Effectiveness of Self-Management Enhancement Program for Thais with CKD at Pre-dialysis Stages: A Randomized Controlled Trial
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Published:
Oct 31, 2016
Keywords:
Chronic Kidney Disease Disease Control Intervention Program Pre-dialysis Stage Quality of Life Self-Management Behaviors Self-Management Enhancement Program
Main Article Content
Abstract
This randomized controlled trial aimed to examine the effects of a nurse-led, self-management, enhancement program used as an intervention for self-management behaviors, disease control, and quality of life among Thais with chronic kidney disease, pre-dialysis. Purposive sampling was used to recruit 120 participants, of whom 60 were equally diagnosed with chronic kidney disease at stages 3 and 4. Participants were randomly assigned to either the experimental (n=60) or control group (n=60). The experimental group received the 6-week intervention in addition to usual care, while the control group received only usual care. Outcome variables included self-management behaviors, systolic blood pressure, diastolic blood pressure, HbA1c, serum creatinine, and quality of life. Data were collected through self-reported questionnaires, blood pressure measurements, and laboratory procedures, at baseline, 4 weeks, 12 weeks, and 24 weeks after participation in the program. Data were analyzed using descriptive statistics, paired t-test, and independent t-test. Results revealed that after program completion and compared to the control group, at 4 weeks the experimental group had significantly better self-management behaviors; at 12 weeks, lower systolic blood pressure, diastolic blood pressure, and HbA1c; and, at 24 weeks, better quality of life. However, there was no significant difference in serum creatinine between groups at 24 weeks. Findings indicate the program improved health outcomes. Hence, self-management enhancement should be incorporated into nursing practice for individuals with chronic kidney disease at pre-dialysis stage.
Article Details
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1.
Suwanwaha S, Wonghongkul T, Panuthai S, Chaiard J. Effectiveness of Self-Management Enhancement Program for Thais with CKD at Pre-dialysis Stages: A Randomized Controlled Trial. PRIJNR [Internet]. 2016 Oct. 31 [cited 2022 Sep. 29];20(4):320-36. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/48863
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Original paper
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
References
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29. Li H, Jiang Y, Lin CC. Factors associated with selfmanagement by people undergoing hemodialysis: a descriptive study. International Journal of Nursing Studies. 2014; 5: 208-16.
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31. Byrne J, Khunti K, Stone M, Farooqi A, Carr S. Feasibility of a structured group education session to improve selfmanagement of blood pressure in people with chronic kidney disease: an open randomized pilot trial. BMJ. 2011; 1(2): 1-9.
32. Flesher M, Woo P, Chiu A, Charlebois A, Warburton DE, Leslie B. Self-management and biomedical outcomes of a cooking, and exercise program for patients with chronic kidney disease. J RenNutr. 2011; 21(2): 188-95.
33. Kazawa K, Monyama M.Effects of a self-management skills-acquisition program on pre-dialysis patients with diabetic nephropathy. NephrolNurs J. 2013; 40(2): 141-8.
34. Chen SH, Tsai YF, Sun CY, Wu IW, Lee CC, Wu MS. The impact of self-management support on the progression of chronic kidney disease. Nephrol Dial Transplant. 2011; 26(11): 3560-6.
35. Choi ES, Lee J. Effects of a face-to-face self-management program on knowledge, self-care practice and kidney function in patients with chronic kidney disease before the renal replacement therapy. J Korean AcadNurs. 2012; 42(7): 1070-8.
36. Walker R, Marshall MR, Polaschek N. Improving selfmanagement in chronic kidney disease: a pilot study. Renal Society of Australasia Journal. 2013; 9(3): 116-125.
37. Lin CC, Tsai FM, Lin HS, Hwang SJ, Chen HC. Effects of a self-management program on patients with early-stage chronic kidney disease: a pilot study. ApplNurs Res. 2013; 26(3): 151-6.
38. Thaweethamcharoen T, Srimongkol W, Noparatayaporn P, Jariyayothin P, Sukthinthai, N, Aiyasanon N, et al. Patientreported outcome (Pro) or quality of life (QOL) studies validity and reliability of KDQOL-36 in Thai kidney disease patient. Value in Health Regional. 2013; 2: 98-102.
