Effectiveness of self-care supported motivational interview to increase self-care agency and disease adaptation levels of hemodialysis patients: A randomized controlled trial

Effectiveness of self-care supported motivational interview to increase self-care agency and disease adaptation levels of hemodialysis patients: A randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of self-care supported motivational interview to increase self-care agency and disease adaptation levels of hemodialysis patients: A randomized controlled trial abdullah gerçek, Phd SERAP PARLAR KILIÇ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5245305/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study aimed to determine the effect of self-care-supported motivational interview on the self-care and disease adaptation of patients with hemodialysis treatment. Self-care training supported by motivational interviewing affects both patients' self-care and adaptation to the disease. Methods The research was conducted between October 2020 and March 2021 in the Hemodialysis Unit of a state hospital in a province in the east of Turkey. 77 hemodialysis patients participated in this study conducted with randomized controlled research pattern. Personal Information Form, Adaptation to Chronic Illness Scale and Self Care Agency Scale were used in the collection of data. Results It was found that the average score in the experimental and control groups was similar prior to, and the score averages of the experimental group increased significantly after compared to those of the control group. In-group comparisons revealed that the difference between pre-test, post-test and follow-up test mean scores of patients in the experimental group and their mean scores has changed significantly. Pre-test, post-test and follow-up test total scores, physical scores and social scores of the patients in the control group showed significant differences. Conclusions In order to increase patients' adaptation to chronic diseases and their self-care power, self-care supported motivational interviewing technique should be applied to patients. In order to increase the health level of patients, nurses should use the self-care supported motivational interviewing technique during care practices. Hemodialysis adaptation with chronic disease motivational interview technique self-care agency Figures Figure 1 Background Chronic renal failure (CRF) is a disease that is characterized by progressive and irreversible nephron loss due to various diseases ( 1 – 3 ). It is considered as an important public health problem from the class of chronic diseases due to its increasing frequency in the world and in our country, high morbidity and mortality rates, reducing quality of life, high cost of renal replacement treatments required for treatment, and bad prognostic course ( 4 ). According to the Ministry of Health and Turkish neurology association (TND) data, as of the end of 2017, the number of hemodialysis patients in our country is 58,635 ( 5 ). The (HD) treatment is one of the most preferred treatment methods in patients with (ESRD) ( 6 ); however, it causes many complications in patients and affects the patient physically, socially and psychologically ( 7 ). This has a significant impact on both the patient and the patient's family and brings about new life arrangements for the patient ( 8 ). These changes also mean that the person has a new habit or changes his/her ongoing habits and necessitates him to make changes in his/her daily life order ( 9 ). Although (HD) can help patients maintain their physical functions and prevent complications, it is difficult to treat (CRF) with (HD) alone. In addition, this disease requires continuous treatment and care ( 10 ). Hemodıalysıs treatment requires significant restrictions on both self-care and social behavior of patients ( 10 ). Despite the important role of self -care in the management of (CRF), most individuals with this disease have difficulty in doing their own care due to complex therapeutic regimes and physical and psychological limitations of the disease ( 11 ). In addition, (HD) also necessitates to comply with many restrictions of treatment such as nutrition diet, drug use and fluid intake ( 12 ). However, the fact that (HD) patients have to cope with many symptoms and symptoms due to the disease and treatment process makes it difficult to comply with the disease and (HD) treatment ( 13 , 14 ). It is known that hemodialysis is common in patients with treatment and fluid restrictions ( 15 ). A study of patients with (CRF) showed that skipping or abbreviation (HD) sessions increased mortality rates by 14%( 16 ). Another study found out that one or more jumping of (HD) sessions increased mortality rates by 30%, that weight gain between (HD) sessions increases more than 5.7%increased mortality rates by 12%, and shortening (HD) sessions increased mortality rates by 11% ( 17 ). For this reason, it is of great importance that individuals with (CRF) are adapted to diseases and life changes in solving existing or subsequent problems ( 18 ). Many different methods are used in keeping diseases under control and providing effective disease management. One of these methods is a motivational interview (MI) ( 19 ). (MI) is a client-centered form of interviews that are offered to help patients discover and solve their problems by providing them with their behavior change ( 20 ). The advisor can be a nurse, doctor or psychologist who has completed (MI) training ( 21 ). (MI) is a personalized intervention aimed at revealing their motivation to enable people to understand, believe in change and take action for change ( 22 , 23 ). It is known that (MI) is effective in supporting the adaptation of treatment and disease, providing behavioral changes and maintaining self-care at a desired level ( 24 , 25 ). It is stated that (MI) with (HD) patients has a positive effect on the diet of patients, the adaptation in fluid intake and the drug management ( 26 ). The study of Chen et al. stated that (MI) positively improves self-care behavior ( 27 ). It is stated that the fact that nurses create behavioral changes by using self-care supported (MI) can increase the adaptation of the patients to the treatment process, ensure that patient care is maintained at a desired level and improves the health status of the patients ( 24 , 28 ). The relevant literature revealed that a study on the effect of self-care-supported (MI) on the self-care agency and disease adaptation of (HD) patients has not yet been conducted. This study predicts that self-care-supported motivational interview will increase self-care agency and compliance with the disease in hemodialysis patients. Methods This randomized controlled experimental study was conducted to determine the effect of self-care-supported motivational interview in patients receiving hemodialysis treatment on self-care and disease adaptation. The research was conducted between October 2020 and March 2021 in the Hemodialysis Unit of a state hospital in a province in the east of Turkey. The universe of the study was 97 patients receiving hemodialysis treatment. The sample size of the research “G. Power-3.1.9.2 ”program was calculated by determining 80%power in size of 0.70 effect. It was understood that a minimum of 68 subjects in total should be included in the research ( 29 ). In the first stage, a total of 85 patients who refused to participate in the research and 85 patients who did not comply with the inclusion criteria were included in the analysis. However, the research was completed with a total of 77 patients, 40 and 37 control groups (Fig. 1 ). Patients were divided into experimental and control groups using simple random sampling method. In order to prevent inter-patient interaction, randomization was performed between hemodialysis sessions of experimental and control groups. The criteria of the inclusion in the study were as follows: being 18 years and older, having received (HD) treatment for at least three months and longer, getting (HD) treatment for 2 or 3 days a week, not having communicative and mental problems, being literate, not having received (MI) training before, and being volunteer to participate in the study. Patients who did not want to continue were excluded during the study. Instruments Personal Information Form (Personal Information Form) This form, created by the researcher by reviewing the literature, consists of 23 questions in total. Self-Care Agency Scale (ESCA) Self-Care Agency Scale was developed by Kearney and Fleischer in 1979. The validity and reliability study of the Turkish version of the scale was conducted in 1993 by Nahcıvan. It consists of 35 items. Each expression of the 5-point Likert type is scored from 0 to 4. The scoring on the scale is as follows: 4: “Defining me a lot”, 3: “Defining me a little”, 2: “No idea”, 1: “Defining me very much”, 0: “He doesn't define me at all”. There are 8 reverse expressions ( 3 , 5 , 7 , 11 , 17 , 20 , 24 , 29 ) on the scale. The maximum score to be obtained from the scale is 140. Cronbach’s alpha coefficient of the scale was determined as 0.89. The increase in points from the scale indicates that the self-care agency of the patients increased ( 21 ). This research found the Cronbach’s Alfa internal consistency coefficient of the scale as 0.910 Adaptation to Chronic llness Scale (ACISS) The scale was developed by Atik and Karatepe in 2016 to measure the level of compliance of individuals with chronic disease. The scoring is made as follows: 1: I never agree, 2: I do not agree, 3: I am indecisive, 4: I agree and 5: I fully agree. The scale has 5 -point Likert type and three sub -dimensions (physical adaptation, social adaptation and psychological adaptation). The items 1, 9, 10, 13, 14, 15, 16, 18, 22, 23, 24 measure physical adaptation (Max = 55, Min = 11 Points ), the items 2, 3, 5, 7, 17, 19, 25 measure social adaptation (max = 35, min = 7 points), and the items 4, 6, 8, 11, 12, 20, 21 measure psychological adaptation in the scale consisting of 25 items in total. Negative items are scored as 1: 5, 2: 4, 3: 3, 4: 2, 5: 1. Article 1, 2, 3, 4, 7, 8, 9, 10, 11, 13, 14, 15, 16, 18, 21, 22, 23 are normally scored whereas items 5, 6, 12, 17, 19, 20, 24, 25 are scored reversely. The high scores obtained from the sub -dimensions and/or all of the scale mean that patients' adaptation levels are also high. The Cronbach Alpha internal consistency coefficient of the scale was found to be 0.88 ( 29 ). This research found the Cronbach’s Alfa internal consistency coefficient of the scale as 0.748. Randomization Patients receiving hemodialysis treatment in the hemodialysis unit of the hospital were divided into two different groups. The first group of patients receive hemodialysis treatment on Monday, Wednesday, and Friday, the second group of patients on Tuesday, Thursday, and Saturdays. Hemodialysis unit has two sessions on Monday, Wednesday, and Friday two sessions (one session morning, other sessions in the afternoon), Tuesday, Thursday, and Saturday two sessions (one session morning, other session afternoon). Four sessions in the hemodialysis unit were listed. Four lots were drawn by a person who was not aware of the study and groups were formed. Respectively, the first lot of experiment, the second draw control, the third draw experiment and the fourth lot control group was made. Thus, the patients during Monday, Wednesday, and Friday morning and afternoon sessions, Tuesday, Thursday, and Saturday morning and afternoon patients in the patients formed the experimental group. Data Collection The data were collected through face to face and individual interviews with patients. At the beginning of the study (pre-test), personal information form, (ESCA) and (ACISS) were applied to patients in both groups. Each patient allocated approximately 15–20 minutes. Experimental Group After the pre-test data were collected, the patients in the experimental group were informed about the self-care-supported motivational interview sessions. Following the collection of the first data, motivational interview sessions with patients started in the second week. The sessions took place during the hemodialysis session. A total of 6 sessions were held, including a session once a week. Self-care training was given in the first, second and third sessions. In the fourth, fifth and sixth sessions, a motivational interview was held. All sessions were performed individually with patients and each session lasted about 15–20 minutes (Table 1 ). Table 1 self-care supported motivational interview program content Session Technique Content Method First Session (First Week) Self-care training Hand Hygiene Mouth, Dental and Prosthesis Care Leather, hair, foot and nail