Effectiveness of a Trans-Theoretical Model-Based Stage-Matched Intervention to Promote Lifestyle Modification Among Chronic Kidney Disease in Taiwan

Sunday, 27 July 2014

Miaofen Yen, PhD, RN, FAAN
Department of Nursing & Institute of Allied Health Sciences, National Cheng Kung University, Tainan city, Taiwan


Chronic Kidney Disease (CKD) is a global public health issue. To following a healthy lifestyle is good for people with CKD. Therefore, lifestyle modification has been promoted for the control of various chronic disease included CKD. The Trans-Theoretical Model (TTM) has become increasingly influential as a framework for understanding health-related behaviors and directing targeted interventions to promote health behavior. The study apply the transtheoretical model (TTM) to assess the effectiveness of a lifestyle modification consultation program on subjects with stage 1 to 3 CKD at baseline, 6, 12, 18, 24, 30 and 36 months later by examining the changes in health promotion lifestyle factors, and overall knowledge of renal protection and quality of life through a longitudinal follow-up survey. 


 A repeated-measures study design applied to evaluate the effectiveness of lifestyle modification intervention using random controlled trail. A total of 103 participants were recruited, 51 and 52 subjects were in control and experimental group, respectively. Data were collected six times over 3 years. The generalized estimating equations (GEE) was used to assessed the main effects of the intervention on the outcome variables after adjusting for the difference in outcome variable baseline scores.


 At baseline, CKD patients in both groups showed no significant difference in the stage of change in diet behavior (χ= 9.35, p =.05). The number of patients in the experimental group reporting a change in the stage of diet behavior with regard to action and maintenance increased across the 36 months, from 13.6% at baseline to 43.7%. Over the 36-month intervention period, there were significant differences for both groups in the follow-up visits for the renal protection knowledge variable. The post hoc analysis showed the 36 months (p = 0.045) and 24 months (p = 0.007) and 18 months (0.016) renal function protection knowledge scores were higher than those at six months. In addition, there were significant differences for both groups in the follow-up visits for the total health promoting lifestyle scores. After using a post hoc test, the 30 (p = 0.027) and 36 month (p = 0.012) total health promoting lifestyle scores were higher than that at 12 months. Between the two groups, there was a significant difference in the follow-up visits for the health responsibility (P = 0.04). However, no differences in quality of lifestyle scores between the two groups were found.


These results partial support the applicability of the Trans-theoretical model stage-matched for lifestyle modification intervention that may promote renal protection knowledge scores and partial health lifestyles scores in patients with early stage of chronic kidney disease.