The Development And Application Of Healthy Eating Cognitive Beliefs Questionnaire In Chronic Kidney Disease Based On Health Action Process Approach Theory

Objectives:This study used Delphi method to compile a chronic kidney disease healthy eating cognitive beliefs questionnaire on which was based on Health Action Process Approach theory,at the same time,it is further used to explore the status quo of healthy eating cognitive beliefs and the influence of the socio-demographic influencing factors on healthy eating cognitive beliefs in patients with chronic kidney disease.Methods:First,a likert self-filling questionnaire was designed based on the Health Action Process Approach.Subsequently,17 chronic kidney disease patients who did not receive any renal replacement therapy were recruitted for qualitative interview to identify a series of issues such as cognition and obstacles of healthy diet,etc.In addition,we have consulted relevant literature both at home and abroad,eventually,an entries pool was formed.25 experts were invited for expert consultation to modify,eliminate or add inappropriate entries.A total of 120 chronic kidney disease patients who did not receive any renal replacement therapy were recruitted by convenient sampling method in three tertiary hospitals in Changchun for pilot investigation,and item analysis was performed,included critical value analysis,correlation analysis,internal consistency test;A total of 350 chronic kidney disease patients who did not receive any renal replacement therapy in three tertiary hospitals in Changchun were recruitted for formal investigation,and questionnaire reliability and validity tests were conducted,which included internal consistency,spilit-half reliability,retest reliability,construct validity and factor analysis,etc.Finally,420 chronic kidney disease patients who met the inclusion and exclusion criteria in three tertiary hospitals in Changchun,Jilin province were selected to investigate the influencing factors using the chronic kidney disease healthy eating cognitive beliefs questionnaire.This study use Epidata3.1 to build the database and conducted by double entry,and Amos24.0 was used for confirmatory factor analysis.SPSS24.0 was used for descriptive statistical analysis,one-way ANOVA,correlation analysis and and other statistical methods.Results: 1.The preparation of the questionnaireThe topics summarized in the semi-structured interview are as follows: insufficient diet knowledge,lack of coping strategies,low self-efficacy,and insufficient social support.The entry pool was initially constructed based on the interview results,literature research and group discussion.24 authoritative experts participated in the consultation,which was deleted,added and modified to form a 42-item questionnaire for the pilot investigation.A 34-item questionnaire was formed after the item analysis of the pilot investigation.The Cronbach's ? of the questionnaire was 0.928,the spilit-half reliability was 0.819,and the test-retest reliability was 0.722.It shows that the questionnaire has a good internal consistency.Eight factors were obtained by exploratory factor analysis,which can explain the variance variability of 72.927%.The results of confirmatory factor analysis correction model showed that all the fitting indexes reached the qualified standard(c2/df(1.992)< 5,AGFI(0.817)? 0.8,NFI(0.888)? 0.85,CFI(0.941)? 0.85,RMSEA(0.055)< 0.1,RFI(0.875)? 0.85,IFI(0.941)? 0.85,TLI(0.933)? 0.85,indicated that the model fitting degree was good.The correlation between the questionnaire items and the factors they belong to was between 0.548 and 0.904.In this study,the S-CVI of the total questionnaire was 0.882,the I-CVI ranged from 0.833 to 0.916,therefore,the validity of this questionnaire was good.The final version of questionnaire includes 34 items in five sections: risk perception(possibility,severity,controllability),outcome expectations,behavioral intentions,planning(action planning and coping planning),and self-efficacy.2.Status quo and influencing factors of healthy eating cognitive beliefs in chronic kidney disease patients.2.1 Status quo of healthy eating cognitive beliefs in chronic kidney disease patients.The results showed that risk perception score was(40.83 ± 7.42),risk probability score was(20.11±4.44),risk severity was(8.74±1.99),risk controllability was(11.97±2.72);outcome expectations score was(17.37±3.89);behavioral intention score was(20.74±3.68),planning score was(25.71±6.39),action planning was(14.92±4.21),coping planning was(10.79±2.78);self-efficacy score was(24.67±6.39),total questionnaire score was(129.32±20.19).The proportion of participant in the high score group in each part of the questionnaire was higher than that in the low score group.2.2 Influencing factors of chronic kidney disease healthy eating cognitive beliefsAs for behavioral intention,there were significant differences in patients with different gender,occupation,educational background and diagnosis time(P<0.05).As for outcome expectations,there were significant differences in patients with different occupation,education,residence and diagnosis time(P<0.05).As for the total score of risk perception,there were significant differences in patients with different disease course and diagnosis time(P<0.05).As for the behavioral intention and total scores of questionnaire,there were significant differences in patients with different diagnosis time(P<0.05).As for coping plan and self-efficacy,there were statistically significant differences in patients with different action stages(P<0.05).Conclusions:1.The chronic kidney disease healthy eating cognitive beliefs questionnaire that developed in this study with a good reliability and validity,which can be used to evaluate patients with chronic kidney disease without dialysis.2.This is still a large percentage of chronic kidney disease patients who lack healthy eating cognitive beliefs.3.General demographic data influence the healthy eating cognitive beliefs in patients with chronic kidney disease.