以系統性文獻回顧方式建構慢性腎臟病之自我管理方案

The Use of Systematic Review to Develop a Self-Management Program for CKD

背景：慢性腎臟病（chronic kidney disease, CKD）因高盛行率及發生率，已成為國際上重視的公共健康議題，自我管理的概念更是廣泛被運用於慢性病教育方案；近年來國內外有許多研究相繼以自我管理方案介入慢性腎臟病，多探討介入前後生、心理之成效，卻仍缺乏完整系統性文獻回顧方式之自我管理方案供給臨床腎臟照護使用。目的：以系統性文獻回顧方式建立慢性腎臟病自我管理方案。方法：採三階段實施步驟，㈠系統性文獻回顧，搜尋CEPS華藝中文電子期刊、碩博士期刊論文、CINAHL、PubMed、Medline、Cochrane Library及Joanna Briggs Institute等資料庫，共計22篇文獻納入嚴謹評析，其中收錄4篇系統性文獻回顧、10篇隨機分派實驗研究、8篇非隨機實驗性研究，並萃取實證證據，㈡建構臨床應用方案，㈢採專家效度進行此方案之效度檢定，最後形成適合本土化之方案之建立。結果：依據實證文獻歸納出慢性腎臟病自我管理方案，方案內容包括方案設計原則、設計內容（介入措施種類）、元素、介入作法及方案大綱等。此方案再進行專家效度檢定，評分使用4分Liker's其適用性CVI值平均值為.98，最後形成本土化慢性腎臟病自我管理方案。結論／實務應用：建構適合本土化之慢性腎臟病自我管理方案，期望本方案能進一步提供臨床照護者健康指導患者之參考。

Background: Chronic kidney disease (CKD) has become a public health issue of international concern due to its high prevalence. The concept of self-management has been comprehensively applied in education programs that address chronic diseases. In recent years, many studies have used self-management programs in CKD interventions and have investigated the pre- and post-intervention physiological and psychological effectiveness of this approach. However, a complete clinical application program in the self-management model has yet to be developed for use in clinical renal care settings. Purpose: A systematic review is used to develop a self-management program for CKD. Method: Three implementation steps were used in this study. These steps include: (1) A systematic literature search and review using databases including CEPS (Chinese Electronic Periodical Services) of Airiti, National Digital Library of Theses and Dissertations in Taiwan, CINAHL, Pubmed, Medline, Cochrane Library, and Joanna Briggs Institute. A total of 22 studies were identified as valid and submitted to rigorous analysis. Of these, 4 were systematic literature reviews, 10 were randomized experimental studies, and 8 were non-randomized experimental studies. (2) Empirical evidence then was used to draft relevant guidelines on clinical application. (3) Finally, expert panels tested the validity of the draft to ensure the final version was valid for application in practice. Results: This study designed a self-management program for CKD based on the findings of empirical studies. The content of this program included: design principles, categories, elements, and the intervention measures used in the self-management program. This program and then was assessed using the content validity index (CVI) and a four-point Liker's scale. The content validity score was .98. The guideline of self-management program to CKD was thus developed. Conclusions/Implications for Practice: This study developed a self-management program applicable to local care of CKD. It is hoped that the guidelines developed in this study offer a reference for clinical caregivers to improve their healthcare practices.