복막투석환자를 위한 모바일 인스턴트 메신저를 활용한 맞춤형 식이교육프로그램의 효과

Abstract

Purpose: The study was conducted to develop a tailored diet education program using mobile instant messenger for peritoneal dialysis patients to examine its effects on diet-related self-efficacy, dietary self-care compliance, and physiological indicators.

Methods: : This study applied Cox’s (1982) interaction model of client health behavior to produce health outcomes by promoting positive diet-related health behaviors through interaction between patients and a nurse as expert. This was a quasi-experimental research with a non-equivalent control group pre-post test design. The data collection period was from May to August 2020. To prevent the spread of treatment, the experimental group was divided into A university hospital located in G city, and the control group was divided into B university hospital in J city and C general hospital in M city; participants were 43 patients (21 in experimental group, 22 in control group) attending the renal clinic, undergoing peritoneal dialysis. Based on Cox’s (1982) elements of client professional, the experimental group underwent a tailored diet education program using mobile instant messenger for 5 weeks. The first session involved an orientation and face-to-face education using a booklet, second and third session involved a dietary guide video transmission through mobile instant messenger, and personal and telephone consultations, and fourth and fifth session involved individual diet education, counseling, and Q&A in real time by sending photos of dietary meal every day before eating to ensure that the participants comply with the correct diet. The control group received face-to-face diet education using a leaflet. The measurements were diet-related self-efficacy, dietary self-care compliance, and physiological indicators (hemoglobin, albumin, serum potassium, serum phosphorus, blood urea nitrogen, and serum creatinine). Measurements were made at pre-test, post-test1 (immediately after treatment), and post-test2 (4 weeks after treatment). The data were analyzed using SPSS/WIN 23.0, and the homogeneity of the two groups was examined using the Chi-square test, Fisher's exact test, and independent t-test. Hypothesis testing of the education program’s effects were performed using the repeated measures ANOVA; if the sphericity assumption was not satisfied, the results were done using a multivariate analysis. Results: The experimental group compared with the control group in dietary self-care compliance in time (F=25.06, p<.001), between groups (F=12.20, p=.001), and interactions between times and groups (F=15.29, p<.001); indicating a statistically significant difference in all. In the post-hoc, the two groups was statistically significant differences in the posttest1-pretest (t=1.87, p=.000) and the post-test2–pretest (t=1.43 p<.005). Additionally, the experimental group compared with the control group indicated a significant difference in interactions between times and groups (F=7.55, p=.001) in hemoglobin level than the control group. In the post-hoc, the experimental group and the control group was statistically significant differences in the posttest1-pretest (t=3.92, p=.000) and the posttest2-pretest (t=2.49, p<.017).

Conclusion: This study findings confirmed that a tailored diet education program using mobile instant messenger is an effective strategies to preventing complications and helping patients perform dietary self-care compliance through systematic and continuous interactions with nurse as an expert on the dietary management of peritoneal dialysis patients.