Illness Perception, Social Support and Quality of Life among Dialysis Patients.

Arooj Tariq
BS Applied Psychology
Session (Spring 2019 – Spring 2023)

Supervisor
Mr. Muhammad Asad Javed
Riphah Institute of Clinical & Professional Psychology Lahore Campus
Riphah International University Lahore
Pakistan
 Abstract

The current study explored the relationship between illness perception, social support and quality of
life among dialysis patients. It was hypothesized that there would likely to be a significant relationship
between illness perception, social support and quality of life among dialysis patients. This study also showed
that illness perception and social support were the predictors of quality of life among dialysis patients. This
study also highlighted significant differences in terms of illness perception, social support and quality of life
among two undergoing dialysis groups (recent 6 months and chronic 2 years onset group). The research
design for this study was correlational and purposive sampling technique was used to collect the data from
200 dialysis patients from males and females. Further results also showed that 2 years undergoing patients
have higher illness perception and 6 month undergoing patients have higher social support and quality of
life. The results were discussed in the light of cultural context of Pakistan.

Keywords: Illness Perception, Scocial Support, Quality of life, Dialysis Patients.

 Chapter I
Introduction
Health is a blessing for all human beings. There are a lot of blessings for human to make their life pleasurable
and healthy but if a person not healthy he cannot take benefit from all these blessings. Every individual takes
the meaning of health in a different way as their own understanding and way. Being well to be an aspect of
your overall life. If a person is satisfied with his health, he can enjoy his life. If a person had any disease than
he must be in need of their family members and social support. These support are important for the better
quality of life of patient.
The personal satisfaction related to health was firstly addressed within late 70 century within the sector of
medical science which is appropriate to change in health and heath care (Sheridan, Radmacher, 1998). Chronic
kidney disease (CKD). CKD is quick turning out to resemble other interminable ailments, for example,
hypertension, diabetes, coronary illness, malignant growth and stroke. CKD influences not just the patients
other than their families.
In 20 century, when it has been observed the extraordinary changes in health care system with different crisis.
These changes weren't due to economical based but the change in the nature disease and pain when the acute
form was changing in to chronic, and it was absolutely effecting the individual's lifestyle.
Chronic kidney disease (CKD) Interminable kidney malady (CKD) is another overall pandemic ailment and the
quantity of end-stage renal illness (ESRD) patients is likewise arriving at pandemic degree.
CKD is quick turning out to resemble other interminable ailments, for example, hypertension, diabetes,
coronary illness, malignant growth, and stroke. CKD influences not just the patients other than their families
moreover. Patients with CKD face a heap of difficulties weighty from different parts of their wellbeing status
and way of life yet in addition their changed functions throughout everyday life (Al-Arabi, 2006)
The system of evacuation of waste and additional water from blood is called dialysis. Dialysis is a fake method
of channel the blood. It is a fundamental response for patients resolved to have the last stage of kidney disease
beside kidney transplantation is open (Gokal and Nolph, 1994; Fourtounas, C., Hardalias, A., Dousdampanis,
P., Savidaki, E., & Vlachojannis, J. G. (2009). In chronic kidney disease reason has reduced to 10-15 percent of
his/her one of a kind working which is dangerous short of management. Nearby the two type of dialysis of
kidney problem. In hemodialysis (HD) the blood is refined through an outside phony kidney. In peritoneal
dialysis (PD) the peritoneal covering limits as a fake kidney (Cameron, 1996; Kerschbaum, J., König, P., &
Rudnicki, M. (2012). Risk factors associated with peritoneal-dialysis-related peritonitis. International journal of
nephrology, 2012.).
People which are undergoing dialysis are incredibly subject to the extensive dialysis method just as unusualness
of ailment and treatment impression of patients with CKD pharmacotherapy. Also, patients experience
numerous physical manifestations, for example, exhaustion (Murtagh, Addington-Hall, and Higginson, 2007).
 It's a fake replacement of kidney working, mainly in renal disappointment circumstances. Dialysis is not totally
perform gone kidney work, however, somewhat, deals with its exercises by methods for stream and filtration
( Sabitha, V & Venkataramana,K 2017).
Dialysis patients might be stood up to with disgraceful trouble associated to the infection and its management,
occur after the ceaseless thought of end renal disease and the insensitivity of the clinical management. Patients
are regularly confronted with difficulties in food and liquefied ratification; with bodily indications, for example,
undeniable irritation and nonattendance of energy; with emotional irritability, for instance, loss of Self-thoought
and confidence, uncertainty about the upcoming events, and estimations of fault about members of family, and
with issues in the social situation(Cameron, 1996; Christensen, and Ehlers, 2002; Covic, Seica, Gusbeth-
Tatomir, Gavrilovici, and Goldsmith, 2004; Krespi, Bone, Ahmad, Worthington, and Salmon, 2004).
Continuous illness, individuals who are enduring with kidney diseases experience adjustment issues throughout
their life, for example, extreme eating routine arrangement, restrictions on liquid admission, standard timetable
of dialysis just as dealing with their spare time and leisure time exercises so as to manage this serious illness.
( Saira Javed,et al 2019).

