The Effect Of Nursing Intervention Based On Health Belief Model On Medication Compliance Of Kidney Transplant Recipients

Background:In kidney transplantation,adherence to immunosuppressive therapy is paramount for long-term graft survival.However,medication non-adherence in kidney transplant recipients is a common problem that results in increased rejection episodes,graft loss and significant morbidity.Studies have shown that effective interventions need to be personalized,targeted,and repeatable under the guidance of behavior change theory.The Health Belief Model is a relatively mature and widely used behavior change theory;Behavior change techniques are used to characterize the content of interventions to achieve visualization and repeatability of interventions.In order to improve the adherence of immunosuppressive medication in kidney transplant recipients,the study intends to determine the effectiveness and sustainability of comprehensive interventions based on Health Belief Model.Objective:To evaluate the effect and the continuity of comprehensive nursing intervention on improving the adherence of immunosuppressive medication and the quality of life in kidney transplant recipients,during 3-month intervention and 3-month follow-upMethods:A randomized controlled trial was used in this study with purpose sampling.From May 2019 to July 2019,a total of 113 kidney transplant recipients who were not adherent with immunosuppressive medications were recruited in the urology clinic of Beijing Chaoyang Hospital.Among them,intervention group 57 cases,56 cases in the control group.Patients in the intervention group received comprehensive nursing interventions on the basis of routine transplantation treatment and care,and received face-to-face interviews once a month,20-30 minutes each time,and followed up by telephone/WeChat/SMS every half a month,each time 5-10 minutes,a total of 3 months,and then followed up for 3 months after the intervention Patients in the control group received routine transplantation treatment and care and then received comprehensive nursing intervention during the 3-month follow-up period.Use general questionnaire,Assessment of Adherence with Immunosuppressive Medication Scale and the MOS 36-item Short Form Health Survey to evaluate the general information,medication adherence and quality of life of kidney transplant recipients before intervention,after 3 months of intervention and after 3 months of follow-upResults:A total of 93 kidney transplant recipients completed data collection,47 for intervention group and 46 for the control group.The results showed that:(1)At baseline,for the intervention group,the medication adherence score was 5(4,5),the self-evaluation score was 90(80,100),and for the control group,the medication adherence score was 5(4,5),the self-evaluation score was 90(85,100).After 3 months of intervention,for the intervention group,the medication adherence rate was 83.0%,the medication adherence score was 4(4,4),and the self-evaluation score was 100(90,100),and for the control group,the medication adherence rate was 50.0%,the medication adherence score was 4.5(4,6),and the self-evaluation score was 90(85,100).Differences in medication adherence rate(?2=11.37),medication adherence score(Z=3.61)and self-evaluation score(Z=-2.16)between the two groups of patients were statistically significant(P<0.05).After 3 months of follow-up,for the intervention group,the medication adherence rate was 78.7%,the medication adherence score was 4(4,4),and the self-evaluation score was 99(90.100),and for the control group,the medication adherence rate was 71.7%.the medication adherence score was 4(4,5),and the self-evaluation score was 98(90,100).There was no statistically significant difference in the medication adherence rate(?2=0.61),medication adherence score(Z=0.79)and self-evaluation score(Z=-0.91)between the two groups of patients(P>0.05).After 3 months of intervention,the medication adherence score(S=-141.5)and self-evaluation score(S=164)of the patients in the intervention group were significantly different from the baseline(P<0.0125).After 3 months of follow-up,the medication adherence score(S=-113.5)and self-evaluation score(S=180)of patients in the intervention group were significantly statistically different from the baseline(P<0.0125),however,compared with 3 months after the intervention,there was no statistically significant difference in the medication adherence rate(S=0.40).medication adherence score(S=13)and self-evaluation score(S=14)of the intervention group(P>0.0125).(2)After 3 months of intervention and 3 months of follow-up,there was no statistically significant difference in the kidney function-related indicators of patients in the intervention group compared with the control group(?2=0.003?3.21,P>0.05)After 3 months of intervention,there was no significant difference in the kidney function-related indicators of patients in the intervention group from the baseline(Z=-0.82?-0.33,P>0.0125).Compared to baseline,the hemoglobin of the intervention group had significantly higher after 3 months of follow-up(Z=-2.65,P<0.0125),however,compared with 3 months after the intervention,there was no significant difference in the indicators of renal function among the patients in the intervention group(Z=-2.12?0.00,P>0.0125).(3)After 3 months of intervention,the body pain dimension score of the intervention group(74(52,84))was lower than that of the control group(84(74,100)),showing a statistically significant difference(Z=2.38,P<0.05).After 3 months of follow-up,there was no statistically significant difference in the scores of quality of life between the two groups(Z=-0.26?1.32,P>0.05).Compared to baseline,the body pain dimension score of the intervention group had significantly lower after 3 months of intervention(S=-2.65,P<0.0125).Compared with the baseline(S=-50?46.5,P>0.0125)and 3 months after the intervention(S=-105?7].5,P>0.0125),there was no statistically significant difference in the scores of quality of life in the intervention group after 3 months of follow-upConclusion:This study shows that comprehensive nursing intervention through education,behavior and emotional support can improve the immunosuppressive medication adherence of kidney transplant recipients,which the intervention effect is continuous providing practical basis and reference for clinical application.In addition,this study shows that the intervention for medication adherence has no obvious effect on improving the quality of life which recommended to enhance the medication adherence and meanwhile strengthen the focus on patients' social functions and mental health.