care Face-to-face once a week 15–20 min Second Session (Second Week) Self-care training Toilet habits and cleaning Sleep and rest Face-to-face once a week 15–20 min Third Session (Third Week) Self-care training Compliance with treatment sessions Compliance with nutritional diet Compliance with the liquid diet Use of salt Face-to-face once a week 15–20 min Fourth, fifth and sixth Session (Fourth, fifth and sixth Week) Motivational Interview Creation of the Agenda Release of Ambivalences Use of Decision Balance Importance and consumption test implementation Plan for change Strengthening of change commitment Face-to-face once a week 15–20 min 6 weeks after the collection of pre-test data (seventh week) (ESCA) and (ACISS) were applied for the second time (pos-test). One ( 1 ) months after the Post-test data was collected, (ESCA) and (ACISS) were repeated for the third time (follow-up test). Control Group After the pre-test data were collected in the control group, the patients continued their routine treatment and no motivational interview (MI) was conducted with this group. After 6 weeks (seventh week), (ESCA) and (ACISS) were applied to this group for the second time (post-test). One month after the post-test data was collected, (ESCA) and (ACISS) were repeated for the third time (follow-up test). Self-Care and Disease Adaptation Training Guide This guide prepared for patients receiving hemodialysis treatment and aimed at developing self-care activities and adapt to the disease was developed in the light of the relevant literature collected by researchers ( 12 , 15 , 19 , 23 , 28 , 30 , 31 ). The opinions of the five experts were used in the development of the guide. Self-care and disease adaptation training guide was given to the experimental group after the first session of the (MI) and the control group at the end of the study. In addition, the sound and video recording of the self-care and adaptation training guide was sent to the phones of patients or relatives. Ethical Consideration Before starting the research, written permissions were obtained from the Ethics Committee and the institution where the study will be carried out. Clinical Trials number received. (ClinicalTrials.gov Identifier: NCT053984329. Patients were informed about the study before the data was collected and then the approval of each participant. The principle of ‘protection of privacy and confidentiality’ was adhered to by notifying the patients that the information obtained will be kept confidential. The inclusion of those who want to participate in the study voluntarily shows that it was adhered to the principle of ‘respect for autonomy’. In general, the principles of ‘not harming/ benefits’ to the participants were adhered to. Data Analysis The data were analyzed in SPSS 22 package program (SPSS Inc., Chicago, IL, USA). The distribution of the data was tested in terms of normality by Kurtosis and Skewness test. Data descriptive statistics, chi-square analysis, T test in independent groups, Mann Whitney U test, Wilcoxon sequence test and Friedman test were analyzed. Descriptive statistics number (n), percent (%), average ± standard deviation (± SD) were considered. The statistical importance was accepted as p < 0.05. Results Participant Characteristics Characteristics of the study population are presented in Table 2 . The average age of 77 patients was found to be 56.13 ± 15.15 in the experimental group and 61.11 ± 10.64 in the control group. Obtained information showed that the majority of patients are married (experimental group = 92.5%, control group = 97.3%), not literate (experimental group = 47.5%, control group = 73.0%), with children (experimental group = 90.0%, control group = 94.6%), and unemployed (experimental group = 50.0%, control group = 67.6%); and their income is equal to the expenses (experimental group = 65.0%, control group = 70.3%). Table 2 socio-demographic characteristics of the participants Exp. Group Control Group Sig. n (%) n (%) Socio-Demographic Feature Mean.±SD. 56.13 ± 15.15 Mean.±SD. 61.11 ± 10.64 U*=599.500 p = 0.152 Gender Male 26 (65.0) 13 (35.1) x 2** =6.858 p = 0.009 Female 14 (35.0) 24 (64.9) Marital Status married 37 (92.5) 36 (97.3) p = 0.616 single 3 (7.5) 1 (2.7) Having a child Yes 36 (90.0) 35 (94.6) p = 0.676 No 4 (10.0) 2 (5.4) Educational status Illiterate 19 (47.5) 27 (73.0) x 2** =6.600 p = 0.159 Prim. sch. graduate 12 (30.0) 7 (18.9) Sec. sch. graduate 1 (2.5) - - H school graduate 6 (15.0) 3 (8.1) University graduate 2 (5.0) - Occupation Unemployed 20 (50.0) 25 (67.6) x 2** =4.382 p = 0.223 Self-employment 10 (25.0) 8 (21.6) Officer/ çivil servant 6 (15.0) 1 (2.7) Retired 4 (10.0) 3 (8.1) Residence Village 15 (37.5) 20 (54.1) x 2** =10.309 p = 0.016 Town 3 (7.5) - District 1 (2.5) 6 (16.2) Province 21 (52.5) 11 (29.7) Income status Income > expense 2 (5.0) 3 (8.1) x 2** =0.884 p = 0.643 Income = expense 26 (65.0) 26 (70.3) Income < expense 12 (30.0) 8 (21.6) Who the patient lives with Spouses and children 35 (87.5) 36 (97.3) p = 0.202 Mother or Father 5 (12.5) 1 (2.7) * U = Mann Whitney u test, ** x 2 = Ki-square test The (HD) treatment period of the experimental and control groups was 7.30 ± 6.83 years and 5.56 ± 4.23 years, respectively. 57.5%of the patients in the experimental group, and 59.5%of the patients in the control group began treatment 1 month after the diagnosis of the disease. In both groups, the majority of the patients adapted to the diet program (experimental group = 75.0%, control group = 67.6%) and move in accordance with the treatment sessions (experimental group = 97.5%, control group = 97.3%) (Table 3 ). Table 3 disease characteristics of participants * U = Mann Whitney u test, ** x 2 = Ki-square test Exp. Group Control Group n (%) n (%) Sig. Characteristics of Patient Mean.±SD. 7.30 ± 6.83 Mean.±SD. 5.56 ± 4.23 U*=676.50 p = 0.515 The start of treatment after the diagnosis of hemodialysis In a month 17 (42.5) 22 (59.5) x 2** =2.212 p = 0.137 After a month 23 (57.5) 15 (40.5) anyone having hemodialysis in the family Yes 10 (25.0) 7 (18.9) x 2** =0.413 p = 0.520 No 30 (75.0) 30 (81.1) Having any other chronic disease Yes 26 (65.0) 30 (81.1) x 2** =2.506 p = 0.113 No 14 (35.0) 7 (18.9) Diabetes Yes 9 (22.5) 14 (37.8) x 2** =2.159 p = 0.142 No 31 (77.5) 23 (62.2) Hypertension Yes 25 (62.5) 27 (73.0) x 2** =0.961 p = 0.327 No 15 (37.5) 10 (27.0) Rheumatic Diseases Yes - 1 (2.7) p = 0.481 No 40 (100) 36 (97.3) Heart diseases Yes 12 (30.0) 14 (37.8) x 2** =0.528 p = 0.467 No 28 (70.0) 23 (62.2) Drug use Yes 36 (90.0) 33 (89.2) p = 1.000 No 4 (10.0) 4 (10.8) Compliance with the diet program Yes 30 (75.0) 25 (67.6) x 2** =0.520 p = 0.471 No 10 (25.0) 12 (32.4) Salt use Yes 21 (52.5) 12 (32.4) x 2** =3.161 p = 0.075 No 19 (47.5) 25 (67.6) Following the treatment sessions Yes 39 (97.5) 36 (97.3) p = 1.000 No 1 (2.5) 1 (2.7) Frequency of compliance with fluid restriction Always 8 (20.0) 8 (21.6) x 2** =0.600 p = 0.963 Often 10 (25.0) 7 (18.9) Half-and-half 11 (27.5) 12 (32.4) Rarely 7 (17.5) 7 (18.9) Never 4 (10.0) 3 (8.1) Frequency of compliance with the diet program Always 10 (25.0) 10 (27.0) x 2** =2.105 p = 0.761 Often 13 (32.5) 8 (21.6) Half-and-half 9 (22.5) 12 (32.4) Rarely 6 (15.0) 4 (10.8) Never 2 (5.0) 3 (8.1) * U =Mann Whitney u test, ** x 2 = Ki-square test The majority of the patients had someone who supported their care (experimental group = 97.5%, control group = 100.0%). 97.5%, 47.5%, and 100% of the patients in the experimental group were determined to have their relatives who supported them physically, economically, and psychologically, respectively. It was found that there were relatives who support all patients in the control group physically, who support 67.6% of them economically, and who support 94.6%of them psychologically supported. Comparison of Both Groups Based on the Mean Scores of ACISS and ESCA There was no statistically significant difference between the Experimental and Control Groups for the total score and subscale scores (excluding psychological compliance sub-dimension) of (ACISS) (p > 0.05). The total (ACISS) score and all the subscale scores of the experimental group were found to be significantly higher than those of the control group one month after 6 weeks (post-test) and one month after the post-test (follow-up test) (p < 0.001). However, the difference between pre-test, post-test and follow-up test measurements of both groups psychological adaptation sub-dimension, was found to be statistically significant (p < 0.05) (Table 4 ). Table 4 Comparison of the pre-test, post-test and follow-up test of both groups according to the means scores of ACISS * and ESCA ** Scale and Process Experimental Group n=40 Control Group n=37 Sig. Mean±SD (Min-Max) Mean±SD (Min-Max) ACISS * Total Pre -test Post -test Follow-up test 73.58±10.01 89.05±7.65 82.70±8.58 23.00-47.00 75.00-109.00 60.00-101.00 69.70±5.27 73.27±11.14 72.03±9.57 24.00-44.00 50.00-96.00 55.00-90.00 t ** =1.697 t ** =7.189 U *** =309.000 p=0.094 p= 0.000 p= 0.000 Physical adaptation sub-dimension Pre -test Post -test Follow-up test 34.33±10.01 40.60±4.08 38.45±4.51 23.00-47.00 32.00-50.00 29.00-48.00 33.03±5.27 34.51±5.75 33.81±4.82 24.00-44.00 24.00-47.00 25.00-42.00 t ** =1.092 t ** =5.386 U *** =377.500 p=0.278 p= 0.000 p= 0.000 Social adaptation sub-dimension Pre -test Post -test Follow-up test 17.13±5.05 23.65±3.25 21.28±3.98 8.00-29.00 18.00-32.00 13.00-31.00 16.73±4.85 18.16±4.87 17.65±4.38 9.00-27.00 8.00-28.00 10.00-25.00 t ** =0.350 t ** =5.768 U *** =415.000 p=0.728 p= 0.000 p= 0.001 Psychologic adaptation sub-dimension Pre -test Post -test Follow-up test 22.13±4.05 24.80±4.42 22.98±3.62 14.00-30.00 16.00-33.00 15.00-31.00 19.95±3.54 20.76±3.55 20.57±3.52 12.00-28.00 13.00-28.00 14.00-27.00 t ** =2.506 t ** =4.400 U *** =474.000 p= 0.014 p= 0.000 p= 0.006 Self Care Agency Scale Pre -test Post -test Follow-up test 99.53±18.76 116.53±13.69 109.88±13.18 45.00-130.00 72.00-139.00 72.00-130.00 88.51±25.74 92.38±22.07 90.11±20.90 30.00-128.00 42.00-126.00 45.00-130.00 t ** =2.157 t ** =5.714 U *** =323.500 p= 0.034 p= 0.000 p= 0.000 * ACISS = Adaptation to chronic illness, ** ESCA= ***t =t test, **** U = Mann Whitney u test. The difference between the total (ESCA) scores of the experimental and control groups was statistically significant in both pre-test, post-test and follow-up test measurements (p < 0.05). However, the total average of the (ESCA) in all three measurements of the experimental group was found to be higher (Table 4 ). In-group Comparison of ACISS and ESCA Scores in Both Groups As shown in Table 5, the difference in pre-test, post-test and follow-up test measurements of both (ACISS) total and scores of the scale’s sub-dimensions and (ESCA) total scores were found statistically significant (p<0.05). Least significant differential (LSD) further analysis was performed to determine the measurement of the difference. The post-test score of the experimental group was higher than its pre-test and follow-up test scores, and the follow-up test score was higher than the pre-test score. In the control group, the differences of the total score of (ACISS), physical adaptation and social adaptation sub-dimension scores in pre-test, post-test and follow-up test were found to be statistically significant (p <0.05). Advanced analysis (LSD) showed that the pre-test score was lower than the post-test and follow-up test. (ACISS) psychological compliance sub-dimension score and (ESCA) total score were found to not be statistically significant in the pre-test, post-test and follow-up test measurements (p> 0.05). Table 5 In -group comparison of ACISS* and ESCA ** score in both groups Pre-test Post-test Follow-up test Mean±SD Mean ± SD Mean ± SD Sig. Experimental group Physical adaptation 34.33±5.16 40.60 ± 4.08 38.45±4.51 F *** =68.405, p= 0.000 Social adaptation 17.13±5.05 23.65 ± 3.25 21.28±3.98 F *** =94.483, p= 0.000 Psychological adaptation 22.13±4.05 24.80 ± 4.42 22.98±3.62 F *** =15.210, p= 0.000 ACISS * Total 73.58±10.01 89.05 ± 7.65 82.70±8.58 F *** =112.972, p= 0.000 ESCA ** Total 99.53±18.76 116.53 ± 13.69 109.88±13.18 F *** =61.017, p= 0.000 Control group Physical adaptation 33.03±5,27 34.51 ± 5,75 33.81±4,82 F *** =3.213, p= 0.046 Social adaptation 16.73±4,85 18.16 ± 4,87 17.65±4,38 F *** =6.056, p= 0.004 Psychological adaptation 19.95±3,54 20.76 ± 3,55 20.57±3,52 F *** =1.543, p=0.221 ACISS * Total 69.70±9,99 73.27 ± 11,14 72.03±9,57 F *** =6.044, p= 0.004 ESCA ** Total 88.51±25,74 92.38 ± 22,07 90.11±20,90 F *** =2.176, p=0.121 * ACISS = Adaptation to chronic illness, ** ESCA =Self-care agency scale *** F = Variance analysis. Discussion It was found that the studies that investigate the self-care agencies of patients and the self-care agencies and the compliance of chronic disease were limited in (HD) patients. Therefore, the results of this study were compared with educational studies conducted in different groups. The study showed that the (ESCA) score of the patients in both experimental and control groups was above the average. The (ESCA) score of (HD) patients was found to be above the average in some studies ( 32 ), it was moderate in some others ( 33 – 37 ), and this score was found to be below the average in Mollaoğlu’s study carried out 2011 ( 38 ). It was seen that the average of (ESCA) score between the experimental and control groups in the pre-test of the present study was different, and the mean (ESCA) score of the experimental group was higher. The high mean of the (ESCA) score of the experimental group may be due to the fact that more than half (52.5%) of patients live in the city center. On the other hand, more than half of the control group (54.1%) lives in the village. The fact that the opportunities of the villages are more limited in terms of treatment and maintenance compared to the provincial centers and that the patients here cannot benefit from health services may have negatively affected self-care. At the beginning of the study (pre-test), there was a significant difference between the (ESCA) mean score of both groups. 