Improving Knowledge, Dietary Behavior, and Clinical Outcomes Through a Protein and Energy Intake Self-Care Support Program among Monks Undergoing Hemodialysis: A Quasi-Experimental Study

Surasak Thakhat; Noppawan Phinitkhajorndech; Suchira Chaiviboontham

doi:10.60099/prijnr.2026.268767

Authors

Surasak Thakhat Master’s student, Master of Nursing Science Program (Adult and Gerontological Nursing), Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand. https://orcid.org/0009-0001-8166-4305
Noppawan Phinitkhajorndech Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand. https://orcid.org/0000-0001-7391-6069
Suchira Chaiviboontham Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand. https://orcid.org/0000-0002-8441-1872

DOI:

https://doi.org/10.60099/prijnr.2026.268767

Keywords:

Dietary behavior, Energy intake, Health, Hemodialysis, Malnutrition, Monks, Protein intake, Self-care support program

Abstract

The Buddhist monastic discipline includes regulations regarding monks' consumption of food and drinks. Even in cases of health problems and with exceptions allowed, most monks still adhere to the practice of eating one to two meals per day. This limits their ability to obtain sufficient nutrients, increasing the risk of malnutrition. Malnutrition and protein-energy wasting commonly occur in people undergoing hemodialysis and may be of intense concern for Buddhist monks. This quasi-experimental study, a one-group pre-posttest with repeated measures, aimed to examine the effects of the Protein and Energy Intake Self-Care Support Program on knowledge, self-care behavior, and clinical outcomes among 30 monks undergoing hemodialysis at the Priest Hospital in Bangkok, Thailand. The participants received an intervention for twelve weeks. The instruments used were a Personal and Health Information Form, the Knowledge of Protein and Energy Intake Questionnaire, and a 24-Hour Dietary Recall Record Form to evaluate dietary behaviors as self-care behaviors. Descriptive statistics and one-way repeated-measures ANOVA were used to analyze data.
The program led to a significant increase in mean scores for knowledge, dietary behaviors, and clinical outcomes (serum albumin and protein catabolic rate). Repeated measures analysis showed that knowledge significantly improved across three evaluation time points. Dietary behaviors and clinical outcomes significantly improved across all four evaluation time points. These findings suggest that the intervention effectively promotes long-term enhancements in both nutritional status and clinical outcomes in monks undergoing hemodialysis. Nurses can apply this intervention in nursing practice. However, further testing of this intervention is needed through a randomized controlled trial in a multi-site study.

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