THE RELATIONSHIP BETWEEN PATIENT'S RESPONSES TO THE MOTIVATIONAL INTERVIEWING AND THEIR DEMOGRAPHIC AND MEDICAL CHARACTERISTICS FOR PATIENT UNDERGOING HEMODIALYSIS

Mankih, Rassoul Abdulzahra; Mirza Hussain, Ala`a Hassan

doi:10.33899/mjn.2023.176929

THE RELATIONSHIP BETWEEN PATIENT'S RESPONSES TO THE MOTIVATIONAL INTERVIEWING AND THEIR DEMOGRAPHIC AND MEDICAL CHARACTERISTICS FOR PATIENT UNDERGOING HEMODIALYSIS

Rassoul Abdulzahra Mankih

Ala`a Hassan Mirza Hussain

Mosul Journal of Nursing, 2023, Volume 11, Issue 1, Pages 7-15
10.33899/mjn.2023.176929

Abstract

Aims: The study aimed to find out the relationship between a response of patients to the motivational interviewing and their demographic and medical characteristic.
Methods: A formal case –series design study, clinical trial was conducted on (30) patients undergoing haemodialysis at Haemodialysis Unit of Al-Sadder hospital, Missan, Iraq.The participants were selected through purposive(non-probability) sample. The participant received five sessions of motivational interviewing. The General Health Questionnaire (GHQ) was completed by the participants before and after the intervention. Data was collected through the use of the Arabic version of HPL-II questionnaire the data was collected in a unified self-report questionnaire. Data were analysed by using descriptive statistics, including Frequency, Percentage, Mean of score, Standard Deviation.
Results: The results presented that there was association between patients’ response with demographic characteristics, but no association with medical status.
Conclusion: The study concluded that the patients of the study are of low socioeconomic class with ignorance their disease, motivational interviewing are important for adherence to medical therapy.

Keywords:

THE RELATIONSHIP BETWEEN PATIENT'S RESPONSES TO THE MOTIVATIONAL INTERVIEWING AND THEIR DEMOGRAPHIC AND MEDICAL CHARACTERISTICS FOR PATIENT UNDERGOING HEMODIALYSIS

Rassoul Abdulzahra Mankih ¹, Ala`a Hassan Mirza Hussain² *

Department of adult nursing, College of Nursing, University of Baghdad, City of Missan, Iraq;

Department of Basic Science, College of Nursing, University of Baghdad, City of Baghdad, Iraq.

Corresponding author:Rassoul Abdulzahra Mankih

Email: rassoul.abdulzahra1202a@conursing.uobaghdad.edu.iq

ABSTRACT

Aims: The study aimed to find out the relationship between a response of patients to the motivational interviewing and their demographic and medical characteristic.

Methods: A formal case –series design study, clinical trial was conducted on (30) patients undergoing haemodialysis at Haemodialysis Unit of Al-Sadder hospital, Missan, Iraq.The participants were selected through purposive(non-probability) sample. The participant received five sessions of motivational interviewing. The General Health Questionnaire (GHQ) was completed by the participants before and after the intervention. Data was collected through the use of the Arabic version of HPL-II questionnaire the data was collected in a unified self-report questionnaire. Data were analysed by using descriptive statistics, including Frequency, Percentage, Mean of score, Standard Deviation.

Results: The results presented that there was association between patients’ response with demographic characteristics, but no association with medical status.

Conclusion: The study concluded that the patients of the study are of low socioeconomic class with ignorance their disease, motivational interviewing are important for adherence to medical therapy.

Keywords:Motivation interview, Relationship, Patient, Haemodialysis.

