健康信念模式与多阶段改变理论相结合对血液透析高磷血症患者饮食管理的研究

发布时间：2018-01-02 02:35

本文关键词：健康信念模式与多阶段改变理论相结合对血液透析高磷血症患者饮食管理的研究　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：【目的】(1)初步制定血液透析高磷血症患者低磷饮食健康信念量表,并检验量表的信度和效度,以适用于临床广泛研究;(2)评估血液透析高磷血症患者低磷饮食行为阶段和健康信念水平,了解其影响因素,为制定护理干预措施提供理论依据;(3)探讨健康信念模式与多阶段改变理论相结合的干预模式对血液透析高磷血症患者饮食管理的研究。【方法】依据健康信念模式理论为编制量表的理论基础,通过查阅相关参考文献、专家咨询及半结构式访谈确定初始量表条目。选取广西医科大学第一附属医院血液净化部符合纳入标准的175例患者为研究对象进行问卷调查,采用项目分析、相关系数法、探索性因素分析进行条目筛选,形成正式量表,进一步进行信效度检验。选取广西医科大学第一附属医院血液净化部进行维持性血液透析治疗的110例高磷血症患者为研究对象,随机分配入对照组(55例)和干预组(55例)。采用一般资料调查表、高磷血症患者饮食及服药相关知识和行为调查问卷、低磷饮食健康信念量表、低磷饮食行为阶段评估表、社会支持量表。对照组接受血液净化部常规护理。干预组接受健康信念模式与多阶段改变理论相结合的干预模式,在干预第12周、第24周时再次调查健康信念量表、低磷饮食行为阶段评估及血磷、血钙、钙磷乘积、白蛋白等生化指标,分析干预效果。【结果】(1)维持性血液透析高磷血症患者低磷饮食健康信念量表包含33个条目,5个维度,分别为感知的疾病易感性、感知的疾病严重性、感知的行为益处、感知的行为障碍、自我效能。探索性因子分析的kmo值为0.864,p0.05,7个因子的方差累计贡献率为71.736%,相应条目上的因子载荷为0.559~0.912。量表和各维度信度cronbach,sɑ为0.778~0.938,分半信度为0.710~0.935,重测信度为0.754~0.921。(2)维持性血液透析高磷血症患者低磷饮食行为阶段现状调查的110例患者中,13例(11.8%)的患者处于无意图阶段;17例(15.5%)的患者处于有意图阶段;47例(42.7%)的患者处于准备阶段;24例(21.8%)的患者处于行动阶段;9例(8.2%)的患者处于维持阶段;(3)维持性血液透析高磷血症患者低磷饮食健康信念与社会支持具有相关性;(4)干预12周及24周后,两组患者高磷血症相关知识及行为得分的比较差异有统计学意义(p0.05),干预组相关知识行为得分高于对照组,组间与时间之间有交互作用,在不同时间点得分差异有统计学意义;(5)干预12周及24周后,两组患者血磷、钙磷乘积指标比较差异具有统计学意义(p0.05),干预组血磷、钙磷乘积指标低于对照组,组间与时间之间有交互作用,在不同时间点得分差异有统计学意义,干预后两组患者血钙和白蛋白指标差异无统计学意义(p0.05);(6)干预12周及24周后,两组患者健康信念总分、感知到低磷饮食障碍、低磷饮食自我效能得分比较差异有统计学意义(p0.05),组间与时间之间有交互作用(p0.05),进一步分析单独效应,在固定时间点条件下,不同分组患者得分比较差异有统计学意义(p0.05)。干预后,两组患者感知到的易感性、严重性差异无统计学意义(p0.05);两组患者感知到低磷饮食的益处得分具有时间效应及时间与分组交互作用,固定时间点条件下,不同分组得分差异无统计学意义(p0.05)。【结论】(1)维持性血液透析高磷血症患者低磷饮食健康信念量表语言通俗易懂,患者易于接受,量表具有良好的信效度,适于临床研究和应用。(2)维持性血液透析高磷血症患者低磷饮食行为现状不理想,健康信念水平需要进一步提高,维持性血液透析高磷血症患者健康信念与低磷饮食行为阶段具有相关关系;(3)维持性血液透析高磷血症患者健康信念水平与社会支持具有相关性,加强社会及家庭支持系统是提高维持性血液透析高磷血症患者低磷健康信念水平的重要环节;(4)运用健康信念模式与多阶段改变理论相结合的干预模式对维持性血液透析高磷血症患者进行饮食管理,可降低患者血清磷水平及钙磷乘积;(5)运用健康信念模式与多阶段改变理论相结合的干预模式对维持性血液透析高磷血症患者进行干预,可提高患者高磷血症知识水平及健康信念水平。
[Abstract]:[Objective] (1) established the health belief of hyperphosphatemia in hemodialysis patients with low phosphorus diet scale, and test the reliability and validity of the scale, which is suitable for a wide range of clinical stage; (2) hemodialysis patients with hyperphosphatemia and low phosphorus diet behavior assessment and health belief level, understand the impact factors, provide the theoretical basis for the development of nursing intervention; (3) study on the intervention model of health belief model and multi phase change theory of combining hemodialysis patients with hyperphosphatemia diet management. [method] Based on the health belief model theory as the theoretical basis for system scale, through the related literature, expert consultation and half structured interviews to determine the initial scale items selected. Blood purification Department of the First Affiliated Hospital of Guangxi Medical University 175 patients met the inclusion criteria were conducted a questionnaire survey as the research object, using item analysis, correlation Coefficient method, exploratory factor analysis to select the item, the formal scale and further test of the validity. Select the blood purification Department of the First Affiliated Hospital of Guangxi Medical University were 110 cases of hyperphosphatemia in patients with maintenance hemodialysis treatment as the research object, were randomly divided into control group (55 cases) and intervention group (55 cases). The general information questionnaire, questionnaire and medication in patients with high phosphorus diet related knowledge and behavior, low phosphorus diet health beliefs scale, stage of low phosphorus diet behavior assessment scale, social support scale. The control group received routine nursing department of blood purification. The intervention group received intervention model of health belief model and multi phase change theory the intervention in twelfth weeks, twenty-fourth weeks again when the investigation of health belief scale, stage of low phosphorus diet behavior assessment and serum phosphorus, calcium, calcium phosphorus product, serum albumin and other biochemical indicators, analysis of intervention effect Fruit. [results] (1) in hemodialysis patients with hyperphosphatemia and low phosphorus diet health belief scale includes 33 items and 5 