长透析龄血液透析患者运动锻炼依从性的质性研究

A qualitative research on the adherence of long dialysis duration hemodialysis patients to exercise training

目的了解长透析龄血液透析患者运动锻炼依从性的促进与阻碍因素,为提高该类患者运动锻炼水平提供参考依据。方法于2023年3—5月,通过质性研究中现象学研究方法,采用目的抽样法,选取中国人民解放军中部战区总医院(汉口院区)血液净化科15例透析龄≥10年的患者进行深入访谈,运用Colaizzi 7步法分析资料并提炼主题。结果15例访谈对象中,男5例,女10例,年龄39~76岁。分析资料共提炼出3种类别7个主题,分别为行为态度(规律运动后感知到的获益、疾病治疗无望感导致负性心理状态、社会包容度欠佳导致病耻感增加)、主观规范(家庭照顾者认知偏差导致过度保护、担任某种社会角色的压力与动力)、知觉行为控制(自身合并症限制、运动锻炼专业知识获得局限)。结论长透析龄血液透析患者运动锻炼水平受多重因素影响,医护人员应从纠正长透析龄血液透析患者认知偏差、转变行为态度,加强外部支持性环境、减轻主观规范压力,逐步增加促进长透析龄血液透析患者运动锻炼的客观支持这三方面出发,提高长透析龄血液透析患者运动锻炼水平。

Objective To explore the factors that promote and hinder exercise adherence in long dialysis duration hemodialysis patients,and to provide a reference for improving their exercise levels.Methods From March to May 2023,a qualitative research method using phenomenon approach was conducted and 15 patients with peritoneal dialysis for at least 10 years at the People′s Liberation Army Central Command Headquarters Hospital(Hankou Hospital)were selected for in-depth interviews using purposive sampling method.The data were analyzed using Colaizzi 7-step method and the main themes were extracted.Results Among the 15 interviewers,there were 5 males and 10 females,aged 39-76 years old.A total of 3 categories and 7 themes were extracted:behavioral attitudes(sense of benefits after regular exercise,negative psychological states due to hopelessness in disease treatment and increased sense of shame due to poor social inclusion),subjective norms(overprotective behavior by family caregivers due to cognitive biases,pressure and motivation from assuming a certain social role),perceptual behavior control(limitations due to own illnesses,limited knowledge of exercise-related expertise).Conclusions The exercise level of long dialysis duration hemodialysis patients is influenced by multiple factors.Medical staff should correct their cognitive biases and change their behavioral attitudes,strengthen external supportive environments and reduce subjective normative pressures,gradually provide more objective support,thereby promoting the exercise training of long dialysis duration hemodialysis patients.