A Study On The Application Of A Self-management Program Based On The COM-B Model In Maintenance Hemodialysis Patients

Objective1.To investigate the current status of self-management in maintenance hemodialysis patients and explore the influencing factors of self-management.2.Based on the results of the current survey,a self-management program based on the COMB model was constructed based on literature review,expert panel discussion and preexperimentation,and interventions were conducted for maintenance hemodialysis patients.To investigate the effects of the COM-B model-based self-management program on the selfmanagement level,weight gain,biochemical indexes and quality of life of maintenance hemodialysis patients,and to provide a reference basis for clinical health care professionals to improve the self-management level of maintenance hemodialysis patients.Methods1.Study on the status of self-management and the influencing factors of maintenance hemodialysis patientsPatients who were on regular dialysis treatment at the Hemodialysis Center of Jiangsu Subei People’s Hospital from January to February 2022 and met the criteria of nadir were selected as the study subjects using convenience sampling method.Self-designed general information questionnaire,hemodialysis patient self-management scale,chronic disease selfefficacy scale,hemodialysis patient health literacy questionnaire,social support scale,anxiety self-assessment scale and depression self-assessment scale were used to investigate the maintenance hemodialysis patients.The questionnaire data were collected and entered into the data,and SPSS26.0 was applied to analyze the data after establishing the database.Descriptive analysis,independent sample t-test,one-way ANOVA,Pearson correlation analysis and multiple linear regression analysis were used for statistical analysis.2.A study on the application of a self-management program based on the COM-B model in maintenance hemodialysis patients2.1 Construction of the intervention program:Combining the results of the status quo survey study,the self-management program based on the COM-B model was initially constructed through literature review and expert group discussion,and then six cases of maintenance hemodialysis patients were selected for pre-experimentation,and the intervention program was further improved according to the pre-experimentation results to finally form the selfmanagement intervention program based on the COM-B model.2.2 Intervention phase:132 patients who performed regular dialysis in the hemodialysis center of Jiangsu Subei People’s Hospital from June to November 2022 were selected for this study,with a sample loss of 7 cases and a final completion of 125 cases,62 cases in the control group and 63 cases in the experimental group.The control group implemented a conventional selfmanagement intervention program and the experimental group used a self-management intervention program based on the COM-B model,comparing the scores of self-management scale,weight gain values,blood phosphorus values and health survey short form scores of patients in both groups after six months of intervention.Descriptive analysis,χ2 test,independent sample t-test,and paired sample t-test were used for statistical analysis.Results1.Study on the status of self-management and factors influencing maintenance hemodialysis patientsA total of 228 questionnaires were distributed,8 invalid questionnaires were excluded,220 valid questionnaires were returned,with a valid recovery rate of 96.49%.220 maintenance hemodialysis patients scored(49.45±8.35)on the self-management scale.The results of univariate analysis showed statistically significant differences in patients’ self-management levels in terms of age,education,spouse,employment status,monthly per capita household income,age on dialysis,and primary illness(P<0.05).The results of correlation analysis indicated that patients’ self-management level was positively correlated with self-efficacy(r=0.535,P<0.001),health literacy(r=0.611,P<0.001),and social support(r=0.666,P<0.001)and positively correlated with anxiety(r=-0.687,P<0.001)and depression(r=-0.698,P<0.001)were negatively correlated.Multiple linear regression analysis showed that spouse,monthly per capita household income,education,employment status,self-efficacy,health literacy,social support,and psychological status were the influencing factors,explaining 76.5%of the variance in self-management among maintenance hemodialysis patients.2.A study on the application of a self-management program based on the COM-B model in maintenance hemodialysis patientsThere was no statistically significant difference in baseline information between the two groups of maintenance hemodialysis patients before the intervention(P>0.05).①Selfmanagement scale scores of MHD patients:After the intervention,the self-management scale scores of the experimental group and the control group were(60.22±7.48)and(54.24±5.17),respectively,with statistically significant differences(P<0.001);The self-management scale scores of both groups were improved after the intervention,with statistically significant differences before and after the intervention in the experimental group(P<0.001).②Interdialysis weight gain values:The weight gain values during the interdialysis period were(2.56±0.57)Kg and(2.93±0.55)Kg in the experimental group and the control group after the intervention,and the differences were statistically significant(P<0.001);The weight gain values during the interdialysis period decreased in both groups after the intervention,and the differences were statistically significant(P<0.001)in the experimental group before and after the intervention.③Blood phosphorus value:The blood phosphorus values of the experimental group and the control group were(1.76±0.22)mmol/L and(1.94 ±0.23)mmol/L after the intervention,and the differences were statistically significant(P<0.001);The blood phosphorus values of the patients in both groups decreased after the intervention,and the differences were statistically significant(P<0.001)in the experimental group before and after the intervention.④Quality of life:The total health survey short form scores were(67.90±7.96)and(54.59±6.19)in the experimental and control groups after the intervention,respectively,and the differences were statistically significant(P<0.001);After the intervention,the total health survey short form scores of patients in both groups were improved,among which the differences between the experimental group and the control group before and after the intervention were statistically significant(P<0.001).Conclusion1.Self-management of maintenance hemodialysis patients is moderate and influenced by many factors.Among them,patients with no spouse,low per capita monthly household income,low education level,inactivity,low self-efficacy,low health literacy,low social support level and poor psychological status need more attention.2.The self-management program based on the COM-B model can improve the selfmanagement level of maintenance hemodialysis patients,reduce the weight gain value and blood phosphorus value during the interdialysis period,and improve the quality of life,which provides some reference for health care professionals to develop intervention programs to improve the self-management of maintenance hemodialysis patients and is worthy of clinical promotion.