背景：中介影響之分析有助於醫護人員瞭解持守健康行為、幫忙關係及健康促進生活型態之關係，進而建立有效的照護策略。慢性腎臟病病人持守健康行為於幫忙關係與健康促進的生活型態之中介效果仍未被探討。
目的：本研究目的為探討慢性腎臟病病人持守健康行為、幫忙關係及健康促進生活型態的長期軌跡變化及相關因素，並檢視持守健康行為對於幫忙關係與健康促進生活型態之長期中介影響。
方法：研究設計為二年長期縱貫性研究。研究對象預邀請於南臺灣門診之242位慢性腎臟病病人，並排除接受腎臟替代療法及無法溝通之病人。研究測量工具包含人口學及疾病相關變項、持守健康行為量表、重要關鍵人幫忙關係量表及中文版健康促進生活型態量表。統計方法以SPSS第17版之邏輯式回歸分析流失率是否為完全隨機結果；於描述性統計針對類別變項呈現次數分配及百分比、連續性變項則以平均值及標準差顯示。推論性統計則採用廣義估計方程式了解持守健康行為、幫忙關係及健康生活型態，持續追蹤二年四次之歷程變化，並辨認統計顯著變項為中介效果之控制變項。中介效果檢測分析以拔靴法於R統計軟體進行之。
結果：共收案250位研究個案經四次追蹤研究後，排除追蹤期間個案死亡、接受腎臟替代療法、無法溝通及拒絕之病人50位，流失率為20％，最後之研究對象為200位，統計顯示個案流失為隨機結果。本研究對象多為男性（59.5%）、平均年齡64歲（標準差13.4）、已緍（82%）、接受12年國教以上（54%）、無工作或退休（57%）、有高血壓（67.6%）、及有其他共病症（86.4%）、平均身體質量指數25.5 kg/m2（標準差4.5）、平均腎絲球過濾率44.5 ml/min/1.73m2（標準差32.4）、多為慢性腎臟病3b期（26%）。慢性腎臟病病人持守健康行為的趨勢變化呈現緩慢的上升、幫忙關係則先下降後上升走向。多數健康促進生活型態層面一開始呈現波動後上升走勢，於壓力管理及健康責任層面則出現統計顯著之持續上升趨勢。而於身體活動則呈現未達統計顯著之波動後下降趨勢。比較各層面之健康促進生活型態之得分，分數最高為人際關係與健康責任層面，而身體活動層面則得分最低。健康促進生活型態之多數層面與共病症指數、幫忙關係及持守健康行為有關。中介影響分析結果，顯示慢性腎臟病病人持守健康行為顯著的部份中介影響幫忙關係及多數健康促進生活型態層面，除靈性成長、健康責任及身體活動層面於特定追蹤時間呈現顯著的完全中介影響。
結論：慢性腎臟病病人在二年的追蹤中，持守健康行為呈現持續緩慢的提升，然而幫忙關係及多數健康促進生活型態層面則出現顯著的動態變化。共病症指數、幫忙關係及持守健康行為與健康促進生活型態多數健康促進生活型態層面有關。持守健康行為是幫忙關係及健康促進生活型態之靈性成長、健康責任及身體活動層面之重要中介角色。
護理應用：儘早辨認慢性腎臟病病人持守健康行為，同時增加重要關鍵人和病人的幫助關係，以完善健康促進生活型態的維持。研究人員未來可根據本研究結果，考慮募不同環境的參與者，並調查這些因素之關係達2年以上、或進行介入性研究。

Background: To Apply mediation analysis would help health care providers clarify the relationships among helping relationships, health-promoting lifestyles, adherence to healthy behaviors and facilitate to develop effective care strategies. The mediating role of adherence to healthy behaviors on the association between helping relationships and health-promoting lifestyles has not yet been explored among patients with chronic kidney disease (CKD).
Purpose: This research aimed to explore the longitudinal trajectories of adherence to healthy behaviors, helping relationships and health-promoting lifestyles and related factors as covariates and examine longitudinal mediation effects of adherence to healthy behaviors on the association of certain factors (helping relationships and health-promoting lifestyles) among patients with CKD.
