Effects of health education based on self-determination theory on hemodialysis knowledge, self-management and negative emotions in maintenance hemodialysis patients

doi:10.21203/rs.3.rs-4812122/v1

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Effects of health education based on self-determination theory on hemodialysis knowledge, self-management and negative emotions in maintenance hemodialysis patients

https://doi.org/10.21203/rs.3.rs-4812122/v1

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To explore the application effect of health education based on self-determination theory on hemodialysis knowledge, self-management and negative emotions in maintenance hemodialysis patients. The research is a quasi-randomized control trial, a total of 86 maintenance hemodialysis patients who met the exclusion criteria were included (43 patients each in the intervention group and the control group). The control group received routine care, and the intervention group implemented health education guided by self-determination theory on the basis of the control group. Three months after the intervention, the two groups were compared in terms of hemodialysis knowledge, self-management, interdialytic weight gain value and anxiety and depression. Before the intervention, there was no statistical difference in the comparison of hemodialysis knowledge scores, self-management scores, interdialytic weight gain value and anxiety and depression scores (P > 0.05). After 3 months of intervention, the hemodialysis knowledge scores of the intervention group was higher than that of the control group and baseline; the scores of the intervention group in problem solving, partnership, emotional processing, executive self-care dimensions and the total self-management scores were higher than that of the control group and baseline; the interdialytic weight gain value of the intervention group was lower than that of the control group and baseline; the anxiety and depression scores of the intervention group were lower than that of the control group and baseline. All these differences were statistically significant (P < 0.05). Health education based on self-determination theory can improve the hemodialysis knowledge level and self-management ability of maintenance hemodialysis patients, and reduce the interdialytic weight gain value and anxiety and depression level, which is worthy of clinical promotion.

Health sciences/Health care/Patient education

Health sciences/Nephrology/Renal replacement therapy/Haemodialysis

Maintenance hemodialysis

Self-management

Self-determination theory

quasi-randomized control trial

Chronic kidney disease(CKD)is an abnormality of renal function caused by a variety of reasons, such as genetic or environmental, with proteinuria or glomerular filtration rate༈GFR༉<60 ml/min /1.73m²>3 months, according to the GFR, it can be divided into stages 1 to 5, and stage 5 is called End-stage renal disease༈ESRD )¹. CKD affects over 850 million people globally², the prevalence of CKD in China is about 10.8%³, affecting more than 120 million people. The prevalence of adult CKD is projected to increase 16.7% by 2030⁴. The United States is expected to have more than 1 million people of end-stage renal disease by 2030⁵, the cost to Medicare already exceeding $30 billion/year⁵. The total number of hemodialysis patients in China has reached more than 700,000 people, and the trend is rising year by year, and the overall mortality rate of hemodialysis patients is 14.4%⁶. CKD, with its poor prognosis and high medical costs, is a major public health problem worldwide and a significant burden on health care systems⁷. Although kidney transplantation is the first choice for ESRD patients, kidney transplantation is currently faced with the major problems of kidney scarcity and high treatment cost in the world. Maintenance hemodialysis (MHD), as the main treatment for ESRD, has been widely used in clinical practice⁸.

Starting with a CKD diagnosis, patients face profound changes, including coping with the diagnosis, the future outlook of the effects, physical symptoms, and social impact⁹. Patients receiving MHD are characterized by long disease cycles, frequent and regular dialysis, and more dialysis-related complications. Self-management is a set of behaviors that patients adopt to enhance their organism's health and improve health outcomes, improving self-management of hemodialysis patients can reduce their complication rates¹⁰, and slows disease progression and reduces the risk of adverse health outcomes, improving quality of life and survival in the near and long term¹¹. According to literature reports¹², about 57.4% of hemodialysis patients had low levels of self-management ability. Health education can improve patients' self-management ability, while conventional health education through the distribution of pamphlets or group education, the guidance information is cumbersome, resulting in poorer effectiveness of the mission. In practice, support is provided according to the individual needs of the patient, by providing advice to help the patient change behavior, and to help the patient continuously learn and maintain complex self-management skills¹³ .

