Factors Predicting Intention of Adequate Protein-Energy Consumption in Patients Undergoing Hemodialysis

Abstract

Introduction Malnutrition is recognized as one of the long-term complications in patients with end-stage renal disease (ESRD) undergoing hemodialysis. It predisposes patients to inflammatory processes, increases the risk of cardiovascular disease, and contributes to higher morbidity and mortality rates. The primary causes can be categorized into two domains: 1) patient-related factors and 2) the dialysis process itself. Despite ongoing nutritional health promotion, patients often fail to maintain adequate protein and energy intake over time because sustaining consistent dietary behaviors is challenging. Additional factors may also influence patients’ intention to consume sufficient protein and energy. Investigating the predictors of such intention provides valuable insights for assessing and developing care models to improve nutritional status and clinical outcomes in this population.

Objectives This study aimed: 1) to examine age, nutritional status, attitude towards protein-energy consumption, subjective norm, perceived behavioral control, and intention of adequate protein-energy consumption; and 2) to investigate factors predicting intention of adequate protein-energy consumption among patients undergoing hemodialysis.

Design This study employed a cross-sectional descriptive design to examine predictive relationships, applying Ajzen’s Theory of Planned Behavior as the conceptual framework. The Theory of Planned Behavior posits that most human behaviors are governed by intention, which is influenced by three key determinants: attitude towards behavior, subjective norms, and perceived behavioral control. Attitude is shaped by individuals’ beliefs and evaluations of behavioral outcomes, while learning through life experiences or knowledge transfer fosters positive attitudes and strengthens behavioral intention. Furthermore, people assess their own capability to perform and regulate their behavior. When adequate skills are developed and perceived behavioral control is enhanced, intention is strengthened, thereby increasing the likelihood of actual behavior.

Methodology The study participants comprised 97 patients with end-stage renal disease, both male and female, undergoing hemodialysis. Data were collected between March and May 2023 through purposive sampling. Inclusion criteria were: 1) patients who had received hemodialysis for at least three months; 2) ability to communicate in Thai; 3) patients aged ≥ 60 years who achieved a 6-Item Cognitive Impairment Test (6CIT) score ≤ 7; and 4) clinically stable status without acute complications such as intradialytic hypotension, with the ability to consume food orally. Data collection was conducted during periods of stable vital signs and was discontinued if abnormalities were observed. The research instruments demonstrated reliability coefficients ranging from .67 to .87. Data were analyzed using descriptive statistics, and relationships among study variables were examined using Spearman rank correlation. After confirming normality, predictive analysis was performed using Multiple regression.

Results The study sample consisted of 97 patients with end-stage renal disease undergoing hemodialysis. More than half were male (56.7%), with a mean age of 63.7 years (SD 14.3; ranging from 22–86 years). The majority had attained at least a bachelor’s degree (65.0%), were employed in government service (68.0%), reported sufficient income with savings (70.1%), and utilized civil servant or state enterprise health benefits for themselves or their children (77.3%). The findings revealed that age, nutritional status, attitude towards protein-energy consumption, subjective norms, and perceived behavioral control significantly predicted intention (F 22.564, p < .001), accounting for 55.4% of the variance (R² .554, Adjusted R² .529). Attitude towards protein-energy consumption emerged as the strongest predictor β 0.409, p <.001, followed by subjective norms (β 0.228, p .006), perceived behavioral control (β 0.250, p .016), and age (β 0.166, p .029). However, nutritional status did not significantly contribute to the prediction of intention.

Recommendations The findings should be applied to the development of programs that emphasize the promotion of attitudes towards protein-energy consumption, enhancement of perceived behavioral control, and reinforcement of support from reference groups. Such interventions are expected to strengthen the intention of adequate protein-energy consumption and, consequently, lead to adequate protein and energy consumption.