TTM干预对维持性血液透析患者自我管理行为及生存质量的影响
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摘要
目的
了解维持性血液透析(MHD)患者的自我管理行为及生存质量现状；采用行为转变理论模式(TTM)对MHD患者自我管理行为及生存质量进行干预,探讨TTM干预对MHD患者自我管理行为及生存质量的影响。
方法
采用便利抽样法,在衡阳市某三级甲等医院血液透析室抽取符合本研究要求的维持性血液透析患者80名为研究对象。本研究采用类实验性研究,量性研究和质性研究相结合的方法；将研究对象随机分为实验组和对照组各40名,对照组给予常规护理,实验组在常规护理的基础上给予为期24周的行为转变干预；于干预前后使用血液透析患者自我管理行为问卷、综合性医院焦虑抑郁量表(HAD)和世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评估和比较两组患者的自我管理行为及生存质量水平。将所收集的资料进行整理,使用SPSS13.0软件包建立数据库进行描述性分析、t检验、单因素方差分析、相关分析和逐步回归分析。
结果
1自我管理状况：
1)MHD患者的自我管理行为及其影响因素主要为2个主题：①医院信息支持,包括医嘱的可操作性和医院自我管理健康教育；②患者自我管理能力,包括患者的认知水平、行为习惯、负性情绪及家庭经济状况。
2)MHD患者自我管理总分为32.93～60.33(55.90±6.58)分；TTM干预前两组患者的自我管理各领域得分差异无统计学意义(P>0.05)；TTM干预后,实验组自我管理的4个领域得分均高于对照组,差异有统计学意义(P<0.05)。
2负性情绪发生率：
MHD患者中焦虑情绪发生率为66.7%；抑郁情绪发生率为61.1%。TTM干预前两组患者焦虑、抑郁情绪发生率差异无统计学意义(P＞0.05)；TTM干预后,实验组患者焦虑、抑郁情绪发生率均低于对照组,差异有统计学意义(P<0.05)。
3生存质量状况：
MHD患者生存质量总分为(41.51±5.26)分,各领域得分均低于常模,差异有统计学意义(均P=0.000)；个人月收入和年龄组与MHD患者生存质量总分有线性回归关系,复相关系数R=0.503,决定系数R2=0.253。自我管理总分与生存质量各领域得分及总分均呈正相关,相关系数r为(0.235～0.448)；焦虑、抑郁情绪得分与生存质量各领域得分及总分均呈负相关,相关系数r为(-0.785～-0.372)。TTM干预前两组患者的生存质量各领域得分差异无统计学意义(P>0.05)；TTM干预后实验组患者生存质量各领域得分均高于对照组,差异有统计学意义(均P<0.05)。
4 TTM干预效果：
实验组患者在TTM干预后自我管理、生存质量各领域得分及总分均高于干预前,差异有统计学意义(P=0.000)；干预后焦虑、抑郁情绪发生率均低于干预前,差异有统计学意义(P=0.000)。对照组患者自我管理各领域得分、生存质量各领域得分及总分、焦虑抑郁情绪发生率在TTM干预前后差异无统计学意义(P>0.05)；自我管理总分在TTM干预后高于干预前,差异有统计学意义(P<0.01)。
结论
1 MHD患者生存质量低于普通人群,个人月收入和年龄段是影响其生存质量的主要因素。
2 MHD患者的自我管理水平和负性情绪对其生存质量具有较好的预测效果；自我管理水平越高,负性情绪发生率越低,其生存质量越好。
3 TTM干预模式有助于提高MHD患者的自我管理水平,降低其负性情绪发生率,有效改善其生存质量。
OBJECTIVE
To investigate the self-management behavior and living quality in maintaince hemodialysis(MHD) patients; to explore the influences of the behavior trans-theoretical model(TTM) intervention on self-management behavior and living quality of MHD patients.