6 weeks later (post-test) and one month after the post-test (follow-up test), although there was a significant increase in the (ESCA) mean score in the experimental group, there was no change in that of the control group. In addition, the examination of the (ESCA) scores regarding the comparison of all measurements of both groups in itself showed that the (ESCA) score increased significantly in the experimental group and there was no change in the control group. These findings indicate that the self-care-supported (MI) given to (HD) patients increases their participation in patients' self-care and improves their compliance with the disease. A study states that after self-care training, both the self-care agencies and the adaptation of the disease increased ( 39 ). Özdemir and Akyol (2019) found that there was a significant relationship between pre-tests and post-tests in which they conducted in one group in one group in (HD) patients ( 40 ). Fırat and Öztunç (2019) gave self-care training to patients in a certain program and order in a randomized controlled study. They found that the total score of the experimental group patients was higher than the control group of the control group and that (HD) patients developed self-care agencies ( 41 ). Muslu (2016) stated that (MI) is effective in increasing self-care behaviors and compliance with the disease in patients with type 2 diabetes ( 42 ). Social, physical, emotional and economic difficulties caused by chronic disease make it difficult for the patient to adapt to new conditions ( 43 ). (HD) requires compatibility of many dimensions and is an important concern that affects patient results, including survival ( 25 ). This study found that more than half of the experimental and control groups in the pre-test data complies with the recommended diet program and the majority of the majority adapt to the treatment sessions. It is stated that the compliance rates of dialysis treatment are between 8.5–86%worldwide, the compliance rates in drug treatment in people receiving (HD) treatment is 15.4–50.2%, the compliance rates to fluid restriction are 9.7–49.5%and the compliance rates to the nutritional regime are between 9-22.1% ( 44 ). A number of studies have been conducted on hemodialysis patients. Sağduyu et al. (2006) found the compliance rate for nutritional treatment as 66% ( 45 ). Korkmaz and Kavın (2016) reported that the proportion of those who never missed the treatment sessions in the previous month was 96.5%and the rate of those who adhere to the fluid restriction was 45.9% ( 46 ). Kim et al. (2010) determined the dietary compliance rate of patients as 68.2% and the compliance rate of fluid restriction as 79.5% ( 47 ). Complications may be prevented in patients with chronic renal failure by adequate (HD) application and adaptation of the patient to treatment, and morbidity and mortality rates can be reduced ( 1 ). Success in treatment depends on the adaptation of patients to treatment ( 12 ). Compliance with treatment plays an important role in the effectiveness of (HD) in patients and the development of health ( 28 ). At the beginning of the study (pre-test), there was a statistically significant difference between the (ACISS) total score and scores of all sub-dimension of the scale in two groups. Six weeks later (post-test) and one month after the post-test (follow-up test), despite a considerable rise in the experimental group's (ACISS) total score and all sub-dimensions’ scores were significant higher than those of the control group. In-group investigation of (ACISS) total and all sub-dimension scores of both groups of pre-test, post-test and follow-up test measurements showed that (ACISS) total score and all sub-dimensions’ scores increased significantly in the experimental group. These findings have shown that (MI), given by the nurse, increased the adaptation of patients to treatment and disease. The total and all sub-dimension scores in the follow-up test measurements applied one ( 1 ) months after self-care supported (MI) training are low compared to the final test measurements. However, these scores are higher than the mean of the front-test score. This shows that (MI) with self-care support has a lasting effect on (HD) patients. (MI) enables patients to participate in their treatment and guides them in their ability to manage their treatment ( 39 ). Matteson and Russell (2010) found that there was a significant improvement in the adaptation of patients to treatment, drug, diet and fluid consumption, although they were short in their study in hemodialysis patients ( 44 ). The mean scores of (ESCA) and (ACISS) in this study vary in favor of the experimental group. Our study compared the pre-test, post-test and follow-up test measurements in the experimental group. The fact that (ESCA) and (ACISS) mean scores in the post-test and follow-up test increased significantly compared to mean scores of the pre-test can be accepted as an indication that self-care-supported (MI) causes changes in patients' self-care behaviors and improves the adaptation with (HD) treatment. In the process of acquiring health-enhancing behaviors, it is essential to give the individual a certain period of time in order to adopt this health behavior and to continue it ( 48 ). This study followed the patients again one ( 1 ) months after the motivational interview to see if the desired behavioral change has permanently. In follow-up tests, we found that the difference between them is meaningful, although the patients' total and sub-dimensions and self-care agency scale decreased compared to the end-class. Despite the decrease in the post-test, the average scores are higher than the pre -test shows the effectiveness of education. This result corresponds to the findings in the existing literature ( 31 , 49 ). This study revealed that motivational interviews increase the self-care agency of (HD) patients and contribute to adaptation to the disease. This study is limited to patients who were treated in the hemodialysis unit in the east of Turkey. Its results can be generalized to patients with similar characteristics. Conclusion and Clinical Relevance The study found that (MI) yielded positive results in the experimental group of self-care support and increased patients' self-care agencies and adaptation to the disease. According to these results, it is crucial to carry out (MI) with self-care support for (HD) patients. In order to test the validity of this study, it is recommended to repeat in larger samples, to make longer and more repeated measurements, and to repeat the study in hemodialysis centers in different cities and different regions. Self-care-supported (MI) can be an effective and cost-effective strategy to increase (HD) patients' adaptation to the disease and self-care agency. Nurses have a critical role to promote patients' adaptation to treatment and to increase their self-care agencies. It is suggested that the use of (MI) in research by nurses will increase the level of evidence of the studies in which it is used. Declarations Conflict of interest: The authors declare no conflict of interest in this study. Financial Disclosure This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors Author Contributions Abdullah GERÇEK contributed to the design, conducted the searches, screening and data extraction, and contributed to the analysis and write-up of the manuscript. Serap PARLAR KILIÇ conducted the searches, screening and contributed to write-up of the manuscript. Ethical Principles of the Research Approval was obtained from Muş Alparslan University Scientific Research and Publication Ethics Committee for the research (number: 10879717-050.01.04). Verbal consent to participate in the research was obtained from the individuals by giving information about the purpose of the research, the method, the time they would spare for the research, and by declaring that participating in the research would not do any harm and that the participation was completely voluntary Acknowledgements: The authors wish to thank and acknowledge the participants for sharing their experiences with us. References Özkurt S, Sağlan Y, Gölgeli H, Sağlan R, Balcıoğlu H, Bilge U, et al. Hemodiyaliz Hastalarında Tedaviye Uyumun Değerlendirilmesi. Ankara Med J. 2017;17(4):275–83. Duran SGE-. Determination of the emotional and social problems in dialysis patients. J Uludağ Univ Med Health. 2015;41:59–63. عشوندي خدايار, اميني شيلا, م مبيگي. عباس, The Effect Of Spiritual Care On Death Anxiety In Hemodialysis Patients With End-Stage Of Renal Disease: A Randomized Clinical Trial. Hayat. 2018;23(4). Lam DY, Scherer JS, Brown M, Grubbs V, Schell JO. 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Falahee ML, Benkert R, George NM, Hartlieb KB, Cederna J. Motivational Interviewing To Increase Physical Activity In Underserved Women. J Nurse Practitioners. 2016;12(10):704–9. Özdemİr H, Taşci S. Motivasyonel Görüşme Tekniği ve Hemşirelikte Kullanimi-The Application Of Motivational Interviewing Technique In Nursing. ERÜ Sağlık Bilimleri Fakültesi Dergisi. 2013;1(1):41–7. Ok E, Kutlu Y. The Effect of Motivational Interviewing on Adherence to Treatment and Quality of Life in Chronic Hemodialysis Patients: A Randomized Controlled Trial. Clin Nurs Res. 2021;30(3):322–33. Yangöz ŞT, Özer Z. Hemodiyaliz Tedavisi Uygulanan Bireylerde Sıvı Alımına, Diyet ve İlaç Yönetimine Uyumda Motivasyonel Görüşmenin Etkisi: Sistematik Derleme. Turkiye Klinikleri Hemsirelik Bilimleri. 2020;12(3):419–29. Chen J, Zhao H, Hao S, Xie J, Ouyang Y, Zhao S. Motivational Interviewing To Improve The Self-Care Behaviors For Patients With Chronic Heart Failure: A Randomized Controlled Trial. Int J Nurs Sci. 2018;5(3):213–7. Dashtidehkordi A, Shahgholian N, Maghsoudi J, Sadeghian J. The Effects Of Motivational Interviewing On The Health Status Of Patients Undergoing Hemodialysis. Iran J Nurs Midwifery Res. 2018;23(4):287. Atik D, Karatepe H. Scale Development Study: Adaptation To Chronic Illness. Acta Med Mediterranea. 2016;32(1):135–42. Rubak S, Sandbæk A, Lauritzen T, Borch-Johnsen K, Christensen B. Effect Of Motivational Interviewing On Quality Of Care Measures In Screen Detected Type 2 Diabetes Patients: A One-Year Follow-Up Of An Rct, Addition Denmark. Scand J Prim Health Care. 2011;29(2):92–8. Gülsoy H. Yaşlı Bireylere Verilen Öz-Bakım Eğitiminin Sağlığın Geliştirilmesine Etkisi. İstanbul: Haliç Üniversitesi; 2017. Akyol AD, Karadakovan A. Hemodiyalize Giren Hastalarin Yaşam Kalitesi ve Özbakim Gücü İle Bunlar Üzerine Etkili Değişkenlerin İncelenmesi. Ege Tıp Dergisi. 2002;41(2):97–102. Eylem B, Mollaoğlu M. Hemodiyaliz Uygulanan Hastalarda Özbakım Gücü ve Öz Yeterliliğin Değerlendirilmesi. Nefroloji Hemşireliği Dergisi. 2007;7(1–2):31–8. Moattari M, Ebrahimi M, Sharifi N, Rouzbeh J. The Effect Of Empowerment On The Self-Efficacy, Quality Of Life And Clinical And Laboratory Indicators Of Patients Treated With Hemodialysis: A Randomized Controlled Trial. Health Qual Life Outcomes. 2012;10(1):1–10. Alemdar H, Pakyüz SÇ. Hemodiyaliz Hastalarında Öz Bakım Gücünün Yaşam Kalitesine Etkisinin Değerlendirilmesi. Nefroloji Hemşireliği Dergisi. 