Effectiveness of a Structured Intervention on the Development of Self-Care Behaviors With AVF in HD Patients
Effectiveness of a Structured Intervention on the Development of Self-Care Behaviors With AVF in HD Patients
End stage renal disease patients (ESRD) should be educated to take care of their
 arteriovenous fistula (AVF). Educational programs should have clear objectives and the
 interventions should be well defined. Therefore, assessing the interventions that can have
 the strongest impact on the patient's acquisition of self-care behaviors with AVF is
 extremely important. The aim is to assess the effectiveness of a structured intervention on
 the frequency of self-care behaviors with AVF by patients with ESRD on hemodialysis (HD).
This was a quasi-experimental study in dialysis units, involving patients using AVF for HD.
 The dialysis units are located in the north of Portugal (two units) and in the Autonomous
 Region of the Azores (one unit). The study started after approval by the institution ethics
 committee.

 Study Setting and Population The study was carried out in dialysis units the north of
 Portugal, identified as Control Group (CG), and on an island in the Autonomous Region of the
 Azores, identified as Intervention Group (IG).

 Data Collection and Instrument All data were collected from January to June 2018. Information
 concerning the sample demographic characteristics (age, gender, education, employment,
 marital status) and clinical characteristics (ESRD etiology, dialysis vintage, previous AVFs,
 AVF duration, information on care with the AVF) was collected with a questionnaire designed
 by the authors.

 Information concerning self-care behaviors with the AVF was collected from the Scale of
 Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis (ASBHD-AVF) (8).
 This scale has 16 items in two subscales: subscale 1 - Management of Signs and Symptoms (6
 items) and subscale 2 - Prevention of Complications (10 items). Responses to each item are
 based on a 5-point Likert-type scale. Higher scores show patients' higher frequency of
 self-care with the AVF. The ASBHD-AVF scale has been applied to Portuguese patients with
 Cronbach's alpha of 0.797, 0.797 and 0.722 for the global scale and sub-scales 1 and 2,
 respectively.

 Memory problems were assessed by the Six-Item Cognitive Impairment Test (6CIT), Portuguese
 version (9).
Inclusion Criteria:

 -  participants should be 18 years or older;

 -  have an AVF duration on HD greater than 6 months

 -  have no memory problems

 -  be medically stable.

 Exclusion Criteria:

 -  patients with double vascular access (central venous catheter and AVF) or grafts as
 vascular access

 -  hospitalized patients at the time of data collection