dimensions, respectively, susceptibility to disease awareness, perceived disease severity, perceived benefits, perceived self-efficacy, behavior disorders, exploratory factor analysis of kmo. The p0.05,7 value is 0.864, variance factor the cumulative contribution rate was 71.736%, the factor loading on the corresponding entries for the 0.559~0.912. scale and the Cronbach alpha Cronbach, s 0.778~0.938, split half reliability is 0.710~0.935, the test-retest reliability was 0.754~0.921. (2) of 110 cases of maintenance hemodialysis in patients with hyperphosphatemia and low phosphorus the present stage dietary behavior of patients, 13 cases (11.8%) of the patients at precontemplation stage; 17 cases (15.5%) of the patients in the intention stage; 47 cases (42.7%) of the patients in the preparation stage; 24 cases (21.8%) of the patients in the stage of action; 9 cases (8.2%). Patients in the maintenance phase; (3) maintaining blood dialysis health beliefs of patients with hyperphosphatemia and low phosphorus diet is associated with social support; (4) after 12 weeks and 24 weeks later, there was a significant difference between the scores of knowledge of two groups of patients with hyperphosphatemia and behavior (P0.05), the intervention group scores of knowledge and behavior related is higher than that of control group, the interaction between group and time was statistically significant in different time point score difference; (5) 12 and 24 weeks after intervention, two groups of patients with serum phosphorus, calcium and phosphorus product index was statistically significant difference between the intervention group (P0.05), serum phosphorus, calcium and phosphorus product indicators below the control group, there is interaction between group and time was statistically significant differences at different time points after the intervention, the difference between the two groups of serum calcium and albumin index had no statistical significance (P0.05); (6) 12 and 24 weeks after intervention, two groups of patients with health belief scores, Perceived barriers to low phosphorus diet had significant low phosphorus diet self-efficacy score difference (P0.05), there is interaction between group and time (P0.05), further analysis of single effect, in the condition of the fixed time, there was statistical significance of different groups of patients score difference (P0.05). The intervention group, two the patients perceived susceptibility, no statistically significant differences in severity (P0.05); two patients perceive the benefits of low phosphorus diet score has time effect and group by time interaction, conditions at a fixed time, no statistically significant differences in scores of different groups (P0.05). [Conclusion] (1) in maintenance hemodialysis hyperphosphatemia in patients with low phosphorus diet health beliefs scale language easy to understand, easy to accept patients, the scale has good reliability and validity, which is suitable for clinical research and application. (2) in hemodialysis patients with hyperphosphatemia and low phosphorus drink Eating behavior status is not ideal, the need to further improve the level of health beliefs, maintenance hemodialysis patients with hyperphosphatemia and low phosphorus diet health beliefs and behavior stage is correlated; (3) maintaining blood health belief levels in dialysis patients with hyperphosphatemia and social support are related to strengthen the social and family support system is an important link to improve maintenance hemodialysis patients with hyperphosphatemia and low phosphorus level of health beliefs; (4) using the intervention model of health belief model and multi phase change theory in combination with the dietary management of maintenance hemodialysis patients with hyperphosphatemia, can reduce serum phosphorus levels in patients with calcium and phosphorus product; (5) using the intervention model of health belief model and multi stage change by combining the theory of intervention on maintenance hemodialysis patients with hyperphosphatemia, hyperphosphatemia can improve the patients' knowledge and health belief level.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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