Received: 03 September 2021, Accepted: 15 December 2021, Available online: 20 January 2022

INTRODUCTION

More than 800 million people, i.e more than 13% of the world's population, suffer from chronic renal disease. Chronic kidney disease is , a degenerative ailment, more common in older persons, women, colored people, and those with diabetes and high blood pressure. In low- and middle-income nations, chronic kidney disease is a particularly significant burden.¹

Kidney replacement therapy (RRT), as either dialysis or renal transplantation, is necessary for end-stage renal disease (ESRD), a potentially fatal condition. In many nations around the world, including Turkey, haemodialysis (HD) is the type of dialysis that is most frequently utilized.²

Haemodialysis is a procedure used to remove endovascular substances from circulation. During the procedure, the patient's blood passes through a semipermeable membrane while the dialysis fluid passes through the other sides. Dialysis has advantages for patients, but it also has a variety of major and small issues associated to the removal process.³

When fluid limitations are not followed, it may result in hypertension (HT), pulmonary edema, congestive heart failure, muscle cramps, nausea, vomiting, anxiety, panic, and hypotension during HD, all of which increase the likelihood of being sent to the hospital. According to a number of studies, the prevalence of fluid restriction nonadherence ranges from 10% to 73 percent.⁴

Nursing intervention, including the application of educational, cognitive, behavioral and dietary methods, has been shown to exert favorable effects on the physical and emotional health of ESRD patients.⁵Motivational interviewing (MI) has been utilized in recent years to enhance treatment adherence and maintain behavioral change in people with chronic physical diseases.⁶ One of the most important techniques for patient health enhancing is motivational interviewing. As a result, research into the influence of motivational interviewing on the health of hemodialysis patients is critical, particularly in our region.⁴Moreover, no evidence on the influence of motivational interviewing on hemodialysis patients' general health have been found in Iraq. therefore, Improving patient health appears to be essential given the vast number of patients receiving hemodialysis and the challenges involved with the procedure. The aim of this study was to investigate the impact of motivational interviewing on the health of patients with chronic kidney disease.

METHODOLOGY

Design of the Study: clinical trial (pretest-posttest) was used to achieve the goals of the study. The period of this study started from (17th of October, 2021) to (30th June, 2022).

Setting of the Study: The study was conducted at Al-Sadder Teaching Hospital, Hemodialysis Unit. This hospital is the only teaching hospital that contains hemodialysis unit in missan governorate

The Sample of the Study: purposive sample was selected to obtain representative and accurate data. From (73) patients with CRF who were undergoing hemodialysis, Only 30 were able to follow up and to continue with this study. The participants was intervened by motivational interviewing program that was prepared by Mankih and Mirza Hussain 2022⁷, which includes five sessions, each session lasted for 90 minutes. Also, the study instrument and data collection were used as described Mankih & Mirza Hussain 2022⁷.

Data collection: Data was collected through the use of the Arabic version questionnaire the data was collected in a unified self-report questionnaire that includes three parts. The first axis includes socio-demographic data, the second axis includes vital signs and laboratory lab, and the third axis includes 52 items for general heath questioner, ( 1^st February 2022 to 1^st Maye 2022).

Statistical data analysis: Data were analyzed through the use of IBM-Statistical Package of Social Sciences (SPSS) version 23 software program which included descriptive statistical.

RESULTS

Table (1) shows that (53.3%) of the experimental group was within age (40 – 49) years old. Moreover. With regard to the level of education, (90%) of the study’s sample had primary school graduate. The majority of participants in study was housewives which accounted for 43.33percentage. The percentage of married people in the experimental group was 43%. Related to residency, 73.3% of the samples were lived in urban area. also, to monthly income, 63.3% had insufficient income. Moreover, represents in table(2) the medical history of the study’s samples. It declares that The majority of patients had a history of kidney problem for either 5 years or more, or 2 years (39.9% and 36.7%) respectively for the experimental group. Meanwhile, the diagnosis as a chronic renal failure had been done a year ago in 33.3% of experimental group . In addition, 33.3% of the study population had edema of the extremities as the most common sign with renal disease that they had. The highest percentage of the experimental group 80% and the control group 86.7% were not use psychotherapy drugs. With regard chronic diseases, nearly all patients had diabetes and/ or hypertension account as 96.7%. 90 percent of the study group have history of chronic diseases appear before renal failure. In addition, most of the study group (70) percent were injured by corona virus previously.