2015;10(2):19–30. Kalender N, Tosun N. Determination Of The Relationship Between Adequacy Of Dialysis And Quality Of Life And Self-Care Agency. J Clin Nurs. 2014;23(5–6):820–8. Kirik BTG. Hemodiyaliz Hastalarında Öz Bakım Gücü Değerlendirilmesi. Adana: Çukurova Üniversitesi; 2017. Mollaoğlu M. Diyaliz Hastalarında Yeti Yitimi, Günlük Yaşam Aktiviteleri Ve Öz Yeterlilik Durumu. TAF Prev Med Bull. 2011;10(2):181–6. Fırat HAŞ. Hemodiyaliz Hastalarına Uygulanan Grup Eğitiminin Hastaların Psikososyal Uyum ve Öz-Bakım Gücüne Etkisi. İstanbul:: Marmara Üniversitesi; 2013. Özdemİr ST, Akyol AD. Hemodiyaliz Hastalarına Arteriyovenöz Fistüle İlişkin Verilen Eğitim Özbakım Davranışlarını Etkiler mi? Nefroloji Hemşireliği Dergisi. 2019;14(2):45–56. Firat S, Öztunç G. Total Larenjektomili Hastalara Verilen Eğitimin Öz Bakım Gücüne Etkisi. Cukurova Med J. 2019;44(3):911–21. Muslu L, Günbayi İ, Ardahan M. Motivasyonel Görüşme Programı’nın Tip 2 Diyabet Tanılı Yetişkinlerin Hastalıkla Başetme Ve Uyumlarına Etkisi: Bir Eylem Araştırması. Akdeniz Üniversitesi Bilimsel Araştırma Projesi Antalya; 2016. Bakan G, Akyol AD. Theory-Guided Interventions For Adaptation To Heart Failure. J Adv Nurs. 2008;61(6):596–608. Matteson ML, Russell C. Interventions To Improve Hemodialysis Adherence: A Systematic Review Of Randomized-Controlled Trials. Hemodial Int. 2010;14(4):370–82. Sağduyu A, Şentürk V, Sezer S, Emiroğlu R, Özel S. Hemodiyalize Giren ve Böbrek Nakli Yapılan Hastalarda Ruhsal Sorunlar, Yaşam Kalitesi ve Tedaviye Uyum. Türk psikiyatri dergisi. 2006;17(1):22–31. Korkmaz Y, Kav S. Hemodiyaliz Hastalarının Tedavi ve Sıvı Kısıtlamasına Uyum, Uyumsuzluk ve Öz Etkililik Durumunun Incelenmesi Ankara. Başkent Üniversitesi; 2016. Kim Y, Evangelista LS. Relationship Between Illness Perceptions, Treatment Adherence, And Clinical Outcomes In Patients On Maintenance Hemodialysis. Nephrol Nurs journal: J Am Nephrol Nurses' Association. 2010;37(3):271. Kececi A, Bulduk S. Health Education For The Elderly. In: jozipovic m, editor. Geriatrics : Intech Desing Team; 2012. pp. 153 – 77. Mathers TR. Effects Of Psychosocial Education On Adaptation In Elderly Hemodialysis Patients. Nephrol Nurs J. 1999;26(6):587. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5245305","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":367667266,"identity":"148a7e5e-fe21-4ce2-bb4a-9acacb7dd6d7","order_by":0,"name":"abdullah gerçek","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"abdullah","middleName":"","lastName":"gerçek","suffix":""},{"id":367667267,"identity":"71ae8b82-ae71-4143-a637-e604908294e9","order_by":1,"name":"Phd SERAP PARLAR KILIÇ","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Phd","middleName":"SERAP PARLAR","lastName":"KILIÇ","suffix":""}],"badges":[],"createdAt":"2024-10-11 10:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5245305/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5245305/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67294318,"identity":"d8182a37-f582-4f72-be91-ed98da6b4bca","added_by":"auto","created_at":"2024-10-23 10:43:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":637941,"visible":true,"origin":"","legend":"\u003cp\u003eConsolidated Standards of Reporting Trials diagram showing the flow of participants through each stage of a randomized trial.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5245305/v1/f97908ad43dd801af728aac7.jpg"},{"id":68015869,"identity":"52c2d171-9246-4d9c-95f7-5054c10edd8d","added_by":"auto","created_at":"2024-11-01 10:46:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1665211,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5245305/v1/d68dd4a2-9901-4b98-a043-1c7da18bfc0e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of self-care supported motivational interview to increase self-care agency and disease adaptation levels of hemodialysis patients: A randomized controlled trial","fulltext":[{"header":"Background","content":"\u003cp\u003eChronic renal failure (CRF) is a disease that is characterized by progressive and irreversible nephron loss due to various diseases (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It is considered as an important public health problem from the class of chronic diseases due to its increasing frequency in the world and in our country, high morbidity and mortality rates, reducing quality of life, high cost of renal replacement treatments required for treatment, and bad prognostic course (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). According to the Ministry of Health and Turkish neurology association (TND) data, as of the end of 2017, the number of hemodialysis patients in our country is 58,635 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe (HD) treatment is one of the most preferred treatment methods in patients with (ESRD) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e); however, it causes many complications in patients and affects the patient physically, socially and psychologically (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This has a significant impact on both the patient and the patient's family and brings about new life arrangements for the patient (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These changes also mean that the person has a new habit or changes his/her ongoing habits and necessitates him to make changes in his/her daily life order (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Although (HD) can help patients maintain their physical functions and prevent complications, it is difficult to treat (CRF) with (HD) alone. In addition, this disease requires continuous treatment and care (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHemodıalysıs treatment requires significant restrictions on both self-care and social behavior of patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Despite the important role of self -care in the management of (CRF), most individuals with this disease have difficulty in doing their own care due to complex therapeutic regimes and physical and psychological limitations of the disease (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In addition, (HD) also necessitates to comply with many restrictions of treatment such as nutrition diet, drug use and fluid intake (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, the fact that (HD) patients have to cope with many symptoms and symptoms due to the disease and treatment process makes it difficult to comply with the disease and (HD) treatment (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is known that hemodialysis is common in patients with treatment and fluid restrictions (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). A study of patients with (CRF) showed that skipping or abbreviation (HD) sessions increased mortality rates by 14%(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Another study found out that one or more jumping of (HD) sessions increased mortality rates by 30%, that weight gain between (HD) sessions increases more than 5.7%increased mortality rates by 12%, and shortening (HD) sessions increased mortality rates by 11% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). For this reason, it is of great importance that individuals with (CRF) are adapted to diseases and life changes in solving existing or subsequent problems (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMany different methods are used in keeping diseases under control and providing effective disease management. One of these methods is a motivational interview (MI) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). (MI) is a client-centered form of interviews that are offered to help patients discover and solve their problems by providing them with their behavior change (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The advisor can be a nurse, doctor or psychologist who has completed (MI) training (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). (MI) is a personalized intervention aimed at revealing their motivation to enable people to understand, believe in change and take action for change (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). It is known that (MI) is effective in supporting the adaptation of treatment and disease, providing behavioral changes and maintaining self-care at a desired level (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). It is stated that (MI) with (HD) patients has a positive effect on the diet of patients, the adaptation in fluid intake and the drug management (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The study of Chen et al. stated that (MI) positively improves self-care behavior (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is stated that the fact that nurses create behavioral changes by using self-care supported (MI) can increase the adaptation of the patients to the treatment process, ensure that patient care is maintained at a desired level and improves the health status of the patients (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The relevant literature revealed that a study on the effect of self-care-supported (MI) on the self-care agency and disease adaptation of (HD) patients has not yet been conducted. This study predicts that self-care-supported motivational interview will increase self-care agency and compliance with the disease in hemodialysis patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis randomized controlled experimental study was conducted to determine the effect of self-care-supported motivational interview in patients receiving hemodialysis treatment on self-care and disease adaptation. The research was conducted between October 2020 and March 2021 in the Hemodialysis Unit of a state hospital in a province in the east of Turkey. The universe of the study was 97 patients receiving hemodialysis treatment. The sample size of the research \u0026ldquo;G. Power-3.1.9.2 \u0026rdquo;program was calculated by determining 80%power in size of 0.70 effect. It was understood that a minimum of 68 subjects in total should be included in the research (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In the first stage, a total of 85 patients who refused to participate in the research and 85 patients who did not comply with the inclusion criteria were included in the analysis. However, the research was completed with a total of 77 patients, 40 and 37 control groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients were divided into experimental and control groups using simple random sampling method. In order to prevent inter-patient interaction, randomization was performed between hemodialysis sessions of experimental and control groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe criteria of the inclusion in the study were as follows: being 18 years and older, having received (HD) treatment for at least three months and longer, getting (HD) treatment for 2 or 3 days a week, not having communicative and mental problems, being literate, not having received (MI) training before, and being volunteer to participate in the study. Patients who did not want to continue were excluded during the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInstruments\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003ePersonal Information Form (Personal Information Form)\u003c/h2\u003e \u003cp\u003eThis form, created by the researcher by reviewing the literature, consists of 23 questions in total.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eSelf-Care Agency Scale (ESCA)\u003c/h3\u003e\n\u003cp\u003eSelf-Care Agency Scale was developed by Kearney and Fleischer in 1979. The validity and reliability study of the Turkish version of the scale was conducted in 1993 by Nahcıvan. It consists of 35 items. Each expression of the 5-point Likert type is scored from 0 to 4. The scoring on the scale is as follows: 4: \u0026ldquo;Defining me a lot\u0026rdquo;, 3: \u0026ldquo;Defining me a little\u0026rdquo;, 2: \u0026ldquo;No idea\u0026rdquo;, 1: \u0026ldquo;Defining me very much\u0026rdquo;, 0: \u0026ldquo;He doesn't define me at all\u0026rdquo;. There are 8 reverse expressions (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) on the scale. The maximum score to be obtained from the scale is 140. Cronbach\u0026rsquo;s alpha coefficient of the scale was determined as 0.89. The increase in points from the scale indicates that the self-care agency of the patients increased (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This research found the Cronbach\u0026rsquo;s Alfa internal consistency coefficient of the scale as 0.910\u003c/p\u003e\n\u003ch3\u003eAdaptation to Chronic llness Scale (ACISS)\u003c/h3\u003e\n\u003cp\u003eThe scale was developed by Atik and Karatepe in 2016 to measure the level of compliance of individuals with chronic disease. The scoring is made as follows: 1: I never agree, 2: I do not agree, 3: I am indecisive, 4: I agree and 5: I fully agree. The scale has 5 -point Likert type and three sub -dimensions (physical adaptation, social adaptation and psychological adaptation).