39. Tangri N, Steven, LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011; 305(15): 1553-9.
40. Campbell KL, Ash S, Bauer JD. The impact of nutrition intervention on quality of life in pre-dialysis chronic kidney disease patients. Clin Nutr. 2008; 27(4): 537-44.
41. Walker J, Almond P. Interpreting statistical findings: a guide for health professionals and students. McGraw-Hill Companies: Incorporated; 2010.
42. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003; 289(19): 2560-72.
43. The Nephrology Society of Thailand. CKD knowledge for Thai people [clip video]. C2013 [cited 2013 November 5]. Available from http://www.nephrothai.org.
2. Staples A, Wong C. Risk factors for progression of chronic kidney disease. CurrOpinPediatr. 2010; 22(2): 161-69.
3. Carmen M, Perales M, Ana G, Gustavo A, Reyes-del P. Psychosocial predictors of the quality of life of chronic renal failure patients undergoing hemodialysis. Nefrologia. 2012; 32(5): 622-30.
4. Porter A, Fischer MJ, Brooks D, Bruce M, Charleston J, et al. Quality of life and psychosocial factors in African Americans with hypertensive chronic kidney disease. Transl Res. 2012; 159(1): 4-11.
5. Braun L, Sood V, Hogue S, Lieberman B, CopleyMerriman C. High burden and unmet patient needs in chronic kidney disease. Int J NephrolRenovasc Dis. 2012; 5: 151-63.
6. Pagels AA, Soderkvist BK, Medin C, Hylander B, Heiwe S. Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment. Health Qual Life Outcomes. 2012; 10(71): 1-11.
7. McKercher CM, Venn AJ, Blizzard L, Nelson MR, Palmer AJ. Psychosocial factors in adults with chronic kidney disease: characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study. BMC Nephrology. 2013; 83(14): 1-9.
8. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: impact on the National Kidney Foundation. AJKD. 2012; 60(5): 689-91.
9. Shurraw S, Hemmelgarn B, Lin M, Majumdar SR, Klarenbach S. Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: a population-based cohort study. Arch Intern Med. 2011; 171(21): 1920-27.
10. Sarnak MJ, Astor BC.Implications of proteinuria: CKD progression and cardiovascular outcomes. Adv Chronic Kidney Dis. 2011; 18(4): 258-66.
11. Narva AS, Norton JM, Boulware LE. Educating patients about CKD: The path to self-management and patient-centered care. Clin J Am SocNephrol. 2015; 4: 18-27.
12. Tuot DS, Plantinga LC, Judd SE, Muntner P, Hsu CY, Warnock DG, et al. Healthy behaviors, risk factor control, and awareness of chronic kidney disease. Am J Nephrol. 2013; 37(2): 135-43.
13. Curtin RB, Walters BAJ, Schatell D, Pennell P, Wise M, Klicko K.Self-efficacy and self-management behaviors in patients with chronic kidney disease. Adv Chronic Kidney Dis. 2008; 15(2): 191-205.
14. Sritarapipat P, Pothiban L, Panuthai S, Lumlertgul D, Nanasilp P. Causal model of elderly Thais’ self-management behaviors of pre-dialysis chronic kidney disease. Pacific Rim Int J of Nurs Res. 2012; 16(4): 277-93.
15. Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanism. Ann Behav Med. 2003; 26(1): 1-7.
16. Creer TL. Behavioral and cognitive processes in selfmanagement of asthma. Journal of Asthma. 2008; 45: 81-94.
17. Bandura A. Self-efficacy: The exercise of control. New York, NY: W.H. Freeman and Company; 1997.
18. Ounsrimuang K, Siriwatanamethanon J,Buatee S.Effects of self-management program on knowledge, self–management, and health indicators among patients with chronic kidney disease stage 3. JNHC. 2013; 31(2): 91-9.
19. Pothatong S, Poomthongdee T. Effects of self-management program on self-management behaviors and clinical indicator among patients with diabetic nephropathy. Journal of SakonNakhon Hospital. 2011; 15 (1): 31-39.
20. Thungtong S, Chinnawong T, Thaniwattananon P. Effects of self-management support program for delayed progression diabetic nephropathy on self-management behaviors and clinical outcomes in patients with uncontrolled type 2 diabetes mellitus. Songkhlanagarind Journal of Nursing. 2015; 35(1): 67-84.