1.1 Quality of Life

Person’s perception about their position in life in the setting of the culture in which they live and their
expectations and standards about their life (WHOQoL, 1998; Donkor, E. S. 2018). Quality of life is wide-ranging
concept in which individual enjoys his good quality of life when he is healthy, doing well in physical, mental and
social domains. An individual can perform better in his life when the essential needs are fulfilling within the life as
a result quality of life get increase, (Barccacia & Barbara, 2013).
The possibility of individual attainment all around passions how people measures the 'respectability' of a couple of
parts of their life. These appraisals join one's energetic reactions to life occasions, air, sentiment of life
acknowledgment and satisfaction, and satisfaction through work and specific associations (Diener, Suh, Lucas, and
Smith, 1999; Majumdar, C., & Gupta, G. 2015).
Quality of Life is a construct utilized to define overall well-being of person. The individual with a high or better
quality of life may perceive the health conditions of others in good color. As concerned with the perception of
mental illness individual with good quality of life may display a more healthy view about mental illness and also
perceive stigma about mental illness in a less amount. Therefore, his or her attitude to seek professional help or
consultation may be much better as compared to others with low quality of life.
According to (Calman 1984; Emami, E., de Souza, R. F., Kabawat, M., & Feine, J. S. 2013) that quality of life may
also defined as "the gap between a person's expectations and achievements". This gap can be reserved small in two
ways: one can live up to one's expectations or lower these expectations. To lower one's expectation is an adaptation
psychological process. Most individual may not able to keep the balance between the expectations and
achievements and it result in rich living but with lower quality of life. And on the other hand, people have poor
livings but with good quality of life. The person impartial sense of quality of life is important in making his or her
mind-set to view metal health conditions and also plays significant role in evaluation of the mental illness and
associated stigma. An individual impression of their circumstance in life period of the lifestyle and worth structures
during which they breathing, and equivalent to their aims, wants, levels and concerns.
An individual impression of their circumstance in life period of the lifestyle and worth structures during which they
breathing, and equivalent to their aims, wants, levels and concerns. Its extensive running thought influenced in a
problematic way by the individual' physical prosperity, public, level of opportunity, community concerns and their
relationship to remarkable geographies of their condition. (WHOQOL Group, 1995; Donkor, E. S. 2018). In 1948
the World Health Organization characterized wellbeing from a novel new perspective, expressing that wellbeing
was characterized not just by the nonattendance of illness and sickness, yet additionally by the presence of physical,
mental and social well-being.
The WHO characterizes personal satisfaction (QOL) as an individual reason adjusted social and worth framework
by which somebody lives, comparative with their points, trusts, expectations for everyday comforts and interests.
According to Jankison (2019), the real happiness of individuals and societies, shows positive and negative aspects
of life are known as quality of life. It generally measure satisfaction with life, involving everything from biological
condition, family, safety, education, employment, wealth, freedom, beliefs of spirituality, and the surroundings. The
extent to which a person enjoys health, comforts, and can participate in or enjoy important events of life is called
life quality. Therefore, it is purely subjective domain. Its definition can vary from individual to individual. A person
can explain quality of life in terms of wealth or life satisfaction, another person may describe it according to
capabilities. A high quality of life may be reported by a person with disability and at the same time an individual
who is healthy and recently fired from job may express low quality of life. In the area of health, it is taken as
multidimensional, concept including psychological, biological, material and social wellbeing

