Construction And Application Of Self-management Intervention Program In Diabetic Nephropathy Patients Based On ITHBC Theory

Objective To investigate the self-management level of diabetic nephropathy patients,to establish a self-management plan based on the integrative theory of health behavior change and apply it to patients with stage Ⅲ diabetic nephropathy and evaluate the application effect.Provide new practice options for the improvement of stage Ⅲ diabetic nephropathy patients’ self-management.Method A cross-sectional survey was conducted on 351 diabetic nephropathy patients picked by convenient sampling,using general information questionnaire,self-management behavior scale,resilience scale,and social support scale,while hierarchical regression analysis was used to explore their relationship.The mediating effect of resilience on the relationship between social support and self-management behavior in diabetic nephropathy patients was analyzed using mediating effect test.Stratified regression analysis was used to explore its effects on self-management behavior and their relationship.The constructed protocol was applied clinically to screen90 patients with stage Ⅲ diabetic nephropathy and randomly divided into control and trial groups using randomized digital tables.After the establishment of the intervention based on the integrative theory of health behavior change,patients with stage Ⅲ diabetic nephropathy were screened out,the control group received formal nursing interventions,while the experimental group received a self-management program based on the integration theory of health behavior change,then both groups were scored by selfmanagement behavior scale,resilience scale,and social support scale,combined with testing the levels of fasting blood glucose and urinary albumin creatinine ratio(UACR)to test the self-management ability of the two groups of patients.Results (1)The total scores of self-management behavior in patients with diabetic nephropathy was relatively low,which was 36.80±14.85;the results of hierarchical regression analysis showed that the factors of marital status,occupation,personal average monthly income,and the stage of diabetic nephropathy in the general questionnaire data could explain 19.20% of the total variance in the self-management behavior.After controlling of the general data,psychological resilience(β=0.257)and social support(β=0.268)could explain 14.80% of the total variance of self-management behavior.The analysis of the mediating effect of psychological resilience indicated that the psychological resilience has a mediating effect between social support and selfmanagement behavior.(2)Build based on the theory of self management plan,health behavior change including knowledge-faith mode,self management skills and ability mode,social promotion mode three module content,involving emotional support,social participation,information support,goal setting,emotional response management,optimistic quality construction,tough quality,self-improvement quality construction of 16 dimensions of measures.(3)At the time of discharge,the physiological and biochemical indicators such as fasting blood glucose(t=2.34,P=0.02)and UACR(t=2.54,P=0.01)of the experimental group were significantly lower than those of the control group,and the scores of the selfmanagement behavior scale,psychological resilience scale and social support scale were significantly higher,and they continued to receive self-management behavior interventions after discharge.The control of the disease process and the level of psychological resilience in the experimental group were still better than those of the control group at two time points that had been tested(P<0.01): one month and three months after the intervention of the self-management program based on the integration theory of health behavior change(P<0.01).Conclusions (1)The self-management behavior of patients with diabetic nephropathy needs to be improved urgently.Based on the regression results,social support and psychological resilience have a positive effect on the self-management behavior of patients,and psychological resilience also has a mediating effect.The social support,psychological and emotional management of patients should be focused to intervene,which is of great significance for the improvement of the patients’ self-management behavior level,in the meantime could slow down the patients’ disease progression and improve the level of health.(2)The self-management intervention plan based on the Integrated Theory of Health Behavior Change has achieved well.In the near term,the physiological and biochemical indicators such as blood glucose,urinary microalbumin/creatinine ratio in patients with stage Ⅲ diabetic nephropathy have been improved,and the scores of self-management behavior,psychological resilience and social support have been improved.In the long term,in the first and third month after discharge,the above physiological and biochemical indicators and scores of the experimental group were still better than those of the control group.