| Objectives1.To construct a comprehensive intervention program of "Internet +home blood pressure monitoring" for maintenance hemodialysis patients using the health promotion model and self-efficacy theory as guidance;2.A randomized controlled trial was designed to evaluate the effect of the "Internet + home blood pressure monitoring" intervention program on home blood pressure monitoring knowledge,attitude,monitoring compliance,medication adherence and blood pressure and other health outcome indicators in maintenance hemodialysis patients.Methods1.Using the literature analysis method,a preliminary draft of the "Internet + home blood pressure monitoring" comprehensive intervention program for maintenance hemodialysis patients was constructed based on the health promotion model and self-efficacy theory,and the intervention program was revised according to the comments made by experts in the focus group meeting.2.81 maintenance hemodialysis patients who met the nadir criteria for dialysis in the hemodialysis unit from January 2022 to July 2022 in a tertiary care hospital in Guangdong Province were selected as study subjects.The group random sampling method was used to divide them into 42 cases in the intervention group and 39 cases in the control group.The patients in the control group were given conventional care,and the patients in the intervention group were given a comprehensive intervention based on the health promotion model and self-efficacy theory of "Internet + home blood pressure monitoring".The patients in both groups were evaluated by the home blood pressure monitoring knowledge questionnaire,the home blood pressure monitoring attitude scale,the home blood pressure monitoring compliance scale and the medication adherence scale before and 1,3 and 6 months after the intervention to assess the effect of the intervention on the health outcome indicators such as home blood pressure monitoring knowledge,attitude,monitoring compliance,medication adherence and blood pressure in maintenance hemodialysis patients.The home blood pressure monitoring knowledge,attitude,monitoring compliance,medication adherence and Charlson comorbidity index were analyzed by repeated measures ANOVA,and the pre-dialysis blood pressure compliance rate,cardiovascular disease risk and dialysis adequacy were analyzed by generalized estimating equations.Results1.The preliminary draft of the "Internet + Family Blood Pressure Monitoring" comprehensive intervention program,with "Internet +Family Blood Pressure Monitoring",We Chat public health education and one-on-one personalized health education as the core intervention content,was formed.After two rounds of focus group discussions,the final draft of the "Internet + family blood pressure monitoring" comprehensive intervention program was revised.The expert judgment coefficient was 0.804,the expert familiarity coefficient was 0.938,and the expert authority coefficient was 0.871.2.A total of 81 patients on maintenance hemodialysis were included in this study,and 69 patients eventually completed a 6-month follow-up.Before the intervention,there was no statistically significant difference between the two groups in terms of general demographic data,disease-related data and various health outcome indicators(P>0.05).(1)Knowledge of home blood pressure monitoring: Patients in the intervention group had higher total scores of knowledge of home blood pressure monitoring,knowledge of hypertension prevention and treatment,and knowledge of home blood pressure monitoring than the control group at 1,3,and 6 months after the intervention(P<0.05).Repeated-measures ANOVA results showed that the differences in the total score of home blood pressure monitoring knowledge,knowledge of hypertension prevention and control,and home blood pressure monitoring knowledge scores were statistically significant in terms of time effect,between-group effect,and interaction effect(P<0.01).(2)Attitude toward home blood pressure monitoring: patients in the intervention group had higher total scores of attitude toward home blood pressure monitoring at 3 and 6 months after the intervention than the control group(P<0.001);higher scores of perceived behavioral benefits,perceived behavioral barriers,and situational influences at 6 months after the intervention than the control group(P<0.001);higher behavioral self-efficacy,promise action plan,and immediate competing needs and liking scores at 1,3,and 6 months after the intervention were higher than those of the control group(P<0.001).Repeated-measures ANOVA results showed statistically significant differences in total home blood pressure monitoring attitude scores,perceived behavioral benefits,perceived behavioral barriers,behavioral self-efficacy,situational influences,promise action plans,and immediate competitive need and preference scores for time effects,between-group effects,and interaction effects(P<0.01).(3)Home blood pressure monitoring adherence: patients in the intervention group had higher home blood pressure monitoring adherence scores than the control group at 1,3,and 6 months after the intervention(P<0.001).Repeated measures ANOVA showed statistically significant differences in home blood pressure monitoring adherence scores in terms of time effect,between-group effect and interaction effect(P<0.01).(4)Medication adherence: Patients in the intervention group had higher medication adherence scores than the control group at 1,3,and 6 months after the intervention(P<0.05).Repeated-measures ANOVA showed that the differences in medication adherence scores were statistically significant(P<0.01)in terms of time effect,between-group effect and interaction effect.(5)Pre-permeability blood pressure compliance rate: The results of the generalized estimating equation analysis showed a statistically significant difference in the time effect of patients’ pre-permeability blood pressure compliance rate(P<0.05)and a 48.9% reduction in the risk of non-compliance with pre-permeability blood pressure in the intervention group at 3 months after the intervention(OR=0.511,P<0.05).(6)Risk of cardiovascular disease: the results of the generalized estimating equation analysis showed a statistically significant difference in the time effect of patients’ risk of cardiovascular disease(P<0.01),and the odds of patients in the intervention group progressing to moderate to high risk of cardiovascular disease at 1,3,and 6 months after the intervention were reduced by 52.9%(OR=0.471,P<0.01),67.5%(OR=0.325,P<0.01),and 46.9%(OR=0.531,P=0.017).(7)Dialysis adequacy: The results of the generalized estimating equation analysis showed a statistically significant difference in the time effect of patients’ dialysis adequacy(P<0.01),with a 44%(OR=0.560,P=0.035)and 61.6%(OR=0.384,P=0.04)decrease in the odds of inadequate dialysis occurring in the intervention group at 1 and 6 months after the intervention,respectively.(8)Disease progression: patients in the intervention group had a lower Charlson comorbidity index than the control group at 1,3,and 6 months after the intervention,with a statistically significant time effect(P<0.05).Conclusions1.The comprehensive intervention program "Internet + home blood pressure monitoring" constructed based on health promotion model and self-efficacy has high authority and good motivation among experts,and the intervention program is scientific and feasible.2.The intervention program is conducive to improving the knowledge,attitude,monitoring compliance,medication adherence and health outcome indicators of maintenance hemodialysis patients.It provides guidance for clinical nursing staff to carry out related interventions. |
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