fourth statement has a weighted mean of 2.8 which means often. The fifth

statement has a weighted mean of 2.6 which means sometimes. The sixth statement has a

weighted mean of 3.85 which means always.

Table 5. Affect of the clients

 Responden Statement Statemen
t 7 Statement 8 t9
1 4 4 4
2 4 4 4
3 4 4 4
4 4 4 4
5 4 4 4
6 4 4 4
7 4 4 4
8 4 4 4
9 4 3 4
10 4 4 4
11 4 4 4
12 4 4 4
13 4 4 4
14 4 4 4
15 4 4 4
16 4 4 4
17 4 4 4
18 4 4 4
19 4 4 4
20 4 4 4
Mean 4 3.95 4

Table 4 shows the seventh statement has a weighted mean of 4 which means always. The

eighth statement has a weighted mean of 3.95 which means always. The ninth statement has a

weighted mean of 4 which means always.

Chapter V
 Summary of Findings, Conclusions, and Recommendations

This chapter presents the findings, the conclusions, as well as the recommendations based on

the analyzed data.

Summary of Findings

The results showed an equal number of single and married respondents. The study has resulted

in three other important results that merit comment. First, dialysis clients comply with physician

prescriptions when their family encourages them to religiously take them; gathering the highest

mean of 3.85 meaning always. Second, dialysis clients gain better access to healthcare when

their family helps in seeking assistance from organizations that offer financial and emotional

aids for dialysis patients; gathering the highest mean of 3.85 meaning always. Third, dialysis

clients decrease the risk of depression when their family checks upon them all the time

especially after dialysis sessions and when their family empowers them to complete all their

sessions successfully. Taken together, our findings indicate that clients decrease the risk of

depression when going through Hemodialysis treatments; gaining the highest weighted mean

among the other factors identified. Finally, we obtained evidence that social support has a

positive effect on dialysis clients in adhering to their Hemodialysis treatment regimens.

One limitation of this study is that it has not covered the age range of the dialysis clients. It is

possible that the aforementioned factor has effect to dialysis clients coping mechanism to their

situation. Although the present rule cannot rule out these explanations, it seems useful to point

out issues that may conflict with these results. In summary, our research replicates the study

indicating hemodialysis patients to adopt a more positive attitude towards the disease including

improvement in their attitude towards the disease including improvement in their coping

mechanisms (Alexopouou, Margarita et al., 2016; p. 338-342). Although the generality of the

current results must be established by future research, the present study has clear support for
the study that social support is one of the most effective ways to facilitate the long-term

treatment success and patients and is associated with more effective disease management

(Theodoritsi, Anastasia et al.,2016; p.1261-1269).

Conclusions

1. Therefore, there is an equal number of single and married respondents.

2. Therefore, dialysis clients have positive affect towards adherence to Hemodialysis

treatment regimens.

3. Therefore, social support encourages dialysis clients to adhere to Hemodialysis

treatment regimens when their family encourages them to take medications prescribed

by physicians.

4. Therefore, social support helps dialysis clients to gain wider access to to seek

assistance from organizations that offers financial and emotional aids for dialysis

patients.

5. Therefore, social support influences positive affect to dialysis clients when their family

checks up on them all the time especially every after session, and when their family

empowers them to complete their treatments successfully. The dialysis clients gain a

positive outlook about their treatment because of their family’s social support.

Recommendations

The following are the recommendations of this study:

Family of Dialysis Patient. The researchers would recommend to the family of the dialysis

patients to provide social support so that patients can positively adhere to the Hemodialysis

treatment regimens.
Healthcare Providers. The researchers would recommend to the healthcare providers that

they include social support as part of treatment of the patient undergoing dietary and fluid

restriction and, hemodialysis, to minimize health and economic consequences of non-

adherence.

Readers. The researchers would recommend to the readers that the findings of this study

may benefit them by encouraging them to provide social support if they have family

members and relatives undergoing Hemodialysis treatment.

Future Researchers. The researchers recommend to future researchers that they

understand the relationship between social support and adherence to fluid and dietary

restriction among hemodialysis patients and use this study to further knowledge about

adherence of dialsysis clients to their Hemodialysis treatment regimens.

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 APPENDICES

Transmittal Letter

March 3, 2020
Mrs. Emmalissa B. Ramirez
Dean- College of Nursing and Allied Health Sciences
Western Leyte College of Ormoc City Inc.
Ormoc City 6541

Dear Madame:

Warm Greetings!
The undersigned Fourth Year nursing students of Western Leyte College are conducting

a study on “SOCIAL SUPPORT AND ADHERENCE OF DIALYSIS CLIENTS TO

HEMODIALYSIS TREATMENT REGIMENS” as a partial fulfillment for the degree of Bachelor

of Science in Nursing in WLC. In this regard, the researchers request permission to conduct the

said study in your institution. A total of thirty (30) patients coming from the hemodialysis unit will

be the research respondents and they shall be given an informed consent and research

questionnaire to answer as a tool of the data gathering. Specifically, the researchers request to

be permitted to administer the survey to the hemodialysis patients from March 4, 2020 until

March 27, 2020.