METHODS
80 maintenance hemodialysis patients meeting with the study requirement were recruited from the Hemodialysis Room of a third-grade class-A hospital in Hengyang city and were randomly divided into experimental group(40 cases) and control group(40 cases).The combination mean of quatitative research and qualitative research was applied in the quasi-experimental study. Patients in the control group were treated with routine care, and those in the experimental group were given behavior change interventions for 24 weeks on the base of routine care. The self-management behavior and living quality of the two groups were evaluated and compared before and after intervention with the Self-management behavior questionaire of hemodialysis patients,the Hospital Anxiety and Depression Scale(HAD) and WHO Quality of Life Scale-Brief (WHOQOL-BEFF).The statistical software SPSS 13.0 was used to analyze the collected date, the statistical methods including the Description Analyze, the t-Test, Analysis of Variance, the Chi-square Test, Correnlative Analyze and Multiple Linear Stepwise Regressions.
RESULTS
1 The self-management status:
1) Qualitative research interviews showed that MHD patients'self-management behavior and their influencing factors include the following two topics:①hospital information support, including feasibility of doctor's advice and hospital self-management health education;②patients self-management capabilities, including patients' cognitive level, behavior pattern, negative emotions, and family economic status.
2) The study showed that the total score of self-management in MHD patients is 44～76 (55.90±6.58).Each factor score of self-management between two groups had no significant difference before TTM intervcnticn(P>0.05).While each factor score of self-management in experimental group was higher than that in control group after TTM intervention, and there was significant differences (P<0.05).
2 The incidence of negative emotion: The incidence of anxiety and depression in MHD patients was 66.7%,61.1% respectively. The incidence of anxiety and depression between two groups had no significant difference before TTM intervention(P>0.05).while, the incidence of anxiety and depression in experimental group was lower than that in control group after TTM intervention,and the difference had statistic significance(P<0.05).
3 The living quality status: The total score of living quality in MHD patients was 32.93～60.33 (41.51±5.26). Compared to the National norm, the factor scores of iiving quality were lower, and the difference had statistic significance (P<0.01).There was a linear regression relation among MHD patients'economic income, age group and the total score of living quality(R=0.503,R2=0.253). The total score of self-management had positive correlation with all areas scores of living quality, and the correlation coefficient r was between 0.235 and 0.448. however, the anxiety and depression scores had negative correlation with all areas scores of living quality, and the correlation coefficient r was between-0.785 and-0.372. All areas scores of living quality between two groups had no significant difference before TTM intervention (P>0.05). But all areas scores of living quality in experimental group were higher than those in control group after TTM intervention,and the difference had statistically significant(P<0.05).
4 The effects of TTM intervention: For experimental group patients,all areas scores of self-management and living quality after intervention were higher than the before, and the incidence of anxiety and depression was lower than the before,and the difference was statistically significant(P=0.000). For control group patients, each factor score of self-management, anxiety and depression incidence and all areas scores of living quality had no significant differences before TTM intervention(P> 0.05).However,the total score of self-management after intervention was higher than the before, the difference was statistically significant(P<0.01).
CONCLUSION
1 The living quality of patients with MHD is lower than national norm, and its influcening factors including economic income and age group.
2 MHD patients'self-management level and negative emotion can forecast the function of their living quality. That is to say, higher self-management level and less negative emotion will make their living quality better.
3 TTM intervention model may conduce to improve the self-management level and living quality in patients with MHD, and it can reduce the incidence rate of negative emotions.