As medical paradigms have gradually changed in recent years, the actual outcomes of chronic care have largely depended on the level of patient engagement and the motivation of patients to adopt and use these interventions over time. The Self-Determination theory (SDT) is an empirically based theory of motivation proposed by Ryan and Deci¹⁴. Self-determination theory suggests that maintaining healthy behaviors over time requires patients to internalize value, allowing patients to experience self-determination, and only when patients act in a self-determining way can they feel enhanced motivation. SDT suggests that maintaining healthy behaviors over time requires patients to internalize value, allowing patients to experience self-determination, and only when patients' behaviors tend to be self-determined can they feel the enhanced motivation and improve their self-management ability^15–16. Lim¹⁷ used a combination of personal counselling and a text message service providing autonomy support to meet the three basic psychological needs of autonomy, competence, and relationships, which can be effective in promoting workers to engage in smoking cessation. Fenton¹⁸ conducted an intervention based on SDT to provide autonomy support to patients with rheumatoid arthritis, which resulted in positive changes in autonomy motivation, with patients being more motivated to carry out their exercise programs and improving their subjective vitality. In summary, it can be seen that health education under the framework of SDT significantly enhances patients' autonomous motivation and maintains healthy behaviors. There is no relevant research on the application of SDT in MHD patients, so this study investigates the effectiveness of health education based on SDT in MHD patients.

2.1 Sample

The research is a quasi-randomized control trial. 86 MHD patients admitted to a tertiary hospital in Deyang City from June to December 2023 were selected. Inclusion criteria: (1) age ≥ 18 years, meet the diagnostic criteria of end-stage renal disease in K/DOQI guidelines¹⁹;(2) hemodialysis treatment time ≥ 3 months, 3 times/week, 4h/session; (3) signed informed consent. Exclusion criteria: (1) unstable condition or combined with other serious diseases; (2) history of mental illness; (3) There's a possibility of a kidney transplant in the near future.

Sample size calculation: the sample size was calculated using the method of comparing the means of two samples with the formula:n1 = n2 = 2[(Zα + Z_β)σ/δ]², Taking bilateral α = 0.05, β = 0.1, checking the table, we get Zα = 1.960, Z_β=1.282, according to the literature research results²⁰, based on the calculation of MHD patients' self-management scores, δ = 8.7, σ = 11.2, it comes out that n1 = n2 = 35, and considering 10–20% of lost follow-up, therefore, the actual sample size of 86 MHD patients was selected.

Nurses at the hemodialysis center selected patients who met the inclusion criteria for this study and were fully informed of the aims and procedures. 43 patients who were dialyzed on Monday, Wednesday and Friday were in group A; 43 patients who were dialyzed on Tuesday, Thursday and Saturday were in group B. Groups A and B were randomly divided into the intervention group and the control group by using the method of flipping a coin, and all of the 86 people completed the three months of the intervention study.

2.2 Setting

Control group: routine care, including the distribution of health education manuals, centralized education, bedside individual guidance during dialysis and telephone follow-up, which mainly includes hemodialysis knowledge, exercise, diet, fluid intake, maintenance of vascular access, complication prevention and medication knowledge.

2.3 Intervention procedure

The intervention group jointly applied health education based on self-determination theory to meet patients' needs for autonomy, competence and relationships. (1) Establishment of intervention team: 1 nurse manager, 8 hemodialysis specialist nurses, 2 clinicians, 1 dietician, 1 psychologist, and the members of the intervention team receive homogeneous training. (2) Collective health education (1 time/month, 45min/time): Doctors use PPT to conduct preaching, specialist nurses conduct preaching and assessment through scenario simulation, and small gifts are given to those who are excellent in the assessment for commendation. (3) Individual guided interviews (4 times, 20min/ time): ① Autonomy needs: understand the patient's disease process, guide the patient to express positive or negative emotions and acknowledge the patient's point of view; listen to the patient's experience of self-management, guide the patient to draw the weight gain curve in the last 2 weeks; encourage the patient to talk about the important things in his/her life and hobbies, etc.; the dietician take into consideration the patient's financial ability and dietary preferences, etc., work with the patient to develop a home diet plan list; the doctor in charge develops an individualized exercise program with the patient according to the patient's exercise preferences and habits. ② Competence needs: guide patients to formulate practical and progressive goals and plans, explore possible obstacles in the implementation process, and assist patients in finding solutions; use food models as teaching aids to guide patients to master the estimation of food water content, as well as cooking to reduce phosphorus and soaking to reduce potassium, and other interventions such as micro-telephone groups, one-on-one telephone follow-ups, and self-monitoring diaries to ensure the sustainability of the implementation. Sustainability. ③ Relationship needs: Encourage patients to express their own feelings, give psychological support, and channel bad emotions; encourage patients to communicate with bedside patients during the dialysis process; advocate family accompaniment, and it is best for family members to participate in and supervise the whole process of behavioral change, so as to increase the patient's sense of family belonging needs.

