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Adherence to diet and fluids is the cornerstone of patients undergoing hemodialysis. By informing hemodialysis patients we can help them have a proper diet and reduce mortality and complications of toxins. Face to face education is one of the most common methods of training in health care system. But advantages of video- based education are being simple and cost-effective, although this method is virtual.
: Seventy-five hemodialysis patients were divided randomly into face to face and video-based education groups. A training manual was designed based on Orem′s self-care model. Content of training manual was same in both the groups. In the face to face group, 2 educational sessions were accomplished during dialysis with a 1-week time interval. In the video-based education group, a produced film, separated to 2 episodes was presented during dialysis with a 1-week time interval. An Attitude questionnaire was completed as a pretest and at the end of weeks 2 and 4. SPSS software version 11.5 was used for analysis.
Attitudes about fluid and diet adherence at the end of weeks 2 and 4 are not significantly different in face to face or video-based education groups. The patients′ attitude had a significant difference in face to face group between the 3 study phases (pre-, 2, and 4 weeks postintervention). The same results were obtained in 3 phases of video-based education group.
: Our findings showed that video-based education could be as effective as face to face method. It is recommended that more investment be devoted to video-based education.
Today, chronic renal failure (CRF) is one of the biggest public health problems
Treatment methods for patients with CRF include hemodialysis, peritoneal dialysis, and renal transplantation.
Although hemodialysis improves health and survival rate of these patients, it does not fully replace the function of kidneys or change the disease progress.
Self-care behaviors in these patients includes control of fluids, diet and medication intake, participation in care, effective communication, self-efficacy, and role acceptance.
Adherence to diet and fluid improves health, reduces treatment costs, reduces risk of complications and increases quality of life.
Accommodation with diet, fluids, and medication is very difficult for many patients and failure to keep them might result in many dangerous consequences.
Different methods of self-control and education have been arranged to help patients keep up with life style modifications.
Face to face education is one of the most common methods of training in health care system. In this method of discussion and facing, a better behavioral change is achieved, but we need to spend more time while it is not possible in the crowded centers.
Regarding some issues [the increased incidence of hemodialysis cases, the importance of adherence to diet and fluids in their health, special role of nurses in promoting adherence and interventions, the efficient use of time and human resources in face to face education and the fact that we didn′t find any indexed study comparing the two methods (face to face and video-based education)], we should investigate whether video-based education would be effective in changing the patients′ attitude and behavior about diet and fluid adherence in those undergoing hemodialysis.
This study is a randomized clinical trial including 75 hemodialysis patients admitted to 17 thShahrivar and Quaem hospitals′ hemodialysis wards in Mashhad. They were divided randomly into face to face and video-based education groups.
Study inclusion criteria were: as follows
Age between 18 and 65 years Should be able to read and write Has end-stage renal disease and needs constant hemodialysis treatment No cognitive, hearing, and/or visual disorders Between 6 months and 8 years dialysis Two to three times a week each time for 3-4 h dialysis No formal education about diet.
After determining the educational needs of hemodialysis patients about diet and fluid problems and also reviewing new articles on the basis of Self-Care Model of Orem, a training manual was developed with the help of nephrologists, educationists, and nutritionists. The content of training manual was same in both the groups. After filming with the help of educational technologists, a video tape was prepared which was capable to comply with all media types.
Study was implemented in 4 stages (preintervention, intervention, second week postintervention, and fourth week postintervention). The patients were randomly divided into 2 groups regarding the day of the week and the dialysis shift. After introduction and brief explanation of the purpose and methods of work, eligible cases were selected. In this phase after fulfilling the inclusion criteria, questionnaires about diet and fluids in hemodialysis patients were completed as a pre-test. In face to face group, two 30-45 min sessions were run with 1 week gap during the dialysis. In the other group a tape with 2 totally different episodes were broadcasted with a 1 week gap also during dialysis. Again the questionnaire was completed by interviews at the end of weeks 2 and 4, by the 2 groups. Then, the average of all the measurements were taken in three stages and SPSS software version 11.5 was used for analysis.
Our questionnaire is a framework of 22 questions about attitudes related to diet and fluid adherence in hemodialysis patients and how it affects their lives. It follows the design of the 5 icon Likert scale from "completely disagree""to "completely agree.» Higher scores indicate more positive attitudes in patients with adherence to diet and fluid intake.
The questionnaire was validated by Rouche and McGee (1997), in Ireland.
The mean age of the subjects was 49.8 (11.6) years. Sixty percent of the subjects were men and 78.7% of them were married, 57.4% had just primary education and 30.7% of them were housewives. The average income of subjects was 345.8 dollars. A 75.1% of people had social security insurance, and the source of information of most subjects were physicians and nurses (56% and 49.3%, respectively). An 89.3% of subjects did not smoke. Eighty-four percent of them underwent dialysis 3 times a week. The mean duration of hemodialysis of subjects was 3.4 (2.6) years and mean dialysis adequacy was 0.48 (0.18). For the majority of subjects duration of a dialysis session was 4 h (94.6%).
Statistical tests (Mann-Whitney test, independent t test, Chi-square test, Fisher exact test, and Kruskal-Wallis test) showed that the 2 groups did not have a significant difference and were homogeneous regarding the features
Data analysis related to attitudes about fluid and diet adherence in hemodialysis patients with independent t test showed that attitudes related to diet and fluid adherence at the end of weeks 2 and 4 after the training is not significantly different in hemodialysis patients in face to face or video-based education groups (P = 0. 114 and P = 0.06, respectively)
Comparison of mean attitude to diet and fluid adherence at the end of weeks 2 and 4 after the intervention
ANOVA results show that patients′ attitude about diet and fluid adherence had a significant statistical difference in face-to-face group between 3 study phases (pre-, 2, and 4 weeks after intervention) (P = 0.000)
The results of this study revealed that attitudes related to diet adherence in hemodialysis patients 30.31 (6.87) (54.1%) and for fluids, 19.46 (5.32) (60.8%). Almost half of the subjects had a positive attitude toward diet adherence. Our results are consistent with those of Denhaerynck′s (2007)
Several factors are related to failure in adaption with diet and fluid rules in these patients.
The results of this study showed that in a face-to-face training group, attitude related to diet and fluid adherence in weeks 2 and 4 after intervention improved in 41% and 39.6%, respectively, in hemodialysis patients. These results are consistent with the results of Barnett′s (2007) study, which assessed the effect of a face-to-face training program on fluid adherence in hemodialysis patients. They used a self-report fluid adherence questionnaire. Fluid adherence rate of 47% increased to 71.5%.
Our results showed that attitude in the video-based education group in weeks 2 and 4 after the training increased significantly in 19.5% of patients.
The mean improvement in attitude in the 2 groups isn′t significantly different. These results can be compared with Vaez-Zadeh and Ismail′s (2001) results. They showed that the video-based education was as effective as the face-to-face training on learning self-breast examination.
The effectiveness of the 2 methods (face to face and video-based education) on the attitude of patients about diet and fluid adherence was not significantly different. It means that if an educational program is designed with scientific preassessment of patients′ needs and problems, based on a scientific model, it can be as effective as face-to-face method.
Finally, regarding the increase in hemodialysis patients′ number, time-consumption, and practical difficulties of face-to-face training, it is recommended that more attention be paid to video-based education, and organizations should invest in this field of using qualified specialists.
The authors wish to thank the vice-chancellor on research in Mashhad University of Medical Sciences who supported this study and also thank all patients for their participation in this study. This is a master student thesis.