Effectiveness of self-care supported motivational interview to increase self-care agency and disease adaptation levels of hemodialysis patients: A randomized controlled trial

doi:10.21203/rs.3.rs-5245305/v1

Background

This study aimed to determine the effect of self-care-supported motivational interview on the self-care and disease adaptation of patients with hemodialysis treatment. Self-care training supported by motivational interviewing affects both patients' self-care and adaptation to the disease.

Methods

The research was conducted between October 2020 and March 2021 in the Hemodialysis Unit of a state hospital in a province in the east of Turkey. 77 hemodialysis patients participated in this study conducted with randomized controlled research pattern. Personal Information Form, Adaptation to Chronic Illness Scale and Self Care Agency Scale were used in the collection of data.

Results

It was found that the average score in the experimental and control groups was similar prior to, and the score averages of the experimental group increased significantly after compared to those of the control group. In-group comparisons revealed that the difference between pre-test, post-test and follow-up test mean scores of patients in the experimental group and their mean scores has changed significantly. Pre-test, post-test and follow-up test total scores, physical scores and social scores of the patients in the control group showed significant differences.

Conclusions

In order to increase patients' adaptation to chronic diseases and their self-care power, self-care supported motivational interviewing technique should be applied to patients. In order to increase the health level of patients, nurses should use the self-care supported motivational interviewing technique during care practices.

Hemodialysis

adaptation with chronic disease

motivational interview technique

self-care agency

Chronic renal failure (CRF) is a disease that is characterized by progressive and irreversible nephron loss due to various diseases (1–3). It is considered as an important public health problem from the class of chronic diseases due to its increasing frequency in the world and in our country, high morbidity and mortality rates, reducing quality of life, high cost of renal replacement treatments required for treatment, and bad prognostic course (4). According to the Ministry of Health and Turkish neurology association (TND) data, as of the end of 2017, the number of hemodialysis patients in our country is 58,635 (5).

The (HD) treatment is one of the most preferred treatment methods in patients with (ESRD) (6); however, it causes many complications in patients and affects the patient physically, socially and psychologically (7). This has a significant impact on both the patient and the patient's family and brings about new life arrangements for the patient (8). These changes also mean that the person has a new habit or changes his/her ongoing habits and necessitates him to make changes in his/her daily life order (9). Although (HD) can help patients maintain their physical functions and prevent complications, it is difficult to treat (CRF) with (HD) alone. In addition, this disease requires continuous treatment and care (10).

Hemodıalysıs treatment requires significant restrictions on both self-care and social behavior of patients (10). Despite the important role of self -care in the management of (CRF), most individuals with this disease have difficulty in doing their own care due to complex therapeutic regimes and physical and psychological limitations of the disease (11). In addition, (HD) also necessitates to comply with many restrictions of treatment such as nutrition diet, drug use and fluid intake (12). However, the fact that (HD) patients have to cope with many symptoms and symptoms due to the disease and treatment process makes it difficult to comply with the disease and (HD) treatment (13, 14).

It is known that hemodialysis is common in patients with treatment and fluid restrictions (15). A study of patients with (CRF) showed that skipping or abbreviation (HD) sessions increased mortality rates by 14%(16). Another study found out that one or more jumping of (HD) sessions increased mortality rates by 30%, that weight gain between (HD) sessions increases more than 5.7%increased mortality rates by 12%, and shortening (HD) sessions increased mortality rates by 11% (17). For this reason, it is of great importance that individuals with (CRF) are adapted to diseases and life changes in solving existing or subsequent problems (18).

Many different methods are used in keeping diseases under control and providing effective disease management. One of these methods is a motivational interview (MI) (19). (MI) is a client-centered form of interviews that are offered to help patients discover and solve their problems by providing them with their behavior change (20). The advisor can be a nurse, doctor or psychologist who has completed (MI) training (21). (MI) is a personalized intervention aimed at revealing their motivation to enable people to understand, believe in change and take action for change (22, 23). It is known that (MI) is effective in supporting the adaptation of treatment and disease, providing behavioral changes and maintaining self-care at a desired level (24, 25). It is stated that (MI) with (HD) patients has a positive effect on the diet of patients, the adaptation in fluid intake and the drug management (26). The study of Chen et al. stated that (MI) positively improves self-care behavior (27).

