| Objective1.To investigate the status of volume management behavior in peritoneal dialysis patients and analyze the influencing factors based on Interaction Model of Client Health Behavior;2.To deeply investigate the factors towards volume management disorders among patients with volume management behavior compliance at low or moderate levels;3.To explore the effects of intervention based on Interaction Model of Client Health Behavior on volume management behavior,self-efficacy,disease cognition,quality of life and volume load in patients with peritoneal dialysis.Methods1.Quantitative investigation:We selected patients meeting eligibility criteria from December 2018 to April 2019 at a 3A grade hospital in Zhengzhou,Data were collected including demographic characteristics,the volume management behavior scale for patients with continuous ambulatory peritoneal dialysis,self-efficacy scale for chronic,Herth hope index,cognitive evaluation scale,then analyzed the influencing factors of volume management behavior.The collected data were analyzed using IBM SSPS Statistics 21.0,Check level ?=0.05.2.Qualitative study:Patients who met the inclusion criteria in the first stage were recruited for the semi-structured interview,using a purposive sampling.Colaizzi data analysis method was applied for the data analysis,in order to investigate the factors of volume management in patients with low volume management behavior compliance deeply.3.Intervention study:This stage was a quasi-experiment research and 90 peritoneal patients at a 3A grade hospital in Zhengzhou who wanted to join the intervention were selected.They were divided into intervention group(45 patients)and control group(45 patients).The patients in control group received routine education,the patients in the intervention group received intervention based on Interaction Model of Client Health Behavior.The intervention lasted for 3 months.Before the intervention,immediately after the intervention,and three months after the intervention,the volume management behavior,self-efficacy,disease cognitive evaluation,quality of life,edema degree,and dry weight were collected.The collected data were analyzed by descriptive statistics,t-test,rank sum test,chi-square test.generalized estimation equation and repeated measurement variance analysis.Check level ?=0.05.Results1.Quantitative investigation:In the study,a total of 254 questionnaires granted,included 247 effective questionnaires,so the effective rate is 97.2%.(1)In this study,the score of volume management behavior was(14.79±2.88),rage 6-24.The score of the dietary management dimension is(3.52±1.12)and the monitoring symptom and indicator dimension was(11.26±2.35).(2)The influencing factors of volume management behavior were screened by statistical methods such as Pearson correlation analysis,one-way analysis of variance,and two independent samples t test.The multiple linear regression analysis showed that patients' gender,education,work status,serum creatinine and self-efficacy,level of hope,positive evaluation and responsibility were the influencing factors of their volume management behavior.2.Qualitative research:A total of 12 patients were interviewed.Four topics were extracted from the data analysis,including lack of intrinsic motivation,distressing psychological burden,cognitive bias,and insufficient external support.3.Intervention study:During the intervention,we lost 6 patients,the patients who completed the entire research inclued intervention group(42 patients)and control group(42 patients).(1)The patient's volume magagement behavior and its generalized estimation equations before and after intervention showed statistically significant differences with inter-group effects,time effects and interaction effects(P<0.05).(2)The repeated measures analysis of variance of self-efficacy scores of the two groups of patients before and after the intervention showed that there were statistically significant differences in inter-group effects,time effects,and interaction effects between the groups(P<0.05).(3)There were significant differences in inter-group effects,time effects,and interaction effects between the two groups of patients in the outcome uncertainty,positive evaluation,and responsibility dimension scores before and after the intervention(P<0.05).The threat dimension scores were statistically significant in time effects and interaction effects(P<0.05),and there was no statistically significant difference in inter-group effects between groups(P>0.05).(4)The results of repeated measurement analysis of the quality of life of the two groups of patients before and after the intervention showed that the differences between inter-group effects,time effects,and interaction effects were statistically significant(P<0.05).(5)Before and afer the intervention,there was a significant difference in the degree of edema in the intervention group(P<0.05),while the difference in the control group was not significant(P>0.05).The degree of edema in the intervention group was significantly different from that in the control group immediately after the intervention and three months after the intervention(P<0.05).The analysis results of the generalized estimation equation of dry weight of the two groups of patients showed that there were statistical differences in time effects and interaction effects(P<0.05),and there was no significant difference in the inter-group effects between groups(P>0.05).Conclusions1.The compliance of volume management behaviors in patients with peritoneal dialysis needed to be improved.It was affected by the patient's gender,education,work status and serum creatinine,and was related to its self-efficacy,level of hope,positive evaluation in cognitive evaluation,responsibility and outcome uncertainty.2.The factors of volume management disorders in peritoneal dialysis patients were related to their motivation,psychological burden,cognitive and external support,suggesting that medical staff should give their corresponding support.3.The intervention based on Interaction Model of Client Health Behavior improved the volume management behavior of peritoneal dialysis patients,enhanced their self-efficacy,promoted positive cognition of the disease,improved quality of life,and reduced edema. |
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