【作者】 李雪；

【导师】 单岩；

【作者基本信息】 郑州大学 ， 护理学， 2022， 硕士

【摘要】 目的1.汉化澳大利亚饮食行为心理系列量表,并在维持性血液透析患者中检验信效度,为后续研究提供测评工具。2.通过量性研究、质性研究调查维持性血液透析患者饮食行为现状与影响因素,构建维持性血液透析患者饮食行为干预方案。3.探讨干预方案对改善维持性血液透析患者不良饮食行为的实施效果,为促进患者维持良好饮食行为提供指导。方法1.量表汉化阶段:汉化澳大利亚饮食行为心理系列量表:系列量表包含饮食目标-欲望不一致量表(Dietary Goal-Desire Incongruence,DG-DI)、饮食自我控制动机量表(Motivation for Dietary Self-control,MDSC)、饮食行为满意度量表(Satisfaction with Dietary Behavior,SWDB),采用Brislin翻译模式对饮食行为心理系列量表进行正译、回译、文化调适(专家咨询、认知性访谈)和预调查,形成中文版饮食行为心理系列量表。采用便利抽样法选取2020年11月～2021年2月郑州市三所三甲医院的420名维持性血液透析患者,对其进行问卷调查,评价中文版DG-DI、MDSC和SWDB量表的信度和效度。采用项目-总分分析、决断值、内部一致性信度、折半信度、重测信度、内容效度和结构效度评价DG-DI、MDSC和SWDB的心理测量学属性。2.调查阶段:(1)量性研究:选取2021年3月～5月郑州某三甲医院符合纳排标准的维持性血液透析患者为问卷调查对象,调查工具为患者一般资料调查表、中文版DG-DI量表、MDSC量表和SWDB量表,并分析不同特征患者饮食行为各心理状况的影响因素。使用IBM SPSS Statistics 21.0软件,采用描述性统计、单因素方差分析、卡方检验等方法分析数据,检验水准α=0.05。(2)质性研究:对维持性血液透析患者进行半结构式深度访谈,采用Clolaizz七步分析法分析患者患者饮食行为管理的障碍与促进因素。3.干预方案构建阶段:结合本研究理论框架和量性研究、质性研究的调查结果,初步拟定维持性血液透析患者饮食行为干预方案初稿,通过专家咨询及预试验修正干预方案,最终形成维持性血液透析患者饮食行为干预方案实施稿。4.干预方案实施阶段:采用类实验性研究方法,便利选取河南省郑州市某三甲医院血液净化中心收治的符合入选标准的64例维持性血液透析患者作为干预对象。以不同透析时间为整体,采用抽签法决定两个透析时间段的组别,干预组32例,对照组32例。对照组接受常规饮食教育,干预组在常规饮食教育的基础上实施维持性血液透析患者饮食行为干预方案。在干预前、干预后即刻、干预后3个月收集资料,包括饮食目标-欲望不一致、饮食自我控制动机、饮食行为满意度、肾脏病饮食依从行为以及患者的钠、磷、钾情况。采用描述性统计、t检验、卡方检验、广义估计方程等分析数据,检验水准α=0.05。结果1.量表汉化阶段:形成中文版饮食行为心理系列量表,共包含饮食目标-欲望不一致量表(6个条目);饮食自我控制动机量表(11个条目):内部动机、外部动机、无动机;饮食行为满意度量表(8个条目)。DG-DI、MDSC和SWDB量表项目分析各条目与量表总分的相关系数是0.569～0.919(P<0.01),CR值均>4.0;整体量表的内容效度指数为0.984,各条目的内容指数为0.80～1.00。中文版DG-DI、MDSC和SWDB量表共25个条目,探索性因子分析提取出特征根>1的公因子共5个,累积方差贡献率为65.507%。对DG-DI、MDSC和SWDB进行验证性因子分析,模型拟合指数卡方/自由度(X~2/df)=2.092,拟合优度指数(GFI)=0.822,规范拟合指数(NFI)=0.846,非规准拟合指数(TLI)=0.901,比较拟合指数(CFI)=0.912,近似误差均方根(RMSEA)=0.072;DG-DI的Cronbach’sα系数为0.884,MDSC的Cronbach’sα系数为0.831,各维度的Cronbach’sα系数为0.797～0.865,SWDB的Cronbach’sα系数为0.914。DG-DI、MDSC和SWDB的折半信度分别为0.883、0.702和0.891。DG-DI,MDSC和SWDB的重测信度分别为0.835、0.841和0.760。2.调查阶段:(1)量性研究:共发放问卷205份,其中有效问卷190份,有效率为92.7%。维持性血液透析患者的饮食目标-欲望不一致得分范围为6～42分,平均分为(28.21±8.05)分;饮食自我控制动机得分范围为11～77分,平均分为(38.06±9.99)分;饮食行为满意度得分范围为8～56分,平均分为(29.81±8.49)分。通过t检验及相关性分析等统计学方法分析,结果显示年龄、透析时间和工作状况是患者饮食目标-欲望冲突、自控动机和满意度的重要影响因素。(2)质性研究:共访谈12例维持性血液透析患者,资料分析提炼3个主题依次为:改变饮食行为的动力(承担家庭责任,寻求身体舒适状态,感知外界支持力量,积极饮食信息支持);饮食行为改变的阻碍(疾病治疗负担,社会疏离与社会孤立,家庭支持缺乏);长久饮食控制具有挑战性(挫败感的侵袭,努力长期对抗)。3.干预方案构建阶段:形成维持性血液透析患者饮食行为干预方案施测稿,干预形式采用“团体+个体”的混合干预形式,干预时间为一周一次,每次60～90分钟,共进行6周,每次在患者完成透析治疗后进行,干预地点为血液净化中心宣教室。4.干预方案实施阶段:(1)饮食目标-欲望不一致:干预后两组患者饮食目标-欲望不一致的得分差异在组间、时间、交互效应上均具有统计学意义(P(27)0.05)。(2)饮食自我控制动机:干预后两组患者饮食自我控制动机总分、内部动机、外部动机以及无动机维度得分差异在组间、时间、交互效应上均具有统计学意义(P(27)0.05)。(3)饮食行为满意度:干预后两组患者饮食行为满意度得分差异在组间、时间、交互效应上均具有统计学意义(P<0.05)。(4)肾脏病饮食依从行为:干预后两组患者肾脏病饮食依从行为得分差异在组间、时间、交互效应上均具有统计学意义(P<0.05)。(5)客观指标:干预后3个月,干预组患者钠磷钾定量值较干预前有所降低,但两组患者在该时点钠的水平变化差异无统计学意义(P>0.05),磷钾的定量值在该时点的变化差异具有统计学意义(P<0.05)。结论1.中文版饮食行为心理系列量表具有良好的信效度,可应用在维持性血液透析人群中,为我国肾脏病患者饮食行为的评估提供有效工具。2.使用中文版饮食行为心理系列量表对维持性血液透析患者饮食行为进行测评,结果提示患者存在不良饮食行为问题,年龄、透析时间和工作状况对患者的饮食行为目标-欲望冲突、自控动机与满意度有影响,为干预内容的制定提供依据。3.维持性血液透析患者在长期饮食行为管理时面临的促进与阻碍因素不同,要依据不同的内容制定针对性干预方案。4.维持性血液透析患者饮食行为干预方案有助于降低患者饮食行为冲突,提高饮食行为自我控制能力,改善不良饮食行为状况,提高患者生活质量。更多还原