1.2 Illness Perception

It is characterized as patient’s cognitive judgement and patient's personal understanding of a medical
condition and its possible outcome. (Broadbent et al., 2015). Illness perception focus on how an individual
experience his disease and how perceive his disease. (Weinman and Petrie, 1997; Sekhon, M., Cartwright, M., &
Francis, J. J. 2017). Illness perception is both positive and negative illness belief that can affect the ability to cope
with the disease and to perceive it as manageable or threatening. (Bonsaksen et al., 2015). These examinations show
that when patients spread more certain faiths inside the controllability and reparability of the illness, this decidedly
impacts wellbeing (Hagger and Orbell, 2003). There are many studies which described about the relation of life
satisfaction/quality of life and aliment perception by kidney disease patients. (Fowler & Bass, 2006).
Illness perceptions is a significant construct which defines and portrayals the belief or subjective experience of a
patient about their sickness or illness. These subjective perceptions are seen as significant determinants of behaviors
and have been related with various significant results, for example, treatment adherence, useful recuperation and
functional recovery of the patients. The belief or formation of illness perception is drove by consistent patterns of
thinking (Sadeghi-Akbari, Cheraghi,Kazemnejad, Nomali, &Zakerimoghadam, 2019).
This phenomenon by large contain a personality segment, which incorporates the name of the disease and the range
of manifestations that the patient believed are related with the illness condition. Besides this, illness perception also
involves convictions about the individual outcomes of the condition for the patient and their family, just as the
degree to which the illness is amiable to individual control or to control by treatment (Sawyer, Harris, & Koenig,
2019).
This perception of illness is highly varieties by the strong belief of the sufferer as well their way of perception
towards the disease. For example it can be highly affected by the notion that the person is sensitive towards the
minor diseases or they may bear the effects and consequences of severe diseases. Indeed, even patients with a
similar disease or ailment can hold exceptionally different perspectives on their disease (Broadbent et al., 2015).
This perception of disease determines the course of living and mental frame of the individual because it is
accompanied by the cognitive appraisal and subjective understanding of the sufferer. Thus the abilities to live, cope
with or getting easily frightened and developing further physical or mental health problems i.e. psychological
distress due to illness perception is highly influenced by the internal belief system of the individual (Bonsaksen et
al., 2015). This perception furthermore leads the ways for resolving the quality of life and collective wellbeing of
the sufferer (Petrie, Jago, &Devcich, 2007).
It is characterized as the beliefs or convictions a patient holds about his/her medical issues, has been appeared to
influence adapting with regards to a physical or psychological illness, disease or sickness, for example behavioral
compliance (Vos et al., 2018).
Illness perceptions is a significant construct which defines and portrayals the belief or subjective experience of a
patient about their sickness or illness. These subjective perceptions are seen as significant determinants of behaviors
and have been related with various significant results, for example, treatment adherence, useful recuperation and
functional recovery of the patients. The belief or formation of illness perception is drove by consistent patterns of
thinking (Sadeghi-Akbari, Cheraghi, Kazemnejad, Nomali, &Zakerimoghadam, 2019). This phenomenon by large
contain a personality segment, which incorporates the name of the disease and the range of manifestations that the
patient believed are related with the illness condition. Besides this, illness perception also involves convictions
about the individual outcomes of the condition for the patient and their family, just as the degree to which the illness
is amiable to individual control or to control by treatment (Sawyer, Harris, & Koenig, 2019).
There are many studies which described about the relation of life satisfaction/quality of life and ailment perception
by kidney disease patients. (Fowler & Baas, 2006; Griva, Jayasena, Davenport, Harrison, & Newman, 2009;
Timmers et al., 2008).
1.3 Social Support
Social support is defined as interpersonal relationship of person which affects the persons psychological and
social functioning. (Caplan 1974; Holt-Lunstad, J., Smith, T. B., & Layton, J. B. 2010). The person who had good
relation with his family and friends are more flexible when faced with problems in their lives and cope more
successfully with life’s hardships and experience positive adjustment and mental health outcomes. It can explained
that social support first originates from individual family members and then from his peers. (Folkman and Lazarus
1988; Rambod, M., & Rafii, F. 2010). Social support is the concept of person’s needs for support with close others
and provide it when others experience distress in life. (Davison et al, 2000).
According to Cobb (1981; Marroquín, B. 2011) Perceived Social Support is a person's faith of being concerned by
others, cherished, well-regarded, respected, and fit in a set-up of communication and shared commitments. There
are 4 type of SS; emotional, appraisal informational and instrumental (House, 1981; Thoits, P. A. 2011).
Social support refers to interaction and trustworthy relationship between two or more individuals. It makes
individual confident about their abilities and also help them believe that they can control the situation (Handley,
2004). According to Gottlieb (2010) social support enhances an individual's self-esteem, competence, coping and
sense of belongingness. Concept of social support was first introduced by Durkheim (1984) as cited by Yadav
(2010) according to whom with the increase in social ties, general wellbeing of individual increases.
Social support can be explained as a system that is targeted to mobilize people toward better resources. It also aims
to explain a relationship through which individual motivate and help each other in dealing with physical,
psychological and emotional problems. Generally, it includes support regarding financial problems, emotional
support, psychological and physical help (Gottlieb, 2010). Social support has been classified into various categories
and all these types help individual in developing better coping strategies. Social support ensures one's individuality
and people also get the feeling of being valued by others.
Jale (2006) also classified social support into three types such as esteem support i.e., the feeling of being respected
also called effective support or self-esteem support and emotional support, it is in which information or guidance is
provided regarding some issue. Third type of support is instrumental support or referred to as financial aid (Satici,
Uysal & Akin, 2013).
Positive social support protects psychological and physical health if burdens are shared and positive feedback is
provided during the time of stress (Brieger, 2006). There are various dimensions of social support and it is
expressed in variety of ways. It can also be given by varied authorities, for example emotional support from home,
helpers and significant others. Social support may also originate after interaction with the community members that
includes interaction with colleagues and other members, peer or individual going through same conditions, provides
encouragement for acceptable and challenging behavior (Mattson, 2011).
(Sarason and Pierce 1990; Gottlieb, B. H., & Bergen, A. E. 2010) claimed that perceived Social support make
pupils enough competent to resolve the issues effectively and also deliver a sense of protection to them. A social
capital theory stated people get help from the sources, which are implanted in societal web to fulfil their aims
(Brouwer, Jansen, Flache, & Hofman, 2016).
Social support is an important construct influencing the psychological damage in the elderly patients of dialysis.
With reference to gender social support casts different impacts. For example women who perceive more social
support are likely to experience less psychological distress and better life quality than males (Mathiesen et al.,