21. Nolte S,OsborneRH. A systematic review of outcomes of chronic disease self-management interventions. Qual Life Res. 2013; 22(7): 1805-16.
22. Galdas P, Baker P. Engaging men with long-term conditions in self-management support. Men’s Health. 2015; 6(5): 16-9.
23. Richardson J, Loyola-Sanchez A, Sinclair S, Harris J, Letts L, MacIntyre NJ, et al. Self-management interventions for chronic disease: a systematic scoping review. Clinical Rehabilitation. 2014; 6: 1-11.
24. Holman H, Lorig K. Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep. 2004;119(3): 239-243.
25. Costantini L, Beanlands H, McCay E, Cattran D, Hladunewich M. Francis D. The self-management experience of people with mild to moderate chronic kidney disease. NephrolNurs J. 2008; 35(2): 147-55.
26. Welch JL, Johnson M, Zimmerman L, Russell CL, Perkins SM, Decker, BS. Self-management interventions in stages 1 to 4 chronic kidney disease: an integrative review. WJNR. 2015; 37(5): 652-678.
27. Hoffman AJ. Enhancing self-efficacy for optimized patient outcomes through the theory of symptom self-management. Cancer Nurs. 2013; 36(1): 16-26.
28. Balaga PAG. Self- efficacy and self-care management outcome of chronic renal failure patients.Asian Journal of Health. 2012; 2: 111-19.
29. Li H, Jiang Y, Lin CC. Factors associated with selfmanagement by people undergoing hemodialysis: a descriptive study. International Journal of Nursing Studies. 2014; 5: 208-16.
30. Bonner A, Havas K, Douglas C, Thepha T, Bennett P, Clark R. Self-management programs in stage 1-4 chronic kidney disease: a literature review. Journal of Renal Care. 2014; 40(3): 194-204.
31. Byrne J, Khunti K, Stone M, Farooqi A, Carr S. Feasibility of a structured group education session to improve selfmanagement of blood pressure in people with chronic kidney disease: an open randomized pilot trial. BMJ. 2011; 1(2): 1-9.
32. Flesher M, Woo P, Chiu A, Charlebois A, Warburton DE, Leslie B. Self-management and biomedical outcomes of a cooking, and exercise program for patients with chronic kidney disease. J RenNutr. 2011; 21(2): 188-95.
33. Kazawa K, Monyama M.Effects of a self-management skills-acquisition program on pre-dialysis patients with diabetic nephropathy. NephrolNurs J. 2013; 40(2): 141-8.
34. Chen SH, Tsai YF, Sun CY, Wu IW, Lee CC, Wu MS. The impact of self-management support on the progression of chronic kidney disease. Nephrol Dial Transplant. 2011; 26(11): 3560-6.
35. Choi ES, Lee J. Effects of a face-to-face self-management program on knowledge, self-care practice and kidney function in patients with chronic kidney disease before the renal replacement therapy. J Korean AcadNurs. 2012; 42(7): 1070-8.
36. Walker R, Marshall MR, Polaschek N. Improving selfmanagement in chronic kidney disease: a pilot study. Renal Society of Australasia Journal. 2013; 9(3): 116-125.
37. Lin CC, Tsai FM, Lin HS, Hwang SJ, Chen HC. Effects of a self-management program on patients with early-stage chronic kidney disease: a pilot study. ApplNurs Res. 2013; 26(3): 151-6.
38. Thaweethamcharoen T, Srimongkol W, Noparatayaporn P, Jariyayothin P, Sukthinthai, N, Aiyasanon N, et al. Patientreported outcome (Pro) or quality of life (QOL) studies validity and reliability of KDQOL-36 in Thai kidney disease patient. Value in Health Regional. 2013; 2: 98-102.
39. Tangri N, Steven, LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011; 305(15): 1553-9.
40. Campbell KL, Ash S, Bauer JD. The impact of nutrition intervention on quality of life in pre-dialysis chronic kidney disease patients. Clin Nutr. 2008; 27(4): 537-44.
41. Walker J, Almond P. Interpreting statistical findings: a guide for health professionals and students. McGraw-Hill Companies: Incorporated; 2010.
42. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003; 289(19): 2560-72.
43. The Nephrology Society of Thailand. CKD knowledge for Thai people [clip video]. C2013 [cited 2013 November 5]. Available from http://www.nephrothai.org.