Fistula Care and Mobile Health Applications in Hemodialysis Patients

The Effect of Fistula Care Training With Mobile Health Application on Hemodialysis Patients' Adaptation and Self-Care Behaviors

In recent years, applications designed specifically to encourage physical activity in the field of mobile technology have gained momentum. As a result of the literature research, no examples of mobile health applications developed with educational content on fistula care, which hemodialysis-dependent patients can reach at any time and place, have not been found. Based on this, it was planned to increase the knowledge level of arteriovenous fistula care and examine their self-care behaviors and their adaptation to the disease with the mobile application developed with a focus on education on fistula care, which can be used independently by machine-dependent hemodialysis patients. In this context, it is aimed that dialysis patients will benefit especially in arteriovenous fistula care applications, thanks to the ever-increasing mobile applications in daily use with the developing technology. It is thought that the use of these technology-based trainings will be more comfortable, useful and encouraging for their own self-care. It is planned to be a guide for healthcare professionals.

Study Overview

• Status: Completed
• Conditions: mHealth; Nursing Caries; Arterio-venous Fistula
• Intervention / Treatment: Behavioral: experimental group; Behavioral: control group

Detailed Description

Chronic renal failure is a clinical picture characterized by chronic, progressive deterioration in metabolic and endocrine functions, in adjusting the fluid-electrolyte balance of the kidney as a result of a decrease in glomerular filtration value. When the glomerular filtration value decreases to 5-10 ml/minute, end-stage renal failure develops. Renal replacement therapies such as hemodialysis, peritoneal dialysis and kidney transplantation are applied in patients diagnosed with end-stage renal disease. Renal replacement therapies are life-sparing treatments and the most common method applied is hemodialysis. The success of dialysis, which is a highly effective medical technology, in saving lives is indisputable. Arteriovenous fistula opened for hemodialysis is the lifeline of sick individuals, and hemodialysis is a critical treatment method based on the vascular access pathway. In this context, compliance with treatment is of vital importance in individuals with a diagnosis of end-stage renal disease, and lack of vascular access can reduce its efficiency in a short time. Studies show that only 25% of hemodialysis patients can take care of themselves.

The inadequacy of the individual's knowledge and behaviors of arteriovenous fistula care impairs adherence to treatment, reduces the effectiveness of the treatment and increases the cost. Interventions that encourage changes in health behavior and encourage individuals to change their lifestyle should be integrated into daily life, and there should be support for when and where individuals can make decisions that may affect their health. Mobile technologies, such as smart mobile phones, that individuals regularly carry, can be an effective platform for encouraging health behavior change, especially since they are likely to be with the individual when they need it.

In recent years, applications designed specifically to encourage physical activity in the field of mobile technology have gained momentum. As a result of the literature research, no examples of mobile health applications developed with educational content on fistula care, which hemodialysis-dependent patients can reach at any time and place, have not been found. Based on this, it was planned to increase the knowledge level of arteriovenous fistula care and examine their self-care behaviors and their adaptation to the disease with the mobile application developed with a focus on education on fistula care, which can be used independently by machine-dependent hemodialysis patients. In this context, it is aimed that dialysis patients will benefit especially in arteriovenous fistula care applications, thanks to the ever-increasing mobile applications in daily use with the developing technology. It is thought that the use of these technology-based trainings will be more comfortable, useful and encouraging for their own self-care. It is planned to be a guide for healthcare professionals.

• Study Type: Observational
• Enrollment (Actual): 2

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey, 34660
    • Saglik Bilimleri University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The population of the study consisted of individuals with arteriovenous fistula who applied to Private Hope Dialysis Center and Private Almet Dialysis Center for hemodialysis between June 2020 and October 2020. In the study, the experimental and control groups were selected from two different dialysis centers in order to eliminate the bias and considering the control group's exposure to the interference.