2.4 Measures

Hemodialysis related knowledge scale

The hemodialysis related knowledge scale developed by Curtin²¹, the scale was translated, modified and culturally adjusted by scholar Li Hui to form a Chinese version of the hemodialysis related knowledge scale²². The scale included diet, medication, dialysis treatment, rehabilitation nursing and other subject categories, with a total of 24 items. Correct answers were counted as 1 point, and incorrect answers or ignorance was counted as 0 points. The score range was 0–24 points. In this study, the Cronbach's alpha coefficient was 0.701.

Self-management behavior scale

The self-management behavior scale developed by Li Hui and was used to evaluate the level of self-management behavior in hemodialysis patients²³, including four dimensions of partnership (4 items), executive self-care (7 items), problem solving (5 items) and emotional processing (4 items), with a total of 20 items. The scale adopts Likert 4 scoring method, assigning 1–4 points, ranging from 20 to 80 points. The higher the total score, the better the self-management behavior of MHD patients. In this study, the Cronbach's alpha coefficient was 0.862.

Interdialytic weight gain (IDWG)

Interdialytic weight gain (averaged from the 3 most recent dialysis sessions) was calculated as the average change in weight between dialysis sessions²⁴.

Anxiety and depression levels

In this study, Hospital Anxiety and Depression Scale (HADS) was used to evaluate the negative emotions of the MHD patients. The scale was developed by Zigmond and Snaith in 1983²⁵, including two subscales of anxiety (Anxiety-Symptoms, HADS-A) and depression (Depressive-Symptoms, HADS-D), each with 7 items, and a total of 14 items in the total scale. Likert 4 scores were used for this scale, ranging from 0 to 3, and the total score ranged from 0 to 42. The higher the score, the more serious the degree of anxiety and depression. In this study, Cronbach's alpha coefficient was 0.890 for the total scale and 0.820 and 0.807 for the anxiety and depression subscales, respectively.

2.5 Data analysis

SPSS version 26.0 (IBM Corporation, Armonk, New York, USA) were used to analyze the data, Count data were expressed as frequencies and percentages. Mean and standard deviation (‾x ± s) were used to describe continuous variables. Chi-square test (χ2) was used for comparison between groups. 2-Independent-samples t test was used to compare the two groups before and after intervention. All statistical tests were conducted by two-sided tests, with differences considered statistically significant at P < 0.05.

2.6 Ethical consideration

The study followed the principles of the Declaration of Helsinki, informed consent was obtained from the patients and their families before the start of the intervention, and the project was reviewed and approved by the hospital's ethics committee (ethical number : 2022-04-030-K01). Health education measures based on SDT were also conducted in the control group at the end of the study.

3.1 Sample characteristics

We recruited 96 participants, 10 participants did not meet the inclusion exclusion criteria, 10 participants were excluded, and 86 subjects ultimately met the inclusion criteria. Figure 1 shows the participant recruitment process. Comparison of the sample characteristics between the two groups of MHD patients showed no statistically significant difference (P > 0.05), and more information about the sample characteristics is shown in Table 1.

Table 1

Sample characteristics
Variables	intervention group (n = 43)	Control group (n = 43)	χ2/t	P
Age	60.25 ± 14.78	59.44 ± 14.38	0.259	0.796
Gender			1.720	0.190
Male	28 (65.1%)	15 (34.9%)
Female	22 (51.2%)	21 (48.8%)
Education			1.194	0.567
Junior high school and below	26 (60.5%)	21 (48.8%)
High school and technical secondary school	12 (27.9%)	16 (37.2%)
College or above	5 (11.6%)	6 (14.0%)
Marital status			0.506	0.873
unmarried	6 (14.0%)	4 (9.3%)
married	32(74.4%)	33 (76.7%)
Divorced or widowhood	5(11.6%)	6 (14.0%)
Monthly per capita family income			2.782	0.426
<1000	7 (16.3%)	5 (11.6%)
1000–3000	12 (27.9%)	7 (16.3%)
3000–5000	10 (23.3%)	15 (34.9%)
>5000	14 (32.6%)	16 (37.2%)

3.2 Comparison of hemodialysis related knowledge scores between the two groups before and after intervention

After 3 months of intervention, the hemodialysis related knowledge scores of the intervention group was not only higher than that of the control group, but also higher than that of the baseline. The difference was statistically significant (P < 0.05). Table 2 shows the comparison of hemodialysis related knowledge scores between the two groups before and after intervention.