Table (3) presented that there were significant relationships between patients’ gender, level of education, and job with their responses at p value = (.012, .031, .031) respectively. While, there was no significant relationships with other demographic characteristics at (P > .05).As well as shows there was no significant relationship between patients’ medical history with their responses at p value more than (.05) with all characteristics of medical history

Table (1): The Distribution of the Study’s Samples According to the Demographical Data

Variable	Groups	Study group
Variable	Groups	Freq.	%
Age Groups	20-29	2	6.7
	30-39	5	16.7
	40-49	16	53.3
	50 and over	7	23.3
	Total	30	100
Gender	Male	17	56.7
	Female	13	43.3
	Total	30	100
Educational level	Not Read or write	5	16.7
	Primary School Graduate	18	90
	Diploma degree graduate	4	13.3
	Bachelor’s degree graduate	3	10
	Post graduate degree	0	0
	Total	30	100
Job	Free work	7	23.3
	Employee	2	6.7

	Retired	3	10
	Housewife	13	43.7
	Do not work	5	16.3
	Total	30	100
Marital Status	Single	5	16.7
	Married	13	43.3
	Divorced	1	3.3
	Widowed	9	30
	Separated	2	6.7
	Total	30	100
Residency	Rural	8	26.7
	Urban	22	73.3
	Total	30	100
Monthly income	Sufficient	0	0
	Barley sufficient	11	36.7
	Not sufficient	19	63.3
	Total	30	100

Freq.= frequency,% = percentage.

Variable	Groups	Study group
Variable	Groups	Freq.	%
Disease History	1 year	3	10
	2 years	11	36.7
	3 years	2	6.7
	4 years	2	6.7
	5 years and more	12	39.9
	Total	30	100
Disease Diagnosis	1 year	10	33.3
	2 years	6	20
	3 years	2	6.7
	4 years	3	10
	5 years and more	9	29.9
	Total	30	100
Signs and symptoms that the patient has	Shortness of breath	6	20
	Oedema of the extremities	10	33.3
	Arthralgia	7	23.3
	Loss of appetite	3	10
	All the above	4	13.3
	Total	30	100
Do you take psycho- therapy (drugs)?	Yes	6	20
	No	24	80
	Total	30	100
Do you have chronic diseases (diabetes mellitus/ hypertension?	Yes	29	96.7
	No	1	3.3
	Total	30	100
When Chronic Diseases Appear?	Before renal failure	27	90
	After renal failure	3	10
	Total	30	100

Table (2): The Distribution of the Study’s Samples According to Medical (Disease) History

Freq.= frequency,% = percentage,

Table (3) Correlation between Socio-demographic Variables and Medical History of the Study Group with their Responses to General Health Questionnaire by ANOVA

Study Sample (N=30)

Socio-demographic variables

Post-test

Pre-test

P value

Sig.

M.S

Sum of squares

P value

Sig.