\u003c/p\u003e \u003cp\u003eThe items 1, 9, 10, 13, 14, 15, 16, 18, 22, 23, 24 measure physical adaptation (Max\u0026thinsp;=\u0026thinsp;55, Min\u0026thinsp;=\u0026thinsp;11 Points ), the items 2, 3, 5, 7, 17, 19, 25 measure social adaptation (max\u0026thinsp;=\u0026thinsp;35, min\u0026thinsp;=\u0026thinsp;7 points), and the items 4, 6, 8, 11, 12, 20, 21 measure psychological adaptation in the scale consisting of 25 items in total. Negative items are scored as 1: 5, 2: 4, 3: 3, 4: 2, 5: 1. Article 1, 2, 3, 4, 7, 8, 9, 10, 11, 13, 14, 15, 16, 18, 21, 22, 23 are normally scored whereas items 5, 6, 12, 17, 19, 20, 24, 25 are scored reversely. The high scores obtained from the sub -dimensions and/or all of the scale mean that patients' adaptation levels are also high. The Cronbach Alpha internal consistency coefficient of the scale was found to be 0.88 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This research found the Cronbach\u0026rsquo;s Alfa internal consistency coefficient of the scale as 0.748.\u003c/p\u003e\n\u003ch3\u003eRandomization\u003c/h3\u003e\n\u003cp\u003ePatients receiving hemodialysis treatment in the hemodialysis unit of the hospital were divided into two different groups. The first group of patients receive hemodialysis treatment on Monday, Wednesday, and Friday, the second group of patients on Tuesday, Thursday, and Saturdays. Hemodialysis unit has two sessions on Monday, Wednesday, and Friday two sessions (one session morning, other sessions in the afternoon), Tuesday, Thursday, and Saturday two sessions (one session morning, other session afternoon). Four sessions in the hemodialysis unit were listed. Four lots were drawn by a person who was not aware of the study and groups were formed. Respectively, the first lot of experiment, the second draw control, the third draw experiment and the fourth lot control group was made. Thus, the patients during Monday, Wednesday, and Friday morning and afternoon sessions, Tuesday, Thursday, and Saturday morning and afternoon patients in the patients formed the experimental group.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThe data were collected through face to face and individual interviews with patients. At the beginning of the study (pre-test), personal information form, (ESCA) and (ACISS) were applied to patients in both groups. Each patient allocated approximately 15\u0026ndash;20 minutes.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExperimental Group\u003c/h3\u003e\n\u003cp\u003e After the pre-test data were collected, the patients in the experimental group were informed about the self-care-supported motivational interview sessions. Following the collection of the first data, motivational interview sessions with patients started in the second week. The sessions took place during the hemodialysis session. A total of 6 sessions were held, including a session once a week. Self-care training was given in the first, second and third sessions. In the fourth, fifth and sixth sessions, a motivational interview was held. All sessions were performed individually with patients and each session lasted about 15\u0026ndash;20 minutes (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eself-care supported motivational interview program content\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnique\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMethod\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst Session\u003c/p\u003e \u003cp\u003e(First Week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-care training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHand Hygiene\u003c/p\u003e \u003cp\u003eMouth, Dental and Prosthesis Care\u003c/p\u003e \u003cp\u003eLeather, hair, foot and nail care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFace-to-face once a week 15\u0026ndash;20 min\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond Session\u003c/p\u003e \u003cp\u003e(Second Week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-care training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eToilet habits and cleaning\u003c/p\u003e \u003cp\u003eSleep and rest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFace-to-face once a week 15\u0026ndash;20 min\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird Session\u003c/p\u003e \u003cp\u003e(Third Week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-care training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCompliance with treatment sessions\u003c/p\u003e \u003cp\u003eCompliance with nutritional diet\u003c/p\u003e \u003cp\u003eCompliance with the liquid diet\u003c/p\u003e \u003cp\u003eUse of salt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFace-to-face once a week 15\u0026ndash;20 min\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFourth, fifth and sixth Session\u003c/p\u003e \u003cp\u003e(Fourth, fifth and sixth Week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMotivational Interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCreation of the Agenda\u003c/p\u003e \u003cp\u003eRelease of Ambivalences\u003c/p\u003e \u003cp\u003eUse of Decision Balance\u003c/p\u003e \u003cp\u003eImportance and consumption test implementation\u003c/p\u003e \u003cp\u003ePlan for change\u003c/p\u003e \u003cp\u003eStrengthening of change commitment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFace-to-face once a week 15\u0026ndash;20 min\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e6 weeks after the collection of pre-test data (seventh week) (ESCA) and (ACISS) were applied for the second time (pos-test). One (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) months after the Post-test data was collected, (ESCA) and (ACISS) were repeated for the third time (follow-up test).\u003c/p\u003e\n\u003ch3\u003eControl Group\u003c/h3\u003e\n\u003cp\u003eAfter the pre-test data were collected in the control group, the patients continued their routine treatment and no motivational interview (MI) was conducted with this group. After 6 weeks (seventh week), (ESCA) and (ACISS) were applied to this group for the second time (post-test). One month after the post-test data was collected, (ESCA) and (ACISS) were repeated for the third time (follow-up test).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSelf-Care and Disease Adaptation Training Guide\u003c/h2\u003e \u003cp\u003eThis guide prepared for patients receiving hemodialysis treatment and aimed at developing self-care activities and adapt to the disease was developed in the light of the relevant literature collected by researchers (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The opinions of the five experts were used in the development of the guide. Self-care and disease adaptation training guide was given to the experimental group after the first session of the (MI) and the control group at the end of the study. In addition, the sound and video recording of the self-care and adaptation training guide was sent to the phones of patients or relatives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration\u003c/h2\u003e \u003cp\u003eBefore starting the research, written permissions were obtained from the Ethics Committee and the institution where the study will be carried out. Clinical Trials number received. (ClinicalTrials.gov Identifier: NCT053984329. Patients were informed about the study before the data was collected and then the approval of each participant. The principle of \u0026lsquo;protection of privacy and confidentiality\u0026rsquo; was adhered to by notifying the patients that the information obtained will be kept confidential. The inclusion of those who want to participate in the study voluntarily shows that it was adhered to the principle of \u0026lsquo;respect for autonomy\u0026rsquo;. In general, the principles of \u0026lsquo;not harming/ benefits\u0026rsquo; to the participants were adhered to.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed in SPSS 22 package program (SPSS Inc., Chicago, IL, USA). The distribution of the data was tested in terms of normality by Kurtosis and Skewness test. Data descriptive statistics, chi-square analysis, T test in independent groups, Mann Whitney U test, Wilcoxon sequence test and Friedman test were analyzed. Descriptive statistics number (n), percent (%), average\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026plusmn;\u0026thinsp;SD) were considered. The statistical importance was accepted as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eCharacteristics of the study population are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The average age of 77 patients was found to be 56.13\u0026thinsp;\u0026plusmn;\u0026thinsp;15.15 in the experimental group and 61.11\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64 in the control group. Obtained information showed that the majority of patients are married (experimental group\u0026thinsp;=\u0026thinsp;92.5%, control group\u0026thinsp;=\u0026thinsp;97.3%), not literate (experimental group\u0026thinsp;=\u0026thinsp;47.5%, control group\u0026thinsp;=\u0026thinsp;73.0%), with children (experimental group\u0026thinsp;=\u0026thinsp;90.0%, control group\u0026thinsp;=\u0026thinsp;94.6%), and unemployed (experimental group\u0026thinsp;=\u0026thinsp;50.0%, control group\u0026thinsp;=\u0026thinsp;67.6%); and their income is equal to the expenses (experimental group\u0026thinsp;=\u0026thinsp;65.0%, control group\u0026thinsp;=\u0026thinsp;70.3%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003esocio-demographic characteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExp. Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocio-Demographic Feature\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMean.\u0026plusmn;SD.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e56.13\u0026thinsp;\u0026plusmn;\u0026thinsp;15.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMean.\u0026plusmn;SD.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e61.11\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU*=599.500\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=6.858\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (64.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (92.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.616\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHaving a child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (94.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.676\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=6.600\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrim. sch. graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (18.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSec. sch. graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e- -\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eH school graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=4.382\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOfficer/ \u0026ccedil;ivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=10.309\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistrict\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (16.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvince\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (29.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIncome status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncome\u0026thinsp;\u0026gt;\u0026thinsp;expense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=0.884\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncome\u0026thinsp;=\u0026thinsp;expense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (70.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncome\u0026thinsp;\u0026lt;\u0026thinsp;expense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWho the patient lives with\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpouses and children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother or Father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003cb\u003eU\u003c/b\u003e\u0026thinsp;=\u0026thinsp;Mann Whitney u test, \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003ex\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;Ki-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe (HD) treatment period of the experimental and control groups was 7.30\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83 years and 5.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23 years, respectively. 57.5%of the patients in the experimental group, and 59.5%of the patients in the control group began treatment 1 month after the diagnosis of the disease. In both groups, the majority of the patients adapted to the diet program (experimental group\u0026thinsp;=\u0026thinsp;75.0%, control group\u0026thinsp;=\u0026thinsp;67.6%) and move in accordance with the treatment sessions (experimental group\u0026thinsp;=\u0026thinsp;97.5%, control group\u0026thinsp;=\u0026thinsp;97.