本文關(guān)鍵詞：健康信念模式與多階段改變理論相結(jié)合對(duì)血液透析高磷血癥患者飲食管理的研究　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 健康信念模式 多階段改變理論 血液透析高磷血癥 飲食管理

【摘要】：【目的】(1)初步制定血液透析高磷血癥患者低磷飲食健康信念量表,并檢驗(yàn)量表的信度和效度,以適用于臨床廣泛研究;(2)評(píng)估血液透析高磷血癥患者低磷飲食行為階段和健康信念水平,了解其影響因素,為制定護(hù)理干預(yù)措施提供理論依據(jù);(3)探討健康信念模式與多階段改變理論相結(jié)合的干預(yù)模式對(duì)血液透析高磷血癥患者飲食管理的研究。【方法】依據(jù)健康信念模式理論為編制量表的理論基礎(chǔ),通過查閱相關(guān)參考文獻(xiàn)、專家咨詢及半結(jié)構(gòu)式訪談確定初始量表?xiàng)l目。選取廣西醫(yī)科大學(xué)第一附屬醫(yī)院血液凈化部符合納入標(biāo)準(zhǔn)的175例患者為研究對(duì)象進(jìn)行問卷調(diào)查,采用項(xiàng)目分析、相關(guān)系數(shù)法、探索性因素分析進(jìn)行條目篩選,形成正式量表,進(jìn)一步進(jìn)行信效度檢驗(yàn)。選取廣西醫(yī)科大學(xué)第一附屬醫(yī)院血液凈化部進(jìn)行維持性血液透析治療的110例高磷血癥患者為研究對(duì)象,隨機(jī)分配入對(duì)照組(55例)和干預(yù)組(55例)。采用一般資料調(diào)查表、高磷血癥患者飲食及服藥相關(guān)知識(shí)和行為調(diào)查問卷、低磷飲食健康信念量表、低磷飲食行為階段評(píng)估表、社會(huì)支持量表。對(duì)照組接受血液凈化部常規(guī)護(hù)理。干預(yù)組接受健康信念模式與多階段改變理論相結(jié)合的干預(yù)模式,在干預(yù)第12周、第24周時(shí)再次調(diào)查健康信念量表、低磷飲食行為階段評(píng)估及血磷、血鈣、鈣磷乘積、白蛋白等生化指標(biāo),分析干預(yù)效果�！窘Y(jié)果】(1)維持性血液透析高磷血癥患者低磷飲食健康信念量表包含33個(gè)條目,5個(gè)維度,分別為感知的疾病易感性、感知的疾病嚴(yán)重性、感知的行為益處、感知的行為障礙、自我效能。探索性因子分析的kmo值為0.864,p0.05,7個(gè)因子的方差累計(jì)貢獻(xiàn)率為71.736%,相應(yīng)條目上的因子載荷為0.559~0.912。量表和各維度信度cronbach,sɑ為0.778~0.938,分半信度為0.710~0.935,重測(cè)信度為0.754~0.921。(2)維持性血液透析高磷血癥患者低磷飲食行為階段現(xiàn)狀調(diào)查的110例患者中,13例(11.8%)的患者處于無意圖階段;17例(15.5%)的患者處于有意圖階段;47例(42.7%)的患者處于準(zhǔn)備階段;24例(21.8%)的患者處于行動(dòng)階段;9例(8.2%)的患者處于維持階段;(3)維持性血液透析高磷血癥患者低磷飲食健康信念與社會(huì)支持具有相關(guān)性;(4)干預(yù)12周及24周后,兩組患者高磷血癥相關(guān)知識(shí)及行為得分的比較差異有統(tǒng)計(jì)學(xué)意義(p0.05),干預(yù)組相關(guān)知識(shí)行為得分高于對(duì)照組,組間與時(shí)間之間有交互作用,在不同時(shí)間點(diǎn)得分差異有統(tǒng)計(jì)學(xué)意義;(5)干預(yù)12周及24周后,兩組患者血磷、鈣磷乘積指標(biāo)比較差異具有統(tǒng)計(jì)學(xué)意義(p0.05),干預(yù)組血磷、鈣磷乘積指標(biāo)低于對(duì)照組,組間與時(shí)間之間有交互作用,在不同時(shí)間點(diǎn)得分差異有統(tǒng)計(jì)學(xué)意義,干預(yù)后兩組患者血鈣和白蛋白指標(biāo)差異無統(tǒng)計(jì)學(xué)意義(p0.05);(6)干預(yù)12周及24周后,兩組患者健康信念總分、感知到低磷飲食障礙、低磷飲食自我效能得分比較差異有統(tǒng)計(jì)學(xué)意義(p0.05),組間與時(shí)間之間有交互作用(p0.05),進(jìn)一步分析單獨(dú)效應(yīng),在固定時(shí)間點(diǎn)條件下,不同分組患者得分比較差異有統(tǒng)計(jì)學(xué)意義(p0.05)。干預(yù)后,兩組患者感知到的易感性、嚴(yán)重性差異無統(tǒng)計(jì)學(xué)意義(p0.05);兩組患者感知到低磷飲食的益處得分具有時(shí)間效應(yīng)及時(shí)間與分組交互作用,固定時(shí)間點(diǎn)條件下,不同分組得分差異無統(tǒng)計(jì)學(xué)意義(p0.05)�！窘Y(jié)論】(1)維持性血液透析高磷血癥患者低磷飲食健康信念量表語言通俗易懂,患者易于接受,量表具有良好的信效度,適于臨床研究和應(yīng)用。(2)維持性血液透析高磷血癥患者低磷飲食行為現(xiàn)狀不理想,健康信念水平需要進(jìn)一步提高,維持性血液透析高磷血癥患者健康信念與低磷飲食行為階段具有相關(guān)關(guān)系;(3)維持性血液透析高磷血癥患者健康信念水平與社會(huì)支持具有相關(guān)性,加強(qiáng)社會(huì)及家庭支持系統(tǒng)是提高維持性血液透析高磷血癥患者低磷健康信念水平的重要環(huán)節(jié);(4)運(yùn)用健康信念模式與多階段改變理論相結(jié)合的干預(yù)模式對(duì)維持性血液透析高磷血癥患者進(jìn)行飲食管理,可降低患者血清磷水平及鈣磷乘積;(5)運(yùn)用健康信念模式與多階段改變理論相結(jié)合的干預(yù)模式對(duì)維持性血液透析高磷血癥患者進(jìn)行干預(yù),可提高患者高磷血癥知識(shí)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.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.5

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