A Mixed Study On Influencing Factors And Countermeasures Of Delayed Hospitalization In Patients With Chronic Kidney Disease Based On TPB Theory

Objective:A mixed study combining quantitative study and qualitative study was adopted to investigate the status quo of Chronic Kidney Disease(CKD)patients with delayed hospitalization,and to explore and analyze the influencing factors of delayed hospitalization in CKD patients from the aspects of sociodemographic factors,medical related situation,social support,coping style and self-efficacy.The corresponding countermeasures are proposed to provide reference basis for proposing targeted risk management strategies for delayed medical treatment of CKD patients,effectively improve the prevention awareness and coping ability of high-risk groups,promote timely medical treatment of CKD patients,improve their early diagnosis rate,and improve the quality of life and prognosis of patients.Methods:1.qualitative study.Through objective sampling method,14 patients with chronic kidney disease who received treatment in a Grade-A hospital in Shanxi Province from June 2021 to October 2021 were selected for semi-structured interviews.After preliminary literature review and discussion by the research group,nephrology experts and clinical workers were consulted.More than 10 years of experience in nephrology.Three patients with delayed medical treatment were selected for pre-interview.According to the interview results,the formal interview outline was optimized and determined.Based on the principle of sample size saturation,one-to-one face-to-face semi-structured interview was conducted to collect data,and Colaizzi’s seven-step analysis method was used to analyze,conclude,integrate and extract the topic of the interview data.2.A cross-sectional survey.A questionnaire survey was conducted among 245 patients with chronic kidney disease in a Grade-A hospital in Shanxi Province from September 2021 to April 2022 by convenient sampling method.The questionnaire consisted of general information questionnaire,patient medical treatment questionnaire,Social support Rating Scale,Simple Coping style questionnaire and general self-efficacy scale.After sorting out the collected data,a database was established through EpiData 3.1,and SPSS 26.0 software was used for statistical analysis.The mean ± standard deviation of measurement data was described,and T-test was used for comparison between groups.χ~2 test was used for comparison between groups,and univariate and multivariate Logistic regression analyses were performed for the collected variables,respectively.Odds ratios(OR)and 95% confidence intervals(95%CI)were calculated.The test level was α=0.05.Results:1.In the descriptive study,5 themes and 10 sub-themes were extracted from the interviews: low awareness rate of CKD,poor self-management ability of chronic diseases,negative psychological mood,socioeconomic factors,and current status of medical resources.2.In the cross-section survey,univariate analysis showed that there were statistical differences between CKD patients in the non-delayed group and the delayed group in terms of general information: education level,per capita monthly family income,place of residence,health insurance,CKD cognition level,frequency of physical examination,residence status,and whether there were medical workers at home(P<0.05).There were statistical differences between the severity of the first symptom,the reasons for not seeking medical treatment in time,and the number of other chronic diseases combined with the delay of seeking medical treatment(P<0.05).There were statistically significant differences in positive coping dimension,negative coping dimension,social support and self-efficacy scores between the two groups(P<0.05).3.The results of binary logistic regression analysis showed that the OR of CKD knowledge level,education level,frequency of physical examination,family income per month,self-efficacy,positive coping style,whether there were medical workers in the family was less than 1,negative coping,the severity of first symptom and the OR value of several chronic diseases more than 1 were the risk factors of CKD patients’ delay in seeking medical treatment.Conclusion:1.1.The current situation of delayed medical treatment in patients with CKD is severe,with varying degrees of delayed medical treatment,most of which are concentrated in six months to five years.Missing the early intervention time will bring huge burden and pressure to individuals and families.2.There are various influencing factors for delayed medical treatment in patients with CKD,and people with different characteristics have different tendency to delay medical treatment.Knowledge level of CKD,education level,frequency of physical examination,per capita monthly family income,self-efficacy,active coping,whether there are medical workers in the family for CKD patients to delay the occurrence of protective factors;Negative coping,severity of first symptom and combination of several chronic diseases were risk factors for delayed hospitalization.From the above aspects,early screening should be conducted for high-risk groups of CKD patients to promote the transition from "passive medical treatment" to "active medical treatment",thus reducing the delay rate of medical treatment and improving the prognosis level.This project is a soft science project of Shanxi province,“The construction of theoretical model of chronic kidney disease patients’ medical-seeking behavior from the perspective of supply--an empirical analysis based on Andersen Behavior Model(No.2019041044-1)”.