| Summary: | 碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 103 === The government of Taiwan implemented a medical program for early-stage chronic kidney disease (CKD) in recent years; however the prevalence of end-stage CKD is still increasing. This has become a burden on individuals, families, and social health care system. CKD is not curable but can be alleviated through lifestyle adjustment. Because the early stages of CKD are typically asymptomatic and easily ignored, awareness of CKD is low, and patients often delay their CKD treatment. CKD patients do not have health-promoting lifestyles even after they are diagnosed with CKD. Moreover, patients with early-stage CKD chronically suffer from CKD. Therefore, they require continuous care and monitoring as well as a health-promoting lifestyle such as a healthy diet, no smoking or drinking, and exercise to maintain their health. A health-promoting lifestyle is the key to preventing diseases. It also improves chronic disease patient health, increases physical activity, and positively influences diet adjustment, self-care, adherence, and disease recovery. Early-stage CKD patients urgently need to apply health promotion and engage in a health-promoting lifestyle. On this basis, the aim of this study is to identify the predictors of early-stage CKD patient health promotion behaviors and provide an evidence result for developing a healthcare plan in the future.
The cross-sectional design was applied in this study, and the participants who are early-stage CKD patients were recruited by simple random sampling in medical institutions of the Northern Taiwan, which comply with the National Health Insurance care plan. Data collection was conducted by a structured questionnaire, which includes a Health-Promoting Lifestyle Profile (HPLP-II) of Chronic Kidney Disease, Short Form Mandarin Health Literacy Scale (s-MHLS), and Short Form Chinese Chronic Illness Resources Survey (s-CIRS). SPSS version 20.0 was used for data analysis. Furthermore, an independent sample t test and one-way ANOVA were conducted to assess the difference in factor influence, and a Pearson correlation coefficient was used to test the correlation of variables. In addition, the predictors of health promotion behaviors (HPLP) were analyzed using multiple regression and stepwise regression, and the mediating effect of health literacy (HL) was assessed using multiple regression.
In this research, 230 subjects were recruited, of which 228 were valid for statistical analysis. According to the data analysis, the subjects’ average age was 67.72 years old, and most of them were CKD stage 3a and male. The average HPLP score of the subjects was 164.47 (σ = 22.89). Among the 6 dimensions of health promotion, Stress Management demonstrated the highest score, followed by Self Actualization, whereas the Physical Activity score was lowest. Subjects with higher levels of education, higher available monthly income, and who are married and living with their spouse registered higher total health-promoting and physical activity scores. Elderly females and young males performed less effectively in health promotion. CIRS demonstrated a significant positive correlation with HPLP (r = 0.656). Except occupation, all the aspects of CIRS had a significant positive correlation with health promotion behaviors. In addition, HL was significantly and positively correlated with HPLP (r = 0.245). According to stepwise regression, CIRS, available monthly income, hospital level, and perceived health status were the major predictors of HPLP, with a 51.1% explanatory power. CIRS exhibited a 42.8% explanatory power, which was the highest among the predictors. HL was a partial mediator between CIRS and HPLP.
The health-promoting behavior for early-stage CKD patients should cover multiple aspects, including diet, physical activity, symptom management, and emotional management. Various system resources must be integrated to execute continuous care and help patients learn and adopt health promotion behaviors. Therefore, follow-ups for high-risk population should be enforced, and proper health care according to the individual characteristics of patients should be provided. Moreover, leveraging patient groups to strengthen support networks and resources improves health promotion behaviors.
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