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003edisease characteristics of participants \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003cb\u003eU\u003c/b\u003e\u0026thinsp;=\u0026thinsp;Mann Whitney u test, \u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003ex\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;Ki-square test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExp. Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharacteristics of Patient\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMean.\u0026plusmn;SD.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e7.30\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMean.\u0026plusmn;SD.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e5.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU*=676.50 p\u0026thinsp;=\u0026thinsp;0.515\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThe start of treatment after the diagnosis of hemodialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=2.212\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (40.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eanyone having hemodialysis in the family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=0.413\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (81.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHaving any other chronic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (81.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=2.506\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (18.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=2.159\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (62.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=0.961\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.327\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (27.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRheumatic Diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHeart diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=0.528\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (62.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDrug use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (89.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCompliance with the diet program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=0.520\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.471\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (32.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSalt use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=3.161\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (67.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollowing the treatment sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eFrequency of compliance with fluid restriction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=0.600\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (18.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHalf-and-half\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (32.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (18.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eFrequency of compliance with the diet program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2**\u003c/sup\u003e=2.105\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHalf-and-half\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (32.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003eU\u003c/strong\u003e=Mann Whitney u test, \u003csup\u003e\u0026nbsp;\u003cstrong\u003e**\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e= Ki-square test\u003c/p\u003e \u003cp\u003eThe majority of the patients had someone who supported their care (experimental group\u0026thinsp;=\u0026thinsp;97.5%, control group\u0026thinsp;=\u0026thinsp;100.0%). 97.5%, 47.5%, and 100% of the patients in the experimental group were determined to have their relatives who supported them physically, economically, and psychologically, respectively. It was found that there were relatives who support all patients in the control group physically, who support 67.6% of them economically, and who support 94.6%of them psychologically supported.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Both Groups Based on the Mean Scores of ACISS and ESCA\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference between the Experimental and Control Groups for the total score and subscale scores (excluding psychological compliance sub-dimension) of (ACISS) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The total (ACISS) score and all the subscale scores of the experimental group were found to be significantly higher than those of the control group one month after 6 weeks (post-test) and one month after the post-test (follow-up test) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eHowever, the difference between pre-test, post-test and follow-up test measurements of both groups psychological adaptation sub-dimension, was found to be statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 886px;\"\u003e\n \u003cp\u003eTable 4 Comparison of the pre-test, post-test and follow-up test of both groups according to the means scores of \u0026nbsp;ACISS\u003csup\u003e*\u003c/sup\u003e and \u0026nbsp;ESCA\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScale and Process\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperimental Group n=40\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl Group n=37\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(Min-Max)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(Min-Max)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eACISS\u003csup\u003e*\u003c/sup\u003e Total\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePre -test\u003c/p\u003e\n \u003cp\u003ePost -test\u003c/p\u003e\n \u003cp\u003eFollow-up test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e73.58\u0026plusmn;10.01\u003c/p\u003e\n \u003cp\u003e89.05\u0026plusmn;7.65\u003c/p\u003e\n \u003cp\u003e82.70\u0026plusmn;8.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.00-47.00\u003c/p\u003e\n \u003cp\u003e75.00-109.00\u003c/p\u003e\n \u003cp\u003e60.00-101.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69.70\u0026plusmn;5.27\u003c/p\u003e\n \u003cp\u003e73.27\u0026plusmn;11.14\u003c/p\u003e\n \u003cp\u003e72.03\u0026plusmn;9.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24.00-44.00\u003c/p\u003e\n \u003cp\u003e50.00-96.00\u003c/p\u003e\n \u003cp\u003e55.00-90.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=1.697\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=7.189\u003c/p\u003e\n \u003cp\u003eU\u003csup\u003e***\u003c/sup\u003e=309.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.094\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical adaptation sub-dimension\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePre -test\u003c/p\u003e\n \u003cp\u003ePost -test\u003c/p\u003e\n \u003cp\u003eFollow-up test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34.33\u0026plusmn;10.01\u003c/p\u003e\n \u003cp\u003e40.60\u0026plusmn;4.08\u003c/p\u003e\n \u003cp\u003e38.45\u0026plusmn;4.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.00-47.00\u003c/p\u003e\n \u003cp\u003e32.00-50.00\u003c/p\u003e\n \u003cp\u003e29.00-48.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33.03\u0026plusmn;5.27\u003c/p\u003e\n \u003cp\u003e34.51\u0026plusmn;5.75\u003c/p\u003e\n \u003cp\u003e33.81\u0026plusmn;4.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24.00-44.00\u003c/p\u003e\n \u003cp\u003e24.00-47.00\u003c/p\u003e\n \u003cp\u003e25.00-42.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=1.092\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=5.386\u003c/p\u003e\n \u003cp\u003eU\u003csup\u003e***\u003c/sup\u003e=377.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.278\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial adaptation sub-dimension\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePre -test\u003c/p\u003e\n \u003cp\u003ePost -test\u003c/p\u003e\n \u003cp\u003eFollow-up test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17.13\u0026plusmn;5.05\u003c/p\u003e\n \u003cp\u003e23.65\u0026plusmn;3.25\u003c/p\u003e\n \u003cp\u003e21.28\u0026plusmn;3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e8.00-29.00\u003c/p\u003e\n \u003cp\u003e18.00-32.00\u003c/p\u003e\n \u003cp\u003e13.00-31.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16.73\u0026plusmn;4.85\u003c/p\u003e\n \u003cp\u003e18.16\u0026plusmn;4.87\u003c/p\u003e\n \u003cp\u003e17.65\u0026plusmn;4.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.00-27.00\u003c/p\u003e\n \u003cp\u003e8.00-28.00\u003c/p\u003e\n \u003cp\u003e10.00-25.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=0.350\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=5.768\u003c/p\u003e\n \u003cp\u003eU\u003csup\u003e***\u003c/sup\u003e=415.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=0.728\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychologic \u0026nbsp;adaptation sub-dimension\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePre -test\u003c/p\u003e\n \u003cp\u003ePost -test\u003c/p\u003e\n \u003cp\u003eFollow-up test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22.13\u0026plusmn;4.05\u003c/p\u003e\n \u003cp\u003e24.80\u0026plusmn;4.42\u003c/p\u003e\n \u003cp\u003e22.98\u0026plusmn;3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e14.00-30.00\u003c/p\u003e\n \u003cp\u003e16.00-33.00\u003c/p\u003e\n \u003cp\u003e15.00-31.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19.95\u0026plusmn;3.54\u003c/p\u003e\n \u003cp\u003e20.76\u0026plusmn;3.55\u003c/p\u003e\n \u003cp\u003e20.57\u0026plusmn;3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e12.00-28.00\u003c/p\u003e\n \u003cp\u003e13.00-28.00\u003c/p\u003e\n \u003cp\u003e14.00-27.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=2.506\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=4.400\u003c/p\u003e\n \u003cp\u003eU\u003csup\u003e***\u003c/sup\u003e=474.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf Care Agency Scale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePre -test\u003c/p\u003e\n \u003cp\u003ePost -test\u003c/p\u003e\n \u003cp\u003eFollow-up test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e99.53\u0026plusmn;18.76\u003c/p\u003e\n \u003cp\u003e116.53\u0026plusmn;13.69\u003c/p\u003e\n \u003cp\u003e109.88\u0026plusmn;13.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45.00-130.00\u003c/p\u003e\n \u003cp\u003e72.00-139.00\u003c/p\u003e\n \u003cp\u003e72.00-130.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e88.51\u0026plusmn;25.74\u003c/p\u003e\n \u003cp\u003e92.38\u0026plusmn;22.07\u003c/p\u003e\n \u003cp\u003e90.11\u0026plusmn;20.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e30.00-128.00\u003c/p\u003e\n \u003cp\u003e42.00-126.00\u003c/p\u003e\n \u003cp\u003e45.00-130.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=2.157\u003c/p\u003e\n \u003cp\u003et\u003csup\u003e**\u003c/sup\u003e=5.714\u003c/p\u003e\n \u003cp\u003eU\u003csup\u003e***\u003c/sup\u003e=323.500\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003eACISS\u003c/strong\u003e= Adaptation to chronic illness, \u003csup\u003e**\u003c/sup\u003e ESCA= \u003cstrong\u003e***t\u003c/strong\u003e=t test, \u0026nbsp;\u003cstrong\u003e\u003csup\u003e****\u003c/sup\u003eU\u003c/strong\u003e= Mann Whitney u test.\u003c/p\u003e \u003cp\u003eThe difference between the total (ESCA) scores of the experimental and control groups was statistically significant in both pre-test, post-test and follow-up test measurements (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the total average of the (ESCA) in all three measurements of the experimental group was found to be higher (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eIn-group Comparison of ACISS and ESCA Scores in Both Groups\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\u003cp\u003eAs shown in Table 5, the difference in pre-test, post-test and follow-up test measurements of both (ACISS) total and scores of the scale\u0026rsquo;s sub-dimensions and (ESCA) total scores were found statistically significant\u0026nbsp;(p\u0026lt;0.05).\u0026nbsp;Least significant differential (LSD) further analysis was performed to determine the measurement of the difference. The post-test score of the experimental group was higher than its pre-test and follow-up test scores, and the follow-up test score was higher than the pre-test score. In the control group, the differences of the total score of (ACISS), physical adaptation and social adaptation sub-dimension scores in pre-test, post-test and follow-up test were found to be statistically significant (p \u0026lt;0.05). Advanced analysis (LSD) showed that the pre-test score was lower than the post-test and follow-up test. (ACISS) psychological compliance sub-dimension score and (ESCA) total score were found to not be statistically significant in the pre-test, post-test and follow-up test measurements (p\u0026gt; 0.05).