M.S

Sum of squares

N.S

.75

.412

.095

.286

N.S

.74

,41

.06

.188

Between groups

Age

.231

6.014

.153

3.979

Within groups

6.3

4.167

Total

.012

7.312

1.035

1.305

N.S

.074

3.44

.456

Between groups

Gender

.178

4.995

.133

3.71

Within groups

6.3

4.167

Total

.031

3.46

1.8

N.S

.285

1.333

.185

.556

Between group

Education Level

.173

4.5

.139

3.611

Within groups

6.30

4.167

Total

.031

3.17

.53

2.12

N.S

.15

1.85

.238

.952

Between groups

Job

.167

4.17

.129

3.214

Within groups

6.3

4.167

Total

N.S

.297

1.301

.271

1.085

N.S

.277

1.35

.186

.744

Between groups

Marital Status

.209

5.215

.137

3.42

Within groups

6.3

4.167

Total

N.S

.604

.275

.061

N.S

.477

.519

.076

Between group

Residency

.233

6.23

.146

4.091

Within groups

6.3

4.167

Total

N.S

.060

3.83

.759

N.S

.066

3.66

.48

.482

Between groups

Monthly Income

.198

5.54

.132

3.68

Within groups

6.3

4.167

Total

N.S

.771

.595

.145

1.164

N.S

.581

.837

.126

1.008

Between group

Disease History

.245

5.136

.15

3.15

Within groups

6.3

4.167

Total

N.S

.64

.75

.175

1.4

N.S

.273

1.35

.177

1.417

Between groups

Disease Diagnosis

.233

4.9

.131

2.75

Within groups

6.3

4.167

Total

N.S

.02

.005

.021

N.S

.99

.021

.136

.543

Between groups

Signs and symptoms of the patient

.251

6.27

.145

3.62

Within groups

6.3

4.167

Total

N.S

.849

.037

.008

N.S

.235

1.47

.208

Between group

Do you take psychotherapy drugs?

.225

6.29

.141

3.958

Within groups

6.3

4.167

Total

N.S

.129

2.45

.507

N.S

.129

2.45

.029

Between groups

Do you have chronic diseases (diabetes mellitus, hypertension)?

.207

5.79

.148

4.138

Within groups

6.3

4.167

Total

N.S

.89

.016

.004

N.S

.432

.636

.093

Between groups

When chronic diseases appear?

.225

6.29

.146

4.074

Within groups

6.3

4.167

Total

N.S

.274

1.24

.268

N.S

.608

.269

.40

Between groups

Injury by corona virus

.215

6.03

.147

4.127

Within groups

6.3

4.167

Total

M.S= mean of score, df= degree of freedom, NS = non-significant at P>0.05, S=significant at P<0.05

Discussion

1.Discussion of the Socio-Demographic Characteristics and Medical History of the Study Sample (Study and Control Groups).

No study was found on the effect of motivational interviewing on the health in Iraq. Therefore, this study may be the first one on improving the health status by motivational interviewing of dialysis patients, as well as Iraqi patients in general. In order to obtain accurate results, the selection of the sample was based on the patient's cognitive ability. Because, patients with CKD who are on RRT are up to three times more common to develop cognitive impairment independently to age(it can occur in young age)⁵.

Results in table (1) showed more than half of the study group patients (53.3%) were aged 40-49 years, while the percentage of those aged 50 and over was only 23.3%. These results can be attributed to the fact that the majority of patients in both groups suffer from chronic diseases such as high blood pressure and diabetes. Russell et al. (2011)⁸ conducted a study on 29 hemodialysis patients aimed to determine the effect of motivational intervention on treatment, diet, and fluid adherence. The sample of the study was selected from hemodialysis clinic in central of the United States of America, Who reported that the mean of starting dialysis treatment was approximately 56 months, and the main cause of kidney disease was diabetes mellitus. Moreover, patients undergoing hemodialysis had 90% chronic disease, respectively, before the development of renal disease. On the other hand, a high percentage (70%) of them was infected with corona virus. The results of this study showed that the prevalence of CKD was higher in males than in females (56.7% and 43.3%), respectively. This can interpret that males in Iraqi population are higher than females in injury by kidney diseases who need hemodialysis. The reason for this variability is not clear, but it is consistent with the local study and the study of around area that produced by Dashtidehkordi et al. (2018)⁹ respectively. Dashtidehkordi et al. (2018)⁹ also found that among 28 patients in experimental group, there were 18 males and among 29 patients, while in control group there were 19 males also who accounted the highest proportion of the study sample. But, the finding of this study contradicts with global studies. Ethnicity may play a role in determining the relationship between CKD and gender¹⁰

2.Correlation between Socio-demographic Variables and Medical History of the Study Group with their Responses to General Health Questionnaire by ANOVA.