It is stated that the fact that nurses create behavioral changes by using self-care supported (MI) can increase the adaptation of the patients to the treatment process, ensure that patient care is maintained at a desired level and improves the health status of the patients (24, 28). The relevant literature revealed that a study on the effect of self-care-supported (MI) on the self-care agency and disease adaptation of (HD) patients has not yet been conducted. This study predicts that self-care-supported motivational interview will increase self-care agency and compliance with the disease in hemodialysis patients.

This randomized controlled experimental study was conducted to determine the effect of self-care-supported motivational interview in patients receiving hemodialysis treatment on self-care and disease adaptation. The research was conducted between October 2020 and March 2021 in the Hemodialysis Unit of a state hospital in a province in the east of Turkey. The universe of the study was 97 patients receiving hemodialysis treatment. The sample size of the research “G. Power-3.1.9.2 ”program was calculated by determining 80%power in size of 0.70 effect. It was understood that a minimum of 68 subjects in total should be included in the research (29). In the first stage, a total of 85 patients who refused to participate in the research and 85 patients who did not comply with the inclusion criteria were included in the analysis. However, the research was completed with a total of 77 patients, 40 and 37 control groups (Fig. 1). Patients were divided into experimental and control groups using simple random sampling method. In order to prevent inter-patient interaction, randomization was performed between hemodialysis sessions of experimental and control groups.

The criteria of the inclusion in the study were as follows: being 18 years and older, having received (HD) treatment for at least three months and longer, getting (HD) treatment for 2 or 3 days a week, not having communicative and mental problems, being literate, not having received (MI) training before, and being volunteer to participate in the study. Patients who did not want to continue were excluded during the study.

Instruments

Personal Information Form (Personal Information Form)

This form, created by the researcher by reviewing the literature, consists of 23 questions in total.

Self-Care Agency Scale (ESCA)

Self-Care Agency Scale was developed by Kearney and Fleischer in 1979. The validity and reliability study of the Turkish version of the scale was conducted in 1993 by Nahcıvan. It consists of 35 items. Each expression of the 5-point Likert type is scored from 0 to 4. The scoring on the scale is as follows: 4: “Defining me a lot”, 3: “Defining me a little”, 2: “No idea”, 1: “Defining me very much”, 0: “He doesn't define me at all”. There are 8 reverse expressions (3, 5, 7, 11, 17, 20, 24, 29) on the scale. The maximum score to be obtained from the scale is 140. Cronbach’s alpha coefficient of the scale was determined as 0.89. The increase in points from the scale indicates that the self-care agency of the patients increased (21). This research found the Cronbach’s Alfa internal consistency coefficient of the scale as 0.910

Adaptation to Chronic llness Scale (ACISS)

The scale was developed by Atik and Karatepe in 2016 to measure the level of compliance of individuals with chronic disease. The scoring is made as follows: 1: I never agree, 2: I do not agree, 3: I am indecisive, 4: I agree and 5: I fully agree. The scale has 5 -point Likert type and three sub -dimensions (physical adaptation, social adaptation and psychological adaptation).

The items 1, 9, 10, 13, 14, 15, 16, 18, 22, 23, 24 measure physical adaptation (Max = 55, Min = 11 Points ), the items 2, 3, 5, 7, 17, 19, 25 measure social adaptation (max = 35, min = 7 points), and the items 4, 6, 8, 11, 12, 20, 21 measure psychological adaptation in the scale consisting of 25 items in total. Negative items are scored as 1: 5, 2: 4, 3: 3, 4: 2, 5: 1. Article 1, 2, 3, 4, 7, 8, 9, 10, 11, 13, 14, 15, 16, 18, 21, 22, 23 are normally scored whereas items 5, 6, 12, 17, 19, 20, 24, 25 are scored reversely. The high scores obtained from the sub -dimensions and/or all of the scale mean that patients' adaptation levels are also high. The Cronbach Alpha internal consistency coefficient of the scale was found to be 0.88 (29). This research found the Cronbach’s Alfa internal consistency coefficient of the scale as 0.748.

