Elliott John O, Ortman Carl, Almaani Salem, Lee Yun Hui, Jordan Kim
Department of Medical Education, OhioHealth Riverside Methodist Hospital, Columbus, Ohio.
OhioHealth O'Bleness Hospital, Primary Care Athens Castrop Center, Athens, Ohio.
J Ren Nutr. 2015 Mar;25(2):111-20. doi: 10.1053/j.jrn.2014.08.006. Epub 2014 Oct 1.
Hyperphosphatemia in end-stage renal disease is associated with significant morbidity and mortality. Because phosphorus is not effectively dialyzed, dietary adherence remains a significant problem. Previous studies have examined the health belief model, but none have looked at stages of change and dietary adherence in patients undergoing hemodialysis (HD).
Cross-sectional survey.
Three dialysis centers in Columbus, Ohio, between August 2012 and March 2013.
English-speaking patients age 18 or older on HD without dementia or developmental delay.
None.
Associations between dietary adherence based on the Precaution Adoption Process Model (stages of change) and serum phosphorus levels via a conceptual model incorporating modifying factors and individual health beliefs.
Ninety-five patients completed the survey; 59 (62%) endorsed adherence to a low-phosphorus diet and 32 (34%) had phosphorus values ≤5.5 mg/dL. Modifying factors associated with diet adherence included nonminority status odds ratio (OR), 95%CI 8.99 (1.08-74.60), greater level of education OR 18.23 (1.62-205.00), better quality of life OR 9.28 (1.35-63.71), and time on dialysis OR 1.04 (1.01-1.07). Individual health beliefs associated with diet adherence included perceived benefits OR 3.18 (1.47-6.88) and self-efficacy OR 1.22 (1.09-1.38). Modifying factors associated with phosphorus control included: age OR 0.94 (0.90-0.99), minority status OR 0.11 (0.02-0.68), greater level of education OR 6.60 (1.41-31.04), knowledge about chronic kidney disease OR 1.48 (1.03-2.13), and time on dialysis OR 0.98 (0.96-0.99). Individual health beliefs associated with phosphorus control included self-efficacy OR 1.08 (1.01-1.16).
HD clinicians and educators may obtain better results with dietary adherence and phosphorus control if they focus not only toward disease and dietary education but also on understanding modifying factors and individual health beliefs. Assessing where the patient is with regard to stages of change may assist health care providers in better matching interventions that build patients' self-efficacy.
终末期肾病中的高磷血症与显著的发病率和死亡率相关。由于磷无法通过透析有效清除，饮食依从性仍然是一个重大问题。既往研究已对健康信念模型进行了检验，但尚无研究关注血液透析（HD）患者的行为改变阶段和饮食依从性。
横断面调查。
2012年8月至2013年3月期间，俄亥俄州哥伦布市的三个透析中心。
年龄在18岁及以上、讲英语、接受HD治疗且无痴呆或发育迟缓的患者。
无。
基于预防采纳过程模型（行为改变阶段）的饮食依从性与血清磷水平之间的关联，通过纳入调节因素和个体健康信念的概念模型进行分析。
95名患者完成了调查；59名（62%）认可坚持低磷饮食，32名（34%）患者的磷值≤5.5mg/dL。与饮食依从性相关的调节因素包括非少数族裔状态优势比（OR）为8.99（95%CI 1.08 - 74.60）、受教育程度较高OR为18.23（1.62 - 205.00）、生活质量较好OR为9.28（1.35 - 63.71）以及透析时间OR为1.04（1.01 - 1.07）。与饮食依从性相关的个体健康信念包括感知益处OR为3.18（1.47 - 6.88）和自我效能感OR为1.22（1.09 - 1.38）。与磷控制相关的调节因素包括：年龄OR为0.94（0.90 - 0.99）、少数族裔状态OR为0.11（0.02 - 0.68）、受教育程度较高OR为6.60（1.41 - 31.04）、对慢性肾病的了解OR为1.48（1.03 - 2.13）以及透析时间OR为0.98（0.96 - 0.99）。与磷控制相关的个体健康信念包括自我效能感OR为1.08（1.01 - 1.16）。
HD临床医生和教育工作者若不仅关注疾病和饮食教育，还注重理解调节因素和个体健康信念，可能在饮食依从性和磷控制方面取得更好的效果。评估患者在行为改变阶段所处的位置，可能有助于医疗服务提供者更好地匹配增强患者自我效能感的干预措施。
