Establishment And Application Of The Self-management Program After Kidney Transplantation

Objectives:1,To investigate the status of self-efficacy,self-management,symptom distress and quality of life(QOL)in discharged renal transplant recipients.2,To analyze the influential factors of self-efficacy,self-management,symptom distress and QOL in discharged renal transplant recipients.3,To explore the relationships between self-efficacy,self-management,symptom distress and QOL in discharged renal transplant recipients.4,To evaluate the four-month effectiveness of the self-management program after kidney transplantation on self-efficacy,self-management,symptom distress and QOL.Methods:1,A convenient sample of 206 renal transplant recipients discharged from one provincial general hospital in Fuzhou was taken. The survey research last from February to August in 2007.Datas were collected by the self-made personal characteristics questionnaire,the Chinese version of self-efficacy for managing chronic disease 6-item scale,renal transplant recipients'self-management scale,self-designed renal transplant recipients'symptom distress questionnaire and quality of life scale for patients of renal transplantation. The descriptive statistics,two-sample t-test,one way analysis of variance,Pearson correlation and multiple stepwise regression analysis were adopted. 2,A clinic-based randomized controlled trial design was used in the intervention study directed by self-efficacy theory. Volunteer participants after kidney transplantation were individually matched into intervention group(n=52)or control group(n=52).The control group received the routine health education. Besides, the intervention group received self-management education course. Four-month changes in all evaluation indicators were compared between the two groups in pre-intervention and post-intervention phase. The descriptive statistics,chi-square test,fisher exact probabilities in 2×2 table and wilcoxon signed-rank test were adopted.Results:1,The average score of renal transplant recipients'self-efficacy was 7.31±1.80 points,60.68% of recipients had high level of self-efficacy;the total score of self-management was 87.98±12.24 points,score indicator was 78.55%,50.00% of recipients had moderate level of self-management,among the 4 dimensions,treatment management was the highest dimension;the score of symptom distress'frequency and condition were separately 21.55±13.32 and 17.91±11.40 points;the total score of renal transplant recipients'QOL was 126.59±18.85 points,57.77% of recipients had moderate level of QOL, among the 5 dimensions,the score of general assessment of QOL was the highest dimension.2,There was a statistically significant relationship between renal transplant recipients'self-efficacy and gender,the time after kidney transplantation,current state of job,the way of payment,education level(all P<0.05).Meanwhile the time after kidney transplantation had the strongest influence on self-efficacy ( Beta=-0.183 ) .There was a statistically significant relationship between renal transplant recipients'self-management and the time after kidney transplantation,the way of payment,education level(all P<0.05).There was a statistically significant relationship between the time after kidney transplantation and symptom distress'frequency,condition of renal transplant recipients(all P<0.05). There was a statistically significant relationship between renal transplant recipients'QOL and the state of marriage,current state of job,the way of payment,education level(all P<0.05).3,Renal transplant recipients'self-efficacy was positively related to self-management,QOL(all P<0.01),and negatively related to symptom distress'frequcncy and condition ( all P<0.01 ) .Renal transplant recipients'QOL was positively correlated with self-management(P<0.01),and negatively correlated with symptom distress'frequcncy and condition(all P<0.01),meanwhile self-management had the strongest influence on QOL(Beta=0.231).4,Compared with control group,intervention group significantly increased 2.10,12.84 and 31.52 scores separately in self-efficacy,self-management and QOL(all P<0.01),and decreased 4.65 and 10.74 scores in symptom distress'frequency and condition(all P<0.05).80.77% of study subjects considered self-management program was very helpful in self-managing illness and health,all of them considered conducting the program had significance.Conclusions:1,Most renal transplant recipients had high level of self-efficacy,while still need to improve.The factors influencing the renal transplant recipients'self-efficacy included gender,education level,the time after kidney transplantation,current state of job and the way of payment,then the time after kidney transplantation was the strongest influential factor.2,The levels of self-management among renal transplant recipients were between moderate a nd high levels,an d still need t o improve.Besides,treatment behaviors management had the highest score,and there were significant difference in self-management behaviors among recipients.The major influential factors of self-management were the time after kidney transplantation,the way of payment,education level. 3,Renal transplant recipients'symptom distress happened not very often and were not very hard,but there existed significant difference among recipients.The top one among these symptoms was short memory.The time after kidney transplantation was the main influential factor of symptom distress'frequency and condition.4,The level of QOL among renal transplant recipients were between moderate and high level,and the factors influencing the QOL included the state of marriage,current state of job,the way of payment,education level.5,There were closely relationships among self-efficacy,self-management,symptom distress and QOL of renal transplant recipients.The recipients who had higher level of self-efficacy can conduct self-management behaviors better,relieve symptom distress and improve QOL . Mean while , these change scanen hance recipients'self-efficacy.Therefore,educators can improve recipients'self-management behaviors by enhancing their self-efficacy.6,A preliminary evaluation demonstrated that the self-management program based on self-efficacy theory after kidney transplantation was effective:it improved study subjects'self-efficacy,self-management bahaviors and QOL,relieved symptom distress four months after the implementation;most of study subjects gave the program positive assessments.