Method: A two-year longitudinal study was conducted. A total of 242 adults with CKD who attended outpatient clinics in southern Taiwan would be invited to participate. Individuals who received renal replacement therapy (RRT) and were unable to communicate were excluded. Study measurements included demographic and disease-related characteristics, a scale of adherence to healthy behaviors, a scale of helping relationships from significant others, and a scale of health-promoting lifestyles profile-II-Chinese version as well. Using logistic regression examined whether missing completely at random via software SPSS V.17. Regarding descriptive statistics, distributions and percentages of categorical variables were used, while continuous variables were analyzed in terms of means and standard deviations (SDs) by utilizing SPSS V.17. In relation to inferential statistics, the generalized estimating equations (GEE) used to show the trajectories of adherence to healthy behaviors, helping relationships, and health-promoting lifestyles for four times over two-year period as well as identify the statistically significant variables as the covariates for further mediation analysis. The bootstrap confidence interval was used to explore longitudinal mediation effects by using the statistical software R.
Results: A total of 250 individuals followed up four times over two years. After excluding death, receiving RRT, being unable to communicate due to other diseases, and voluntary withdrawal, the final sample size were 200 participants with missing completely at random (50 missing and attrition rate 20%). The majority of participants were male (59.5%), mean age 64 (SD: 13.4), married (82%), had at least a 12th grade education (54%), were unemployment or retired (57%), had hypertension (67.6%), with comorbidities (86.4%), mean body mass index 25.5 kg/m2 (SD: 4.5), mean eGFR 44.5 ml/min/1.73m2 (SD: 32.4) with CKD stage 3b. The two-year longitudinal trajectory of adherence to healthy behaviors showed a minor increasing trend, while helping relationships demonstrated a downward direction and then an upward direction. The most dimensions of health-promoting lifestyles presented fluctuating trends then rising trends. The trajectories of health-promoting lifestyles in stress management and health responsibility dimensions showed continuous significantly increasing trends. While physical activity dimension illustrated a non-significant dynamic trend then decreasing trend. In comparison with the scores of each dimension of the health-promoting lifestyles, the highest scores were interpersonal relations and health responsibility dimensions, whereas the physical activity dimension showed the lowest score. The results of mediation analysis showed adherence to healthy behaviors significantly partially mediated on the associations between helping relationships and most dimensions of health-promoting lifestyles. Whereas the adherence to healthy behaviors significantly entirely accounted for the associations between helping relationships and spiritual growth, health responsibility as well as physical activity dimensions of health-promoting lifestyles at certain times.
Conclusion: The trajectory of adherence to healthy behaviors showed a slight increasing trend, while helping relationships and most dimensions of health-promoting lifestyles illustrated dynamic changes among patients with CKD over two-year follow-up. Comorbidities, helping relationships and adherence to healthy behaviors correlated with the most dimensions of health-promoting lifestyles. The adherence to healthy behaviors played a significant mediating role in relation to the helping relationships and spiritual growth, health responsibility as well as physical activity dimensions among patients with CKD over two years.
Nursing Implications: Early identification of adherence to healthy behaviors and simultaneously increasing helping relationships from significant others and patients are needed to optimize the maintenance of healthy lifestyles among patients with CKD. Based on the findings of the study, researcher can consider missing individuals and recruiting participants from different setting as well as investigate the relationships among these factors for periods of time longer than two years or develop an interventional study in the future.