2018). In clinical light of dialysis man psychosocial problems arouses in consequences of poor social support, lack
of knowledge about disease and many other uncontrollable factors which disrupts their cognitive, emotional,
behavioral and social life aspects (Silveira, Moura Neto, Sposito, Siminerio, &Pavin, 2019).
1.4. Literature Review:
A research were conducted by (Zazzeroni. L. et al., in 2017) they investigate the illness perception and
satisfaction of life among peritoneal dialysis (PD) and Haemodialysis patients (HD). The result of study ensure that
there were significant scores on illness perception in peritoneal patients (PD) therefore their quality of life were
significant and other haemodialysis (HD) group have lower quality of life because they got low scores on illness
perception.
To explore the relationship between illness perception and quality of life, (Shahnavazi. M. et al., 2018) investigate
that nurses can affect patient’s quality of life through perception-based interferences. 120 dialysis patients
participates in this study. This study shows that there was an inverse correlation between parameters of
consequences, nature of illness, anxiety, emotional response and quality of life. In this study regression analysis tell
the nature of illness and emotional response is participated to explore the quality of life. This study shows that
nurses can improve the quality of life in haemodialysis patients by giving proper training and consulting courses to
patients and their families about treating options and nature of illnesses and also by having they participate in health
improvement programs.
A study conducted by (Sadoughi. M. et al., 2017) they investigate the relationship between anxiety, depression,
perceived social support and quality of life among hemodialysis patients. 84 dialysis patients were selected through
randomized sampling from the hospital of Tehran. The findings indicate that the quality of life of haemodialysis
patients could be improved due to increasing of social support, increasing care offered by patient’s family and
nurses and also by giving preventive measure of anxiety and depression to haemodialysis patients to develop
necessary interventions.
Similarly, another study conducted by (Tommel. J.et al., 2021) explore many social and cognitive behavioural
factors on negative expectations which will be relevant for HRQOL of end stage renal disease kidney dialysis
patients. Patients treated with hemodialysis or peritoneal dialysis were enlist from Dutch hospitals and dialysis
centers in Netherlands. This study examine that helplessness and worrying, and less perceived social support were
significantly related to worse HRQOL.
Furthermore, a study conducted by (Moreno, F. et al,. 1996; Palmer, S. C., 2012). They investigate the quality of
life in patients on chronic dialysis and various factors which are related to treatment and ESRD on quality of life.
Cross-sectional study was used and 1013 dialysis patients were randomly selected. In this study, twenty-six percent
of patients showed severe quality of life. This study showed that patient disease has important effect on their quality
of life. In dialysis patients the increase of haemoglobin was related to good quality of life and advance age
comorbidity also effect the dialysis patient’s quality of life.
A study which were conducted on 164 haemodialysis patients to determine quality of life and social support of
haemodialysis patients. In this investigation Multidimensional Scale of Perceived Social Support questionnaire was
used and it was come about that women and married person have high social support and person who have low
social support have low quality of life and social support will help them to increase their quality of life. (Tel, H.,
2011).
(Jansen, D. L., Heijmans, M. J. Et al., 2011) conducted a study to examine the variability of illness and treatment
perceptions which affects the haemodialysis and pre-dialysis patient’s quality of life. Cross sectional and
longitudinal study design were used in this study. The study sample consisted 105 haemodialysis and 161 pre
dialysis patients. Findings of this study suggest that patients on haemodialysis and peritoneal dialysis strongly
believed that their treatment controls their illness than pre dialysis patients and this potentially helpful for patients in
order to improve their quality of life.
A study which were conducted on Iranian needed to recognize the connection between Social support and Quality
of life in patients under haemodialysis. In this investigation 95 patients partook and it was come about that the good
social support was related with a superior Quality of life/personal satisfaction in the physical and mental fields
(Bras, Enferm., 2019).
Moreover, a research conducted on end-stage renal disease patients by (Chilcot, J., Wellsted, D. Et al., 2018)
investigate whether haemodialysis patients and illness perception impact upon their survival. Haemodialysis
patients in UK completed the revised illness perception questionnaire and conclude that patients perception of
dialysis therapy predict to survival risk factors including comorbidity.
The point of this investigation was to decide impacts of dialysis patient’s apparent social help on their life
characteristics. This exploration was led with 60 dialysis patients in Turkey. Seen social help and personal
satisfaction were expanded together. Male patients resigned patients quality life score and saw social help were
high. In the interim when instructive level was expanded, seen social help and personal satisfaction were expended.
The quality of life scores and saw social help scores were high in patients who living alone (Karaoz, Ekiz, Cetin,
2007).
A study which were conducted on spinal cord injured patients. This research indicated that 98.7% patients described
that due to social support their quality of life improved, so its mean social support would be a predictor of quality of
life. (Elizabeth, N Mathaeis., et al in 2006)
A study were conducted by (Ahmed. R. et al,. 2021) investigate that Haemodialysis having a great impact on the
patient’s quality of life. This study were conducted in Peshawar, Pakistan. 184 undergoing dialysis patients
participated. The finding shows that 45% haemodialysis patients having hypertension due to disease, 16% having
higher physical component summary and 60% having higher mental component summary. The patient have poor
quality of life receiving haemodialysis therapy in all three domains like PCS, MCS and KDCS.
Moreover, (Patel et al,. 2011) investigate the quality of life and social support of hemodialysis patients. In this study
164 patients participated. The finding of this study is that Married patients had high specific person support and
retired person had high friends support.
End-stage renal ailment influences personal satisfaction (QOL) of the patients thoughtfully. This used to evaluate
the QOL of patients taking haemodialysis and compare it and maternal facts of these patients. Reason for ESRD and
dialysis-related element influencing QOL were additionally tried (Muhammad Anees, et al 2011).
Another study were conducted by (Hayat. M et al,. 2017) they conducted a study in provincial hospital Quetta. 185
patients were participated and they found that the patent have poor HRQOL, age of the patients was contributing
factor in poor HRQoL of the patients.
Furthermore, this examination researches the social help, expectation and quality of life of dialysis patients. A
cross-sectional in configuration was among 150 dialysis patients getting treatment, care, and backing from eight
network based NGOs. QOL was evaluated utilizing the WHO (QOL)-26 instruments, and social help was surveyed
by utilization of a modified sarasin’s Social Support Questionnaire. A Hope Assessment Scale was additionally
created. The non-family encouraging group of people was more prominent than family encouraging group of
people. By and large fulfilment from social help and expectation was significantly connected with QOL, the best
impact of social help was on natural working, and the most minimal was on social connections, enthusiastic help
was less an indicator of social relationship than different sorts of backings. The impact of apparent fulfilment from
social help was through the intervention variable expectation. As it has broadly been perceived that network based
help is fundamental for issues of personal satisfaction, procedures to improve social help and expectation mediation
projects are emphatically supported (Sushil, Yadav, 2003).