Table 2

Comparison of hemodialysis related knowledge scores between the two groups before and after intervention (x̄ ± s, scores)
Variables	n	Timing of comparison	intervention group	Control group	t	P
Hemodialysis related knowledge	43	Baseline	14.33 ± 2.93	14.58 ± 2.04	-0.470	0.639
	43	After intervention	17.12 ± 2.16	15.65 ± 1.99	3.272	0.002

3.3 Comparison of self-management behavior scores between the two groups before and after intervention

After 3 months of intervention, the partnership, problem solving, emotion handling, executive self-care dimensions and total self-management scores of the intervention group were higher than those of the control group and baseline, and the difference was statistically significant (P < 0.05). Table 3 shows the comparison of self-management ability between the two groups before and after the intervention.

Table 3

Comparison of self-management behavior scores between the two groups before and after intervention (x̄ ± s, scores)
Timing of comparison	Group	n	partnership	problem solving	emotional processing	executive self-care	Total score
Baseline	intervention group	43	9.12 ± 1.48	11.86 ± 1.71	7.84 ± 2.15	17.02 ± 2.74	45.84 ± 5.72
	Control group	43	9.58 ± 1.82	11.60 ± 1.75	7.67 ± 1.95	17.23 ± 2.47	46.09 ± 4.82
	t		-1.301	0.686	0.368	-0.372	-0.224
	P		0.197	0.495	0.714	0.711	0.823
After intervention	intervention group	43	11.74 ± 1.56	13.44 ± 1.35	9.37 ± 1.25	20.23 ± 2.10	54.79 ± 4.34
	Control group	43	10.39 ± 1.37	12.33 ± 1.41	8.47 ± 1.52	18.42 ± 2.34	49.60 ± 4.05
	t		4.267	3.750	3.021	3.779	5.726
	P		<0.001	<0.001	<0.001	<0.001	<0.001

3.4 Comparison of IDWG between the two groups before and after intervention

After 3 months of intervention, the IDWG was lower in the intervention group than in the control group and baseline, these differences were statistically significant(P<0.05). Table 4 shows the comparison of IDWG between the two groups before and after the intervention.

Table 4

Comparison of IDWG between the two groups before and after intervention (x̄ ± s, kg)
Variables	n	Timing of comparison	intervention group	Control group	t	P
IDWG	43	Baseline	2.49 ± 0.36	2.35 ± 0.49	1.468	0.146
	43	After intervention	1.66 ± 0.54	1.93 ± 0.57	-2.238	0.028

Table 4

Comparison of IDWG between the two groups before and after intervention(x̄ ± s)
Variables	n	Timing of comparison	intervention group	Control group	t	P
IDWG	43	Baseline	2.49 ± 0.36	2.35 ± 0.49	1.468	0.146
	43	After intervention	1.66 ± 0.54	1.93 ± 0.57	-2.238	0.028

3.5 Comparison of anxiety and depression scores between the two groups before and after intervention

After 3 months of intervention, the intervention group was lower than the control group and baseline in anxiety, depression and total scores, these differences were statistically significant (P < 0.05). Table 5 shows the comparison of anxiety and depression scores between the two groups before and after intervention.

Table 5

Comparison of anxiety and depression scores between the two groups before and after intervention (x̄ ± s, scores)
Timing of comparison	Group	n	anxiety	depression	Total score
Baseline	intervention group	43	8.42 ± 2.96	8.07 ± 2.22	16.49 ± 4.67
	Control group	43	8.28 ± 3.04	8.30 ± 2.58	16.58 ± 5.00
	t		0.216	-0.447	-0.089
	P		0.830	0.656	0.929
	After intervention
After intervention	intervention group	43	6.42 ± 2.98	5.88 ± 2.21	12.30 ± 4.69
	Control group	43	7.86 ± 2.41	7.67 ± 2.10	15.53 ± 3.95
	t		-2.466	-3.844	-3.454
	P		0.016	<0.001	0.001

