




































Humanitas: Indonesian Psychological Journal  

Vol. 19 (2), August 2022, 122-128 
ISSN:  2598-6368(online); 1693-7236(print)                                                                 

        humanitas@psy.uad.ac.id       https://doi.org/10.26555/humanitas.v19i2.9 

Differences in health beliefs and behavior compliance of the patients 

with chronic renal failure 

Jehan Safitri, Miranda Seftiana, Rusdi Rusli, Muhammad Rezki  

Department of Psychology, Lambung Mangkurat University, Indonesia 
Corresponding author: j.safitri@ulm.ac.id  
 

 

Introduction 

Renal failure is the acute deterioration of renal function (recurrence) and chronic condition. 
From this condition, kidney disease will develop into a chronic renal failure condition, a 
progressive and irreversible end-stage disease in which the body's ability fails to maintain the 
metabolism and balance of fluid and electrolytes, thus occurring uremia (Rostanti et al., 
2016). According to Pranandari and Supadmi (2015), chronic renal failure progressively and 
slowly worsens renal failure. This condition happens since the kidney loses the ability to 
maintain the volume and composition of body fluid in a normal diet.  

In Indonesia, the number of chronic renal failure patients is rising rapidly, becoming a 
devastating medical, social, and economic problem for patients and their families 
(Prodjosudjadi & Suhardjono, 2009). Patients with chronic renal failure need hemodialysis, 
peritoneal dialysis, and hemofiltration treatment. The length of treatment depends on the 
causes and extent of the kidney damage (Sukarwanto & M., 2014). Rostanti et al. (2016) state 
that behavior compliance is related to long-term treatment, which commonly makes the 
patients feel worried about their unpredictable illness and disruption in their lives. Long 
hemodialysis often eliminates one’s spirit of life, affecting dialysis compliance (Guerra, 
2020). 

Ardani et al. (2007) define behavior compliance as the level of patient willingness to 
carry out the treatment and behavior suggested by their doctor or other people. Behavior 
compliance in the treatment or therapy process begins with a person's belief in the seriousness 
of his illness, leading to action for treatment even though it is overshadowed by the risks or 

ART ICLE  INFO  

 

AB ST R ACT  

 

Article history 

Received June 18, 2020 

Revised July 27, 2021 

Accepted February 22, 2022 

 Health belief is about a patient’s belief that vulnerability and 
treatment efficacy can affect health behavior decisions. This research 
investigated the difference in behavior compliance of patients with 
chronic renal failure based on gender and health beliefs' contribution 
to it. The sample of this research was 30 male and 30 female renal 
failure patients at Brigjend H. Hasan Basry Hospital. Data was 
collected by behavior compliance scale and health belief scale. 
Multivariate analysis was used to analyze the data. The results show 
a significant relationship between male and female patients' health 
beliefs and behavior compliance. The health belief of male patients is 
higher than female patients, while the behavior compliance of female 
patients is higher than males. It can be concluded that health and 
gender are factors affecting behavior compliance. Therefore, 
paramedics may increase patients' health beliefs to enhance behavior 
compliance, especially among female patients with chronic renal 
failure. 

    

 
Keywords 

behavior compliance; 

chronic renal failure; 

health belief; 

patient. 

 

 

mailto:humanitas@psy.uad.ac.id
https://doi.org/10.26555/humanitas.v19i2.31
mailto:j.safitri@ulm.ac.id


Humanitas: Indonesian Psychological Journal 123 

 

Safitri et.al (Differences in health beliefs and behavior compliance of the patients with chronic renal failure)   

side effects of the action. Health belief and behavior compliance behavior are interrelated. 
Non-compliance with medications can be reviewed from doses, ways of taking the drug, time 
to take medicine, and the period of taking the medication accordingly (Gokoel et al., 2020).  

The physical organ of the kidneys is a sieve or blood filter in the body. Blood flows 
into the kidneys, and the fluids in the blood come out through glomeruli. The kidneys also 
maintain a fluid balance in the body (Kerthyasa, 2013). Both kidneys are depressed during 
inspiration due to the diaphragm contraction (Yasmine, 2009). According to Kerthyasa 
(2013), human life aims to achieve a perfect balance. Homeostasis involves the work of heart 
rate, body temperature, metabolic arrangement, death and organization of cells, digestion, and 
others to achieve balance in the body (Paul et al., 2021). Not only from within the body, but 
people also pursue the balance of the surrounding environment, such as working, establishing 
social relationships, and praying to balance spiritual life.  

