ความรู้ พฤติกรรมการบริโภค และสภาวะสุุขภาพของผู้ป่วยฟอกเลือด ภายหลังการใช้โมเดลการจัดการตนเองผ่านแอปพลิเคชัน

Natthida Tansangworn; Kamonwan Tangvoraphonkchai; Sirirat  Anutrakulchai; On-anong  Waleekhachonloet; Thananan  Rattanachotphanit

doi:10.64960/srimedj.v41i4.271714

Authors

Natthida Tansangworn Mahasarakham Hospital, Mueang District, Maha Sarakham, Thailand 44000
Kamonwan Tangvoraphonkchai Faculty of Medicine, Maha Sarakham University, Mueang District, Maha Sarakham Province, Thailand 44000
Sirirat Anutrakulchai Faculty of Medicine, Khon Kaen University, Mueang District, Khon Kaen Province, Thailand 40002
On-anong Waleekhachonloet Faculty of Pharmacy, Maha Sarakham University, Kantarawichai District, Maha Sarakham Province, Thailand 44150
Thananan Rattanachotphanit Faculty of Pharmacy, Maha Sarakham University, Kantarawichai District, Maha Sarakham Province, Thailand 44150

DOI:

https://doi.org/10.64960/srimedj.v41i4.271714

Keywords:

hemodialysis, self-management, mobile health, patient education, dietary behavior

Abstract

Background and objectives: Self-management plays a crucial role in maintaining fluid and electrolyte balance among patients with end-stage kidney disease undergoing hemodialysis. However, education provided in dialysis units is often episodic and may be insufficient to support sustained behavioral change. This study aimed to assess changes in knowledge, dietary behavior, and clinical parameters including blood pressure and serum electrolyte levels following the implementation of an integrated application-based self-management model in hemodialysis patients.

Methods: A quasi-experimental one-group pretest–posttest study was conducted in five hemodialysis units in Maha Sarakham Province. Ninety-nine patients with end-stage kidney disease participated in a 4-week application-based self-management program, which included educational content, behavior tracking, and two-way communication with healthcare providers. Pre–post differences were analyzed using paired t-tests.

Results: After the intervention, knowledge scores related to fluid and nutrition significantly increased (p<0.001) from 8.43±1.67 to 9.11±1.22 (p<0.001) and 7.23±1.67 to 8.44±1.22 (p<0.001) accordingly. The mean self-care behavior score improved from 10.34±2.29 to 13.36±1.64 (p<0.001). While the frequency of salty food consumption during breakfast and lunch decreased significantly from 8.40±18.10 to 5.00±14.40 and 13.90±23.00 to 8.10±17.90. However, no statistically significant changes were observed in blood pressure or serum electrolyte levels, both of which remained within clinically acceptable ranges.

Conclusions: The application-based self-management model was associated with improvements in knowledge and self-care behaviors among hemodialysis patients, although no short-term changes in clinical parameters were observed. These findings suggest the potential role of digital health tools in supporting continuous care in real-world settings. Further studies with controlled designs and longer follow-up periods are warranted to confirm these findings.

References

Global Burden of Disease Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020;395(10225):709-33. doi:10.1016/S0140-6736(19)32977-0.

Nephrology Society of Thailand. Thailand Renal Replacement Therapy Report 2022. Bangkok:Nephrology Society of Thailand; 2023.

Richard CJ. Self-care management in adults undergoing hemodialysis. Nephrol Nurs J 2006;33(4):387-94.

Kalantar-Zadeh K, Tortorici AR, Chen JL, Kamgar M, Lau WL, Moradi H, et al. Dietary restrictions in dialysis patients: Is there anything left to eat? Semin Dial 2015;28(2):159-68. doi:10.1111/sdi.12348.

Salt Reduction Network. Situation of sodium consumption in the Thai population. [cited Mar 20, 2025]. Available from: http://www.lowsaltthailand.com.