Table 5

Comparison of anxiety and depression scores between the two groups before and after intervention(x̄ ± s)
Timing of comparison	Group	n	anxiety	depression	Total score
Baseline	intervention group	43	8.42 ± 2.96	8.07 ± 2.22	16.49 ± 4.67
	Control group	43	8.28 ± 3.04	8.30 ± 2.58	16.58 ± 5.00
	t		0.216	-0.447	-0.089
	P		0.830	0.656	0.929
	After intervention
After intervention	intervention group	43	6.42 ± 2.98	5.88 ± 2.21	12.30 ± 4.69
	Control group	43	7.86 ± 2.41	7.67 ± 2.10	15.53 ± 3.95
	t		-2.466	-3.844	-3.454
	P		0.016	<0.001	0.001

Although hemodialysis can save a patient's life, it cannot continuously remove excess water and toxins from the patient's body and has certain limitations²⁶, therefore, dietary and exercise evangelism needs to be strengthened and sodium intake restricted. Disease factors and lack of knowledge are common factors of malnutrition in hemodialysis patients ²⁷, ²⁸, and patients can better manage their daily behaviors only if they have the relevant knowledge, so mastering dialysis-related knowledge is the most basic and extremely important part. Routine health education used in clinical practice can also help hemodialysis patients to improve their knowledge level, while SDT-based health education, patients' knowledge level improvement is more significant, and the difference between the two groups is statistically significant (P < 0.05), which may be due to the routine care adopted by the medical staff to explain the routine mission focused on theoretical knowledge inculcation, while the patient is passive mastery of the relevant knowledge, initiative and autonomy is low, resulting in the Poor effect of health guidance²⁹. The intervention group is more to make the patients actively participate in the learning process, fully inform the patients of the importance of mastering knowledge, mobilize the patients' enthusiasm for learning through group discussions and other modes, give the dialysis patients the right to actively choose the learning mode, and make them actively participate in the process of mastering knowledge related to the disease.

Self-management in MHD patients can help correct bad habits, as well as increase one's ability to monitor disease status, increase treatment compliance and subjective motivation, thereby reducing complications and improving quality of life. Behavior change comes from internal motivation, and a healthy lifestyle is easier to implement and maintain, so increasing patients' awareness of psychological need satisfaction and self-determined motivation plays an important role in improving self-management. The results of the study showed that the self-management score of the intervention group was higher than that of the control group, which is consistent with the results of the study by Yan Xiaoying et al³⁰, and it is possible that as the level of patients' knowledge related to hemodialysis improves, the patients' confidence and ability to manage their own symptoms increases, which in turn improves the level of self-management. As patients' level of knowledge about hemodialysis increases, their confidence and ability to manage their symptoms increases, leading to improved self-management. In addition, this study enabled patients to face up to their illnesses and accept themselves by meeting their basic psychological needs and developing motivation for self-management³¹. Throughout the intervention process, patients were informed of the importance of self-management by means of videos, verbal emphasis, group and other discussions, provided with reasons to reduce controlling behaviors, and trained in the skills they lacked; existing problems were discussed and exchanged by means of listening and a self-management plan was jointly developed. Individual guided interviews, on the other hand, took a step-by-step approach, adjusting goals and corresponding plans in a timely manner according to the patient's implementation, enhancing the patient's competence, and promoting autonomous motivation through the fulfilment of needs. The patients' motivation for self-management was strengthened, helping them to move from passive acceptance of care to active self-management, and promoting the establishment of their health behaviors³², by guiding patients to master diet management knowledge and cooking skills, such as cutting ingredients before washing, green leafy vegetables immersed in water for more than 30 minutes to reduce potassium intake. The dietitian works with the patient to develop an individualized nutrition plan, using the phosphorus/protein ratio concept to adjust the diet³³, limiting the intake of potassium, phosphorus and other elements ensures adequate nutrient intake.

Excessive fluid intake and poor dietary management are major influences on imbalanced weight control during the interdialytic period, and weight gain during the interdialytic period in patients with MHD leads to increased volume loading and a 2.1-fold increase in the risk of death³⁴, ³⁵. The better the self-management of MHD patients, the better the IDWG can control them, only when patients internalize their motivation and make choices autonomously can they develop health behaviors autonomously and adhere to them in the long term, and the autonomy process of motivation internalization needs to satisfy the three basic psychological needs of autonomy, competence, and belonging for patients to be able to change or maintain their health behaviors. In this study, patients were instructed on how to estimate the water content of food and how to manage fluids by using graduated water cups, which increased their interest and confidence in diet and fluid management. The results showed that IDWG in the intervention group was lower than that control group and baseline, which was basically similar to that reported by Wang Z. et al³⁶. It is suggested that health education based on SDT reduces IDWG of MHD patients by improving self-management ability.