1.5 Rationale of the Study

The aim of this study to examine the illness perception, social support and quality of life among dialysis
patients in Pakistani culture. This study examine how dialysis patients perceive their illness, level of perception,
how social support effect their quality of life and how much they cope with their chronic disease. The purpose of
study to explore that better social support and developing positive health behaviors playing important role in
manage with chronic disease and manage with physical and psychological difficulties which are caused by chronic
disease. Furthermore, this study explore that illness perception, social support and quality of life among two
undergoing dialysis groups (recent 6 months and chronic 2 years onset group) are different

1.6 Objectives of the Study

1. This research is conducted to discover the impact of illness perception and social support which affect the
quality of life among dialysis patients.
2. To find out the relationship between illness perception, social support and quality of life between dialysis
patients.
3. To determine the difference within illness perception, social support and quality of life among two groups
(one group having dialysis early 6 months other one undergoing to late 2 years).
1.7 Hypotheses
 There will be a significant relationship between illness perception, social support and quality of life among
dialysis patients.
 There will be a positive relationship between family social support and quality of life.
 There will be a positive relationship between friend’s social support and quality of life.
 There will be a positive relationship between other significant social support and quality of life.
 Illness perception and social support would likely predict quality of life among dialysis patients.
 There would be a significant gender difference in illness perception among dialysis patients.
 There would be a significant gender difference in social support among dialysis patients.
 There would be a significant gender difference in quality of life among dialysis patients.
 There is likely to be difference in illness perception, social support and quality of life between two groups
(one group having dialysis early 6 months other group undergoing late 2 years)
Chapter 02
Methodology
2.1. Research Design
Correlational research design in this examination used. To compare the illness perceptions, social support
and quality of life among two group of dialysis patient (one group which were undergoing dialysis treatment from
early 6 month and other group who were undergoing dialysis treatment since at least 2 years and in this research.
2.2. Sample
The target population of the research included undergoing dialysis's two groups one having 6 months and
other one group undergoing to late 2 years.
2.3. Sample strategy
The sample was drawn by using the purposive sampling. The sampling was taken from government and
semi government dialysis canters.
2.4. Inclusion Criteria
• Patients were included with undergoing dialysis.
• Married and unmarried both male and female included.
• Government and semi government dialysis centers patients were included.
• Patients included with the age range of 20 to 40 years.
• Patients included of two undergoing dialysis groups (recent 6 months and chronic 2 years onset group).

2.5. Exclusion Criteria

• In the study those participants were exclude who having additional problem (sugar, diabetic, heart or lungs
disease). And these problem if diagnosed before kidney disease.
• Below 20years and more than 40 years aged participants excluded.

2.6 Assessment Measures

Demographic Assessment
Demographic form was constructed which included participants information i.e. age, gender, education,
designation, number of siblings, relationship with siblings, home's environment , marital status, and family system,
duration of the problem and complaint of any other disease.
Illness Perception Questionnaire-Brief (IPQ-B)
Broadbent et al. in 2006. This scale incorporates eight questions. This was Likert-type scoring scale somewhere in
the range of O and 10. The initial 5-questions used to measure the intellectual ailment interpretations, to be specific,
consequences (item 1), course of occasions (Item 2), personal control (Item 3), treatment control (Item 4), and
character (Item 5). Two of the items structure the excited disease observations, specifically, concern (Item 6) and
emotions (Item 8). One thing assesses disease safety (Item 7). The unwavering quality of ailment observation scale
reliability was .80-85. In this examination we utilized Urdu form decoded Illness Perception Questionnaire Brief
this scale.
Multidimensional Scale of Perceived Social Support
Multidimensional Scale of Perceived Social Support (MSPSS) was developed by Zimet in 2010 and translated by
Prof. Dr. Kausar in 2011. MSPSS consist of 12 items and each item was rated on a 7- point Likert type scale
ranging from very strongly disagree (1) to very strongly agree (7). The scale was designed to see perceptions of
social support acceptability from three specific sources: family, friends, and significant other. The reliability of sale
was .88.

World Health Organization Quality of Life Scale (WHOQOL)

This scale (QOLS) was initially made by Flanagan (1970). It is self- report from which was translated in Urdu by
Bano and Kausar (2010), to examine quality of life in individuals who have chronic ailment. This scale comprised
of 16 items measuring physiological and material comfort, relationships, social communication, and communal
activity, subjective growth and contentment, leisure and freedom. It has 7-point likert-type scale range from
‘delighted’ (7) to ‘terrible’ (1). Over-all scale score possible range from 16 to 112. Coefficient Alpha of this scale
was .82 to .92.

2.7 Procedure
A letter was acquired from RIPHAH Institute of Clinical and Professional Psychology (RICPP) RIPHAH
International University to start the exploration. This position letter was introduced to the foundation from which
the information was gathered. The researcher recognized the inclusion and exclusion categories, and guaranteed the
privacy of all the data got. The reason for the exploration was additionally clarified. The members were given
inform consent, information form, demographic and the tools of study which were used in the study.

2.8 Ethical considerations:

• Study was started after topic approval and permission from university.
• Scales was utilize in the study after taking agreement from the creator through Email.
• Take authority letter from RIPHAH International University before start the research.
• Consent form was introduced to the person to give them opportunity to contribute in this study or not.
• Research was directed utilizing APA moral code.
Chapter III
Results

The purpose of this study is to explore the Illness Perception, Social Support and Quality of life among
Dialysis Patients. Corerlational research design and purposive sampling strategy is used in this study. The sample of
200 participants is evaluated through SPSS Analysis. The age of the participants was between 20-40 years. Three
different standardized scales were used. Descriptive statistics, Pearson product movement correlation,
Independendent sample t-test, as well as linear regression analysis is used to assess the relationships, compare mean,
and predict variables.
Table 3.1
Psychometric Properties of Illness Perception, Social Support and Quality of Life (N=200)
Scale k M SD Range Cronback’s α
Actual Potential
TBIQ 8 44.49 13.23 8-80 22.00-69.00 .85

