| Objective1.To establish a dietary management program for peritoneal dialysis patients with teach-back method.2.To evaluate the effects of this program on improving dietary knowledge and compliance,forming a reasonable dietary habit,improving nutritional status and metabolic disorders of peritoneal dialysis patients.Methods1.This study was conducted from September 2017 to December 2018 at the first and second Nephrology Department of a first tertiary hospital.112 patients with peritoneal dialysis who met the inclusion criteria were selected.The patients in the second Nephrology Department were randomly selected as the intervention group(56cases)and the patients in the first Nephrology Department were determined as the control group(56 cases).The diet management in a routine manner was conducted in control group.On the basis of this,The diet management was conducted with teach-back method based on the theory of planned behavior in intervention group,which includes pre-intervention assessment,transfer of dietary knowledge,retelling diet knowledge by patient,evaluation and correction of patient retelling,re-question,comprehensive diet and nutritional assessment.2.Patients'dietary knowledge,dietary compliance,dietary behavior and nutritional status with the"Peritoneal dialysis diet knowledge questionnaire","Renal Adherence Attitudes Questionnaire(RAAQ)","Renal Adherence Behaviour Questionnaire(RABQ)","Three-day diet diary","Modified quantitative subjective global assessment(MQSGA)"were collected before the intervention,at the date of discharging from the hospital,3 months and 6 months after discharge.At the same time,relevant biochemical tests were performed to evaluate patient-related biochemical indicators.3.SPSS21.0 statistical software is used for statistical analyses.Statistical description is adopted byX±S,frequency and constituent ratio;About statistical analysis,we analyze qualitative data using chi-square test and quantitative data using two independent sample T test,non-parametric test,repeated measurement analysis of variance and etc.The test level is specified as?=0.05.ResultsFive patients were lost to follow-up,with three patients in the intervention group,and 2 patients in the control group.In the end,a total of 107 patients were effectively treated,including 53 in the intervention group and 54 in the control group.1.There were no statistical significant difference between the two groups in the general sociodemographic data and clinical data,the score of Peritoneal dialysis diet knowledge questionnaire,RAAQ,RABQ and MQSGA,and clinical relevant clinical biochemical indicators before intervention(P>0.05).2.Comparison of dietary knowledge scores between the two groups:there was a statistically significant difference in dietary knowledge scores at discharge day,3months,and 6 months after discharge(P<0.001).Repeated measures analysis of variance showed that the time effect was statistically significant(F=169.309,P<0.001);the intervention effect was statistically significant(F=32.997,P<0.001);there is an correlation between the time and intervention effect(F=37.917,P<0.001).The trend of dietary knowledge scores in the intervention group was better than the control group.3.Comparison of dietary adherence between the two groups:There was a statistically significant difference in scores of RAAQ at discharge day,3 months,and6 months after discharge(P<0.001).There was a statistically significant difference in scores of RABQ at 3 months and 6 months after discharge(P<0.001).Repeated measures analysis of variance showed that the time effect was statistically significant(F=77.302,P<0.001;F=260.651,P<0.001);intervention effect was statistically significant(F=10.840,P<0.05;F=60.006,P<0.001);there is a correlation between the time and intervention effect(F=9.734,P<0.05;F=114.045,P<0.001).The trend of dietary adherence and dietary adherence behavior in the intervention group were better than control group.4.Comparison of"Three-day diet diary"between the two groups:The intake of sodium intake at discharge day,3 months and 6 months after discharge were statistically significant(P<0.001);the intake of protein,dietary calories,total calories,phosphorus and fluid on 3 months and 6 months after discharge were statistically significant(P<0.001);Repeated measures analysis of variance showed that the time effect of protein(F=99.309,P<0.001),dietary calories(F=90.225,P<0.001),total calories(F=90.140,P<0.001),sodium(F=119.515,P<0.001),phosphorus(F=68.948,P<0.001)and fluid intake(F=176.250,P<0.001)was statistically significant;the intervention effect of protein(F=4.317,P<0.05),dietary calories(F=7.390,P<0.05),total calories(F=6.348,P<0.05),sodium(F=11.530,P<0.05),phosphorus(F=4.206,P<0.05)and fluid intake(F=8.370,P<0.05)was statistically significant;there is a correlation between the time and intervention effect of protein(F=55.893,P<0.001),dietarycalories(F=55.586,P<0.001),total calories(F=45.889,P<0.001),sodium(F=34.155,P<0.001),phosphorus(F=20.190,P<0.001)andfluid intake(F=30.561,P<0.001).The dietary intake of the intervention group showed better trends than the control group.5.Comparison of MQSGA scores between the two groups:The incidence rate of good nutritional status in the intervention group was 71.70%at 6 months after discharge,which was significantly higher than that of the control group(48.15%).The difference was statistically significant(?~2=6.171,P<0.05).6.Comparison of clinically relevant biochemical indicators between the two groups:There were significant differences in the indexes of hemoglobin(t=7.341,P<0.001),albumin(t=4.434,P<0.001),Total cholesterol(t=–4.898,P<0.001),triglyceride(t=–2.893,P=0.005),phosphorus(t=–4.891,P<0.001),calcium and phosphorus product(t=–3.282,P<0.001)between the two groups,with a significant improvement compared with the control group.ConclusionsApplying teach-back method to construct a dietary management program for peritoneal dialysis patients can enhance the dietary knowledge and adherence of peritoneal dialysis patients,and contribute to form good dietary behavior,improve nutritional status,lower the disorder of metabolismn and calcium-phosphorous metabolism... |
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