Anxiety and depression are the most common mood disorders in MHD patients, which can lead to complications such as fatigue and sleep disorders, affecting their quality of life and treatment results³⁷. Due to the similarity of symptoms between mood disorders and uremia, early diagnosis is often not possible³⁸, and timely prevention is needed to reduce the disease burden of patients³⁹. The results of this study showed that after three months of intervention, the anxiety and depression scores of the intervention group were lower than control group and baseline, and the differences were statistically significant. This may be related to the following reasons, firstly, in the process of communicating with patients, so that patients feel that they are cared for and accepted by others this study provides support for patients from multiple dimensions such as family members and patients' friends, which meets the relational needs of patients; secondly, in routine care, patients seldom take the initiative to look for caregivers to ask questions during the dialysis period, and health education measures based on SDT can allow patients to experience more attention and support for autonomy, patients emotions can be released more; Finally, praise and encouragement for patients who successfully complete the goal, affirm the efforts made by patients, thus prompting patients to produce a positive psychology; the positive concept throughout the study to improve emotional control, more conducive to the gradual transformation of patients' negative emotions, and positively cope with the problems of life.

4. limitations

The study has several limitations. First of all, this is a three-month single-center study, and there may be some limitations in sample selection, which may not represent all patients receiving MHD. Secondly, the intervention time is short, which has certain limitations in promotion. It is suggested that future studies should extend the intervention time and conduct a multi-center large-sample study to further explore the application effect of this theory in health education.

In conclusion, health education based on self-determination theory can improve the hemodialysis knowledge level and self-management ability of maintenance hemodialysis patients, and reduce the interdialytic weight gain value and anxiety and depression level, which is worthy of clinical promotion.

CKD

Chronic kidney disease

MHD

Maintenance Hemodialysis

GFR

glomerular filtration rate

ESRD

End-stage Renal Disease

SDT

Self- Determination theory

HADS

Anxiety and Depression Scale

Competing interests

The authors have no conflicts of interest to declare.

Funding

This research received no external funding.

Author Contribution

Jiquan Zhang：Data curation, Formal analysis, Investigation, Conceptualization, Writing–original draft, Writing–review & editing.Fan Xu：Data curation, Formal analysis, Investigation, Conceptualization, Writing–original draft, Writing–review & editing.Peimin Zhuang：Writing–original draft, Software, Formal analysis.Xingying Xu：Writing–original draft, Investigation.Zhaohua Zou：Writing–original draft, Data curation.Wei Qing：Writing–original draft, Writing–review & editing, Investigation, Software.

Acknowledgement

We would like to thank all patients who participated in this study.