The results presented that there were significant relationships between patients’ gender, education, and job with their responses at p value = (.012, .031, .031) respectively. While, there was no significant relationships with other demographic characteristics at (P > .05). On the other hand, there was no significant relationship between patients’ medical history with their responses at p value 0).05) with all characteristics of medical history. These results reflected that patients’ responses to motivational interviewing were affected by their gender, as males could represent higher responses with general health questionnaire. On the other hand, the response to MI is significantly higher in unemployed, in spite the bonefferoni correction showed insignificant association, but the highest respond to motivational interviewing was appeared in patient with low educational level and either barley sufficient or insuffient income.

It is important to mention that Resull et al., (2011)⁸ reported the adherence to therapy in hemodialysis patients depends on many factors, such as, demographics, complexity of therapy with it’s side effects, economic status of patient, and the ability to obtain social and environmental supports.

CONCLUSION

The conclusion obtained from this study appears that the patients of studied sample are of low socio economic class and they are ignorant about their disease, with MI can enhance their adherence to medical therapy. the male, unemployed, low educate significant effect on patients’ response to the MI program.

RECOMMENDATION

Based on the findings and s of the current study, the researchers suggest that need to rain health care professionals in the MI program and providing them with validated certificates accepted by the Ministry of Health that qualify them to administer this program, especially postgraduate nurses and mental health professionals.

REFERENCE

1.Dhaidan, F. A. (2018). Prevalence of end stage renal disease and associated conditions in hemodialysis Iraqi patients. Int J Res Med Sci, 6(5), 1515-1518.‏

2.Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 12(1), 7-11.‏

3.Lv, J. C., & Zhang, L. X. (2019). Prevalence and disease burden of chronic kidney disease. Renal Fibrosis: Mechanisms and Therapies, 3-15.‏

4. Gatua, M. (2017). Burden of Care and Health-Related Quality of Life Among Caregivers of Patients Undergoing Maintenance Hemodialysis at The Renal Unit of Kenyatta National Hospital (Doctoral dissertation, University of Nairobi).

‏5. Crowe, K., Quinn, T. J., Mark, P. B., & Findlay, M. D. (2021). “Is it removed during dialysis?”—cognitive dysfunction in advanced kidney failure—a review article. Frontiers in Neurology, 12.‏

6.Mirkarimi, K., Kabir, M. J., Honarvar, M. R., Ozouni-Davaji, R. B., & Eri, M. (2017). Effect of motivational interviewing on weight efficacy lifestyle among women with overweight and obesity: a randomized controlled trial. Iranian Journal of Medical Sciences, 42(2), 187.‏

7. Mankih, R. A., & Hussain, A. H. M. (2022). The Role of Motivational Interviewing in Improving Health State of Patients Undergoing Hemodialysis. Pakistan Journal of Medical & Health Sciences

8.Russell, C. L., Cronk, N. J., Herron, M.,Knowles, N., Matteson, M. L., Peace, L., & Ponferrada, L. (2011). Motivational Interviewing in Dialysis Adherence Study (MIDAS). Nephrology Nursing Journal, 38(3).

9.Dashtidehkordi, A., Shahgholian, N., Maghsoudi, J., & Sadeghian, J. (2018). The effects of motivational interviewing on the health status of patients undergoing hemodialysis. Iranian Journal of Nursing and Midwifery Research, 23(4), 287

10.Poudyal, A., Karki, K. B., Shrestha, N., Aryal, K. K., Mahato, N. K., Bista, B., ... & Dhimal, M. (2022). Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study. BMJ open, 12(3), e057509.‏

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1.Dhaidan, F. A. (2018). Prevalence of end stage renal disease and associated conditions in hemodialysis Iraqi patients. Int J Res Med Sci, 6(5), 1515-1518.‏

2.Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 12(1), 7-11.‏

3.Lv, J. C., & Zhang, L. X. (2019). Prevalence and disease burden of chronic kidney disease. Renal Fibrosis: Mechanisms and Therapies, 3-15.‏

7. Mankih, R. A., & Hussain, A. H. M. (2022). The Role of Motivational Interviewing in Improving Health State of Patients Undergoing Hemodialysis. Pakistan Journal of Medical & Health Sciences

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