Effects of Strategies of Promoting Helping Relationships from Significant Others on Healthy Lifestyle among Patients with Chronic Kidney Disease

• Main Authors: PEI-YULEE, 李佩玉
• Other Authors: Miaofen Yen
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/vv9t6x

碩士 === 國立成功大學 === 護理學系 === 104 === SUMMARY Continuous assistance from significant others may promote a healthy lifestyle and prevent disease progression. The objective of this study was to understand the effects of helping relationship strategies on healthy lifestyle among patients with CKD. This study was an experimental two-group pretest–posttest design study. A total of 120 patients with CKD were randomly assigned to the experimental or control group. Subjects in the experimental group were provided with helping relationship strategies and monthly follow-up by phone. Strategies of improving helping relationship included warning mechanisms, target setting, encouragement, and feedback. In contrast, the subjects in the control group received regular care and monthly follow-up by phone. There were 72% male in this study. The mean age of the subjects was 63.14 years. We used the mean of difference to compare the effect of posttest between the two groups. Significant differences in helping relationship (t = −2.15, p 〈 .05) and health-promoting lifestyle (t = 3.12, p 〈 .05) were found between the two groups. No significant differences in physical activity (t = 1.62, p 〉 .05) were found between the two groups. Appropriate helping relationship strategies may improve the helping relationship between significant others and patients with CKD for promoting a healthy lifestyle. Key words: helping relationships, healthy lifestyle, chronic kidney disease INTRODUCTION People are less aware of chronic kidney disease (CKD) because of its mild early symptoms. It is difficult for them to adhere to lifestyle changes, regular clinic visits, and timely medication administration. However, continuous assistance from significant others may promote a healthy lifestyle and prevent disease progress. The necessary characteristics of significant others should include dependability, credibility, and positivity. Significant others may use understanding, caring, faith, and honesty to help patients deal with CKD and improve their self-care efficacy. Four teaching strategies, warning mechanisms, target setting, encouragement, and feedback, were developed to improve the helping relationship with significant others. The objective of this study was to understand the effects of helping relationship strategies on healthy lifestyle among patients with CKD. MATERIALS AND METHODS This study was an experimental two-group pretest–posttest design study. A total of 120 patients with CKD were selected from nephrology outpatient clinics from a regional hospital and a national medical center in southern Taiwan. Study subjects were randomly assigned to the experimental or control group. The inclusion criteria of the subjects were: (1) age 〉20 years, (2) diagnosis of CKD stages 1–4, (3) having significant others, and (4) with clear consciousness. The exclusion criteria were with: (1) good healthy lifestyle and (2) a psychiatric history. Power analysis calculation indicated that for an effect size of 0.5, power of 0.8, and 20% loss rate, 120 participants would be required. Before starting the interventions, all patients completed a structured questionnaire as a pretest. Subjects in the experimental group were provided with helping relationship strategies and monthly follow-up by phone. Strategies of improving helping relationship included warning mechanisms, target setting, encouragement, and feedback. In contrast, the subjects in the control group received regular care and monthly follow-up by phone. Three months later, all subjects completed a structured questionnaire as a posttest. The structured questionnaire included helping relationships scale, health-promoting lifestyle profile, and International physical activity questionnaire. Descriptive statistical analyses were used to describe variable distributions using means, standard deviations, frequencies, and percentages. The chi-square test was used to examine differences between groups in terms of demographic variables. The t-test was used to assess differences between the experimental and control groups for pretest. Difference in differences was used to assess differences between experimental and control groups for posttest. RESULTS AND DISCUSSION A total of 120 subjects diagnosed with CKD were recruited. Four subjects (one in control group and three in experimental group) did dropped out at first month; Valid data from 116 subjects (57 in experimental group and 59 in control group) were included. Among the subjects, 72% were males and mean age was 63.14 years. The percentage of subjects with stage 1, 2, 3, and 4 of CKD were 3.4%, 9.5%, 57.8%, and 29.3%, respectively. There were no significant different between the two groups in terms of demographic variables. In the baseline data, the mean of helping relationship score was 68.04 (SD = 13.56) in the experimental group and 72.85 (SD = 10.37) in the control group. The mean of health-promoting lifestyle score was 129.23 (SD = 19.64) in the experimental group and 143.37 (SD = 19.84) in the control group. The mean of physical activity scores was 1767.28 (SD = 1605.92) in the experimental group and 3369.01 (SD = 3286) in the control group. Significant differences were found in helping relationship (t = −2.15, p 〈 .05), International Physical Activity Score (t = −3.27, p 〈 .05), and health-promoting lifestyle (t = −3.85, p 〈 .05) between the two groups. We used the mean of difference to compare the effect of posttest between the two groups. The mean difference of helping relationship score was 3.05 (SD = 15.22) in the experimental group and −5.05 (SD = 12.61) in the control group. The mean difference of health-promoting lifestyle score was 0.18 (SD = 0.35) in the experimental group and −0.06 (SD = 0.35) in the control group. The mean difference of physical activity scores was 33.59 (SD = 1580.87) in the experimental group and −674.7 (SD = 1.62) in the control group. Significant differences in helping relationship (t = −2.15, p 〈 .05) and health-promoting lifestyle (t = 3.12, p 〈 .05) were found between the two groups. No significant differences in physical activity (t = 1.62, p 〉 .05) were found between the two groups. CONCLUSION Appropriate helping relationship strategies may improve the helping relationship between significant others and patients with CKD for promoting a healthy lifestyle. We recommend that significant others, such as families and friends, should be included in the care plan as part of clinical case management; therefore, helping relationships can be expanded from medical centers to communities, and everyone can contribute in building a health-promoting environment. Because of time and human resource limitations, the study was performed only for 3 months. It is suggested that longitudinal studies can be implemented to understand the long-term effects of helping relationships from significant others among patients with CKD.