Data Availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Gao X, Mei C. Interpretation of the Guidelines for Early Screening, Diagnosis and Prevention of Chronic Kidney Disease (2022 edition). Chinese Journal of Practical Internal Medicine .2022; 42: 735-739.doi:10.19538/j.nk2022090108.
Eckardt KU, Delgado C, Heerspink H, Pecoits-Filho R, Ricardo AC, Stengel B,et al. Trends and perspectives for improving quality of chronic kidney disease care: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. KIDNEY INT .2023; 104: 888-903.doi:10.1016/j.kint.2023.05.013.
Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J,et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. LANCET .2012; 379: 815-822.doi:10.1016/S0140-6736(12)60033-6.
Hoerger TJ, Simpson SA, Yarnoff BO, Pavkov ME, Ríos BN, Saydah SH,et al. The future burden of CKD in the United States: a simulation model for the CDC CKD Initiative. AM J KIDNEY DIS .2015; 65: 403-411.doi:10.1053/j.ajkd.2014.09.023.
McCullough KP, Morgenstern H, Saran R, Herman WH, Robinson BM. Projecting ESRD Incidence and Prevalence in the United States through 2030. J AM SOC NEPHROL .2019; 30: 127-135.doi:10.1681/ASN.2018050531.
Xinju Z, Liangying G, Qingyu N, Yuchun C, Fanfan H, Zhaohui N,et al. Analysis of causes and characteristics of death in Chinese hemodialysis patients - Implications of the DOPPS study. Chinese Journal of Blood Purification .2022; 21: 89-93
Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. LANCET .2020; 395: 709-733.doi:10.1016/S0140-6736(20)30045-3.
Kramer A, Pippias M, Noordzij M, Stel VS, Andrusev AM, Aparicio-Madre MI,et al. The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2016: a summary. CLIN KIDNEY J .2019; 12: 702-720.doi:10.1093/ckj/sfz011.
de Jong Y, van der Willik EM, Milders J, Meuleman Y, Morton RL, Dekker FW,et al. Person centred care provision and care planning in chronic kidney disease: which outcomes matter? A systematic review and thematic synthesis of qualitative studies : Care planning in CKD: which outcomes matter? BMC NEPHROL .2021; 22: 309.doi:10.1186/s12882-021-02489-6.
Curtin RB, Walters BA, Schatell D, Pennell P, Wise M, Klicko K. Self-efficacy and self-management behaviors in patients with chronic kidney disease. ADV CHRONIC KIDNEY D .2008; 15: 191-205.doi:10.1053/j.ackd.2008.01.006.
Lee MC, Wu SV, Hsieh NC, Tsai JM. Self-Management Programs on eGFR, Depression, and Quality of Life among Patients with Chronic Kidney Disease: A Meta-Analysis. ASIAN NURS RES .2016; 10: 255-262.doi:10.1016/j.anr.2016.04.002.
Gela D, Mengistu D. Self-management and associated factors among patients with end-stage renal disease undergoing hemodialysis at health facilities in Addis Ababa, Ethiopia. INT J NEPHROL RENOV .2018; 11: 329-336.doi:10.2147/IJNRD.S184671.
Campbell F, Lawton J, Rankin D, Clowes M, Coates E, Heller S,et al. Follow-Up Support for Effective type 1 Diabetes self-management (The FUSED Model): A systematic review and meta-ethnography of the barriers, facilitators and recommendations for sustaining self-management skills after attending a structured education programme. BMC HEALTH SERV RES .2018; 18: 898.doi:10.1186/s12913-018-3655-z.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. AM PSYCHOL .2000; 55: 68-78.doi:10.1037//0003-066x.55.1.68.
Ryan RM PHDE. Facilitating health behaviour change and its maintenance: Interventions based on self-determination theory. The European Health Psychologist.2008; 1: 2-5
Sheldon KM, Prentice M. Self-determination theory as a foundation for personality researchers. J PERS .2019; 87: 5-14.doi:10.1111/jopy.12360.
Lim JH, Ha Y. Effectiveness of a Workplace Smoking Cessation Program based on Self-determination Theory Using Individual Counseling and Tailored Text Messaging: A Pilot Study. ASIAN NURS RES .2019; 13: 53-60.doi:10.1016/j.anr.2019.01.004.
Fenton S, Veldhuijzen VZJ, Metsios GS, Rouse PC, Yu CA, Ntoumanis N,et al. Testing a self-determination theory-based process model of physical activity behavior change in rheumatoid arthritis: results of a randomized controlled trial. TRANSL BEHAV MED .2020; 11: 369-380.doi:10.1093/tbm/ibaa022.
Isakova T, Nickolas TL, Denburg M, Yarlagadda S, Weiner DE, Gutiérrez OM,et al. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). AM J KIDNEY DIS .2017; 70: 737-751.doi:10.1053/j.ajkd.2017.07.019.
Xiaojuan L. The influence of motivational interview on the self-management level of maintenance hemodialysis patients[MS].Chengde Medical College, 2019.
Curtin RB, Sitter DC, Schatell D, Chewning BA. Self-management, knowledge, and functioning and well-being of patients on hemodialysis. NEPHROL NURS J .2004; 31: 378-386, 396, 387
Hui L, Yafang J, Hongwei Z, Jinghua X, Tao S. Research progress of self-management in hemodialysis patients and its influencing factors. Chinese Nursing Management .2012; 12: 93-95