Respectfully Yours;

Mary Grace F. Baltazar Noted By.

Aubrey Mariel D. Eway
Arjay P. Garrido
Marie Grace P. Quintana
Rice Cindy D. Santillan
Mrs. Ciedelle Honey Lou Dimalig-Gapasin, RN,MAN,LPT,EDD
Instructor- Research 2
Approved By:
Asielo Estela M. Sulla Mrs. Emmalissa B. Ramirez RM, RN,MAN
Dean –College of Nursing and Allied Health Sciences
Research Instrument

Questionnaire: All information provided below are held confidential and will be used for this

study only. Thank you for your time and cooperation.

Instructions: Please read carefully and check (/) the corresponding boxes for your answers.

Part I. Respondent’s Profile

1. What is your civil status?

Single Married

Part II. Research Instrument

4 3 2 1

Questions Always Often Sometimes Never

I. Compliance to physician prescriptions
1. My family encourages me to

adhere to religiously take

medications prescribed by the

doctor.
2. My family encourages me to eat

healthy food options as

prescribed by the doctor.

3. My family encourages me to

involve myself in physical

exercises as prescribed by the

doctor.
II. Access to healthcare
4. My family encourages me to
 attend my dialysis sessions

regularly.
5. My family accompanies me to my

dialysis sessions.
6. My family helps me to seek

assistance from organizations

that offers financial and

emotional aids for dialysis

patients.
III. Affect of clients
7. My family checks up on me all

the time especially after my

dialysis sessions.
8. My family assures me that they

will be with me throughout my

dialysis sessions.
9. My family empowers me that I

can successfully complete all my

sessions.

Curriculum Vitae

BALTAZAR, MARY GRACE F.

Contact No: 09771634454
Barangay. Cogon, Ormoc City,Leyte
baltazargrace91@gmail.con
A. PERSONAL INFORMATION

Name : Mary Grace F. Baltazar

Nationality : Filipino
Date of Birth : September 22, 1998
Place of Birth : Mandaluyong City, Manila
Status : Single
Gender : Female
Height : 5’5”
Weight : 75 kls.
Religion : Roman Catholic
Home Address :Dama de noche 104 Sitio Kalipay, Cogon, Ormoc City
Mobile/Phone No. : 09771634454

EWAY, AUBREY MARIEL D.

Contact No: 09457637025
Barangay Mantahan, Maasin City So. Leyte
aubreyeway@gmail.com
A. PERSONAL INFORMATION

Name : Aubrey Mariel D. Eway

Nationality : Filipino
Date of Birth : October 12, 1997
Place of Birth : Maasin City
Status : Single
Gender : Female
Height : 5’2”
Weight : 55 kls.
Religion : Roman Catholic
Home Address : Barangay Mantahan, Maasin City
Mobile/Phone No. : 09457637025

GARRIDO, ARJAY PALLER

Contact # 0927 294 6932
Tinago 2, Benolho, Albuera, Leyte
Aishiteiruyo4@gmail.com
A. PERSONAL INFORMATION

Name : Arjay P. Garrido

Nationality : Filipino
Date of Birth : April 27, 1989
Place of Birth : Ormoc City Maternity Center
Status : Single
Gender : Male
Height : 5’6”
Weight : 80 kls.
Religion : Roman Catholic
Home Address : 305 Tinago Dos, Benolho, Albuera, Leyte
Mobile/Phone No. : 09272946932

QUINTANA, MARIE GRACE P.

Contact No: 0995967116
Poblacion Dist 1 Barugo, Leyte
mg.quintana.22@gmail.com
Name : Marie Grace P. Quintana
Nationality : Filipino
Date of Birth : December 22, 1997
Place of Birth : Barugo, Leyte
Status : Single
Gender : Female
Height : 5’6”
Weight : 70 kls.
Religion : Roman Catholic
Home Address : 300 Sto. Rosario St, Poblacion Dist 1 Barugo
Mobile/Phone No. : 09959671116

SANTILLAN,RICE CINDY D.
Contact No: 09772687220
Barangay. Kadauhan, Ormoc City,Leyte
Rcsantillan23@gmail.com
Name : Rice Cindy D. Santillan
Nationality : Filipino
Date of Birth : December 23, 1998
Place of Birth : Ormoc City
Status : Single
Gender : Female
Height : 5’6”
Weight : 48 kls.
Religion : Roman Catholic
Home Address : Sitio Cabatoan, Brgy.Kadauhan, Ormoc City
Mobile/Phone No. : 09772687220

SULLA, ASIELO ESTELA M.

Contact No: 09433939375
Barangay. Ibarra, Maasin City, So. Leyte
asielosulla59@gmail.com
Name : Asielo Estella M. Sulla
Nationality : Filipino
Date of Birth : November 6, 1998
Place of Birth : Maasin City
Status : Single
Gender : Female
Height : 5’4”
Weight : 50 kls.
Religion : Roman Catholic
Home Address : Purok Seaside Barangay Ibarra, Maasin City So. Leyte
Mobile/Phone No. : 09433939375