Randomization

Patients receiving hemodialysis treatment in the hemodialysis unit of the hospital were divided into two different groups. The first group of patients receive hemodialysis treatment on Monday, Wednesday, and Friday, the second group of patients on Tuesday, Thursday, and Saturdays. Hemodialysis unit has two sessions on Monday, Wednesday, and Friday two sessions (one session morning, other sessions in the afternoon), Tuesday, Thursday, and Saturday two sessions (one session morning, other session afternoon). Four sessions in the hemodialysis unit were listed. Four lots were drawn by a person who was not aware of the study and groups were formed. Respectively, the first lot of experiment, the second draw control, the third draw experiment and the fourth lot control group was made. Thus, the patients during Monday, Wednesday, and Friday morning and afternoon sessions, Tuesday, Thursday, and Saturday morning and afternoon patients in the patients formed the experimental group.

Data Collection

The data were collected through face to face and individual interviews with patients. At the beginning of the study (pre-test), personal information form, (ESCA) and (ACISS) were applied to patients in both groups. Each patient allocated approximately 15–20 minutes.

Experimental Group

After the pre-test data were collected, the patients in the experimental group were informed about the self-care-supported motivational interview sessions. Following the collection of the first data, motivational interview sessions with patients started in the second week. The sessions took place during the hemodialysis session. A total of 6 sessions were held, including a session once a week. Self-care training was given in the first, second and third sessions. In the fourth, fifth and sixth sessions, a motivational interview was held. All sessions were performed individually with patients and each session lasted about 15–20 minutes (Table 1).

Table 1

self-care supported motivational interview program content
Session	Technique	Content	Method
First Session (First Week)	Self-care training	Hand Hygiene Mouth, Dental and Prosthesis Care Leather, hair, foot and nail care	Face-to-face once a week 15–20 min
Second Session (Second Week)	Self-care training	Toilet habits and cleaning Sleep and rest	Face-to-face once a week 15–20 min
Third Session (Third Week)	Self-care training	Compliance with treatment sessions Compliance with nutritional diet Compliance with the liquid diet Use of salt	Face-to-face once a week 15–20 min
Fourth, fifth and sixth Session (Fourth, fifth and sixth Week)	Motivational Interview	Creation of the Agenda Release of Ambivalences Use of Decision Balance Importance and consumption test implementation Plan for change Strengthening of change commitment	Face-to-face once a week 15–20 min

6 weeks after the collection of pre-test data (seventh week) (ESCA) and (ACISS) were applied for the second time (pos-test). One (1) months after the Post-test data was collected, (ESCA) and (ACISS) were repeated for the third time (follow-up test).

Control Group

After the pre-test data were collected in the control group, the patients continued their routine treatment and no motivational interview (MI) was conducted with this group. After 6 weeks (seventh week), (ESCA) and (ACISS) were applied to this group for the second time (post-test). One month after the post-test data was collected, (ESCA) and (ACISS) were repeated for the third time (follow-up test).

Self-Care and Disease Adaptation Training Guide

This guide prepared for patients receiving hemodialysis treatment and aimed at developing self-care activities and adapt to the disease was developed in the light of the relevant literature collected by researchers (12, 15, 19, 23, 28, 30, 31). The opinions of the five experts were used in the development of the guide. Self-care and disease adaptation training guide was given to the experimental group after the first session of the (MI) and the control group at the end of the study. In addition, the sound and video recording of the self-care and adaptation training guide was sent to the phones of patients or relatives.

Ethical Consideration

Before starting the research, written permissions were obtained from the Ethics Committee and the institution where the study will be carried out. Clinical Trials number received. (ClinicalTrials.gov Identifier: NCT053984329. Patients were informed about the study before the data was collected and then the approval of each participant. The principle of ‘protection of privacy and confidentiality’ was adhered to by notifying the patients that the information obtained will be kept confidential. The inclusion of those who want to participate in the study voluntarily shows that it was adhered to the principle of ‘respect for autonomy’. In general, the principles of ‘not harming/ benefits’ to the participants were adhered to.