【Abstract】 Objective1.The Australian Eating behavioral Psychology series scale was translated and tested for reliability and validity in maintenance hemodialysis patients to provide an evaluation tool for subsequent studies.2.Through quantitative and qualitative studies,the status quo and influencing factors of dietary behavior of maintenance hemodialysis patients were investigated to establish dietary behavior intervention programs for maintenance hemodialysis patients.3.To explore the implementation effect of intervention program on improving poor eating behavior of maintenance hemodialysis patients,and to provide guidance for promoting the maintenance of good eating behavior of patients.Methods1.Scale translation stage:To translate the Australian Eating Behavior Psychology Series Scales into Chinese:The series of scales contains Dietary Goal-Desire Incongruencess Scale、Motivation for Dietary Self-control Scale and Satisfaction with Dietary Behavior Scale.The Brislin translation model was used to conduct forward translation,back translation,cultural adaptation(expert consultation,cognitive interview)and pre-survey of the series of eating behavioral psychology scales,and the Chinese version of the series of eating behavioral psychology scales was formed.The convenience sampling method was used to select 420 patients who underwent maintenance hemodialysis treatment in three grade III,Grade A hospitals in Zhengzhou from November 2020 to February 2021,and a questionnaire survey was conducted to evaluate the reliability and validity of the Chinese version of the Eating behavior psychology Scale.The psychometric attributes of DG-DI,MDSC and SWDB were evaluated by item-total score analysis,decision value,internal consistency reliability,split reliability,retest reliability,content validity and structure validity.2.investigation phase:(1)Quantitative study:From March to May 2021,maintenance hemodialysis patients who met the inclusion criteria in a grade III,Grade A hospital in Zhengzhou were selected as the questionnaire subjects.The survey tools were the patient general data questionnaire,Chinese version of DG-DI scale,MDSC scale and SWDB scale,and the influencing factors of various psychological conditions of eating behavior of patients with different characteristics were analyzed.IBM SPSS Statistics 21.0 software was used to analyze the data using descriptive Statistics,one-way analysis of variance,Chi-square test and other methods,and the test level was=0.05.(2)Qualitative study:Semi-structured in-depth interviews were conducted for maintenance hemodialysis patients,and Clolaizz seven-step analysis was used to analyze the obstacles and promoting factors of dietary behavior management of patients.3.Intervention program construction stage:Combined with the theoretical framework of this study and the survey results of quantitative and qualitative studies,a preliminary draft of dietary behavior intervention program for maintenance hemodialysis patients was prepared,and the intervention program was revised through expert consultation and pre-test,and finally the implementation draft of dietary behavior intervention program for maintenance hemodialysis patients was formed.4.Intervention program implementation stage:A quasi-experimental study method was adopted to facilitate the selection of 64 maintenance-hemodialysis patients who met the inclusion criteria and were admitted to the blood purification Center of a grade-a grade III hospital in Zhengzhou city,Henan Province as intervention objects.Taking different