Effects Of TTM Intervention On Self-management Behavior And Living Quality In The Maintenance Hemodialysis Patients

OBJECTIVETo investigate the self-management behavior and living quality in maintaince hemodialysis(MHD) patients; to explore the influences of the behavior trans-theoretical model(TTM) intervention on self-management behavior and living quality of MHD patients.METHODS80 maintenance hemodialysis patients meeting with the study requirement were recruited from the Hemodialysis Room of a third-grade class-A hospital in Hengyang city and were randomly divided into experimental group(40 cases) and control group(40 cases).The combination mean of quatitative research and qualitative research was applied in the quasi-experimental study. Patients in the control group were treated with routine care, and those in the experimental group were given behavior change interventions for 24 weeks on the base of routine care. The self-management behavior and living quality of the two groups were evaluated and compared before and after intervention with the Self-management behavior questionaire of hemodialysis patients,the Hospital Anxiety and Depression Scale(HAD) and WHO Quality of Life Scale-Brief (WHOQOL-BEFF).The statistical software SPSS 13.0 was used to analyze the collected date, the statistical methods including the Description Analyze, the t-Test, Analysis of Variance, the Chi-square Test, Correnlative Analyze and Multiple Linear Stepwise Regressions.RESULTS1 The self-management status:1) Qualitative research interviews showed that MHD patients'self-management behavior and their influencing factors include the following two topics:①hospital information support, including feasibility of doctor's advice and hospital self-management health education;②patients self-management capabilities, including patients' cognitive level, behavior pattern, negative emotions, and family economic status.2) The study showed that the total score of self-management in MHD patients is 44～76 (55.90±6.58).Each factor score of self-management between two groups had no significant difference before TTM intervcnticn(P>0.05).While each factor score of self-management in experimental group was higher than that in control group after TTM intervention, and there was significant differences (P<0.05).2 The incidence of negative emotion: The incidence of anxiety and depression in MHD patients was 66.7%,61.1% respectively. The incidence of anxiety and depression between two groups had no significant difference before TTM intervention(P>0.05).while, the incidence of anxiety and depression in experimental group was lower than that in control group after TTM intervention,and the difference had statistic significance(P<0.05).3 The living quality status: The total score of living quality in MHD patients was 32.93～60.33 (41.51±5.26). Compared to the National norm, the factor scores of iiving quality were lower, and the difference had statistic significance (P<0.01).There was a linear regression relation among MHD patients'economic income, age group and the total score of living quality(R=0.503,R2=0.253). The total score of self-management had positive correlation with all areas scores of living quality, and the correlation coefficient r was between 0.235 and 0.448. however, the anxiety and depression scores had negative correlation with all areas scores of living quality, and the correlation coefficient r was between-0.785 and-0.372. All areas scores of living quality between two groups had no significant difference before TTM intervention (P>0.05). But all areas scores of living quality in experimental group were higher than those in control group after TTM intervention,and the difference had statistically significant(P<0.05).4 The effects of TTM intervention: For experimental group patients,all areas scores of self-management and living quality after intervention were higher than the before, and the incidence of anxiety and depression was lower than the before,and the difference was statistically significant(P=0.000). For control group patients, each factor score of self-management, anxiety and depression incidence and all areas scores of living quality had no significant differences before TTM intervention(P> 0.05).However,the total score of self-management after intervention was higher than the before, the difference was statistically significant(P<0.01).CONCLUSION1 The living quality of patients with MHD is lower than national norm, and its influcening factors including economic income and age group.2 MHD patients'self-management level and negative emotion can forecast the function of their living quality. That is to say, higher self-management level and less negative emotion will make their living quality better.3 TTM intervention model may conduce to improve the self-management level and living quality in patients with MHD, and it can reduce the incidence rate of negative emotions.