López-Gómez JM, Villaverde M, Jofre R, Rodriguez-Benítez P, Pérez-García R. Interdialytic weight gain as a marker of blood pressure, nutrition, and survival in hemodialysis patients. Kidney Int Suppl 2005;(93):S63-8. doi:10.1111/j.1523-1755.2005.09314.x.

Grady PA, Gough LL. Self-management: A comprehensive approach to management of chronic conditions. Am J Public Health 2014;104(8):e25-31. doi:10.2105/AJPH.2014.302041.

Yoomuang P, Suphunnakul P. Mobile application for slowing chronic kidney disease progression based on creer self-management. EAU Heritage 2019;13(3):33-43.

Saedkong P, Potchana R, Wayo W, Klungklang R. Effects of using Hug Tai Application on health literacy among patients with diabetes type 2, hypertension, and chronic kidney disease stage 3 at Wat Nong Weang Pra-Aramluarg Primary Care Unit in Khon Kaen. Southern Coll Netw J Nurs Public Health 2020;7(3):195-206. [cited Dec 25, 2025]. Available from: https://he01.tci-thaijo.org/index.php/scnet/article/view/243068/166513

Noorid A, Rookkapan K. Effect of self-management support via Line Official application on knowledge, attitude and practice in chronic kidney disease patients. Thai Public Health Sci J 2023;18(4):379-88. [cited Dec 25, 2025]. Available from: https://ejournals.swu.ac.th/index.php/pharm/article/view/15184

Kulsuwan S, Chantamit-O-Pas C, Ponpinij P, Chantamit-O-Pas P. The effects of an individual and family self-management program for slowing disease progression via a mobile application on self-management behaviors and clinical outcomes in patients with stage 3 chronic kidney disease in Thailand: A quasi-experimental study. Korean J Adult Nurs 2026;38(1):108-123. doi:10.7475/kjan.2025.1027.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

Lorig KR, Holman HR. Self-management education:History, definition, outcomes, and mechanisms. Ann Behav Med 2003;26(1):1-7. doi:10.1207/S15324796ABM2601_01.

Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Arch Intern Med 2004;164(15):1641-9. doi:10.1001/archinte.164.15.1641.

Srisa-ard B. Introduction to research. 9th ed. Bangkok: Suwiriyasarn; 2011.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3(1):1–150. doi:10.1038/kisup.2012.76.

Yangöz ŞT, Özer Z, Boz İ. Comparison of the effect of educational and self-management interventions on adherence to treatment in hemodialysis patients: A systematic review and meta-analysis of randomized controlled trials. Int J Clin Pract 2021;75:e13842. doi:10.1111/ijcp.13842.

Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev 1977;84(2):191–215. doi:10.1037/0033295X.84.2.191.

Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q 1996;74(4):511–44. doi:10.2307/3350391.

World Health Organization. mHealth: new horizons for health through mobile technologies: second global survey on eHealth [Internet]. Geneva: World Health Organization; 2011 [cited 2026 Aug 25]. Available from: https://iris.who.int/bitstream/handle/10665/44607/9789241564250_eng.pdf

Pack S, Lee J. Randomised controlled trial of a smartphone application-based dietary selfmanagement program on haemodialysis patients. J Clin Nurs 2021;30(5–6):840–8. doi:10.1111/jocn.15627.

Xu Q, Xu Y, Liu X, Ma X. The application of mobile health in self-management among patients undergoing dialysis: Scoping review. J Med Internet Res 2026;28:e76880. doi:10.2196/76880.

Hayashi A, Yamaguchi S, Waki K, Fujiu K, Hanafusa N, Nishi T, et al. Testing the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients: A pilot study. JMIR Res Protoc 2017;6(4):e63. doi:10.2196/resprot.7105.

Hosseini A, Jackson AC, Chegini N, Dehghan MF, Mazloum D, Haghani S, et al. The effect of an educational app on hemodialysis patients’ selfefficacy and self-care: A quasi-experimental longitudinal study. Chronic Illn 2023;19(2):383-94. doi:10.1177/17423953211073365