Application Of Nutrition Education Based On KAP Theory In Patients With Gastric Cancer After Subtotal Gastrectomy

Objective(s):(1)To investigate the nutritional knowledge needs of patients with gastric cancer after subtotal gastrectomy based on the knowledge-attitude-practice(KAP)theory to constitute a nutrition education manual for patients with gastric cancer after subtotal gastrectomy.(2)To explore the effect of nutrition education based on KAP theory in patients with gastric cancer after subtotal gastrectomy.Methods:This study consisted of two parts.Part Ⅰ: Section I,Qualitative research.Review literature review to draw the first draft of interview outline and nutrition education manual based on KAP theory.Purposive sampling was adopted to conduct semi-structured interviews with doctors,nutrition specialty nurses,clinical nurses and patients with gastric cancer after subtotal gastrectomy who met the inclusion and exclusion criteria in the Department of Gastric and small Bowel Surgery of a tertiary tumor hospital in Yunnan Province from January to March 2022.The content was analyzed by Colaizzi’s seven-step analysis method on Nvivo12 to obtain meaningful themes.Section II,expert meeting.The first draft of the nutrition education manual was prepared by reviewing the literature,guidelines and the interview results in section 1.An application plan of the nutrition education manual based on the Ebbinghaus forgetting curve was formed.The nutrition education manual and its application plan were revised through the expert meeting method.Part Ⅱ: Application and effect evaluation of nutrition education based on the KAP theory.Quasi-experimental study method was adopted.to 82 hospitalized patients with gastric cancer who met the inclusion and exclusion criteria in the Department of Gastric and small Bowel Surgery of a tertiary tumor hospital in Yunnan Province were selected to study.They were divided into two groups according to the admission time order.41 patients admitted from February to April 2022 were selected as the control group and received routine nutrition education.based on the KAP theory.41 patients admitted from July to September 2022 were selected as the intervention group and received nutrition education based on the KAP theory.The basic information questionnaire was collected before the patients were discharged,and patients’ height,weight,Mid-Arm Circumference(MAC)and Triceps Skin-Fold thickness(TSF)were measured on the day of the patient’s discharge,1 month after discharge,2 months after discharge,and 3 months after discharge.Laboratory test indicators including Total Protein(TP),Pre-Albumin(PA),Albumin(Alb),Hemoglobin(Hemoglobin,Hb)Hb),Prognostic Nutritional Index(PNI)and Neutrophil to Lymphocyte Ratio(NLR)were calculated.NLR)and Platelet to Lymphocyte Ratio(PLR)were collected;The Patient Generated-Subjective Global Assessment scale(PG-SGA),Postoperative dietary nutrition KAP questionnaire for gastric European Organization for Research and Treatment of Cancer(QLQ-STO22)were also distributed.SPSS25.0 was used for statistical analysis.Results:Part Ⅰ,section 1: semi-structured qualitative interviews were conducted on 6doctors,6 nutrition specialist nurses,7 clinical nurses and 8 patients.A total of 3categories and 11 themes are extracted from the summary of themes according to KAP theory.(1)Knowledge:(1)Lack of nutritional knowledge,(2)limited dissemination of nutritional knowledge;(2)Attitude:(1)inconsistent nutritional cognition,(2)patients’ self-perceived heavy burden,(3)patients’ high need for postoperative nutritional education;(3)Behaviors:(1)the Hospital nutrition education process is not perfect and large work strength,(2)the hospital education way is single,(3)poor dietary compliance of patients,(4)the disease reason disturbs the patient to eat,(5)the patient family support is insufficient.Section 2: the Cr of experts this meeting:Cr=(Ca+Cs)/2=(0.9625+0.875)/2=0.92,indicating that the experts at the meeting are highly authoritative in gastric cancer treatment,gastric cancer nutrition and gastric cancer nursing,and discussion results is highly credible.The final nutrition education manual is revised according to the advice given by the experts.Part Ⅱ: 1.41 patients,respectively,in the intervention group and the control group after subtotal gastrectomy met the inclusion and exclusion criteria were included in this study.At the end of the intervention,there were 39 and 40 cases in the control group and the intervention group,respectively,with an effective completion rate of96.34%.The loss of follow-up had no impact on this study.Patients’ age ranged from30 to 75 years old,with an average age of 54.34±10.69 years old.There were no significant differences in baseline data between the two groups(P>0.05),indicating comparability.2.The anthropometric index results showed that there was no statistical significance in MAC,TSF and BIM in 1,2 and 3 months after discharge between control group and intervention group after intervention(P>0.05);After the intervention,BMI,MAC and TSF in the intervention group were higher than those in the control group after discharge,1 month after discharge,2 months after discharge and 3 months after discharge,but only BMI at 2 months after discharge and 3 months after discharge was statistically significant(P<0.05).3.For laboratory test indicators,there were no significant differences in TP,PA and HB between the control group and the intervention group before and after intervention(P>0.05).There were no significant differences in Alb,PIN,NLR and PLR in the intervention group at the first month after discharge,but there were significant differences in Alb,NLR and PLR at the second and third month after discharge,and PIN at the third month after discharge(P<0.05).4.The PG-SGA scores showed that the degree of malnutrition in both the control group and the intervention group decreased after intervention,and the PG-SGA score in the observation group was lower than that in the control group,with statistical significance(P<0.05).5.The results of postoperative dietary nutrition knowledge and practice questionnaire in patients with gastric cancer showed that there was no statistical significance in the scores of postoperative dietary nutrition knowledge and practice questionnaire between control group and intervention group before intervention(P>0.05).The scores in the intervention group were higher than those in the control group after intervention,and the difference was statistically significant(P<0.05).6.The results of EORTC QLQ-STO22 showed that there were no statistical significance in symptom scores of reflux,dryness in the mouth,taste alteration,body image and hair loss between control group and intervention group before and after intervention(P>0.05).Before intervention,the symptom scores of dysphagia,pain,eating disorder and anxiety were not statistically significant between the control group and the intervention group(P>0.05).After intervention,the symptom scores of the intervention group were lower than those of the control group at the first month,the second month and the third month after surgery,with statistical significance(P<0.05).Conclusion(s):1.It is known from semi-structured interview that patients with gastric cancer after subtotal gastrectomy have a positive attitude to receive nutritional knowledge and a high need for nutritional knowledge,but their nutritional cognition level and behavior need to be raised.The factors affecting their nutritional knowledge level and behavior include patients’ poor dietary compliance,disease troubles and insufficient family support,which are also closely related to the medical staff’s own nutritional knowledge and the nutrition education process of the hospital.Nutrition education manual and nutrition education program based on the KAP theory and the memory forgetting curve,constructed by expert meeting method have relatively high credibility.2.Nutrition education based on the KAP theory could reduce the risk of malnutrition in patients with gastric cancer after subtotal gastrectomy,which can also increase their nutritional knowledge reserve and their understanding of nutrition to promote the formation of scientific and healthy dietary behavior with their attention to dietary nutrition.