Development And Application Of Perioperative Self-management Intervention Scheme For IVF-ET Patients Based On Empowerment Theory

ObjectiveThe study aimed to develop the perioperative self-management intervention program for invitro fertilization-embryo transfer(IVF-ET)patients based on empowerment Theory,which in order to improve their self-efficacy and regulate their negative emotions in the perioperative period of invitro fertilization-embryo transfer(IVF-ET),meanwhile to decrease the incidence of postoperative complications and promote the success rate of pregnancy,and evaluate the feasibility and effectiveness of the program.MethodsThis study was a hybrid study,which was divided into two parts: the first part was the construction of the perioperative self-management intervention program for IVFET patients based on empowerment theory;the second part was the implementation and effect evaluation of the intervention program.1 Construction of perioperative self-management intervention scheme for IVF-ET patients.After the research group discussion,literature analysis,semi-structured interview,the first draft of intervention program was constructed based on the empowerment theory and self-efficiency theory as the theoretical framework;To modify the intervention program according to expert advice,the final draft of the intervention scheme was formed after the preliminary test.2 Implementation and evaluation of perioperative self-management intervention for IVF-ET patients based on empowerment theory.This part of the study is quasi-experimental study.A total of 108 IVF-ET perioperative patients who received IVF-ET were selected as the research objects in department of reproductive medicine of a grade A hospital in Zhengzhou city,Henan Province according to inclusive and exclusive criteria from May 2021 to September2021.The subjects were divided into intervention group and control group by random number table method.The patients in the intervention group were supplied with selfmanagement intervention program based on empowerment theory,and the patients in the control group were supplied with routine nursing program.Intervention scheme includes one-to-one intervention for six times: trigger day(2 days before the oocytes pick up,OPU),the day of OPU,embryo observation(take two days after OPU),embryo transfer(3 or 5 days post OPU),14 days after the embryo transfer(determining the biochemical pregnancy),the 30 th day after embryo transplantation(determining the clinical pregnancy),the total intervention time took 35 days.Intervention effect data were collected through questionnaires and semi-structured interviews.Baseline data of both groups were collected on trigger day,including Selfrating Anxiety Scale,Self-rating Depression Scale and Infertility Self-efficacy Scale.The post-intervention evaluation indexes,which consisted of perioperative self-rating Anxiety Scale,self-rating depression Scale,infertility self-efficacy scale,pregnancy outcome indicators,complication rate and semi-structured interview were collected 14 days and 30 days after ET,respectively.SPSS25.0 statistical software was used for data analysis.Two independent samples t-test or nonparametric test,Chi-square test and repeated measures analysis of variance were mainly used.Results1.Based on empowerment theory and self-efficacy theory,the intervention program of perioperative self-management for IVF-ET patients was constructed based on empowerment theory through research group discussion,literature analysis,semistructured interview,expert consultation and pre-test,etc.2 Quantitative resultsA total of 108 subjects were included in this study,the number of effective sample size was 100 except 8 missing cases.including 50 subjects in the control group and 50 subjects in the experimental group.(1)Comparison of general data between the two groupsThere were no statistically significant differences between the intervention group and the control group in age,BMI,education level,occupation type,income,place of residence,marital status,presence or absence of children,infertility factors,infertility years,infertility type,embryo transfer score and other aspects(P > 0.05),with comparability.(2)Before intervention,the self-efficacy score of the intervention group was(57.56 ± 10.172),and that of the control group was(56.82 ± 8.070);The depression score of the intervention group was(38.50 ± 5.132)and that of the control group was(37.88 ± 5.371).The anxiety score of the intervention group was(39.70 ± 4.011),and that of the control group was(38.50 ± 5.411),and the difference was not statistically significant(P>0.05),with comparability.(3)Comparison of scores of self-efficacy,anxiety and depression between the two groups after interventionThe total self-efficacy score of patients in the intervention group increased from(57.56 ± 10.172)points before intervention to(65.72 ± 8.107)points after intervention,and the total self-efficacy score of patients in the control group increased from(56.82± 8.070)points before intervention to(58.88 ± 8.265)points after intervention.The difference was statistically significant(P<0.05).The anxiety score of patients in the intervention group decreased from 39.70 ±4.011 points before intervention to 32.24 ± 4.736 points after intervention,and the anxiety score of patients in the control group decreased from 38.50 ± 5.411 points before intervention to 37.46 ± 5.191 points after intervention.The difference was statistically significant(P<0.05).The depression score of patients in the intervention group decreased from 38.50 ±5.132 points before intervention to 33.24 ± 4.736 points after intervention,and the depression score of patients in the control group decreased from 37.88 ± 5.371 points before intervention to 36.18 ± 5.896 points after intervention.The difference was statistically significant(P<0.05).(4)Comparison of clinical outcome indicators between the two groups after interventionIn terms of clinical outcome indicators,the pregnancy rate of the two groups was70% in the intervention group and 50% in the control group,and the difference was statistically significant(P<0.05),and there was no statistical significance in reducing the incidence of complications(P>0.05).3.Qualitative resultsPost-intervention intervention group Interview Results In view of patients’ experience of participating in the intervention program based on empowerment theory,the method of targeted sampling was adopted to collect data through interviews,and the data were analyzed by Colaizz 7-step analysis method,and 3 themes and 7 subthemes were extracted.(1)Improvement of self-management consciousness: selfmanagement ability evaluation,increased interest in learning self-management related knowledge,self-efficacy and self-observation consciousness are improved;(2)The desire to continue to implement the self-management intervention program based on the empowerment theory: to deeply experience the fun of self-control and actively face the difficulties and challenges in life;(3)Suggestions for self-management intervention programs based on empowerment theory: enrich intervention measures and hope to share a series of propaganda and teaching videos on negative emotions.Conclusion(1)The intervention scheme of IVF-ET patients’ perioperative self-management based on empowerment theory is helpful to improve patients’ self-efficacy level,relieve patients’ anxiety and depression and other negative emotions,so as to improve their self-management ability.(2)The intervention program of IVF-ET patients’ perioperative self-management based on empowerment theory has certain positive significance in improving pregnancy rate,but it has no significant effecttion in reducing the incidence of postoperative complications.