Data Analysis

The data were analyzed in SPSS 22 package program (SPSS Inc., Chicago, IL, USA). The distribution of the data was tested in terms of normality by Kurtosis and Skewness test. Data descriptive statistics, chi-square analysis, T test in independent groups, Mann Whitney U test, Wilcoxon sequence test and Friedman test were analyzed. Descriptive statistics number (n), percent (%), average ± standard deviation (± SD) were considered. The statistical importance was accepted as p < 0.05.

Participant Characteristics

Characteristics of the study population are presented in Table 2. The average age of 77 patients was found to be 56.13 ± 15.15 in the experimental group and 61.11 ± 10.64 in the control group. Obtained information showed that the majority of patients are married (experimental group = 92.5%, control group = 97.3%), not literate (experimental group = 47.5%, control group = 73.0%), with children (experimental group = 90.0%, control group = 94.6%), and unemployed (experimental group = 50.0%, control group = 67.6%); and their income is equal to the expenses (experimental group = 65.0%, control group = 70.3%).

Table 2

socio-demographic characteristics of the participants
		Exp. Group	Control Group	Sig.
		n (%)	n (%)	Sig.
Socio-Demographic Feature		Mean.±SD. 56.13 ± 15.15	Mean.±SD. 61.11 ± 10.64	U*=599.500 p = 0.152
Gender	Male	26 (65.0)	13 (35.1)	x^2=6.858 p = 0.009**
Gender	Female	14 (35.0)	24 (64.9)	x^2=6.858 p = 0.009**
Marital Status	married	37 (92.5)	36 (97.3)	p = 0.616
Marital Status	single	3 (7.5)	1 (2.7)	p = 0.616
Having a child	Yes	36 (90.0)	35 (94.6)	p = 0.676
Having a child	No	4 (10.0)	2 (5.4)	p = 0.676
Educational status	Illiterate	19 (47.5)	27 (73.0)	x^2**=6.600 p = 0.159
	Prim. sch. graduate	12 (30.0)	7 (18.9)
	Sec. sch. graduate	1 (2.5)	- -
	H school graduate	6 (15.0)	3 (8.1)
	University graduate	2 (5.0)	-
Occupation	Unemployed	20 (50.0)	25 (67.6)	x^2**=4.382 p = 0.223
	Self-employment	10 (25.0)	8 (21.6)
	Officer/ çivil servant	6 (15.0)	1 (2.7)
	Retired	4 (10.0)	3 (8.1)
Residence	Village	15 (37.5)	20 (54.1)	x^2=10.309 p = 0.016**
	Town	3 (7.5)	-
	District	1 (2.5)	6 (16.2)
	Province	21 (52.5)	11 (29.7)
Income status	Income > expense	2 (5.0)	3 (8.1)	x^2**=0.884 p = 0.643
	Income = expense	26 (65.0)	26 (70.3)
	Income < expense	12 (30.0)	8 (21.6)
Who the patient lives with	Spouses and children	35 (87.5)	36 (97.3)	p = 0.202
Who the patient lives with	Mother or Father	5 (12.5)	1 (2.7)	p = 0.202
^U = Mann Whitney u test, ^*x² = Ki-square test

The (HD) treatment period of the experimental and control groups was 7.30 ± 6.83 years and 5.56 ± 4.23 years, respectively. 57.5%of the patients in the experimental group, and 59.5%of the patients in the control group began treatment 1 month after the diagnosis of the disease. In both groups, the majority of the patients adapted to the diet program (experimental group = 75.0%, control group = 67.6%) and move in accordance with the treatment sessions (experimental group = 97.5%, control group = 97.3%) (Table 3).