Hui L, Yingdong C, Yafang J, Jingjing W. Introduction and reliability and validity of self-management scale for hemodialysis patients. Chinese Journal of Nursing .2015; 50: 1392-1395
Inrig JK, Patel UD, Toto RD, Szczech LA. Association of blood pressure increases during hemodialysis with 2-year mortality in incident hemodialysis patients: a secondary analysis of the Dialysis Morbidity and Mortality Wave 2 Study. AM J KIDNEY DIS .2009; 54: 881-890.doi:10.1053/j.ajkd.2009.05.012.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. ACTA PSYCHIAT SCAND .1983; 67: 361-370.doi:10.1111/j.1600-0447.1983.tb09716.x.
Li PK, Garcia-Garcia G, Lui SF, Andreoli S, Fung WW, Hradsky A,et al. Kidney health for everyone everywhere: from prevention to detection and equitable access to care. J NEPHROL .2020; 33: 201-210.doi:10.1007/s40620-020-00728-x.
Saglimbene VM, Wong G, Ruospo M, Palmer SC, Garcia-Larsen V, Natale P,et al. Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis. CLIN J AM SOC NEPHRO .2019; 14: 250-260.doi:10.2215/CJN.08580718.
Xuan-tong D, Geng-ru J. Research progress on the intervention of nutritional therapy on protein energy consumption in dialysis. Chinese Journal of Blood Purification .2019; 18: 499-502.doi:10.3969/j.issn.1671-4091.2019.07.009.
Ren Q, Lian M, Liu Y, Thomas Hawkins C, Zhu L, Shen Q. Effects of a transtheoretical model‐based WeChat health education programme on self‐management among haemodialysis patients: A longitudinal experimental intervention study. J ADV NURS .2019; 75: 1-12.doi:10.1111/jan.14182.
Xiaoying Y, Lin Z, Jinmei Z. Effect of warrantable health education on self-efficacy and serf-management among maintenance hemodialysis patients. Chinese Journal of Health Education .2018; 34: 452-455.doi:10.16168/j.cnki.issn.1002-9982.2018.05.016.
Petros R, Solomon P. Application of Self-determination Theory to Illness Self-management Interventions: Identifying Mediators. ADM POLICY MENT HLTH .2019; 46: 760-767.doi:10.1007/s10488-019-00953-y.
Shenglan L, Heya N, Weihao L, Qingping Y, Xuewen J, Jinglan L,et al. Effect of behavioral intervention on diabetes self-management based on self-determination theory. Journal of Peking University(Health Sciences) .2018; 50: 474-481
Alhambra EM, Molina PM, Olveira G, Arraiza IC, Fernández Soto, M, García Almeida, JM,et al. [Recommendations of the GARIN group for dietary managing of patient with chronic kidney disease]. NUTR HOSP .2019; 36: 183-217.doi:10.20960/nh.1823.
Ali OM, Sayed AA, Mohammed WS, Mohammed RR. Cardiovascular System Affection and Its Relation to First-Year Mortality in Patients Initiating Maintenance Hemodialysis. INT J GEN MED .2020; 13: 379-385.doi:10.2147/IJGM.S242549.
Palmer SC, Hayen A, Macaskill P, Pellegrini F, Craig JC, Elder GJ,et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. JAMA-J AM MED ASSOC .2011; 305: 1119-1127.doi:10.1001/jama.2011.308.
Zhenhua W, Xueying Y, Zhihong S. Application of health education based on self-efficacy theory in weight management of maintenance hemodialysis patients. Chinese Journal of Modern Nursing .2020; 26: 817-821
Gadia P, Awasthi A, Jain S, Koolwal GD. Depression and anxiety in patients of chronic kidney disease undergoing haemodialysis: A study from western Rajasthan. J FAM MED PRIM CARE .2020; 9: 4282-4286.doi:10.4103/jfmpc.jfmpc84020.
Gregg LP, Hedayati SS. Pharmacologic and psychological interventions for depression treatment in patients with kidney disease. CURR OPIN NEPHROL HY .2020; 29: 457-464.doi:10.1097/MNH.0000000000000629.
Auclair-Pilote J, Lalande D, Tinawi S, Feyz M, de Guise E. Satisfaction of basic psychological needs following a mild traumatic brain injury and relationships with post-concussion symptoms, anxiety, and depression. DISABIL REHABIL .2019: 1-9.doi:10.1080/09638288.2019.1630858.

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Effects of health education based on self-determination theory on hemodialysis knowledge, self-management and negative emotions in maintenance hemodialysis patients

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Abstract

Figures

1 Introduction

2 Methods

2.1 Sample

2.2 Setting

2.3 Intervention procedure

2.4 Measures

2.5 Data analysis

2.6 Ethical consideration

3 Results

3.1 Sample characteristics

3.2 Comparison of hemodialysis related knowledge scores between the two groups before and after intervention

3.3 Comparison of self-management behavior scores between the two groups before and after intervention

3.4 Comparison of IDWG between the two groups before and after intervention

3.5 Comparison of anxiety and depression scores between the two groups before and after intervention

4 Discussion

4. limitations

5. conclusion

Abbreviations

Declarations

Competing interests

Funding

Author Contribution

Acknowledgement

Data Availability

References

Additional Declarations

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