Effects of a Supportive-Educative Program on Caregivers’ Knowledge and Behaviors in Volume Control and People Receiving Hemodialysis’s Interdialytic Weight Gain

Abstract

People receiving hemodialysis in the contemporary healthcare landscape demonstrate an increasing demographic trend toward elderly individuals or those requiring assistance with activities of daily living. Consequently, there exists a critical necessity to provide education, support, and enhanced skills development for primary caregivers. This caregiver preparation facilitates collaborative care management with hemodialysis nursing staff when they are in the home environment. Particular emphasis must be placed on fluid volume management protocols to prevent volume overload. This quasi-experimental study investigates the effects of an educational support program on caregivers’ knowledge and behaviors regarding volume control for patients receiving hemodialysis. This study used Orem's self-care theory as a conceptual framework to develop the program. The 24 pairs of caregivers and people receiving hemodialysis at the Somdech Phra Debaratana Medical Center Hemodialysis Unit at Ramathibodi Hospital were recruited based on the inclusion criteria, with people receiving hemodialysis experiencing intradialytic weight gain (IDWG) exceeding 2 kilograms at least once per week, along with their caregivers and underwent a 4-week supportive education program.

Data were collected from April to July 2021. The supportive education program consisted of three phases: self-awareness and knowledge promotion, skill training, and continuous care for four weeks. A follow-up evaluation was conducted for another two weeks. This study employed five instruments: 1) a personal information questionnaire for patients, 2) a personal information questionnaire for caregivers, 3) the Caregivers’ Knowledge of the Volume Control Assessment Form, 4) the Caregivers’ Behaviors Towards Volume Control Assessment Form to measure data before receiving the program, at week 4 and week 6, and 5) the Six Item Cognitive Impairment Test (6-CIT) to evaluate the cognition status of caregivers aged 60 and above. Data were analyzed using descriptive statistics, repeated-measures ANOVA, and the Friedman test.

The descriptive statistics showed that the study sample consisted predominantly of female caregivers (87.50%), with an age range of 40-75 years, and the people receiving hemodialysis in their care were 54% female, with an age range of 55-87 years. Regarding knowledge assessment, statistical analysis revealed that caregivers' mean knowledge scores in weeks 4 and 6 post-intervention were significantly higher than baseline (Z = 3.71, p < .01 and Z = 4.11, p < .01, respectively). However, there was no statistically significant difference between the mean knowledge scores at week 4 and week 6 (Z = 2.27, p =.13). Mean scores for caregiver behavior in controlling fluid intake at week 4 (MD = 8.67, p < .01) and Week 6 (MD = 10.08, p < .01) post-intervention were significantly higher than pre-intervention scores, indicating a progressive improvement in behavior. Nonetheless, the mean fluid control behavior scores between week 4 and week 6 were not statistically different (MD = 1.42, p = .24).

The mean interdialytic weight gain (IDWG) was 2.22 kg (SD = 0.83) pre-intervention, which decreased to 1.56 kg (SD = 0.58) at week 4 and further to 1.30 kg (SD = 0.61) at week 6. An ANOVA revealed a statistically significant difference among the three time points (pre-intervention, week 4, and week 6) (F = 18.69, p < .01). Post-hoc analyses demonstrated that mean IDWG at week 4 (MD = 0.66 kg, p < .01) and week 6 (MD = 0.91 kg, p < .01) were significantly lower than the pre-intervention IDWG. Furthermore, the mean IDWG at week 6 was significantly lower than that at week 4 (MD = 0.26 kg, p = .03), indicating a sustained and progressive reduction in fluid gain. In terms of clinical implications, the intervention protocol and subsequent findings provide substantive evidence for the development of evidence-based nursing care protocols within hemodialysis units. Implementation of similar educational programs may enhance caregiver competence across multiple domains: fluid intake management, restriction of high-sodium food, weight assessment techniques, intradialytic weight gain monitoring, assessment and management of volume overload, and supervision of appropriate diuretic administration.

However, the single-group pretest-posttest design without a control group limits the ability to draw definitive conclusions about intervention efficacy. Future research should incorporate continuous longitudinal assessment of caregiver competencies throughout the care continuum. Program dissemination to the broader population of caregivers of people receiving hemodialysis is recommended, with appropriate modifications to accommodate clinical workflow constraints and time limitations of hemodialysis nursing personnel.

Keywords: Behaviors in volume control, Caregivers, Hemodialysis, Knowledge, Volume overload Supportive-Educative Program

Author’s contributions:

YC: Conceptualization, method and design, tool validation, data collection, data analysis, wrote manuscript, revised manuscript

NP: Conceptualization, method and design, data analysis, wrote manuscript, revised manuscript, edited manuscript, corresponding with editor-in-chief

SC: Conceptualization, method and design, conclusion, recommendation, and revised manuscript