Afsar, B., Siriopol, D., Aslan, G., Eren, O. C., Dagel, T., Kilic, U., Kanbay, A., Burlacu, A., Covic, A., & Kanbay, M. (2018). The impact of exercise on physical function, cardiovascular outcomes and quality of life in chronic kidney disease patients: a systematic review. International Urology and Nephrology, 50(5), 885-904. https://doi.org/10.1007/s11255-018-1790-4
Ahlawat, R., Tiwari, P., & D'Cruz, S. (2016). Prevalence and predictors of medication non-adherence in patients of chronic kidney disease: Evidence from a cross sectional study. Journal of Pharmaceutical Care & Health Systems, 3(152), 2376-0419. https://doi.org/10.4172/2376-0419.1000152
Ajrouche, A., Estellat, C., De Rycke, Y., & Tubach, F. (2020). Trajectories of Adherence to Low-Dose Aspirin Treatment Among the French Population. Journal of Cardiovascular Pharmacology and Therapeutics, 25(1), 37-46. https://doi.org/10.1177/1074248419865287
Alikari, V., & Zyga, S. (2014). Conceptual analysis of patient compliance in treatment. Health Science Journal, 8, 179-186. https://www.researchgate.net/publication/261287073_Conceptual_analysis_of_patient_compliance_in_treatment
Alshihiri, S., & Cohen, S. D. (2021). Chapter 13 - Social support in patients with CKD and ESRD. In D. Cukor, S. D. Cohen, & P. L. Kimmel (Eds.), Psychosocial Aspects of Chronic Kidney Disease (pp. 289-296). Academic Press. https://doi.org/10.1016/B978-0-12-817080-9.00013-0
Andersen, J. S., & Owen, D. C. (2014). Helping relationships for smoking cessation: grounded theory development of the process of finding help to quit. Nursing Research, 63(4), 252-259. https://doi.org/10.1097/nnr.0000000000000040
Anderson, C. A. M., & Nguyen, H. A. (2018). Nutrition education in the care of patients with chronic kidney disease and end-stage renal disease. Seminars in Dialysis, 31(2), 115-121. https://doi.org/10.1111/sdi.12681
Balanzá-Martínez, V., Kapczinski, F., de Azevedo Cardoso, T., Atienza-Carbonell, B., Rosa, A. R., Mota, J. C., & De Boni, R. B. (2021). The assessment of lifestyle changes during the COVID-19 pandemic using a multidimensional scale. Rev Psiquiatr Salud Ment, 14(1), 16-26. https://doi.org/10.1016/j.rpsm.2020.07.003
Bartram, A., Crabb, S., Hanson-Easey, S., & Eliott, J. (2018). “We Were Totally Supportive, of Course”: How People Talk About Supporting a Significant Other to Stop or Reduce Their Drinking. Qualitative Health Research, 29(8), 1120-1131. https://doi.org/10.1177/1049732318809945
Bauer, A. M., Parker, M. M., Schillinger, D., Katon, W., Adler, N., Adams, A. S., Moffet, H. H., & Karter, A. J. (2014). Associations Between Antidepressant Adherence and Shared Decision-Making, Patient–Provider Trust, and Communication Among Adults with Diabetes: Diabetes Study of Northern California (DISTANCE). Journal of General Internal Medicine, 29(8), 1139-1147. https://doi.org/10.1007/s11606-014-2845-6
Bates, D., Mächler, M., Bolker, B., & Walker, S. (2015). fitting linear mixed-effects models Using lme4. Journal of Statistical Software, 67(1), 1–48. https://doi.org/10.18637/jss.v067.i01
Beto, J. A., Schury, K. A., & Bansal, V. K. (2016). Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary. International Journal of Nephrology and Renovascular Disease, 9, 21-33. https://doi.org/10.2147/ijnrd.s76831
Bergström, M., Sverker, A., Larsson Ranada, Å., Valtersson, E., Thyberg, I., Östlund, G., & Björk, M. (2020). Significant others' influence on participation in everyday life - the perspectives of persons with early diagnosed rheumatoid arthritis. Disability and Rehabilitation, 42(3), 385-393. https://doi.org/10.1080/09638288.2018.1499825
Bikbov, B., Purcell, C. A., Levey, A. S., Smith, M., Abdoli, A., Abebe, M., Adebayo, O. M., Afarideh, M., Agarwal, S. K., Agudelo-Botero, M., Ahmadian, E., Al-Aly, Z., Alipour, V., Almasi-Hashiani, A., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Andrei, T., Andrei, C. L., Andualem, Z., …Vos, T. (2020). Global, regional, and national burden of chronic kidney disease: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 395(10225), 709-733. https://doi.org/10.1016/S0140-6736(20)30045-3
