The Effects of a Self-Management Program on Dietary Phosphorus Control in End-Stage Renal Disease Patients Receiving Hemodialysis at Mahasarakham Hospital
Keywords:
Self-management, Phosphorus, End-Stage Renal Disease, HemodialysisAbstract
Objective : To examine the problem situation, develop, and evaluate the effectiveness of a self-management program for dietary phosphorus control on health behaviors and laboratory outcomes among patients with end-stage renal disease undergoing hemodialysis.
Methods : This action research, based on the framework of Kemmis and McTaggart, was conducted in 2 cycles. The sample consisted of 31 end-stage renal disease (ESRD) patients undergoing hemodialysis at Mahasarakham Hospital. Participants were selected through purposive sampling based on the criteria of having a serum phosphorus level > 5.0 mg/dL at least once within three months prior to the study. The research instruments included a self-management program, dietary photo guides, and behavioral assessment scales. These tools were validated for content validity (IOC >0.80) and reliability (Cronbach’s alpha = 0.85). Data were analyzed using descriptive statistics and paired t-test.
Result : The initial situation analysis revealed that most patients had limited knowledge regarding dietary phosphorus control and demonstrated inappropriate dietary behaviors, resulting in serum phosphorus levels exceeding the recommended targets. After implementing the program, the mean knowledge score significantly increased from 13.23 to 14.13 (p < 0.001), and the behavioral score for dietary phosphorus control increased from 4.11 to 4.74 (p < 0.001). Laboratory outcomes also improved, with serum phosphorus levels decreasing from 5.72 ± 0.74 mg/dL to 5.43 ± 0.49 mg/dL (p < 0.001), and the calcium–phosphorus product (Ca×PO₄) decreasing from 52.09 to 48.42 mg²/dL² (p < 0.001). Participants reported the highest level of satisfaction with the program (Mean = 4.72, SD = 0.38).
Conclusion : The developed self-management program effectively improved dietary phosphorus control behaviors and significantly enhanced clinical outcomes among hemodialysis patients. The program has potential to be implemented as a nursing practice guideline for preventing complications related to hyperphosphatemia in hemodialysis patients.
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