The Effects of Self-Care Promoting Program on Knowledge and Self-Care Behaviors Among Patients with Kidney Stone post- Extracorporeal Shock Wave Lithotripsy

Abstract

  Kidney stones are more prevalent in developed countries, while kidney and bladder stones are common in developing countries, likely due to dietary habits, environmental factors, and advancements in diagnostic techniques. Recurrence rates have reached up to 75% over 20 years. Kidney stone formation is a multifactorial condition influenced by both intrinsic risk factors and extrinsic environmental determinants, leading to metabolic disorders and urinary compounds. Additionally, low urine volume can lead to the aggregation and crystallization of stones in the urinary system. Kidney stone disease affects the quality of life and families of patients in multidimensional effects, including physical, as kidney stones can cause discomfort, suffering, and chronic illness, leading to stress and anxiety. These conditions may alter patients’ roles and responsibilities and adversely affect their financial status and overall economic well-being, affecting both patients and their families. The treatment of large kidney stones through extracorporeal shock wave lithotripsy (ESWL). ESWL is the first-line treatment using high-energy sound waves from outside the body to break down the stones without damaging tissues, resulting in minimal side effects and high effectiveness. After ESWL, there is a chance of recurrence and new stone formation within the first 12 months. Changing health behaviors to be appropriate by eating a variety of foods, drinking about 2,500-3,000 ml of water per day, urinating 2-2.5 L per day, exercising regularly, and controlling weight to be in the standard range (body mass index: BMI =18.50-22.90 kg/m2). Therefore, patients must acquire health-promoting knowledge and adopt appropriate self-behaviors to prevent the recurrence of kidney stone disease. The reduction of severe post-ESWL complications and recurrent kidney stone formation significantly enhances patients' quality of life.

This quasi-experimental, one-group pretest-posttest study recruited 30 patients with kidney stones post-ESWL from a university hospital in Bangkok, who were selected through purposive sampling. A self-care promoting program, grounded in the self-care theory by employing a supportive-educative nursing system as the conceptual framework, comprised four activities: building relationships and setting goals, teaching to provide knowledge about kidney stones, guiding on self-care practices and behavior modification to reduce risk factors and prevent stone formation, and supporting through educational tools, environmental modification, and interactive communication to foster effective self-care. The program was delivered in person and online via a video, a guidebook, and the Line Official Account (OA) application, enabling continuous contact between the researcher and participants. Data were collected using the Demographic Form, the Knowledge of Kidney Stone Disease Questionnaire, and the Self-Care Behavior Questionnaire. The analysis employed descriptive statistics, paired t-tests, and Wilcoxon signed-rank tests.

The study showed that after receiving the self-care promoting program, the mean rank score of knowledge about kidney stones was significantly higher than before receiving the self-care promoting program (Z = -4.72, p < .05), and the mean score of self-care behaviors among participants was significantly higher than before receiving the self-care promoting program (t = 16.91, p < .05). In short, the self-care promoting program significantly enhanced knowledge and self-care behaviors among patients with kidney stones following ESWL. However, the lack of a control group restricts the ability to confirm its effectiveness. Further research is necessary to include a control group and evaluate the sustainability of the outcomes over time.

Keywords: Extracorporeal shock wave lithotripsy, Kidney stones, Knowledge about kidney stones, Self-care behaviors, Self-care promoting program

Author’s contributions:

JJ: Conceptualization, method and design, tool validation, data collection, data analysis, writing manuscript, revising manuscript
SC: Conceptualization, method and design, data analysis, writing, editing, and revising the manuscript, and corresponding with the editor-in-chief
NB: Conceptualization, method and design, data analysis, revising manuscript