Brown, R. C. H., Maslen, H., & Savulescu, J. (2019). Responsibility, prudence and health promotion. Journal of Public Health (Oxford academic), 41(3), 561-565. https://doi.org/10.1093/pubmed/fdy113
Burgess, E., Hassmén, P., Welvaert, M., & Pumpa, K. L. (2017). Behavioural treatment strategies improve adherence to lifestylesintervention programmes in adults with obesity: a systematic review and meta-analysis. Clinical Obesity, 7(2), 105-114. https://doi.org/10.1111/cob.12180
Bustamante, A. V., Vilar-Compte, M., & Ochoa Lagunas, A. (2018). Social support and chronic disease management among older adults of Mexican heritage: A U.S.-Mexico perspective. Social Science & Medicine, 216, 107-113. https://doi.org/https://doi.org/10.1016/j.socscimed.2018.09.025
Chan, Y. M., Zalilah, M. S., & Hii, S. Z. (2012). Determinants of compliance behaviours among patients undergoing hemodialysis in Malaysia. PloS One, 7(8), e41362. https://doi.org/10.1371/journal.pone.0041362
Clark, W. F., Sontrop, J. M., Huang, S. H., Gallo, K., Moist, L., House, A. A., Cuerden, M. S., Weir, M. A., Bagga, A., Brimble, S., Burke, A., Muirhead, N., Pandeya, S., & Garg, A. X. (2018). Effect of coaching to increase water intake on kidney function decline in adults with chronic kidney disease: The CKD WIT randomized clinical trial. The Journal of the American Medical Association, 319(18), 1870-1879. https://doi.org/10.1001/jama.2018.4930
Charlson, M. E., Charlson, R. E., Peterson, J. C., Marinopoulos, S. S., Briggs, W. M., & Hollenberg, J. P. (2008). The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. Journal of Clinical Epidemiology, 61(12), 1234-1240. https://doi.org/10.1016/j.jclinepi.2008.01.006
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383. https://doi.org/10.1016/0021-9681(87)90171-8
Chao, S.M., Yen, M., Teng, H. L., Lin, M. F., & Yueh, F. R. (in submitting). Development and psychometric evaluation of the helping relationship from significant other instrument for use with chronic kidney disease patients.
Chen, Y. C., Chang, L. C., Liu, C. Y., Ho, Y. F., Weng, S. C., & Tsai, T. I. (2018). The roles of social support and health literacy in self-management among patients with chronic kidney disease. Journal of Nursing Scholarship, 50(3), 265-275. https://doi.org/10.1111/jnu.12377
Chen, T. K., Sperati, C. J., Thavarajah, S., & Grams, M. E. (2021). Reducing Kidney Function Decline in Patients With CKD: Core Curriculum 2021. American Journal of Kidney Diseases, 77(6), 969-983. https://doi.org/10.1053/j.ajkd.2020.12.022
Chironda, G., & Bhengu, B. R. (2019). Motivators of adherence to integrated management among patients with chronic kidney disease: A qualitative study. Nursing & Health Sciences, 21(1), 63-70. https://doi.org/10.1111/nhs.12556
Chironda, G., & Bhengu, B. (2016). Contributing factors to non-adherence among chronic kidney disease (CKD) patients: a systematic review of literature. Medical & Clinical Reviews, 2(4), 29. https://doi.org/10.21767/2471-299X.1000038
de Brito-Ashurst, I., Perry, L., Sanders, T. A. B., Thomas, J. E., Dobbie, H., Varagunam, M., & Yaqoob, M. M. (2013). The role of salt intake and salt sensitivity in the management of hypertension in South Asian people with chronic kidney disease: a randomised controlled trial. Heart (British Cardiac Society), 99(17), 1256-1260. https://doi.org/10.1136/heartjnl-2013-303688
Delgado, C., & Johansen, K. L. (2012). Barriers to exercise participation among dialysis patients. Nephrology Dialysis Transplantation, 27(3), 1152-1157. https://doi.org/10.1093/ndt/gfr404
DiMatteo, M. R., Haskard-Zolnierek, K. B., & Martin, L. R. (2012). Improving patient adherence: a three-factor model to guide practice. Health Psychology Review, 6(1), 74-91. https://doi.org/10.1080/17437199.2010.537592
