Tanner J L, Craig C B, Bartolucci A A, Allon M, Fox L M, Geiger B F, Wilson N P
Department of Food and Nutrition Services, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA.
J Ren Nutr. 1998 Oct;8(4):203-11. doi: 10.1016/s1051-2276(98)90019-x.
Assess the effectiveness of a self-monitoring tool on perceptions of self-efficacy, health beliefs, and adherence in patients receiving hemodialysis.
A monthly intervention using a pretest, posttest design over a 6-month period. Both the treatment and control groups were randomly selected and received surveys to assess health beliefs, perceptions of self-efficacy for performing specific healthful behaviors, and renal diet knowledge at baseline, before intervention, and 6 months later. The treatment group also received monthly feedback of monthly phosphorus levels and interdialytic weight gains.
A university hospital-based 43-chair ambulatory dialysis center.
Forty patients with end-stage renal disease (25 men and 15 women, age 26 to 78 years), on chronic hemodialysis for at least 2 months and with a history of noncompliance with phosphorus and/or fluid restrictions for 1 or more months.
Self-efficacy, health beliefs, knowledge, biochemical, and demographic variables were analyzed. Analysis of variance tests of repeated measures were used to examine relationships between adherence with phosphorus and fluid restrictions to health beliefs and perceptions of self-efficacy after training in self-monitoring.
Overall, there were no significant improvements in adherence with phosphorus and fluid restrictions between the two groups, although a comparison within the groups revealed the treatment group had a statistically significant decrease in mean phosphorus levels of 7.14 to 6.22 mg/dL (P = .005) from baseline to month 3. However, because this value was not maintained, it was not statistically significant. No significant differences existed between the two groups for health beliefs and perceptions of self-efficacy. Knowledge scores in the treatment group, however, improved significantly as compared to the control group (P = .008) and was a significant increase from baseline (P = . 002). In the control group, all scores fell slightly but this difference was not significant.
The benefits of patient self-monitoring and behavioral contracting upon adherence in patients on hemodialysis are inconclusive, as serum phosphorus and interdialytic weight gains did not differ between the two groups. The interventional tools also appeared to have little effect on perceptions of self-efficacy and health beliefs. Trends of improvement, however, did exist for phosphorus within the treatment group and subjects in this group had a statistically significant increase in knowledge scores over time. Additional research using repeated measures design is needed to explore the effects of increased frequency and duration of an intervention on the attainment of patient clinical outcome measures.
评估一种自我监测工具对接受血液透析患者的自我效能感、健康信念及依从性的影响。
采用前测、后测设计，为期6个月，每月进行一次干预。治疗组和对照组均随机选取，并在基线、干预前及6个月后接受调查，以评估健康信念、进行特定健康行为的自我效能感认知以及肾脏饮食知识。治疗组还每月收到关于血磷水平和透析间期体重增加情况的反馈。
一家大学医院的拥有43个透析椅的门诊透析中心。
40例终末期肾病患者（25名男性和15名女性，年龄26至78岁），接受慢性血液透析至少2个月，且有1个月或更长时间不遵守磷和/或液体限制的病史。
分析自我效能感、健康信念、知识、生化及人口统计学变量。采用重复测量方差分析来检验自我监测训练后，磷和液体限制的依从性与健康信念及自我效能感认知之间的关系。
总体而言，两组在磷和液体限制的依从性方面均无显著改善，尽管组内比较显示治疗组从基线到第3个月平均血磷水平从7.14降至6.22mg/dL具有统计学显著差异（P = .005）。然而，由于该值未持续保持，故无统计学显著性。两组在健康信念和自我效能感认知方面无显著差异。然而，与对照组相比，治疗组的知识得分显著提高（P = .008），且与基线相比有显著增加（P = .002）。对照组所有得分略有下降，但差异不显著。
患者自我监测和行为契约对血液透析患者依从性的益处尚无定论，因为两组之间血清磷和透析间期体重增加并无差异。干预工具似乎对自我效能感认知和健康信念也几乎没有影响。然而，治疗组内磷存在改善趋势，且该组受试者的知识得分随时间有统计学显著增加。需要采用重复测量设计进行更多研究，以探讨增加干预频率和时长对实现患者临床结局指标的影响。
