Study On The Effect Of Health Education Based On Hapa Theory On Dietary Compliance Of Maintenance Hemodialysis Patients

Objective 1.To establish a diet health education program for maintenance hemodialysis patients based on HAPA theory.2.To evaluate the effects of health education programs on diet compliance behavior,selfefficacy,nutritional status,dietary management behavioral stage distribution and related physiological indicators in maintenance hemodialysis patients.Methods 1.This research is a kind of experimental research.From April 2019 to December 2019,64 patients undergoing maintenance hemodialysis at a blood purification center of a thirdlevel first-class hospital were selected for the study.Patients receiving hemodialysis on Monday,Wednesday and Friday were randomly assigned to the control group(32 cases),and patients receiving hemodialysis on Tuesday,Thursday and Saturday were randomly assigned to the intervention group(32 cases).The control group received regular diet health education.The diet health education was conducted with diet guidance based on HAPA theory in the intervention group,which includes group education,motivational interview,one-on-one personalized guidance and face-to-face follow-up.2.Before the invention,after the intervention and 3 months after intervention,patients' dietary compliance,self-efficacy and dietary management behavior changes were measured by the “Renal Adherence Behaviour Questionnaire(RABQ)”,“Self-efficacy scale for managing chronic disease(SSMCD)”and “Diet management behavioral change stage assessment questionnaire”.Before the intervention and 3 months after the intervention,patients' nutritional status was measured by “ Modified quantitative subjective global assessment of nutrition(MGSGA)”.Before and 3 months after the intervention,patients' nutritional status was measured by “MGSGA”,and their hemoglobin,serum albumin,phosphorus,potassium,and interdialysis weight gain were measured by blood biochemical examination and body weight detection.3.SPSS21.0 software was used to analyze the data.Descriptive statistics: qualitative data were described by frequency and percentage.Quantitative data were described by (?) or median and quartile spacing.Statistical analysis: quantitative data were analyzed by repeated measurement analysis of variance,two independent samples T test and nonparametric test.qualitative data were analyzed by chi-square test.Results In this study,sixty patients were effectively intervened,including thirty patients in the control group and thirty patients in the intervention group.Four patients were lost to followup,including two patients in the control group and two patients in the intervention group.1.Before the intervention,there were no statistical significant difference in the demography,disease-related information,the score of RAAQ,SSMCD and MQSGA,stage evaluation of dietary management behavior change and the value of hemoglobin,albumin,phosphorus,potassium,interdialysis weight gain between the two groups(P>0.05).2.Comparison of dietary compliance scores between the two groups at different time points: The results of repeated measures analysis of variance showed that the time effect was statistically significant(F=38.135,P<0.05)when the scores of RAAQ after and 3 months after intervention were compared between the two groups.The difference of intervention effect was statistically significant(F=39.830,P<0.05);The interaction between time effect and intervention effect was statistically significant(F=16.436,P<0.05).The trend of RAAQ scores in the intervention group was better than that in the control group.3.Comparison of self-efficacy scores between the two groups at different time points: The results of repeated measures analysis of variance showed that the time effect was statistically significant(F=15.908,P<0.05)when the scores of SSMCD after and 3 months after intervention were compared between the two groups.The difference of intervention effect was statistically significant(F=5.803,P<0.05);The interaction between time effect and intervention effect was statistically significant(F=4.719,P<0.05).The trend of SSMCD scores in the intervention group was better than that in the control group.4.Comparison of MGSGA between the two groups: Three months after the intervention,the scores of MGSGA in the intervention group was lower than that in the control group,and the difference between the two groups was statistically significant(P<0.05).5.Comparison of stage evaluation of dietary management behavior change between the two groups: Compared with the control group,the number of people at the stage of dietary management behavior change in the intervention group were statistically significant after the intervention and three months after the intervention(P<0.05).Three months after the intervention,the proportion of patients in intention stage and behavior change stage in the intervention group was 33.3% and 43.3% respectively.6.Comparison of hemoglobin,phosphorus,kalium and interdialysis weight gain between the two groups: Three months after the intervention,there were statistical significant difference between the two groups in hemoglobin,phosphorus,kalium and interdialysis weight gain of the patients(P<0.05).7.Comparison of albumin between the two groups: there was no statistical significant difference between the two groups in albumin the 3 months after the intervention(P>0.05).Conclusions The diet health education program for maintenance hemodialysis patients based on the HAPA theory can effectively improve the patients' diet compliance and self-efficacy,enhance patients' nutritional status,improve the situation of the patients' dietary management behavior stage distribution,increase the value of patient's hemoglobin and reduce the value of patient's phosphorus,potassium,and weight gain during dialysis.But the effect of serum albumin on maintenance hemodialysis patients was not significant.