Effect Of Intervention Model Based On BCW Theory On Fluid Management In Hemodialysis Patients

Objectives:The purpose of this study is to understand the current situation and influence factors of fluid management behavior in patients with Hemodialysis（HD）and to construct an intervention model of fluid management in patients with HD based on the Behavior Change Wheel（BCW）theory.To explore the application effect of BCW theory in the field of fluid management in HD patients,to provide further research evidence for the application of BCW theory in promoting behavior change,to provide a basis for clinicians and nurses to conduct more standardized fluid management guidance for HD patients,to provide reference for the construction of a more universal and effective fluid management model for HD patients in China.Methods:This was a quasi-experimental study performed in a blood purification center of a hospital in Changchun over a 6 months period,from May,2020 to January,2021.A total of 34 adult patients with regular HD,were selected and divided into control group and intervention group,with 17 patients in each group.The control group received routine fluid management,and the intervention group received fluid management mode based on BCW theory.The intervention lasted for 6 months and was assessed at baseline（T1）,3 months（T2）,and 6 months（T3）.The outcomes measures include Dry Weight（DW）,Interphase Dialysis Weight Gain（IDWG）,rate of Interphase Dialysis Weight Gain（IDWG%）,volume management compliance rate,pre-dialysis blood pressure,HD patient Fluid Adherence Health Beliefs Scale,Kidney Disease Quality of Life 36-item Short Form(KDQOL-36^TM).SPSS 25.0 software was used for statistical analysis of the data.Results:1.Intervention implementation:A total of 34 patients with regular HD were enrolled,with 17 from each of the control and intervention group.During the intervention period,1 person in the control group was transferred to hospital for kidney transplantation and 1 person died at home during the interdialysis period（sudden unknown cause）.2.T1 comparison results of general data:Demographic data of the control group and intervention group on age,gender,marital status,educational level,work status,occupation,number of children,religion,income,medical insurance,main caregivers,and clinical data on dialysis age,residual urine volume,dry weight,and primary disease were no statistical significance（P>0.05）.3.Independent sample t test results of DW,IDWG,IDWG%and capacity management compliance rate:There was no significant change in DW of patients in the two groups at 3 time points.The IDWG and IDWG%in control group had no significant change at 3 time points.In the intervention group,IDWG and IDWG%were improved at 3 time points,The mean difference between the groups of T2 was the largest（0.50kg,1.17）,T3 decreased（0.41kg,1.07）but was still larger than T1（0.16kg,0.65）.There was statistically significant mean difference between the groups of T2 and T3（P<0.05）.4.Results of IDWG%repeated measure ANOVA:There was no interaction effect of treatment×time in IDWG%,but the main effect of intervention and time exists.Pairwise comparison of IDWG%between the two groups showed that the IDWG%of HD patients in the intervention group was 0.962 lower than that in the control group,and the difference was statistically significant（P<0.05）.Time factors had different effects on IDWG%in HD patients,but there was no statistical significance at different time points（P>0.05）.5.Results of volume management compliance rate~2 test:The volume management compliance rate of patients in T1 was basically consistent in the two groups.And in T2,the intervention group was significantly increased by 6 to 15 patients（88.2%）.There were statistically significant differences in volume management compliance rate between T2 and T3 groups（P<0.05）.6.Comparison of the scores of HD patient Fluid Adherence Health Beliefs Scale:there was no statistical significance in the scores of all dimensions between the two groups before intervention（P>0.05）;After intervention,there was no statistically significant difference in the scores of Susceptibility dimension between the two groups（P>0.05）,and the scores of other dimensions were statistically significant（P<0.05）.7.Comparison of KDQOL-36^TM scores:there was no statistical significance in scores of all dimensions between the two groups before intervention（P>0.05）;After intervention,the scores of mental state dimension in control group decreased,but the scores of other dimensions increased.The scores of all dimensions in the intervention group were significantly increased compared with those before the intervention.Although the scores of all dimensions in the intervention group were higher than those in the control group,the differences were not statistically significant（P>0.05）.8.Results of pre-dialysis systolic blood pressure repeated measures ANOVA:There were an interaction effect of treatment×time on pre-dialysis systolic blood pressure between the two groups（P<0.05）.At different time points,pre-dialysis systolic blood pressure of the control groups compared with the intervention group was higher9.983mm Hg and 8.800mm Hg respectively in T2 and T3.The difference between groups was statistically significant（P<0.05）.Pairwise comparison of pre-dialysis systolic blood pressure between the two groups at different time points.The independent effect of time on patients’pre-dialysis systolic blood pressure was not statistically significant（P>0.05）.The Pre-dialysis systolic blood pressure in the intervention group at T1 was higher 9.837mm Hg than T2,and the time difference was statistically significant（P<0.001）.Systolic blood pressure in the intervention group at T1 was 9.500mm Hg higher than T3 before dialysis,and the time difference was statistically significant（P<0.001）.The pre-dialysis systolic blood pressure in the intervention group increased in T3 compared with T2,with a mean difference of-0.336mm Hg,and the time difference was not statistically significant（P>0.05）.9.Results of pre-dialysis diastolic blood pressure repeated measures ANOVA:There was no interaction effect of treatment×time on pre-dialysis diastolic blood pressure between the two groups（P>0.05）,and there was no significant difference in the main effect of intervention measures（P>0.05）.The pre-dialysis diastolic blood pressure was affected by time factor,and the difference was statistically significant at different time points（P<0.05）.Conclusions:1.The intervention model based on BCW theory had no effect on DW of HD patients,and could effectively improve the IDWG,IDWG%and volume management compliance rate of HD patients.2.The Intervention model based on BCW theory can effectively improve the barriers and benefits of fluid compliance,the seriousness of fluid non-compliance,and self-efficacy in HD patients.However,the susceptibility of fluid non-compliance need to be further studied.3.The intervention model based on BCW theory can effectively reduce the pre-dialysis systolic blood pressure of HD patients,but has little effect on the pre-dialysis diastolic blood pressure.4.The intervention model based on BCW theory may improve the quality of life of HD patients.5.The intervention model based on BCW theory can improve the ability,opportunity and motivation of HD patients to comply with fluid management,promote patients to form a long-term good habit of volume management,and reduce the inappropriate fluid intake behavior of HD patients.