MSSS 12 56.53 12.84 12-84 21.00-80.00 .91

WHOQOL 18 79.04 16.25 18-126 38.00-116.00 .84

Note: k= number of items, M= Mean, SD= Standard Deviation, Range= Actual range, α= Cronbach alpha
reliability.
The table 3.1 indicates that Illness Perception Scale was having Cronbach’s alpha of .85, M= (44.49), SD=
(13.23) which means it has a high reliability. Multidimensional Scale of Social Support reliability was .91, M=
(56.53), SD= (12.84) which shows a good internal consistency. Similarly World Health Organization Quality of
Life was having Cronbach’s alpha of .84, M= (79.04), SD= (16.25) this means that the scales was reliable.
Table 3.2

Descriptive Statistics for Demographics and Other Characteristics of the Participants (N=200)
Variables Frequency (f) Percentage (%)

Age
20 to 40 years 200 100
Hospital
GH1 100 50
GH2 100 50
Gender
Male 100 50
Female 100 50
Religion
Muslim 184 92
Christian 16 8
No. of siblings
Less than 4 124 62
More than 4 76 38
Birth Order
First born 76 38
Middle born 103 51
Last born 20 10
Only Child 1 5
Relation with siblings
And family
Satisfied 110 55
Strongly Satisfied 61 30
Unsatisfied 28 14
Strongly unsatisfied 1 5
Family environment
Satisfied 110 55
Strongly satisfied 59 29
Unsatisfied 13 15
Strongly unsatisfied 1 5
Marital Status
Married 97 48
Unmarried 85 42
Engaged 7 3
Separation 7 3
Widowed 4 2
Family System
Nuclear 100 50
Joint 100 50
Education
Primary 20 10
Middle 43 21
Matric 77 38
Intermediate 42 21
Graduate 18 9
Occupation
Worker 17 8
Unemployed 149 74
Own business 34 17
Time taken to
reach hospital
30 min 147 73
1 hour 53 26
Transport
Public 79 39
Private 121 60
Do you know about
your disease
Yes 178 89
Maybe 22 11
Duration to complete
dialysis process
4 Hour 198 99
5 Hour 2 1
 How long you doing
dialysis
6 months 100 50
2 years 100 50
Whom you come for
dialysis
Father 47 23
Brother 69 34
Husband/Wife 61 30
Son/Daughter 23 11

Personality type
Introvert 150 75
Extrovert 50 25
Follow the instructions
of doctor
Agree 188 94
Maybe 12 6
Another disease except dialysis
No 200 100

Table 3.2 shows the appropriate descriptive statistical analysis and explained the characteristics of
demographic. Participants were between the ages of 20-40. Data is collected from two hospital 50% from one
hospital and 50% from second hospital. In this male 50% and female 50% participated in research. Majority of
participants were 92% Muslim and 8% Cristian in religion. 62% participants have less than 4 siblings and 38%
participants have more than 4 siblings. 38% first born, 51% middle born, 10% last born and 5% only child were
found. 55% participants have satisfied, 30% strongly satisfied, 14% unsatisfied and 5% have strongly unsatisfied
relationship with siblings and family. 55% have satisfied, 29% strongly satisfied, 15% unsatisfied and 5% strongly
unsatisfied family environment.
48% participants were married, 42% were unmarried, 3% were engaged, 3% were separated and 2% were widowed.
Half of participants have 50% nuclear family system and 50% joint family system. 10% Primary, 21% Middle, 38%
Matric, 21% Intermediate and 9% Graduate were found. 8% worker, 74% unemployed and 17% have own business.
73% have 30 min, 26% have 1 hour drive to reach hospital. 39% have public and 60% have private transport. 89%
know about their disease, 11% maybe know about disease. 99% complete dialysis in 4 hour, 1% complete dialysis
in 5 hour. 50% participants selected those undergoing dialysis early 6 months and 50% undergoing dialysis 2 years.
No participants were found with another disease except dialysis.

Table 3.3
Correlation of Illness Perception, Social Support and Quality of Life among Dialysis patients.

Variables M SD 1 2 3 4 5
Illness perception 44.49 13.23 1 - - - -
SS fa 20.49 5.01 1 . . .
SS fr 14.94 6.15 -.280** .377** 1
SS O 21.10 4.70 -.440 .819** .306** 1 .
Quality of life 79.04 16.25 -.449** .637** 407** .704** 1

Note: **p<.01

Table 3.3 shows high significant positive relationship between illness perception and friends social support.
There is significant positive relationship between social support of other significant with friend social support and
family social support. Results exhibits a high significant positive relationship between family social support, friend
social support and other significant social support.
Table 3.5

Linear Regression Coefficient of Illness Perception, Social Support and Quality of Life

Variables β SE B 95% CI

LL UL

(Constant) 6.17 35.52*** 23.34 47.70

TBIPQ -.131 .067 -.161 -.29 -.029

MSSfa .077 .281 .250 -.30 .80

MSSfr .179 .138 .472** .20 .74

MSSo .529 .291 1.82*** 1.25 2.39

R²
.55
Note. N=200 ***p<.001

Table 3.5 shows the impact illness perception and social support on quality of life among dialysis patients. The R²
value of .55 reveled that predictor variables explained .55% variance in the outcome variable with F (4, 195,199) = 60.37, p
<.001. The finding revealed that illness perception and social support (β = -.13, .07, .17, .52, p <.001)
Table 3.6

Independent sample t-test analysis of Illness Perception, Social Support and Quality of Life of duration of dialysis
in dialysis patients (N=200)

