Effects of a Health Literacy Education Program on Mental Health and Renal Function in Patients With Chronic Kidney Disease: A Randomized Controlled Trial

Hsiao-Ling HUANG ； Ya-Hui HSU ； Chung-Wei YANG ； Min-Fang HSU ； Yu-Chu CHUNG

《The Journal of Nursing Research》 32卷1期 (2024/02) Pp. 1-10

https://doi.org/10.1097/jnr.0000000000000595

摘要

Background: Chronic kidney disease (CKD) refers to permanent damage to the kidneys that occurs gradually over time. Further progression may be preventable depending on its stage. Purpose: This study was developed to evaluate the effect of a health literacy education program (HLEP) on mental health and renal functioning in patients with CKD. Methods: A single-blind, randomized controlled trial study was conducted. Data were collected from March 25 to December 18, 2021. Participants were randomly assigned to either the experimental group (n = 42), which received multidisciplinary care and HLEP, or the control group (n = 42), which received multidisciplinary care only. Data were collected at baseline (T1), Month 3 (T2), and Month 6 (T3), and the data included patient characteristics, estimated glomerular filtration rate, and responses to the Mandarin Multidimensional Health Literacy Questionnaire and Beck Depression Inventory. Results: After 6months of the HLEP intervention, the results of generalized estimating equations analysis showed that, compared with the control group, the experimental group had significantly higher health literacy at Month 3 (β = -3.37, 95% CI [-5.68, -1.06]), significantly improved depression at Month 3 (β = -2.24, 95% CI [-4.11, -0.37]) and Month 6 (β = -4.36, 95%CI [-6.60, -2.12]), and a significantly higher estimated glomerular filtration rate at Month 6 (β = 5.87, 95% CI [1.35, 10.38]). Conclusions/Implications for Practice: The findings of this study may provide a reference for healthcare providers to educate patients with Stage 3-4 CKD using the HLEP. Positive effects on health literacy, depression, and renal function in patients with Stage 3-4 CKD were observed in the short term. Findings from this study may facilitate the implementation of multidisciplinary and nurse-led strategies in primary care to reinforce patients' health literacy, self-care ability, and adjustment to CKD as well as delay disease progression.

關鍵字

chronic kidney disease ； depression ； health literacy ； renal function ； self-management health education

參考文獻

Wang, S.-L., Chen, T.-H., Kung, L.-F., Chiou, C.-L., & Lin, M.-Y. (2018). The effect of multidisciplinary integrated care program on self-care behavior and renal function in patient with chronic kidney disease. Chang Gung Nursing, 29(1), 1–15. https://doi.org/10.6386/CGN.201803_29(1).0001 (Original work published in Chinese)

Wei, M.-H., Wang, Y.-W., Chang, M.-C., & Hsieh, J.-G. (2017). Development of Mandarin Multidimensional Health Literacy Questionnaire (MMHLQ). Taiwan Journal of Public Health, 36(6), 556–570. https://doi.org/10.6288/TJPH201736106061 (Original work published in Chinese)

Chen, Y.-C., Chang, L.-C., Liu, C.-Y., Ho, Y.-F., Weng, S.-C., & Tsai, T.-I. (2018). The roles of social support and health literacy in self-management among patients with chronic kidney disease. Journal of Nursing Scholarship, 50(3), 265–275. https://doi.org/10.1111/jnu.12377

Chu, C. D., McCulloch, C. E., Banerjee, T., Pavkov, M. E., Burrows, N. R., Gillespie, B. W., Saran, R., Shlipak, M. G., Powe, N. R., Tuot, D. S., & Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team. (2020). CKD awareness among US adults by future risk of kidney failure. American Journal of Kidney Diseases, 76(2), 174–183. https://doi.org/10.1053/j.ajkd.2020.01.007

Elliott, M. J., Love, S., Donald, M., Manns, B., Donald, T., Premji, Z., Hemmelgarn, B. R., Grinman, M., Lang, E., & Ronksley, P. E. (2020). Outpatient interventions for managing acute complications of chronic diseases: A scoping review and implications for patients with CKD. American Journal of Kidney Diseases, 76(6), 794–805. https://doi.org/10.1053/j.ajkd.2020.04.006