Evangelidis, N., Craig, J., Bauman, A., Manera, K., Saglimbene, V., & Tong, A. (2019). Lifestyles behaviour change for preventing the progression of chronic kidney disease: a systematic review. BMJ open, 9(10), e031625. https://doi.org/10.1136/bmjopen-2019-031625
Franz, M. J., Boucher, J. L., Rutten-Ramos, S., & VanWormer, J. J. (2015). Lifestyles weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447-1463. https://doi.org/10.1016/j.jand.2015.02.031
Gardner, C. L. (2015). Adherence: A Concept Analysis. International Journal of Nursing Knowledge, 26(2), 96-101. https://doi.org/10.1111/2047-3095.12046
Gregg, E. W., & Shaw, J. E. (2017). Global Health Effects of Overweight and Obesity. The New England Journal of Medicine, 377(1), 80-81. https://doi.org/10.1056/NEJMe1706095
Grosso, G., Bella, F., Godos, J., Sciacca, S., Del Rio, D., Ray, S., Galvano, F., & Giovannucci, E. L. (2017). Possible role of diet in cancer: systematic review and multiple meta-analyses of dietary patterns, lifestylesfactors, and cancer risk. Nutrition Reviews, 75(6), 405-419. https://doi.org/10.1093/nutrit/nux012
Gustavson, K., von Soest, T., Karevold, E., & Røysamb, E. (2012). Attrition and generalizability in longitudinal studies: findings from a 15-year population-based study and a Monte Carlo simulation study. BMC Public Health, 12, 918. https://doi.org/10.1186/1471-2458-12-918
Hayes, A. F. (2018). The simple mediation model. In Little, T. D. (Eds.). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd Edition., pp. 77-112). Guilford Publications. http://www.afhayes.com/introduction-to-mediation-moderation-and-conditional-process-analysis.html
Health Promotion Administration. (2018). Chronic kidney disease management booklet. Retrieved from https://www.hpa.gov.tw/File/Attach/6639/File_6234.pdf
Hellfritzsch, M., Thomsen, R. W., Baggesen, L. M., Larsen, F. B., Sørensen, H. T., & Christiansen, C. F. (2017). Lifestyle, socioeconomic characteristics, and medical history of elderly persons who receive seasonal influenza vaccination in a tax-supported healthcare system. Vaccine, 35(18), 2396-2403. https://doi.org/10.1016/j.vaccine.2017.03.040
Hinwood, M., Ilicic, M., Gyawali, P., Kluge, M. G., Coupland, K., Smith, A., Nilsson, M., & Walker, F. R. (2020). Exploration of stress management interventions to address psychological stress in stroke survivors: a protocol for a scoping review. BMJ open, 10(3), e035592. https://doi.org/10.1136/bmjopen-2019-035592
Hsu, C. H. C., & Huang, S. (2016). Reconfiguring Chinese cultural values and their tourism implications. Tourism Management, 54, 230-242. https://doi.org/10.1016/j.tourman.2015.11.011
Huang, C., Natashia, D., Lin, T., & Yen, M. (2021). Development of the Adherence to Healthy Behaviors Scale. Clinical Nursing Research. https://doi.org/doi:10.1177/1054773820988629
Ikizler, T. A., Robinson-Cohen, C., Ellis, C., Headley, S. A. E., Tuttle, K., Wood, R. J., Evans, E. E., Milch, C. M., Moody, K. A., Germain, M., Limkunakul, C., Bian, A., Stewart, T. G., & Himmelfarb, J. (2018). Metabolic Effects of Diet and Exercise in Patients with Moderate to Severe CKD: A Randomized Clinical Trial. Journal of the American Society of Nephrology, 29(1), 250-259. https://doi.org/10.1681/asn.2017010020
Inker, L. A., Astor, B. C., Fox, C. H., Isakova, T., Lash, J. P., Peralta, C. A., Kurella Tamura, M., & Feldman, H. I. (2014). KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. American Journal of Kidney Diseases, 63(5), 713-735. https://doi.org/10.1053/j.ajkd.2014.01.416
Jiamjariyapon, T., Ingsathit, A., Pongpirul, K., Vipattawat, K., Kanchanakorn, S., Saetie, A., Kanistanon, D., Wongprompitak, P., Leesmidt, V., Watcharasaksilp, W., Wang, W., Chandraker, A. K., & Tungsanga, K. (2017). Effectiveness of Integrated Care on Delaying Progression of stage 3-4 Chronic Kidney Disease in Rural Communities of Thailand (ESCORT study): a cluster randomized controlled trial. BMC Nephrol, 18(1), 83. https://doi.org/10.1186/s12882-016-0414-4