了解维持性血液透析(MHD)患者的自我管理行为及生存质量现状；采用行为转变理论模式(TTM)对MHD患者自我管理行为及生存质量进行干预,探讨TTM干预对MHD患者自我管理行为及生存质量的影响。
方法
采用便利抽样法,在衡阳市某三级甲等医院血液透析室抽取符合本研究要求的维持性血液透析患者80名为研究对象。本研究采用类实验性研究,量性研究和质性研究相结合的方法；将研究对象随机分为实验组和对照组各40名,对照组给予常规护理,实验组在常规护理的基础上给予为期24周的行为转变干预；于干预前后使用血液透析患者自我管理行为问卷、综合性医院焦虑抑郁量表(HAD)和世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评估和比较两组患者的自我管理行为及生存质量水平。将所收集的资料进行整理,使用SPSS13.0软件包建立数据库进行描述性分析、t检验、单因素方差分析、相关分析和逐步回归分析。
结果
1自我管理状况：
1)MHD患者的自我管理行为及其影响因素主要为2个主题：①医院信息支持,包括医嘱的可操作性和医院自我管理健康教育；②患者自我管理能力,包括患者的认知水平、行为习惯、负性情绪及家庭经济状况。
2)MHD患者自我管理总分为32.93～60.33(55.90±6.58)分；TTM干预前两组患者的自我管理各领域得分差异无统计学意义(P>0.05)；TTM干预后,实验组自我管理的4个领域得分均高于对照组,差异有统计学意义(P<0.05)。
2负性情绪发生率：
MHD患者中焦虑情绪发生率为66.7%；抑郁情绪发生率为61.1%。TTM干预前两组患者焦虑、抑郁情绪发生率差异无统计学意义(P＞0.05)；TTM干预后,实验组患者焦虑、抑郁情绪发生率均低于对照组,差异有统计学意义(P<0.05)。
3生存质量状况：
MHD患者生存质量总分为(41.51±5.26)分,各领域得分均低于常模,差异有统计学意义(均P=0.000)；个人月收入和年龄组与MHD患者生存质量总分有线性回归关系,复相关系数R=0.503,决定系数R2=0.253。自我管理总分与生存质量各领域得分及总分均呈正相关,相关系数r为(0.235～0.448)；焦虑、抑郁情绪得分与生存质量各领域得分及总分均呈负相关,相关系数r为(-0.785～-0.372)。TTM干预前两组患者的生存质量各领域得分差异无统计学意义(P>0.05)；TTM干预后实验组患者生存质量各领域得分均高于对照组,差异有统计学意义(均P<0.05)。
4 TTM干预效果：
实验组患者在TTM干预后自我管理、生存质量各领域得分及总分均高于干预前,差异有统计学意义(P=0.000)；干预后焦虑、抑郁情绪发生率均低于干预前,差异有统计学意义(P=0.000)。对照组患者自我管理各领域得分、生存质量各领域得分及总分、焦虑抑郁情绪发生率在TTM干预前后差异无统计学意义(P>0.05)；自我管理总分在TTM干预后高于干预前,差异有统计学意义(P<0.01)。
结论
1 MHD患者生存质量低于普通人群,个人月收入和年龄段是影响其生存质量的主要因素。
2 MHD患者的自我管理水平和负性情绪对其生存质量具有较好的预测效果；自我管理水平越高,负性情绪发生率越低,其生存质量越好。
3 TTM干预模式有助于提高MHD患者的自我管理水平,降低其负性情绪发生率,有效改善其生存质量。
OBJECTIVE
To investigate the self-management behavior and living quality in maintaince hemodialysis(MHD) patients; to explore the influences of the behavior trans-theoretical model(TTM) intervention on self-management behavior and living quality of MHD patients.
METHODS
80 maintenance hemodialysis patients meeting with the study requirement were recruited from the Hemodialysis Room of a third-grade class-A hospital in Hengyang city and were randomly divided into experimental group(40 cases) and control group(40 cases).The combination mean of quatitative research and qualitative research was applied in the quasi-experimental study. Patients in the control group were treated with routine care, and those in the experimental group were given behavior change interventions for 24 weeks on the base of routine care. The self-management behavior and living quality of the two groups were evaluated and compared before and after intervention with the Self-management behavior questionaire of hemodialysis patients,the Hospital Anxiety and Depression Scale(HAD) and WHO Quality of Life Scale-Brief (WHOQOL-BEFF).The statistical software SPSS 13.0 was used to analyze the collected date, the statistical methods including the Description Analyze, the t-Test, Analysis of Variance, the Chi-square Test, Correnlative Analyze and Multiple Linear Stepwise Regressions.
RESULTS
1 The self-management status:
1) Qualitative research interviews showed that MHD patients'self-management behavior and their influencing factors include the following two topics:①hospital information support, including feasibility of doctor's advice and hospital self-management health education;②patients self-management capabilities, including patients' cognitive level, behavior pattern, negative emotions, and family economic status.
