This study examined the effects of a targeted helping relationships strategies improved quality of life, health-promoting lifestyle behaviors, renal protection knowledge, and physical indicators of patients with early CKD.Helping relationships from significant others, including understanding, caring and coach to assist people to act and maintain health promotion, which is a positive behavior to prevent disease or solve health problems for increasing health and approach to wellness. The trans-theoretical model (TTM) has become increasingly influential as a framework for understanding health-related behavior and directing efforts in health promotion. Whether helping relationships from significant others of TTM are effectively associated with the processes of healthy lifestyle modification among patients with CKD is still unknown, and this study addresses this gap in the literature.
Methods:
A repeated-measures design randomized 120 CKD patients from two southern Taiwan outpatient nephrology clinics into control and intervention groups. Data were collected four times over a year from July 2015 to September 2016. The generalized estimating equation (GEE) model was used to determine whether outcome variables (physical indicators, renal protection knowledge, healthy promoting lifestyle, and quality of life) were different across time in patients in the experimental and control groups. Measurements at baseline and at 3, 6, 9, and 12 months included World Health Organization Quality of Life Questionnaire, the Health Promoting Lifestyle Profile–II Chinese version (HPLP-IIC) questionnaire, the Renal Protection Knowledge (RPK) Checklist, and physical indicators.
Results:
The attrition rates were similar between the two groups. Reasons for failure to follow up included refusal to participate, missing the clinic appointment, lack of time, and death. The participant retention rate was 87.5%. The majority of the subjects were male 72 (72.4%), married 86 (81.9%), 52 participants in experiment group, and 53 participants in control group. The mean age was 62.99 ( SD = 13.06) years old with more than half reporting a junior high school education. Over half were employed 59 ( 56.2%). From stage 1 to stage 4 of CKD were 4 (2.9 %), 8 (5.8 %), 62 (44.6 %), and 31(25.3 %) participants, respectively. At baseline, CKD patients in both groups showed no significant difference in physical indicators, such as body mass index, waist circumference, hip circumference, waist-hip ratio, systolic blood pressure, diastolic blood pressure, BUN, creatinine, HbA1C and Modification of Diet in Renal Disease(MDRD), except comorbidity index. The baseline values different were adjusted as a covariance-comorbidity index and helping relationships from significant others for these variables in the GEE model. The results of hip circumference (p = .027) indicated the experimental had significant changes comparing control groups. The results of body mass index (p = .000), systolic blood pressure (p = .002), diastolic blood pressure (p = .000) revealed significant changes between the two groups over 12 months. The intervention group demonstrated significant improvement with regard to improve trend of renal function protection knowledge (p = .000), renal function protection (p = .000), diet with CKD (p = .000), use of Chinese herbs (p = .000), overall health-promoting lifestyle (p = .003), health responsibility (p = .001), physical activity (p = .000), and overall quality of life (p = .000), physical domain (p = .000), psychological domain (p = .000), social domain (p = .000) as well environmental domain (p= .000) indicated the experimental had significant changes comparing control groups over 12 months. The interventions of helping relationships from significant others among patients with CKD promotes improve health status, adherence health behaviors and increase quality of life.
Conclusion:
The interventions of helping relationships for patients with CKD increased renal protection knowledge, act and maintained health-promoting lifestyle as well improved health status and quality of life. Individualized plan about health-promoting lifestyle according to assessment of helping relationships from significant others should include partners, families, peers and medical staff to assist and accompany with people for learning, performing and maintaining disease-related knowledge as well health promoting lifestyles. Educate nurse students or medical staff to assess and implement strategies of helping relationships from significant others for improving individual’s health-promoting lifestyle and quality of life.