Johnson, E. R., Carson, T. L., Affuso, O., Hardy, C. M., & Baskin, M. L. (2014). Relationship Between Social Support and Body Mass Index Among Overweight and Obese African American Women in the Rural Deep South, 2011-2013. Preventing Chronic Disease, 11, E224. https://doi.org/10.5888/pcd11.140340
Kalantar-Zadeh, K., & Li, P. K. (2020). Strategies to prevent kidney disease and its progression. Nature Reviews Nephrology, 16(3), 129-130. https://doi.org/10.1038/s41581-020-0253-1
Kasl, S. V., & Cobb, S. (1966). Health behavior, illness behavior, and sick role behavior. I. Health and illness behavior. Archives of Environmental Health, 12(2), 246-266. https://doi.org/10.1080/00039896.1966.10664365
Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS One, 9(4), e94207. https://doi.org/10.1371/journal.pone.0094207
Kelly, D. L., Yang, G. S., Starkweather, A. R., Siangphoe, U., Alexander-Delpech, P., & Lyon, D. E. (2020). Relationships Among Fatigue, Anxiety, Depression, and Pain and Health-Promoting LifestylesBehaviors in Women With Early-Stage Breast Cancer. Cancer Nursing, 43(2), 134-146. https://doi.org/10.1097/ncc.0000000000000676
Kendrick, J., Ritchie, M., & Andrews, E. (2019). Exercise in Individuals With CKD: A Focus Group Study Exploring Patient Attitudes, Motivations, and Barriers to Exercise. Kidney Medicine, 1(3), 131-138. https://doi.org/https://doi.org/10.1016/j.xkme.2019.03.004
Kiajamali, M., Hosseini, M., Estebsari, F., Nasiri, M., Ashktorab, T., Abdi, A., Mahmoudi, A., & Abadi, A. S. A. (2017). Correlation between social support, self-efficacy and health-promoting behavior in hemodialysis patients hospitalized in Karaj in 2015. Electronic physician, 9(7), 4820. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586999/pdf/epj-09-4820.pdf
Kim, Y., Evangelista, L. S., Phillips, L. R., Pavlish, C., & Kopple, J. D. (2010). The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): testing the psychometric properties in patients receiving in-center hemodialysis. Nephrology nursing journal : journal of the American Nephrology Nurses' Association, 37(4), 377-393.
Koetsenruijter, J., van Eikelenboom, N., van Lieshout, J., Vassilev, I., Lionis, C., Todorova, E., Portillo, M. C., Foss, C., Serrano Gil, M., Roukova, P., Angelaki, A., Mujika, A., Knutsen, I. R., Rogers, A., & Wensing, M. (2016). Social support and self-management capabilities in diabetes patients: An international observational study. Patient Education and Counseling, 99(4), 638-643. https://doi.org/https://doi.org/10.1016/j.pec.2015.10.029
Kong, L. N., Hu, P., Yao, Y., & Zhao, Q. H. (2019). Social support as a mediator between depression and quality of life in Chinese community-dwelling older adults with chronic disease. Geriatric Nursing, 40(3), 252-256. https://doi.org/10.1016/j.gerinurse.2018.10.014
Kovesdy, C. P., Furth, S. L., & Zoccali, C. (2017). Obesity and kidney disease: hidden consequences of the epidemic. Journal of Nephrology, 30(1), 1-10. https://doi.org/10.1007/s40620-017-0377-y
Kuiper, J. S., Zuidersma, M., Oude Voshaar, R. C., Zuidema, S. U., van den Heuvel, E. R., Stolk, R. P., & Smidt, N. (2015). Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Research Reviews, 22, 39-57. https://doi.org/10.1016/j.arr.2015.04.006
Kumar, A., Narayan, P., & Kokkinos, P. (2019). Chronic Kidney Disease and Physical Activity. In P. Kokkinos & P. Narayan (Eds.), Cardiorespiratory Fitness in Cardiometabolic Diseases: Prevention and Management in Clinical Practice (pp. 363-372). Springer International Publishing. https://doi.org/10.1007/978-3-030-04816-7_21
Lam, L. W., Lee, D. T., & Shiu, A. T. (2014). The dynamic process of adherence to a renal therapeutic regimen: perspectives of patients undergoing continuous ambulatory peritoneal dialysis. International Journal of Nursing Studies, 51(6), 908-916. https://doi.org/10.1016/j.ijnurstu.2013.10.012