dialysis time as the whole,32 patients in the intervention group and 32 patients in the control group were selected by drawing lots.The control group received routine diet education,and the intervention group implemented dietary behavior intervention program for maintenance hemodialysis patients on the basis of routine diet education.Data were collected before intervention,immediately after intervention,and 3 months after intervention,including dietary goal-desire inconsistency,dietary self-control motivation,dietary behavior satisfaction,dietary compliance behavior of kidney disease,and sodium,phosphorus,and potassium status of patients.Descriptive statistics,T test,Chi-square test and generalized estimation equation were used to analyze the data,and levelα=0.05 was tested.Results1.Scale translation stage:A Chinese version of the eating behavior Psychology scale was developed,including the Dietary Goal-Desire Incongruencess Scale(6items)、Motivation for Dietary Self-control Scale(11 items):internal motivation,external motivation,amotivation;Satisfaction with Dietary Behavior Scale(8 items)..The correlation coefficients between DG-DI,MDSC and SWDB items and the total score of the scale were 0.569～0.919(P<0.01),and the CR of each item was greater than 4.0.The content validity index of the overall scale was 0.984,and the content index of each item ranged from 0.80 to 1.00.There were 25 items in the Chinese version of DG-DI,MDSC and SWDB scales,and 5 common factors with characteristic roots>1 were extracted by exploratory factor analysis,and the cumulative variance contribution rate was 65.507%.Confirmatory factor analysis was performed on DG-DI,MDSC and SWDB showed that Model fitting index chi square/degree of freedom(X~2/df)=2.092,goodness of fit index(GFI)=0.822,canonical fit index(NFI)=0.846,non-standard fit index(TLI)=0.901,comparative fit index(CFI)=0.912,root mean square error(RMSEA)=0.072;The Cronbach’sαcoefficients of DG-DI and MDSC are 0.884 and 0.831,respectively.The Cronbach’sαcoefficients of each dimension are 0.797～0.865.The Cronbach’sαcoefficient of SWDB is 0.914.The half-fold reliability of DG-DI,MDSC and SWDB are 0.883,0.702 and 0.891,respectively.The retest reliability of DG-DI,MDSC and SWDB were 0.835,0.841 and 0.760,respectively.2.investigation phase:(1)Quantitative study:A total of 205 questionnaires were distributed in this study,of which 190 were valid,with an effective rate of 92.7%.The score range of eating goal-desire inconsistency in maintenance hemodialysis patients was 6 to 42 points,with an average score of(28.21±8.05)points.The dietary self-control motivation score ranged from 11 to 77,with an average score of(38.06±9.99).The satisfaction score of eating behavior ranged from 8 to 56 points,with an average score of(29.81±8.49)points.T test,correlation analysis and other statistical methods showed that age,dialysis time and work status were important influencing factors of eating behavior conflict,self-control motivation and satisfaction.