The five dimensions of health are physical, social, intellectual, emotional, and spiritual 
(Maulana, 2009). On the physical dimension, human health is related to practicing positive 
lifestyles. The physical dimension includes the ability to complete daily tasks, fitness 
achievement (such as cardiovascular, lung, and gastrointestinal), adequate nutrients, and the 
accuracy of the body's proportion of fat deposits, free from drugs, alcohol, and cigarettes. The 
social dimension includes interacting well with others and their environment. Emotional, 
intellectual, and spiritual dimensions include managing stress, expressing emotions 
appropriately, growing and adapting effectively to change, and believing in strength. 

The dimensions of health are intertwined to form a healthy, holistic condition. 
Kerthyasa (2013) describes health as a condition when all components of the body, mind, 
soul, and environment function harmoniously. The body, mind, soul, and environment are 
mutually supportive; therefore, when the condition is not balanced or not functioning 
correctly, it will cause pain (Chauhan & Maheshwari, 2021). The human mind relates to 
health problems or disease experiences (Assegaf, 2011). Discomfort in the body results from 
a negative mental attitude and affects emotions characterized by always lamenting 
difficulties, grieving because of illness, and not believing in healing. 

Health belief confirms that a person's perception of vulnerability and treatment will 
affect one's decision on behavior of health (Setyaningsih et al., 2016). Self-checking is 
included in the function of personal beliefs about the magnitude of the threat of illness and 
its transmission and the benefits of recommendations given by health officers (Sampa et al., 
2020). Perceived threat based on belief in the disease seriousness according to the symptoms 
arose and the person vulnerable to the disease. Individuals then assess the benefits of the 
treatment action and take risks, such as side effects or medical expenses.  

The differences in adherence behavior among patients with chronic renal failure 
undergoing hemodialysis have been studied. However, no study yet on health beliefs and 
gender differences in behavior compliance. Previous study at Dr. Hospital. Pringadi Medan 
found that the highest proportion of patients with chronic kidney failure (CKD) was male, 
54.7% (Ningsih et al., 2012). Therefore, this study aimed to investigate the different levels of 
behavior compliance of male and female patients with chronic renal failure and its correlation 
with the health belief of the patients in the process of hemodialysis at Brigjen H. Hasan Basry 
Kandangan Hospital  

Method 

Participants 

The population in this research was 93 patients with chronic renal failure that underwent 
hemodialysis at Brigjen H. Hasan Basry Kandangan Hospital, 50 male and 43 female, 
respectively. The research sample was 60 patients consisting of 30 males and 30 females. The 
inclusion criteria are: (1) patients with chronic renal failure had been diagnosed at least three 



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months; (2) the patients are undertreatment with hemodialysis 2-3 times a week; (3) the 
patients aged from 15 to 45 years old. 

Instruments  

This research used a quantitative method with a questionnaire as the instrument. The data was 
collected using a Likert scale consisting of a behavior compliance scale and a health belief 
scale. The behavior compliance scale was developed based on the aspects proposed by Niven 
(Safitri, 2013). The aspects consist of the level of patients undergoing treatment according to 
the rules and the level of patients in carrying out their recommended or ordered behavior. 
After a field trial, 32 items can be used for the data collection with good reliability (α = .971). 

The health belief scale consists of perceived vulnerability, perceived severity, perceived 
benefits, perceived barriers, cues to action, and self-efficacy (Glanz et al., 2008). After a field 
trial, 43 items can be used for the data collection with good reliability (α = .956). 

Procedure 

The data collection was conducted in the morning and afternoon after patients underwent 
dialysis. If the questionnaire was not filled, the patients could continue to the next dialysis 
session. The authors explained the purpose of the research and ensured the patients did not 
affect medical service if patients had not been involved in the study. Therefore, the patients 
were voluntarily involved. The authors were guided by the internist, general practitioner, head 
of the hemodialysis installation, and nurse during the data collection. After filling out the 
questionnaire, the patient was given follow-up counseling about health beliefs or behavior 
compliance. 

Data Analysis 

Multivariate analysis or MANOVA was applied to analyze the data with SPSS. Multivariate 

analysis is applied to analyze multi variables in one or more relationships (Santoso, 2017). 

All MANOVA tests are described as A E 1 and relate to all statistic techniques that 

simultaneously analyze several measurements in an individual. 

Results 

Based on Table 1, there is a significant value of interaction of gender with the health belief 
(p < .05) and with behavior compliance (p < .05). The results indicate differences between 
health belief and behavior compliance based on gender of the patients. 
 

Table 1  
Differences in Health Belief and Behavior Compliance Based on Gender 

Source Variable Type III Sum 

of Squares 

df Mean 

Square 

F p 

Gender Health Belief 12,906.667 1 12,906.667 94.874 .000 

Behavior Compliance  17,035.350 1 17,035.350 83.462 .000 

 

Based on Table 2, the average value of health belief among male and female patients is 
144.50 and 117.17, respectively. These results indicate that based on the average, the health 
belief of male patients undergoing hemodialysis is higher than female patients. On the 
contrary, based on the average, the behavior compliance of female patients is higher than 
male patients, which is 148.20 and 117.83. 