Table 3

disease characteristics of participants ^*U = Mann Whitney u test, ^**x² = Ki-square test
		Exp. Group	Control Group
		n (%)	n (%)	Sig.
Characteristics of Patient		Mean.±SD. 7.30 ± 6.83	Mean.±SD. 5.56 ± 4.23	U*=676.50 p = 0.515
The start of treatment after the diagnosis of hemodialysis	In a month	17 (42.5)	22 (59.5)	x^2**=2.212 p = 0.137
The start of treatment after the diagnosis of hemodialysis	After a month	23 (57.5)	15 (40.5)	x^2**=2.212 p = 0.137
anyone having hemodialysis in the family	Yes	10 (25.0)	7 (18.9)	x^2**=0.413 p = 0.520
anyone having hemodialysis in the family	No	30 (75.0)	30 (81.1)	x^2**=0.413 p = 0.520
Having any other chronic disease	Yes	26 (65.0)	30 (81.1)	x^2**=2.506 p = 0.113
Having any other chronic disease	No	14 (35.0)	7 (18.9)	x^2**=2.506 p = 0.113
Diabetes	Yes	9 (22.5)	14 (37.8)	x^2**=2.159 p = 0.142
Diabetes	No	31 (77.5)	23 (62.2)	x^2**=2.159 p = 0.142
Hypertension	Yes	25 (62.5)	27 (73.0)	x^2**=0.961 p = 0.327
Hypertension	No	15 (37.5)	10 (27.0)	x^2**=0.961 p = 0.327
Rheumatic Diseases	Yes	-	1 (2.7)	p = 0.481
Rheumatic Diseases	No	40 (100)	36 (97.3)	p = 0.481
Heart diseases	Yes	12 (30.0)	14 (37.8)	x^2**=0.528 p = 0.467
Heart diseases	No	28 (70.0)	23 (62.2)	x^2**=0.528 p = 0.467
Drug use	Yes	36 (90.0)	33 (89.2)	p = 1.000
Drug use	No	4 (10.0)	4 (10.8)	p = 1.000
Compliance with the diet program	Yes	30 (75.0)	25 (67.6)	x^2**=0.520 p = 0.471
Compliance with the diet program	No	10 (25.0)	12 (32.4)	x^2**=0.520 p = 0.471
Salt use	Yes	21 (52.5)	12 (32.4)	x^2**=3.161 p = 0.075
Salt use	No	19 (47.5)	25 (67.6)	x^2**=3.161 p = 0.075
Following the treatment sessions	Yes	39 (97.5)	36 (97.3)	p = 1.000
Following the treatment sessions	No	1 (2.5)	1 (2.7)	p = 1.000
Frequency of compliance with fluid restriction	Always	8 (20.0)	8 (21.6)	x^2**=0.600 p = 0.963
	Often	10 (25.0)	7 (18.9)
	Half-and-half	11 (27.5)	12 (32.4)
	Rarely	7 (17.5)	7 (18.9)
	Never	4 (10.0)	3 (8.1)
Frequency of compliance with the diet program	Always	10 (25.0)	10 (27.0)	x^2**=2.105 p = 0.761
	Often	13 (32.5)	8 (21.6)
	Half-and-half	9 (22.5)	12 (32.4)
	Rarely	6 (15.0)	4 (10.8)
	Never	2 (5.0)	3 (8.1)

^*U=Mann Whitney u test, ^**x²= Ki-square test

The majority of the patients had someone who supported their care (experimental group = 97.5%, control group = 100.0%). 97.5%, 47.5%, and 100% of the patients in the experimental group were determined to have their relatives who supported them physically, economically, and psychologically, respectively. It was found that there were relatives who support all patients in the control group physically, who support 67.6% of them economically, and who support 94.6%of them psychologically supported.

Comparison of Both Groups Based on the Mean Scores of ACISS and ESCA

There was no statistically significant difference between the Experimental and Control Groups for the total score and subscale scores (excluding psychological compliance sub-dimension) of (ACISS) (p > 0.05). The total (ACISS) score and all the subscale scores of the experimental group were found to be significantly higher than those of the control group one month after 6 weeks (post-test) and one month after the post-test (follow-up test) (p < 0.001).

However, the difference between pre-test, post-test and follow-up test measurements of both groups psychological adaptation sub-dimension, was found to be statistically significant (p < 0.05) (Table 4).

Table 4 Comparison of the pre-test, post-test and follow-up test of both groups according to the means scores of ACISS^* and ESCA^**

Scale and Process

Experimental Group n=40

Control Group n=37

Sig.