Langford, C. P., Bowsher, J., Maloney, J. P., & Lillis, P. P. (1997). Social support: a conceptual analysis. Journal of Advanced Nursing, 25(1), 95-100. https://doi.org/10.1046/j.1365-2648.1997.1997025095.x
Lau, Y., & Chan, K. S. (2018). Psychometric evaluation of the Chinese version of the fear of intimacy with helping professionals scale. PloS One, 13(5), e0196774. https://doi.org/10.1371/journal.pone.0196774
Lee, M. C., Wu, S. V., Hsieh, N. C., & Tsai, J. M. (2016). Self-Management Programs on eGFR, Depression, and Quality of Life among Patients with Chronic Kidney Disease: A Meta-Analysis. Asian Nursing Research, 10(4), 255-262. https://doi.org/10.1016/j.anr.2016.04.002
Liang, K. Y., & Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73(1), 13-22. https://doi.org/10.1093/biomet/73.1.13
Liu, J., & Ulrich, C. (2016). Mediation analysis in nursing research: a methodological review. Contemporary Nurse, 52(6), 643-656. https://doi.org/10.1080/10376178.2015.1041999
Lopez-Vargas, P. A., Tong, A., Howell, M., & Craig, J. C. (2016). Educational Interventions for Patients With CKD: A Systematic Review. American Journal of Kidney Diseases, 68(3), 353-370. https://doi.org/10.1053/j.ajkd.2016.01.022
Lora, C. M., Gordon, E. J., Sharp, L. K., Fischer, M. J., Gerber, B. S., & Lash, J. P. (2011). Progression of CKD in Hispanics: potential roles of health literacy, acculturation, and social support. American Journal of Kidney Diseases, 58(2), 282-290. https://doi.org/10.1053/j.ajkd.2011.05.004
Luyckx, V. A., Tonelli, M., & Stanifer, J. W. (2018). The global burden of kidney disease and the sustainable development goals. Bulletin of the World Health Organization, 96(6), 414-422D. https://doi.org/10.2471/BLT.17.206441
Lv, N., Azar, K. M. J., Rosas, L. G., Wulfovich, S., Xiao, L., & Ma, J. (2017). Behavioral lifestylesinterventions for moderate and severe obesity: A systematic review. Preventive Medicine, 100, 180-193. https://doi.org/10.1016/j.ypmed.2017.04.022
Lyu, C.-M., & Zhang, L. (2019). Concept analysis of adherence. Frontiers of Nursing, 6(2), 81-86. https://doi.org/https://doi.org/10.2478/FON-2019-0013
Manfredini, F., Mallamaci, F., Catizone, L., & Zoccali, C. (2012). The burden of physical inactivity in chronic kidney disease: is there an exit strategy? Nephrology, Dialysis, Transplantation, 27(6), 2143-2145. https://doi.org/10.1093/ndt/gfs120
Mazzella, F., Cacciatore, F., Galizia, G., Della-Morte, D., Rossetti, M., Abbruzzese, R., Langellotto, A., Avolio, D., Gargiulo, G., Ferrara, N., Rengo, F., & Abete, P. (2010). Social support and long-term mortality in the elderly: role of comorbidity. Archives of Gerontology and Geriatrics, 51(3), 323-328. https://doi.org/10.1016/j.archger.2010.01.011
Meihan, L., & Chung-Ngok, W. (2011). Validation of the psychometric properties of the health-promoting lifestylesprofile in a sample of Taiwanese women. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 20(4), 523-528. https://doi.org/10.1007/s11136-010-9790-6
Meuleman, Y., Hoekstra, T., Dekker, F. W., van der Boog, P. J. M., & van Dijk, S. (2018). Perceived sodium reduction barriers among patients with chronic kidney disease: which barriers are important and which patients experience barriers? International Journal of Behavioral Medicine, 25(1), 93-102. https://doi.org/10.1007/s12529-017-9668-x
Michishita, R., Matsuda, T., Kawakami, S., Tanaka, S., Kiyonaga, A., Tanaka, H., Morito, N., & Higaki, Y. (2017). The association between changes in lifestylesbehaviors and the incidence of chronic kidney disease (CKD) in middle-aged and older men. Journal of Epidemiology, 27(8), 389-397. https://doi.org/10.1016/j.je.2016.08.013
Mojaverian, T., Hashimoto, T., & Kim, H. (2013). Cultural Differences in Professional Help Seeking: A Comparison of Japan and the U.S. Frontiers in Psychology, 3(615). https://doi.org/10.3389/fpsyg.2012.00615
Monfared, A., Soodmand, M., Ghasemzadeh, G., Mirzaee, S., Mohammadi, M., & Amoozadeh Licha, N. (2019). Study of Lifestyle, Sleep Quality, and Related Factors in Hemodialysis Patients. Journal of Holistic Nursing And Midwifery, 29(3), 37-45. https://doi.org/10.32598/jhnm.29.3.159