Group
6 month (100) 2 years (100)
M SD M SD t p Cohen’s d

TBIPQ 36.15 9.46 52.83 11.04 -11.47 .00*** 1.62

MSSSfa 22.79 2.39 18.19 5.84 7.28 .00*** 1.03
MSSSfr 16.92 5.69 12.97 5.99 4.77 .00*** 0.67
MSSSo 23.16 2.33 19.04 5.52 6.86 .00*** 0.97
WHOQOL 85.59 11.35 72.49 17.76 6.21 .00*** 0.87
Note: ***p<.001.
M=Mean, SD=Standard Deviation, t=test statistics, p=Significance level, Cohen’s d= Effect size.
Table revealed the finding that patient undergoing dialysis for 6 months showed lower scores on illness
perception (M=36.15) (SD=9.46) as compared to patient undergoing dialysis for 2 years showed high score on
illness perception (M=52.83) and (SD=11.04). Patient undergoing dialysis for 6 months showed higher score in
family support (M=22.79) (SD=2.39) as compare to patient undergoing dialysis for 2 years showed lower score in
family support (M=18.19) (SD=5.84). Patient undergoing dialysis for 6 months showed higher score in friends
support (M=16.92) (SD= 5.69) as compare to patient undergoing dialysis for 2 years showed low scores in friends
support (M=12.97) (SD=5.99). Patients undergoing dialysis for 6 months showed higher score in others support
(M=23.16) (SD= 2.33) as compare patients undergoing dialysis for 2 years showed lower score in other support
(M=19.04) (SD=5.52). Patients undergoing dialysis for 6 months showed higher score good quality of life
(M=85.59) (SD=11.35) as compare to patient undergoing dialysis for 2 years showed low score in quality of life
(M=72.49) (SD=17.76) There are statistically significant differences at the .05 level of significance between patient
undergoing dialysis for 6 months and patient undergoing dialysis for 2 years. Results showed that patient
undergoing dialysis for 6 months have higher score in social support and quality of life and patient undergoing
dialysis for 2 years have higher score in illness perception.
Table 3.7

Independent sample t-Test analysis of Illness Perception, Social Support and Quality of Life of gender differences
in dialysis patients (N=200)

Group
Male (100) Female (100)
M SD M SD t p Cohen’s d

TBIPQ 42.15 13.12 46.83 12.99 -2.53 .01** 0.35

MSSSfa 20.99 4.99 19.99 5.01 1.41 .15 0.19
MSSSfr 17.29 5.62 12.60 5.78 5.81 .00*** 0.82
MSSSo 21.47 4.52 20.73 4.87 1.11 .26 0.15
WHOQOL 79.28 16.52 78.80 16.06 .20 .83 0.02
Note: ***p<.001 **p<.01
M=Mean, SD=Standard Deviation, t=test statistics, p=Significance level, Cohen’s d= Effect size.
Table revealed the finding that male patient have low illness perception (M=42.15) (SD=13.12) as compared
female patient have high illness perception (M=46.83) (SD=12.99). Male patient have high family support
(M=20.99) (SD=4.99) as compared female have low family support (M=19.99) (SD=5.01). Male patient have high
friend support (M=17.29) (SD=5.62) as compared female patient have low friends support (M=12.60) (SD=5.78).
Male patient have high others support (M=21.47) (SD=4.52) as compared female patents have low others support
(M=20.73) (SD=4.87). Male patient have high score in quality of life (M=79.28) (SD=16.52) as compared female
have low score in quality of life (M=78.80) (SD=16.06). There are significant positive relation at the level
of .01, .001 level of significance of male patient illness perception and friends support. Result showed that male
patient have good social support and quality of life and female patients have good illness perception.
Table 3.8

Independent sample t-test analysis of illness perception, social support and quality of life of different family system
in dialysis patients (N=200)

Group
Nuclear (100) Joint (100)
M SD M SD t p Cohen’s d

TBIPQ 42.75 12.73 49.66 13.41 -3.31 .01** 1.62

MSSSfa 21.83 3.43 16.56 6.64 7.26 .00*** 1.03
MSSSfr 15.28 6.18 13.96 6.03 1.32 .18* 0.67
MSSSo 22.27 3.04 17.66 6.68 6.65 .00*** 0.97
WHOQOL 82.64 14.35 68.50 17.03 5.77 .00*** 0.87
Note: **p<.01 ***p<.001 *p<.05 ***p<.001
M=Mean, SD=Standard Deviation, t=test statistics, p=Significance level, Cohen’s d= Effect size.
Table revealed the finding that patient with joint family showed higher scores on illness perception
(M=49.66) (SD=13.41) as compared to patient with nuclear family showed lower score on illness perception
(M=42.71) and (SD=12.73). Patient with nuclear family showed higher score in family support (M=21.83)
(SD=3.43) as compare to patient with joint family showed lower score in family support (M=16.56) (SD=6.64).
Patient with nuclear family showed higher score in good quality of life (M=82.64) (SD=14.35) as compare to
patient with joint family showed low score in quality of life (M=68.50) (SD=17.03)

There are statistically significant differences at the .05 level of significance between nuclear and joint family
patients. Results showed that nuclear family patients have higher score in social support and quality of life and joint
family patients have higher score in illness perception.
Chapter IV

Discussion

Health is an a precious blessing for human toward Allah almighty if a person healthy they did their work,
their responsibilities in a better way. If the individual have any problem which were minor, major or chronic its
badly effect the individual's life they were not able to perform heir duties, responsibilities in a better way. Kidneys
disease is a chronic disease like other diseases as cancer, diabetics, heart diseases etc.

According to worldwide survey estimation there was 11-13 percent prevalence of kidney dialysis. Kidney
disease not affects only the patient's life it's affected the patient's family too. Kidney dialysis was very severe and
painful way while through this patient enhance and maintain their quality of life and them able to perform different
activities. Hemodialysis was necessary for kidney patients because without dialysis their body functioning too much
effected and they were not perform their duties even death caused.