Mean±SD

(Min-Max)

Mean±SD

(Min-Max)

ACISS^* Total

Pre -test

Post -test

Follow-up test

73.58±10.01

89.05±7.65

82.70±8.58

23.00-47.00

75.00-109.00

60.00-101.00

69.70±5.27

73.27±11.14

72.03±9.57

24.00-44.00

50.00-96.00

55.00-90.00

t^**=1.697

t^**=7.189

U^***=309.000

p=0.094

p=0.000

Physical adaptation sub-dimension

Pre -test

Post -test

Follow-up test

34.33±10.01

40.60±4.08

38.45±4.51

23.00-47.00

32.00-50.00

29.00-48.00

33.03±5.27

34.51±5.75

33.81±4.82

24.00-44.00

24.00-47.00

25.00-42.00

t^**=1.092

t^**=5.386

U^***=377.500

p=0.278

p=0.000

Social adaptation sub-dimension

Pre -test

Post -test

Follow-up test

17.13±5.05

23.65±3.25

21.28±3.98

8.00-29.00

18.00-32.00

13.00-31.00

16.73±4.85

18.16±4.87

17.65±4.38

9.00-27.00

8.00-28.00

10.00-25.00

t^**=0.350

t^**=5.768

U^***=415.000

p=0.728

p=0.000

p=0.001

Psychologic adaptation sub-dimension

Pre -test

Post -test

Follow-up test

22.13±4.05

24.80±4.42

22.98±3.62

14.00-30.00

16.00-33.00

15.00-31.00

19.95±3.54

20.76±3.55

20.57±3.52

12.00-28.00

13.00-28.00

14.00-27.00

t^**=2.506

t^**=4.400

U^***=474.000

p=0.014

p=0.000

p=0.006

Self Care Agency Scale

Pre -test

Post -test

Follow-up test

99.53±18.76

116.53±13.69

109.88±13.18

45.00-130.00

72.00-139.00

72.00-130.00

88.51±25.74

92.38±22.07

90.11±20.90

30.00-128.00

42.00-126.00

45.00-130.00

t^**=2.157

t^**=5.714

U^***=323.500

p=0.034

p=0.000

^*ACISS= Adaptation to chronic illness, ^** ESCA= ***t=t test, ^****U= Mann Whitney u test.

The difference between the total (ESCA) scores of the experimental and control groups was statistically significant in both pre-test, post-test and follow-up test measurements (p < 0.05). However, the total average of the (ESCA) in all three measurements of the experimental group was found to be higher (Table 4).

In-group Comparison of ACISS and ESCA Scores in Both Groups

As shown in Table 5, the difference in pre-test, post-test and follow-up test measurements of both (ACISS) total and scores of the scale’s sub-dimensions and (ESCA) total scores were found statistically significant (p<0.05). Least significant differential (LSD) further analysis was performed to determine the measurement of the difference. The post-test score of the experimental group was higher than its pre-test and follow-up test scores, and the follow-up test score was higher than the pre-test score. In the control group, the differences of the total score of (ACISS), physical adaptation and social adaptation sub-dimension scores in pre-test, post-test and follow-up test were found to be statistically significant (p <0.05). Advanced analysis (LSD) showed that the pre-test score was lower than the post-test and follow-up test. (ACISS) psychological compliance sub-dimension score and (ESCA) total score were found to not be statistically significant in the pre-test, post-test and follow-up test measurements (p> 0.05).

Table 5 In -group comparison of ACISS* and ESCA ** score in both groups

		Pre-test	Post-test	Follow-up test
		Mean±SD	Mean±SD	Mean±SD	Sig.
Experimental group	Physical adaptation	34.33±5.16	40.60±4.08	38.45±4.51		F^*=68.405, p=0.000**
	Social adaptation	17.13±5.05	23.65±3.25	21.28±3.98		F^*=94.483, p=0.000**
	Psychological adaptation	22.13±4.05	24.80±4.42	22.98±3.62		F^*=15.210, p=0.000**
	ACISS^* Total	73.58±10.01	89.05±7.65	82.70±8.58		F^*=112.972, p=0.000**
	ESCA^** Total	99.53±18.76	116.53±13.69	109.88±13.18		F^*=61.017, p=0.000**
Control group	Physical adaptation	33.03±5,27	34.51±5,75	33.81±4,82		F^*=3.213, p=0.046**
	Social adaptation	16.73±4,85	18.16±4,87	17.65±4,38		F^*=6.056, p=0.004**
	Psychological adaptation	19.95±3,54	20.76±3,55	20.57±3,52		F^***=1.543, p=0.221
	ACISS^* Total	69.70±9,99	73.27±11,14	72.03±9,57		F^*=6.044, p=0.004**
	ESCA^** Total	88.51±25,74	92.38±22,07	90.11±20,90		F^***=2.176, p=0.121

^*ACISS= Adaptation to chronic illness, ^** ESCA=Self-care agency scale ^***F= Variance analysis.