Humanitas: Indonesian Psychological Journal 125 

 

Safitri et.al (Differences in health beliefs and behavior compliance of the patients with chronic renal failure)   

Table 2  
Statistic Description of Health Belief and Behavior Compliance Based on Gender 

Variable Gender Average Standard Deviation 

Health Belief Male 144.50 12.883 

Female 117.17 15.564 

Behavior Compliance Male 117.83 11.086 

Female 148.20 12.214 

 
Table 3 shows health belief of male patients contributes significantly to behavior 

compliance (F = 6.867; p = .002). It can be concluded that health belief has a significant role 
in male patients' behavior compliance. 
 

Table 3 
The Contribution of Health Belief on Behavior Compliance among Male Patients 

Source Dependent 

Variable 

Type III Sum 

of Squares 

df Mean 

Square 

F p 

 

Men’s Health 

Belief 

Men’s Behavior 

Compliance 

3,237.750 18 179.875 6.062 .002 

Woman’s 

Behavior 

Compliance 

2,460.000 18 146.667   .957 .549 

 

Table 4 shows the contribution of health belief to behavior compliance among female 
patients is significant (F = 6.6867; p = .037). Therefore, it can be concluded that the health 
belief of female patients significantly contributes to behavior compliance. 
 

Table 4 
The Contribution of Health Belief on Behavior Compliance among Female Patients 

Source Dependent 

Variable 

Type III Sum 

of Squares 

df Mean 

Square 

F p 

Woman’s 

Health Belief 

Male’s Behavior 

Compliance 

2,738.667 25 109.547   .531 .855 

Female’s 

Behavior 

Compliance 

4,227.667 25 169.107 6.867 .037 

Discussion 

Based on the data analysis, health belief contributes significantly to behavior compliance 
among male or female patients. Health belief relates to the behavior of patient's behavior 
compliance because individuals who feel vulnerable and threatened with a symptom of the 
disease will decide more quickly on the treatment. Individu threatened by the disease 
symptoms and believe the good of treatment is more significant than the obstacles certainly 
will not postpone or prevent the treatment process (Sarafino & Smith, 2014). On the other 
hand, patients not feeling threatened by the disease will see that obstacles are more prominent, 
so they probably call off or even prevent them.  

The analysis shows differences in health beliefs and behavior compliance among 
patients with chronic renal failure based on gender. Male patients with chronic renal failure 
have higher health beliefs than females, while the behavior compliance of the male patients 
is lower than that of female patients. The occupation factor may influence male patients to 
take responsibility for their jobs due to financial issues. Males tend not to use health services, 
especially in adolescence and early adulthood, for those who come from underprivileged 



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(Sarafino & Smith, 2014). A male patient can postpone or stop the treatment process due to 
financial factors though they believe in the effectiveness of treatment.  

Other than health beliefs and gender, several factors affect on behavior compliance of 
patients to treatment. This factor includes cost, the effectiveness of hemodialysis, patients' 
perception of vulnerability, relatives' support, and the relationship between patient and 
medical personnel. This finding aligns with Kamran et al. (2014) that behavior compliance is 
low because of vulnerability, symptoms, low perceived severity, bad lifestyle, perception of 
drugs, and access to health services.  

This study's limitation is not all patients met the criteria involved. Some patients have 
unstable conditions, while others refuse to be involved, so only 60 patients with chronic renal 
failure could be involved. Therefore further research with a higher number of samples is needed.  

Conclusion 

Health belief contributes significantly to behavior compliance among male and female 
chronic renal failure patients undergoing hemodialysis. Health belief relates to behavior 
compliance because individuals who feel vulnerable and threatened with a disease symptom 
will decide more quickly on the treatment. Moreover, there is a difference in health beliefs 
and behavioral compliance in male and female patients with chronic renal failure. Health 
belief among male patients with chronic renal failure is higher than that of females. In 
comparison, behavior compliance among female patients is higher than that of males. 
Therefore health beliefs and gender are important in predicting behavior compliance among 
chronic renal failure patients undergoing hemodialysis. 

Acknowledgment 

The authors acknowledge Lambung Mangkurat University for approving the ethical 

clearance of this study. 

Declarations  

Author contribution. JS contributed toward developing the research idea, literature review, 
data analysis, & drafting of the manuscript. MS contributed toward developing the research 
idea, literature review, & drafting of the manuscript. RR contributed toward developing the 

instrument, data analysis, & drafting of the manuscript. MR contributed toward collecting data 

& finishing the final manuscript.  
Funding statement. The researchers themselves funded the research.. 
Conflict of interest. The authors declare no conflict of interest. 
Additional information. No additional information is available for this paper. 
 

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