The purpose of the current study examine the relationship within illness perception, social support and quality
of life among dialysis patients. In this we find out that how much and in which direction variables and population
relate with each other or there were significant relation present among predictors or not. In this analysis results
showed that there were significant positive correlation between illness perception, social support and quality of life
between dialysis patients and this would be increased their life and also effect their life. There were some previous
researches which were indicated that there were significant positive correlation in illness perception and quality of
life these two effect each other in a good way. (Fowler.,Baas,2006).

The current research was conducted to help patients to understand how much illness perception and social
support impact the quality of life. Moreover, the present research was conducted to provide insight to social and
clinical setting about illness perception and social support effect on the life's quality.

The demographic analysis of present study in which after analysis the gender categories indicated that female
have high illness perception (M=46.83) and the male mean (M= 42.15), then mean were indicated that dialytic
females patients having high illness perception rather than male patients.

The demographic analysis of present study in which after analysis the gender categories indicated that male
have high social support (M=20.99) and the female mean (M= 19.99) , then mean were indicated that dialytic
females patients having less social support rather than male patients.

Another demographic analysis of present study in which after analysis the gender categories indicated that
male have good quality of life (M=79.28) and the female mean (M= 78.80) , then mean were indicated that dialytic
females patients having less quality of life rather than male patients.

The other demographic ananlysis of family system indicated that the patients who were belonged to nuclear
family system have higher social support and quality of life as their mean of nuclear family system (SS=21.83,
QOL=82.64) and mean of joint family system on social support and quality of life scale (SS=16.56, QOL=68.50)
proved that nuclear family system belonged patient have high social support and quality of life while illness
perception among joint family system were greater than nuclear family system resulted by analysis mean differene
of illness perception nuclear family system (M-42.72) and in joint family system mean (M=49.66).

After analysing the results of present investigation include examined experience of people with Pakistani
community background, their illness, social support and their quality of life. The literature review provided the
researchers evidence to help and support hypothesis of the current study.

The research investigate that there were highly significant and positive correlation among the
variables.These results explained that if a person have good illness perception related to disease his quality of life
increased. If a person have bad illness perception related to disease his quality of life decreased.

The next hypothesis which were indicated that illness perception would be a predictor of qualiy of life
among dialysis patients. The results of my study indicated the similitance level of illnes perception 000, its mean
this was significantly prediet the quality of life among dialysis polients if this increase quality of life must be
increased. The previous researches also indicated that quality of life enhanced by illness perception.

The next aim of my study is social support of dialysis patients which indicate that if a patient have good
social support in his life than he has good quality of life. If patent has bad social support than he has bad quality of
life.

This study also show that patients undergoing dialysis of 6 months female have high social support and
quality of life (SS=22.79, QOL=85.59) rather than 2 year chronic patients.

For the purpose to identify the difference among two groups we used the Independent sumple t test and after
analysis results ensured that there were significant difference and higher level of difference among two groups. The
results specified that the people who were having dialysis since late 2 years have good illness perception
(M=52.83), rather than earlier 6 months. the mean difference between these two groups proved that illness
perception greater in late 2 years patients than 6 months. A study which were conducted by Timmers, et al in 2008
they justified that illness perception greater in 2 year chronic patients rather 6 months or less than 6 months.

According to my reseach in Pakistani context, male has good social support rather than female because
married female has do a lot of work in their inlaws and they seek less social support from their inlaws after the
diagnose of their disease.
4.1 Conclusion

The objective of the research was conducted on illness perception, social support and quality or life among two
undergoing dialysis patients. Sample size contained was 200 participants 100 males and 100 females, 100 early
6 months undergoing patients and 100 late 2 years undergoing dialytic patients. The results showed there were
significant correlation among illness perception, social support and quality of life. Other result showed that 2
years undergoing patients have higher illness perception and 6 month undergoing patients have higher social
support and quality of life. For further study would be data ensured by other ways as interviewing with family
members.

4.2 Strength of the Study

 This study focused on illness perception, social support and quality of life among dialysis patients.
 Use of Standardized tools in the research.
 Moral standard of American Psychological Association (APA) followed during collection of data.
 Before collecting data inform consent taken to patients and described the criteria of the study.
Questionnaires was filled from hospitals which to some level ensures that the inclusion/ exclusion criteria of
research.
 Demographic provide for further personal information of the patients.

4.3 Limitations of the Study:

 This study was only on dialysis patients.
 Research sample of the study was small size if it conducted on larger population it would be generalized.
 Patient do not want to gave their personal information that’s why they answerd wrong.
 Patients were not that much qualified so they face difficulty to fill the forms.
 Age range was very limited.

4.4 Suggestions
 Sample size should be increased.
 Data should take from of 6 to 8 years of dialysis patients because these patients are more found.
 Data should take from paitents of old age to find their Illness perception, social support and quality of life.
 Sample was taken from one city, data should be taken from different cities so that this was generalized in
good way.
4.5 Implication of the study

 This research would be beneficial for the chronic patients to understand their disease and enhance the quality
of life.
 This study help the patients, professional, family members and social community to enhance the quality of
life their own and others how they cope with their lifestyle.
 The findings of the study would be inform the professionals and patients about the illness perception and
social support which affect the individual's Quality of Life.
 This study shows that male has good quality of life and female has low quality of life due to which we can
further plan more advanced studies.
 APPENDIX A
PERMISSION LETTER FROM AUTHORS
 APPENDIX B
Permission Letter from the Head of health department
APPENDIX C
Consent Form
 APPENDIX D

Demographic Information Questionnaire

 APPENDIX E

First Questionnaire (IPQ-B)

 APPENDIX F

Second Questionnaire (MSPSS)

 APPENDIX G

Third Questionnaire (WHOQOL)

APPENDIX H
Plagiarism Report
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