(2)Qualitative research:A total of 12 patients with maintenance hemodialysis were interviewed.The data were analyzed and three themes were summarized as follows:motivation to change dietary behavior(bearing family responsibilities,seeking physical comfort,perceiving external support,and positive dietary information support);Barriers to dietary behavior change(burden of disease treatment,social alienation and isolation,lack of family support);Long-term dietary control is challenging(the attack of frustration,and efforts to fight it for a long time).3.Intervention program Construction stage:The test draft of dietary behavior intervention plan for maintenance hemodialysis patients was formed,and the intervention form was"group+individual"mixed intervention form.The intervention time was once a week,60～90 minutes each time,for 6 weeks in total,and each time was conducted after the patients completed dialysis treatment,and the intervention place was the propaganda room of Blood Purification Center.4.Intervention program implementation stage:(1)Dietary goal-desire inconsistency:After intervention,the score difference of dietary goal-desire inconsistency between the two groups was statistically significant in terms of inter-group,time and interaction effect(P<0.05).(2)Dietary self-control motivation:After intervention,the total score of dietary self-control motivation,internal motivation,external motivation and amotivation dimensions of the two groups had statistical significance in terms of inter-group,time and interaction effects(P<0.05).(3)Satisfaction with Dietary Behavior:After intervention,there were statistically significant differences in satisfaction scores of eating behavior between the two groups in terms of inter-group,time and interaction effects(P<0.05).(4)Dietary compliance with renal disease:After intervention,the scores of dietary compliance with renal disease in the two groups had statistical significance in terms of intergroup,time and interaction effect(P<0.05).(5)Objective indicators:3 months after intervention,the quantitative values of sodium,phosphorus and potassium in the intervention group were lower than those before intervention,but there was no statistical significance in the quantitative values of sodium between the two groups at this time point(P>0.05),and there was statistical significance in the quantitative values of phosphorus and potassium at this time point(P<0.05).Conclusions1.The Chinese version of the Psychological scale of dietary behavior has good reliability and validity,which can be applied in the maintenance hemodialysis population and provide an effective tool for the assessment of eating behavior in patients with kidney disease in China.2.Using Chinese eating behavior psychology series scale of maintenance hemodialysis patients eating behavior is evaluated,the results suggest patients with poor eating behavior problems,age,dialysis time and work condition of the patient’s eating behavior goal-desire conflict,control influence motivation and satisfaction,provide a basis for intervention of content.3.Maintenance hemodialysis patients face different promotion and hindrance factors in long-term control of eating behavior,so targeted intervention programs should be formulated according to different contents.4.The dietary behavior intervention program of maintenance hemodialysis patients can reduce the conflict of dietary behavior,improve the self-control ability of dietary behavior,improve the status of bad dietary behavior,and improve the quality of life of patients.更多还原