Description

Inclusion Criteria:

• Over 18 years old,
• Literate (can understand and speak Turkish),
• Do not have a diagnosed mental and psychological disease,
• Hearing or visually impaired,
• Open to communication and cooperation,
• Having arteriovenous fistula,
• Having a smart phone,
• Individuals willing to participate in the research will be included.

Exclusion Criteria:

• Those with arteriovenous graft,
• Those with a catheter,
• Those receiving peritoneal dialysis.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
experimental group; The arteriovenous fistula care mobile health application will be installed and promoted on the smart phones of the patients in the experimental group.	Behavioral: experimental group; The arteriovenous fistula care mobile health application will be installed and promoted on the smart phones of the patients in the experimental group. Arteriovenous fistula care mobile health application will be installed in daytime groups during working hours during or at the end of dialysis according to the patient's request. In addition, the information contained in the arteriovenous care mobile health application will be verbally explained to the patients and their relatives, as well as shown in practice. The training results were evaluated by the researcher in the 1st and 3rd months in the "Scale for Evaluation of Self-Care Behaviors Related to Arteriovenous Fistula in Hemodialysis Patients", "Final Level of Renal Failure Compliance Scale", "Arteriovenous Fistula Care Education Knowledge Level Evaluation Form (Post-Training Section)" and " Visual Benchmarking Scale ".
control group; Patients in the control group will receive arteriovenous fistula care training and a training booklet will be given.	Behavioral: control group; Patients in the control group will receive arteriovenous fistula care training and a training booklet will be given. The information contained in the booklet will be explained orally to the patients and their relatives by the researcher, and will also be shown in practice. The results of the training were determined by the researcher at the 1st and 3rd months of the "Self-Care Behaviors Scale for Arteriovenous Fistula in Hemodialysis Patients", "End Stage Renal Failure Compliance Scale", "Arteriovenous Fistula Care Training Information Level Assessment Form (Post-training section)" and "Visual It will be evaluated with the "Comparison Scale".

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
self-care behavior	Patients were informed about the Self-Care Behaviors Assessment Scale for Arteriovenous Fistula in Hemodialysis Patients. (The scale consisting of 16 items in total; Each item is scored according to the statements opposite. A minimum of 1 point indicates that the specified self-care behavior never develops, and the highest 5 points indicate that the specified self-care behavior always exists. The minimum score that can be obtained from the scale is 16, and the maximum score is 80.As the score increases, it is evaluated that the person's self-care behaviors are positive.)	5 month
adaptation to illness	Patients were informed about the End Stage Renal Failure Compliance Scale. (It consists of 5 chapters and 46 items. The total score that can be obtained from the scale varies between 0 and 1200. As the score obtained from the scale increases, the level of adherence to treatment increases.)	5 month
knowledge level	Patients were informed about the Arteriovenous Fistula Care Education Evaluation Form. (It states that there is no "0 point" information when scoring the form, but "1 point" information. The total score that can be obtained from the form varies between 0 and 13. The higher the score, the higher the AVF care knowledge level.)	5 month

Collaborators and Investigators

• Sponsor: Saglik Bilimleri Universitesi
• Investigators: Principal Investigator: Cevriye Ozdemir, Lecturer, Saglik Bilimleri University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2020
• Primary Completion (Actual): October 20, 2020
• Study Completion (Actual): October 31, 2020

Study Registration Dates

• First Submitted: June 1, 2021
• First Submitted That Met QC Criteria: June 7, 2021
• First Posted (Actual): June 14, 2021

Study Record Updates

• Last Update Posted (Actual): June 16, 2021
• Last Update Submitted That Met QC Criteria: June 12, 2021
• Last Verified: June 1, 2021

More Information

Terms related to this study

• Keywords: compliance; nursing; Hemodialysis; arteriovenous fistula; care; mobile health application
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Congenital Abnormalities; Pathological Conditions, Anatomical; Cardiovascular Abnormalities; Vascular Malformations; Arteriovenous Malformations; Vascular Fistula; Fistula; Arteriovenous Fistula
• Other Study ID Numbers: i060708c.A

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No