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e In -group comparison of ACISS* and ESCA ** score in both groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 305px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u003cstrong\u003eSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u003cstrong\u003eSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperimental group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003ePhysical adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e34.33\u0026plusmn;5.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e40.60\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e4.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e38.45\u0026plusmn;4.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=68.405, \u0026nbsp; \u0026nbsp; \u0026nbsp;p=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eSocial adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e17.13\u0026plusmn;5.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e23.65\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e21.28\u0026plusmn;3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=94.483, \u0026nbsp; \u0026nbsp; \u0026nbsp;p=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003ePsychological adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e22.13\u0026plusmn;4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e24.80\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e22.98\u0026plusmn;3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=15.210, \u0026nbsp; \u0026nbsp; \u0026nbsp;p=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 253px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eACISS\u003csup\u003e*\u003c/sup\u003e Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e73.58\u0026plusmn;10.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e89.05\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e7.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e82.70\u0026plusmn;8.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=112.972, p=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 253px;\"\u003e\n \u003cp\u003eESCA\u003csup\u003e**\u003c/sup\u003e\u0026nbsp; Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e99.53\u0026plusmn;18.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e116.53\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e13.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e109.88\u0026plusmn;13.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=61.017, \u0026nbsp;p=\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003ePhysical adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e33.03\u0026plusmn;5,27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e34.51\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e5,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e33.81\u0026plusmn;4,82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=3.213, \u0026nbsp; \u0026nbsp; \u0026nbsp;p=\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eSocial adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e16.73\u0026plusmn;4,85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e18.16\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e4,87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e17.65\u0026plusmn;4,38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=6.056, \u0026nbsp; \u0026nbsp; \u0026nbsp;p=\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003ePsychological adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e19.95\u0026plusmn;3,54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e20.76\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e3,55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e20.57\u0026plusmn;3,52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=1.543, \u0026nbsp; \u0026nbsp; \u0026nbsp;p=0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 253px;\"\u003e\n \u003cp\u003eACISS\u003csup\u003e*\u003c/sup\u003e\u0026nbsp; Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e69.70\u0026plusmn;9,99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e73.27\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e11,14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e72.03\u0026plusmn;9,57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=6.044, \u0026nbsp;p=\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 253px;\"\u003e\n \u003cp\u003eESCA\u003csup\u003e**\u003c/sup\u003e\u0026nbsp; Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e88.51\u0026plusmn;25,74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e92.38\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e22,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e90.11\u0026plusmn;20,90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003csup\u003e***\u003c/sup\u003e\u003c/em\u003e=2.176, \u0026nbsp;p=0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003eACISS\u003c/strong\u003e= Adaptation to chronic illness, \u003cstrong\u003e\u003csup\u003e**\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ESCA\u003c/strong\u003e=Self-care agency scale \u0026nbsp;\u003cstrong\u003e\u003csup\u003e***\u003c/sup\u003eF\u003c/strong\u003e= Variance analysis.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIt was found that the studies that investigate the self-care agencies of patients and the self-care agencies and the compliance of chronic disease were limited in (HD) patients. Therefore, the results of this study were compared with educational studies conducted in different groups.\u003c/p\u003e \u003cp\u003eThe study showed that the (ESCA) score of the patients in both experimental and control groups was above the average. The (ESCA) score of (HD) patients was found to be above the average in some studies (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), it was moderate in some others (\u003cspan additionalcitationids=\"CR34 CR35 CR36\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e–\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), and this score was found to be below the average in Mollaoğlu’s study carried out 2011 (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). It was seen that the average of (ESCA) score between the experimental and control groups in the pre-test of the present study was different, and the mean (ESCA) score of the experimental group was higher. The high mean of the (ESCA) score of the experimental group may be due to the fact that more than half (52.5%) of patients live in the city center. On the other hand, more than half of the control group (54.1%) lives in the village. The fact that the opportunities of the villages are more limited in terms of treatment and maintenance compared to the provincial centers and that the patients here cannot benefit from health services may have negatively affected self-care.\u003c/p\u003e \u003cp\u003eAt the beginning of the study (pre-test), there was a significant difference between the (ESCA) mean score of both groups. 6 weeks later (post-test) and one month after the post-test (follow-up test), although there was a significant increase in the (ESCA) mean score in the experimental group, there was no change in that of the control group. In addition, the examination of the (ESCA) scores regarding the comparison of all measurements of both groups in itself showed that the (ESCA) score increased significantly in the experimental group and there was no change in the control group. These findings indicate that the self-care-supported (MI) given to (HD) patients increases their participation in patients' self-care and improves their compliance with the disease. A study states that after self-care training, both the self-care agencies and the adaptation of the disease increased (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Özdemir and Akyol (2019) found that there was a significant relationship between pre-tests and post-tests in which they conducted in one group in one group in (HD) patients (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Fırat and Öztunç (2019) gave self-care training to patients in a certain program and order in a randomized controlled study. They found that the total score of the experimental group patients was higher than the control group of the control group and that (HD) patients developed self-care agencies (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Muslu (2016) stated that (MI) is effective in increasing self-care behaviors and compliance with the disease in patients with type 2 diabetes (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSocial, physical, emotional and economic difficulties caused by chronic disease make it difficult for the patient to adapt to new conditions (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). (HD) requires compatibility of many dimensions and is an important concern that affects patient results, including survival (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This study found that more than half of the experimental and control groups in the pre-test data complies with the recommended diet program and the majority of the majority adapt to the treatment sessions. It is stated that the compliance rates of dialysis treatment are between 8.5–86%worldwide, the compliance rates in drug treatment in people receiving (HD) treatment is 15.4–50.2%, the compliance rates to fluid restriction are 9.7–49.5%and the compliance rates to the nutritional regime are between 9-22.1% (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). A number of studies have been conducted on hemodialysis patients. Sağduyu et al. (2006) found the compliance rate for nutritional treatment as 66% (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Korkmaz and Kavın (2016) reported that the proportion of those who never missed the treatment sessions in the previous month was 96.5%and the rate of those who adhere to the fluid restriction was 45.9% (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Kim et al. (2010) determined the dietary compliance rate of patients as 68.2% and the compliance rate of fluid restriction as 79.5% (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComplications may be prevented in patients with chronic renal failure by adequate (HD) application and adaptation of the patient to treatment, and morbidity and mortality rates can be reduced (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Success in treatment depends on the adaptation of patients to treatment (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Compliance with treatment plays an important role in the effectiveness of (HD) in patients and the development of health (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). At the beginning of the study (pre-test), there was a statistically significant difference between the (ACISS) total score and scores of all sub-dimension of the scale in two groups. Six weeks later (post-test) and one month after the post-test (follow-up test), despite a considerable rise in the experimental group's (ACISS) total score and all sub-dimensions’ scores were significant higher than those of the control group. In-group investigation of (ACISS) total and all sub-dimension scores of both groups of pre-test, post-test and follow-up test measurements showed that (ACISS) total score and all sub-dimensions’ scores increased significantly in the experimental group. These findings have shown that (MI), given by the nurse, increased the adaptation of patients to treatment and disease. The total and all sub-dimension scores in the follow-up test measurements applied one (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) months after self-care supported (MI) training are low compared to the final test measurements. However, these scores are higher than the mean of the front-test score. This shows that (MI) with self-care support has a lasting effect on (HD) patients. (MI) enables patients to participate in their treatment and guides them in their ability to manage their treatment (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Matteson and Russell (2010) found that there was a significant improvement in the adaptation of patients to treatment, drug, diet and fluid consumption, although they were short in their study in hemodialysis patients (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mean scores of (ESCA) and (ACISS) in this study vary in favor of the experimental group. Our study compared the pre-test, post-test and follow-up test measurements in the experimental group. The fact that (ESCA) and (ACISS) mean scores in the post-test and follow-up test increased significantly compared to mean scores of the pre-test can be accepted as an indication that self-care-supported (MI) causes changes in patients' self-care behaviors and improves the adaptation with (HD) treatment. In the process of acquiring health-enhancing behaviors, it is essential to give the individual a certain period of time in order to adopt this health behavior and to continue it (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). This study followed the patients again one (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) months after the motivational interview to see if the desired behavioral change has permanently. In follow-up tests, we found that the difference between them is meaningful, although the patients' total and sub-dimensions and self-care agency scale decreased compared to the end-class. Despite the decrease in the post-test, the average scores are higher than the pre -test shows the effectiveness of education. This result corresponds to the findings in the existing literature (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). This study revealed that motivational interviews increase the self-care agency of (HD) patients and contribute to adaptation to the disease.