2) The study showed that the total score of self-management in MHD patients is 44～76 (55.90±6.58).Each factor score of self-management between two groups had no significant difference before TTM intervcnticn(P>0.05).While each factor score of self-management in experimental group was higher than that in control group after TTM intervention, and there was significant differences (P<0.05).
2 The incidence of negative emotion: The incidence of anxiety and depression in MHD patients was 66.7%,61.1% respectively. The incidence of anxiety and depression between two groups had no significant difference before TTM intervention(P>0.05).while, the incidence of anxiety and depression in experimental group was lower than that in control group after TTM intervention,and the difference had statistic significance(P<0.05).
3 The living quality status: The total score of living quality in MHD patients was 32.93～60.33 (41.51±5.26). Compared to the National norm, the factor scores of iiving quality were lower, and the difference had statistic significance (P<0.01).There was a linear regression relation among MHD patients'economic income, age group and the total score of living quality(R=0.503,R2=0.253). The total score of self-management had positive correlation with all areas scores of living quality, and the correlation coefficient r was between 0.235 and 0.448. however, the anxiety and depression scores had negative correlation with all areas scores of living quality, and the correlation coefficient r was between-0.785 and-0.372. All areas scores of living quality between two groups had no significant difference before TTM intervention (P>0.05). But all areas scores of living quality in experimental group were higher than those in control group after TTM intervention,and the difference had statistically significant(P<0.05).
4 The effects of TTM intervention: For experimental group patients,all areas scores of self-management and living quality after intervention were higher than the before, and the incidence of anxiety and depression was lower than the before,and the difference was statistically significant(P=0.000). For control group patients, each factor score of self-management, anxiety and depression incidence and all areas scores of living quality had no significant differences before TTM intervention(P> 0.05).However,the total score of self-management after intervention was higher than the before, the difference was statistically significant(P<0.01).
CONCLUSION
1 The living quality of patients with MHD is lower than national norm, and its influcening factors including economic income and age group.
2 MHD patients'self-management level and negative emotion can forecast the function of their living quality. That is to say, higher self-management level and less negative emotion will make their living quality better.
3 TTM intervention model may conduce to improve the self-management level and living quality in patients with MHD, and it can reduce the incidence rate of negative emotions.
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[4]张学军.护理干预对血液透析患者生活质量的影响[J].中外医疗,2010,9：17-18.
[5]吴雪.认知行为干预对改善维持性血液透析患者生活质量的应用研究[D],济南,山东大学,2005.
[6]Lysaght MJ. Maintenance dialysis population dyamics:current trends and long-term implications. J Am Soc Nephrol,2002,12(suppl 1):37-40.
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[9]Fukuhara S,Lopes A A,Bragg-Gresham J I,el al.Health-related quality of life among dialysis patients on three continents:the dialysis outcomes and practice patterns study[J].Kidney Int,2003,64(5):1903-1910.
[10]张红霞,张训保,谭迎春,等.维持性血液透析患者生活质量满意度及影响因素分析[J].徐州医学院学报,2010,30(12)：892-895.
[11]王颖,林可可.维持性血液透析患者生活质量及其相关因素分析[J].中国血液净化,2010,9(2)：106-108.
[12]周刚,王力宁，范秋灵,等.维持性血液透析患者生活质量及其影响因素探讨[J].中国实用内科杂志,2010,30(2)：140-143.
[13]姜敏敏,李鲁.血液透析患者牛活质量的影响因素[J].浙江大学学报(医学版),2004,33(6)：546-549.
[14]秦洁,赵红,汪彬,等.血液透析患者生活质量及其影响因素的调查[J].解放军护理杂志,2010,27(2A)：185-187.
[15]国秀娣.血液透析患者家庭支持与生活质量的相关性研究[J].中国中西医结合肾病杂志,2004,5(8)：468-469.
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[17]Parker K P. Sleep disturbances in dialysis patients[J]. Sleep Med Rev,2003,7(2):131-143.
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[19]纪京平,吕文娟.自我健康管理的个性化信息支持服务探究[J].医学信息学杂志,2010,31(4)：11-24.
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