It was found that the studies that investigate the self-care agencies of patients and the self-care agencies and the compliance of chronic disease were limited in (HD) patients. Therefore, the results of this study were compared with educational studies conducted in different groups.

The study showed that the (ESCA) score of the patients in both experimental and control groups was above the average. The (ESCA) score of (HD) patients was found to be above the average in some studies (32), it was moderate in some others (33–37), and this score was found to be below the average in Mollaoğlu’s study carried out 2011 (38). It was seen that the average of (ESCA) score between the experimental and control groups in the pre-test of the present study was different, and the mean (ESCA) score of the experimental group was higher. The high mean of the (ESCA) score of the experimental group may be due to the fact that more than half (52.5%) of patients live in the city center. On the other hand, more than half of the control group (54.1%) lives in the village. The fact that the opportunities of the villages are more limited in terms of treatment and maintenance compared to the provincial centers and that the patients here cannot benefit from health services may have negatively affected self-care.

At the beginning of the study (pre-test), there was a significant difference between the (ESCA) mean score of both groups. 6 weeks later (post-test) and one month after the post-test (follow-up test), although there was a significant increase in the (ESCA) mean score in the experimental group, there was no change in that of the control group. In addition, the examination of the (ESCA) scores regarding the comparison of all measurements of both groups in itself showed that the (ESCA) score increased significantly in the experimental group and there was no change in the control group. These findings indicate that the self-care-supported (MI) given to (HD) patients increases their participation in patients' self-care and improves their compliance with the disease. A study states that after self-care training, both the self-care agencies and the adaptation of the disease increased (39). Özdemir and Akyol (2019) found that there was a significant relationship between pre-tests and post-tests in which they conducted in one group in one group in (HD) patients (40). Fırat and Öztunç (2019) gave self-care training to patients in a certain program and order in a randomized controlled study. They found that the total score of the experimental group patients was higher than the control group of the control group and that (HD) patients developed self-care agencies (41). Muslu (2016) stated that (MI) is effective in increasing self-care behaviors and compliance with the disease in patients with type 2 diabetes (42).

Social, physical, emotional and economic difficulties caused by chronic disease make it difficult for the patient to adapt to new conditions (43). (HD) requires compatibility of many dimensions and is an important concern that affects patient results, including survival (25). This study found that more than half of the experimental and control groups in the pre-test data complies with the recommended diet program and the majority of the majority adapt to the treatment sessions. It is stated that the compliance rates of dialysis treatment are between 8.5–86%worldwide, the compliance rates in drug treatment in people receiving (HD) treatment is 15.4–50.2%, the compliance rates to fluid restriction are 9.7–49.5%and the compliance rates to the nutritional regime are between 9-22.1% (44). A number of studies have been conducted on hemodialysis patients. Sağduyu et al. (2006) found the compliance rate for nutritional treatment as 66% (45). Korkmaz and Kavın (2016) reported that the proportion of those who never missed the treatment sessions in the previous month was 96.5%and the rate of those who adhere to the fluid restriction was 45.9% (46). Kim et al. (2010) determined the dietary compliance rate of patients as 68.2% and the compliance rate of fluid restriction as 79.5% (47).

