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Randomized Controlled Trial
. 2024 Nov 20:12:1361778.
doi: 10.3389/fpubh.2024.1361778. eCollection 2024.

Effect of a transtheoretical model-based intervention and motivational interviewing on hyperphosphatemia management via telehealth (TMT program) among hemodialysis patients during the COVID-19 pandemic

Arrom Thongsunti  1 , Chatchawan Silpakit  2 , Thanapoom Rattananupong  3 , Wonngarm Kittanamongkolchai  4   5   6 , Warangkana Sumethpimolchai  7 , Vitool Lohsoonthorn  3
Affiliations
Randomized Controlled Trial

Effect of a transtheoretical model-based intervention and motivational interviewing on hyperphosphatemia management via telehealth (TMT program) among hemodialysis patients during the COVID-19 pandemic

Arrom Thongsunti et al. Front Public Health. .

Abstract

Background: Hyperphosphatemia poses a significant risk for cardiovascular diseases and mortality in hemodialysis patients. Non-adherence to phosphate binders and a low-phosphate diet behavior contribute to this issue. Leveraging psychological and behavior change theories has proven effective in addressing many health risks. During the COVID-19 pandemic, face-to-face communication was limited, and telehealth served as a bridge to address healthcare gaps. This study aimed to determine the effect of a transtheoretical model-based intervention and motivational interviewing on hyperphosphatemia management via telehealth (TMT program) among hemodialysis patients during the COVID-19 pandemic.

Method: A two-arm parallel randomized controlled trial with assessors blinding involved 80 participants who were stratified block-randomized into either the TMT program group (n = 40) or the control group (Usual care; n = 40). Linear regression was used to compare the two groups on serum phosphorus levels, knowledge of hyperphosphatemia management, and dietary consumption behavior at the 24-week endpoint. The readiness to change (stage of change), self-efficacy, and phosphate binder adherence were assessed using Fisher's test.

Result: The TMT program demonstrated a significant reduction in serum phosphorus levels compared to usual care (mean difference = -1.03, 95% CI = -1.77, -0.29). Additionally, improvement in dietary consumption behavior related to phosphorus-containing foods was also observed (mean difference = 13.48, 95% CI = 8.41, 18.57). Positive effects emerged in the readiness to change (p < 0.001), self-efficacy in the appropriate use of phosphate binders (p = 0.025), and adherence to phosphate binders (p = 0.001) at the 24-week endpoint. However, groups did not differ in knowledge of hyperphosphatemia management (mean difference = 7.02, 95% CI = -1.03, 15.07).

Conclusion: The study demonstrated that the TMT program has positive effects on reducing serum phosphorus levels, providing a hyperphosphatemia management strategy for ESRD patients undergoing hemodialysis via telehealth.

Clinical trial registration: TCTR20230628003, https://www.thaiclinicaltrials.org.

Keywords: hemodialysis; hyperphosphatemia; motivational interviewing; telehealth; transtheoretical model.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of randomization.
Figure 2
Figure 2
Schematic overview of the TMT program for the intervention group.
Figure 3
Figure 3
Graph of serum phosphorus levels for the TMT program and usual care groups.
See this image and copyright information in PMC

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