\u003c/p\u003e \u003cp\u003eThis study is limited to patients who were treated in the hemodialysis unit in the east of Turkey. Its results can be generalized to patients with similar characteristics.\u003c/p\u003e "},{"header":"Conclusion and Clinical Relevance","content":"\u003cp\u003eThe study found that (MI) yielded positive results in the experimental group of self-care support and increased patients' self-care agencies and adaptation to the disease. According to these results, it is crucial to carry out (MI) with self-care support for (HD) patients. In order to test the validity of this study, it is recommended to repeat in larger samples, to make longer and more repeated measurements, and to repeat the study in hemodialysis centers in different cities and different regions.\u003c/p\u003e\u003cp\u003eSelf-care-supported (MI) can be an effective and cost-effective strategy to increase (HD) patients' adaptation to the disease and self-care agency. Nurses have a critical role to promote patients' adaptation to treatment and to increase their self-care agencies. It is suggested that the use of (MI) in research by nurses will increase the level of evidence of the studies in which it is used.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of interest:\u003c/h2\u003e \u003cp\u003eThe authors declare no conflict of interest in this study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFinancial Disclosure\u003c/strong\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors\u003c/p\u003e \u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbdullah GER\u0026Ccedil;EK\u0026nbsp;\u003c/strong\u003econtributed to the design, conducted the searches, screening and data extraction, and contributed to the analysis and write-up of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSerap PARLAR KILI\u0026Ccedil;\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003econducted the searches, screening and contributed to write-up of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Principles of the Research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was obtained from Muş Alparslan University Scientific Research and Publication Ethics Committee for the research (number: 10879717-050.01.04). Verbal consent to participate in the research was obtained from the individuals by giving information about the purpose of the research, the method, the time they would spare for the research, and by declaring that participating in the research would not do any harm and that the participation was completely voluntary\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eThe authors wish to thank and acknowledge the participants for sharing their experiences with us.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e\u0026Ouml;zkurt S, Sağlan Y, G\u0026ouml;lgeli H, Sağlan R, Balcıoğlu H, Bilge U, et al. Hemodiyaliz Hastalarında Tedaviye Uyumun Değerlendirilmesi. Ankara Med J. 2017;17(4):275\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuran SGE-. Determination of the emotional and social problems in dialysis patients. 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Sağlık Akademisi Kastamonu. 2018;3(2):136\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNahcivan NTN. Sağlıklı Gen\u0026ccedil;lerde \u0026lsquo;\u0026rsquo;\u0026Ouml;z-Bakım G\u0026uuml;c\u0026uuml;\u0026rsquo;' ve Aile Ortamına Etkisi. İstanbul: İstanbul \u0026uuml;niversitesi; 1993.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCang\u0026ouml;l E, Şahİn NH. Emzirmenin Desteklenmesinde Bir Model: Pender\u0026rsquo;in Sağlığı Geliştirme Modeline Dayalı Motivasyonel G\u0026ouml;r\u0026uuml;şmeler. Hemşirelikte Eğitim ve Araştırma. 2017;14(1):98\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFalahee ML, Benkert R, George NM, Hartlieb KB, Cederna J. Motivational Interviewing To Increase Physical Activity In Underserved Women. J Nurse Practitioners. 2016;12(10):704\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ouml;zdemİr H, Taşci S. Motivasyonel G\u0026ouml;r\u0026uuml;şme Tekniği ve Hemşirelikte Kullanimi-The Application Of Motivational Interviewing Technique In Nursing. ER\u0026Uuml; Sağlık Bilimleri Fak\u0026uuml;ltesi Dergisi. 2013;1(1):41\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOk E, Kutlu Y. The Effect of Motivational Interviewing on Adherence to Treatment and Quality of Life in Chronic Hemodialysis Patients: A Randomized Controlled Trial. Clin Nurs Res. 2021;30(3):322\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang\u0026ouml;z ŞT, \u0026Ouml;zer Z. Hemodiyaliz Tedavisi Uygulanan Bireylerde Sıvı Alımına, Diyet ve İla\u0026ccedil; Y\u0026ouml;netimine Uyumda Motivasyonel G\u0026ouml;r\u0026uuml;şmenin Etkisi: Sistematik Derleme. Turkiye Klinikleri Hemsirelik Bilimleri. 2020;12(3):419\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Zhao H, Hao S, Xie J, Ouyang Y, Zhao S. Motivational Interviewing To Improve The Self-Care Behaviors For Patients With Chronic Heart Failure: A Randomized Controlled Trial. Int J Nurs Sci. 2018;5(3):213\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDashtidehkordi A, Shahgholian N, Maghsoudi J, Sadeghian J. The Effects Of Motivational Interviewing On The Health Status Of Patients Undergoing Hemodialysis. Iran J Nurs Midwifery Res. 2018;23(4):287.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtik D, Karatepe H. Scale Development Study: Adaptation To Chronic Illness. Acta Med Mediterranea. 2016;32(1):135\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubak S, Sandb\u0026aelig;k A, Lauritzen T, Borch-Johnsen K, Christensen B. Effect Of Motivational Interviewing On Quality Of Care Measures In Screen Detected Type 2 Diabetes Patients: A One-Year Follow-Up Of An Rct, Addition Denmark. Scand J Prim Health Care. 2011;29(2):92\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026uuml;lsoy H. Yaşlı Bireylere Verilen \u0026Ouml;z-Bakım Eğitiminin Sağlığın Geliştirilmesine Etkisi. İstanbul: Hali\u0026ccedil; \u0026Uuml;niversitesi; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkyol AD, Karadakovan A. Hemodiyalize Giren Hastalarin Yaşam Kalitesi ve \u0026Ouml;zbakim G\u0026uuml;c\u0026uuml; İle Bunlar \u0026Uuml;zerine Etkili Değişkenlerin İncelenmesi. Ege Tıp Dergisi. 2002;41(2):97\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEylem B, Mollaoğlu M. Hemodiyaliz Uygulanan Hastalarda \u0026Ouml;zbakım G\u0026uuml;c\u0026uuml; ve \u0026Ouml;z Yeterliliğin Değerlendirilmesi. Nefroloji Hemşireliği Dergisi. 2007;7(1\u0026ndash;2):31\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoattari M, Ebrahimi M, Sharifi N, Rouzbeh J. 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Adana: \u0026Ccedil;ukurova \u0026Uuml;niversitesi; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMollaoğlu M. Diyaliz Hastalarında Yeti Yitimi, G\u0026uuml;nl\u0026uuml;k Yaşam Aktiviteleri Ve \u0026Ouml;z Yeterlilik Durumu. TAF Prev Med Bull. 2011;10(2):181\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFırat HAŞ. Hemodiyaliz Hastalarına Uygulanan Grup Eğitiminin Hastaların Psikososyal Uyum ve \u0026Ouml;z-Bakım G\u0026uuml;c\u0026uuml;ne Etkisi. İstanbul:: Marmara \u0026Uuml;niversitesi; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ouml;zdemİr ST, Akyol AD. Hemodiyaliz Hastalarına Arteriyoven\u0026ouml;z Fist\u0026uuml;le İlişkin Verilen Eğitim \u0026Ouml;zbakım Davranışlarını Etkiler mi? Nefroloji Hemşireliği Dergisi. 2019;14(2):45\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFirat S, \u0026Ouml;ztun\u0026ccedil; G. Total Larenjektomili Hastalara Verilen Eğitimin \u0026Ouml;z Bakım G\u0026uuml;c\u0026uuml;ne Etkisi. Cukurova Med J. 2019;44(3):911\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuslu L, G\u0026uuml;nbayi İ, Ardahan M. Motivasyonel G\u0026ouml;r\u0026uuml;şme Programı\u0026rsquo;nın Tip 2 Diyabet Tanılı Yetişkinlerin Hastalıkla Başetme Ve Uyumlarına Etkisi: Bir Eylem Araştırması. Akdeniz \u0026Uuml;niversitesi Bilimsel Araştırma Projesi Antalya; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakan G, Akyol AD. Theory-Guided Interventions For Adaptation To Heart Failure. J Adv Nurs. 2008;61(6):596\u0026ndash;608.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatteson ML, Russell C. Interventions To Improve Hemodialysis Adherence: A Systematic Review Of Randomized-Controlled Trials. 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In: jozipovic m, editor. \u003cem\u003eGeriatrics\u003c/em\u003e: Intech Desing Team; 2012. pp. 153\u0026thinsp;\u0026ndash;\u0026thinsp;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathers TR. Effects Of Psychosocial Education On Adaptation In Elderly Hemodialysis Patients. Nephrol Nurs J. 1999;26(6):587.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hemodialysis, adaptation with chronic disease, motivational interview technique, self-care agency","lastPublishedDoi":"10.21203/rs.3.rs-5245305/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5245305/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study aimed to determine the effect of self-care-supported motivational interview on the self-care and disease adaptation of patients with hemodialysis treatment. Self-care training supported by motivational interviewing affects both patients' self-care and adaptation to the disease.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe research was conducted between October 2020 and March 2021 in the Hemodialysis Unit of a state hospital in a province in the east of Turkey. 77 hemodialysis patients participated in this study conducted with randomized controlled research pattern. Personal Information Form, Adaptation to Chronic Illness Scale and Self Care Agency Scale were used in the collection of data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIt was found that the average score in the experimental and control groups was similar prior to, and the score averages of the experimental group increased significantly after compared to those of the control group. In-group comparisons revealed that the difference between pre-test, post-test and follow-up test mean scores of patients in the experimental group and their mean scores has changed significantly. Pre-test, post-test and follow-up test total scores, physical scores and social scores of the patients in the control group showed significant differences.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn order to increase patients' adaptation to chronic diseases and their self-care power, self-care supported motivational interviewing technique should be applied to patients. In order to increase the health level of patients, nurses should use the self-care supported motivational interviewing technique during care practices.\u003c/p\u003e","manuscriptTitle":"Effectiveness of self-care supported motivational interview to increase self-care agency and disease adaptation levels of hemodialysis patients: A randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-23 10:43:45","doi":"10.21203/rs.3.rs-5245305/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"57806ebb-8c80-48ea-8636-ebb1aeff4851","owner":[],"postedDate":"October 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-01T10:38:50+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-23 10:43:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5245305","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5245305","identity":"rs-5245305","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}