Complications may be prevented in patients with chronic renal failure by adequate (HD) application and adaptation of the patient to treatment, and morbidity and mortality rates can be reduced (1). Success in treatment depends on the adaptation of patients to treatment (12). Compliance with treatment plays an important role in the effectiveness of (HD) in patients and the development of health (28). At the beginning of the study (pre-test), there was a statistically significant difference between the (ACISS) total score and scores of all sub-dimension of the scale in two groups. Six weeks later (post-test) and one month after the post-test (follow-up test), despite a considerable rise in the experimental group's (ACISS) total score and all sub-dimensions’ scores were significant higher than those of the control group. In-group investigation of (ACISS) total and all sub-dimension scores of both groups of pre-test, post-test and follow-up test measurements showed that (ACISS) total score and all sub-dimensions’ scores increased significantly in the experimental group. These findings have shown that (MI), given by the nurse, increased the adaptation of patients to treatment and disease. The total and all sub-dimension scores in the follow-up test measurements applied one (1) months after self-care supported (MI) training are low compared to the final test measurements. However, these scores are higher than the mean of the front-test score. This shows that (MI) with self-care support has a lasting effect on (HD) patients. (MI) enables patients to participate in their treatment and guides them in their ability to manage their treatment (39). Matteson and Russell (2010) found that there was a significant improvement in the adaptation of patients to treatment, drug, diet and fluid consumption, although they were short in their study in hemodialysis patients (44).

The mean scores of (ESCA) and (ACISS) in this study vary in favor of the experimental group. Our study compared the pre-test, post-test and follow-up test measurements in the experimental group. The fact that (ESCA) and (ACISS) mean scores in the post-test and follow-up test increased significantly compared to mean scores of the pre-test can be accepted as an indication that self-care-supported (MI) causes changes in patients' self-care behaviors and improves the adaptation with (HD) treatment. In the process of acquiring health-enhancing behaviors, it is essential to give the individual a certain period of time in order to adopt this health behavior and to continue it (48). This study followed the patients again one (1) months after the motivational interview to see if the desired behavioral change has permanently. In follow-up tests, we found that the difference between them is meaningful, although the patients' total and sub-dimensions and self-care agency scale decreased compared to the end-class. Despite the decrease in the post-test, the average scores are higher than the pre -test shows the effectiveness of education. This result corresponds to the findings in the existing literature (31, 49). This study revealed that motivational interviews increase the self-care agency of (HD) patients and contribute to adaptation to the disease.

This study is limited to patients who were treated in the hemodialysis unit in the east of Turkey. Its results can be generalized to patients with similar characteristics.

The study found that (MI) yielded positive results in the experimental group of self-care support and increased patients' self-care agencies and adaptation to the disease. According to these results, it is crucial to carry out (MI) with self-care support for (HD) patients. In order to test the validity of this study, it is recommended to repeat in larger samples, to make longer and more repeated measurements, and to repeat the study in hemodialysis centers in different cities and different regions.

Self-care-supported (MI) can be an effective and cost-effective strategy to increase (HD) patients' adaptation to the disease and self-care agency. Nurses have a critical role to promote patients' adaptation to treatment and to increase their self-care agencies. It is suggested that the use of (MI) in research by nurses will increase the level of evidence of the studies in which it is used.

Conflict of interest:

The authors declare no conflict of interest in this study.

Financial Disclosure

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Author Contributions

Abdullah GERÇEK contributed to the design, conducted the searches, screening and data extraction, and contributed to the analysis and write-up of the manuscript.

Serap PARLAR KILIÇconducted the searches, screening and contributed to write-up of the manuscript.

Ethical Principles of the Research

Approval was obtained from Muş Alparslan University Scientific Research and Publication Ethics Committee for the research (number: 10879717-050.01.04). Verbal consent to participate in the research was obtained from the individuals by giving information about the purpose of the research, the method, the time they would spare for the research, and by declaring that participating in the research would not do any harm and that the participation was completely voluntary

Acknowledgements:

The authors wish to thank and acknowledge the participants for sharing their experiences with us.

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No competing interests reported.

Effectiveness of self-care supported motivational interview to increase self-care agency and disease adaptation levels of hemodialysis patients: A randomized controlled trial

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Background

Methods

Instruments

Personal Information Form (Personal Information Form)

Self-Care Agency Scale (ESCA)

Adaptation to Chronic llness Scale (ACISS)

Randomization

Data Collection

Experimental Group

Control Group

Self-Care and Disease Adaptation Training Guide

Ethical Consideration

Data Analysis

Results

Participant Characteristics

Comparison of Both Groups Based on the Mean Scores of ACISS and ESCA

In-group Comparison of ACISS and ESCA Scores in Both Groups

Discussion

Conclusion and Clinical Relevance

Declarations

Conflict of interest:

Acknowledgements:

References

Additional Declarations

Status:

Version 1