Morisky, D. E., Ang, A., Krousel-Wood, M., & Ward, H. J. (2008). Predictive validity of a medication adherence measure in an outpatient setting. Journal of clinical hypertension (Greenwich, Conn.), 10(5), 348–354. https://doi.org/10.1111/j.1751-7176.2008.07572.x
Nag, N., & Jelinek, G. A. (2019). A Narrative Review of LifestylesFactors Associated with Parkinson's Disease Risk and Progression. Neuro-Degenerative Diseases, 19(2), 51-59. https://doi.org/10.1159/000502292
MDCalc. (2020). Charlson Comorbidity Index. Charlson, M. E. https://www.mdcalc.com/charlson-comorbidity-index-cci
Ministry of Health and Welfare. (2020). Taiwan’s Leading Causes of Death in 2019. Department of Statistics, Ministry of Health and Welfare. https://www.mohw.gov.tw/cp-16-54482-1.html
National Health Insurance Administration. (2020). 2019年國人全民健康保險就醫疾病資訊. Ministry of Health and Welfare. https://www.nhi.gov.tw/Content_List.aspx?n=806314145D8E1187&topn=CDA985A80C0DE710
National Health Research Institutes. (2015). 2015 Taiwan chronic kidney disease clinical guidelines. https://www.tsn.org.tw/UI/H/H00202.aspx
National Kidney Foundation. (2021). Chronic kidney disease (CKD) symptoms and causes. https://www.kidney.org/atoz/content/about-chronic-kidney-disease
Pérez-Fortis, A., Ulla Díez, S. M., & Padilla, J.-L. (2012). Psychometric properties of the Spanish version of the health-promoting lifestylesprofile II. Research in Nursing and Health, 35(3), 301-313. https://doi.org/10.1002/nur.21470
Pan, H., Liu, S., Miao, D., & Yuan, Y. (2018). Sample size determination for mediation analysis of longitudinal data. BMC Medical Research Methodology, 18(1), 32. https://doi.org/10.1186/s12874-018-0473-2
Pappa, K., Doty, T., Taff, S. D., Kniepmann, K., & Foster, E. R. (2017). Self-management program participation and social support in Parkinson's disease: Mixed methods evaluation. Physical & Occupational Therapy in Geriatrics, 35(2), 81-98. https://doi.org/10.1080/02703181.2017.1288673
Pazhayattil, G. S., & Shirali, A. C. (2014). Drug-induced impairment of renal function. International journal of nephrology and renovascular disease, 7, 457–468. https://doi.org/10.2147/IJNRD.S39747
Pelekasis, P., Zisi, G., Koumarianou, A., Marioli, A., Chrousos, G., Syrigos, K., & Darviri, C. (2016). Forming a Stress Management and Health Promotion Program for Women Undergoing Chemotherapy for Breast Cancer: A Pilot Randomized Controlled Trial. Integrative Cancer Therapies, 15(2), 165-174. https://doi.org/10.1177/1534735415598225
Perry, B. (2012). Social Network Dynamics and Biographical Disruption: The Case of “First-Timers” with Mental Illness 1. American Journal of Sociology, 118. https://doi.org/10.1086/666377
Pinar, R., Celik, R., & Bahcecik, N. (2009). Reliability and construct validity of the Health-Promoting LifestylesProfile II in an adult Turkish population. Nursing Research, 58(3), 184-193. https://doi.org/10.1097/NNR.0b013e31819a8248
Prochaska, J., & Diclemente, C. (1982). Trans-Theoretical Therapy - Toward A More Integrative Model of Change. Psychotherapy: Theory, Research & Practice, 19, 276-288. https://doi.org/10.1037/h0088437
Prochaska, J. O., Redding, C. A., & Evers, K. E. (2015). The transtheoretical model and stages of change. In K. Glanz, B. K. Rimer, & K. "V." Viswanath (Eds.), Health behavior: Theory, research, and practice (pp. 125-148). Jossey-Bass/Wiley.
Puchalski, C. M. (2013). Integrating spirituality into patient care: an essential element of person‑centered care. Polskie Archiwum Medycyny Wewnetrznej, 123(9), 491-497.
Pugh, D., Gallacher, P. J., & Dhaun, N. (2019). Management of Hypertension in Chronic Kidney Disease. Drugs, 79(4), 365-379. https://doi.org/10.1007/s40265-019-1064-1
R Core Team (2017). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/
Ramkisson, S., Pillay, B. J., & Sibanda, W. (2017). Social support and coping in adults with type 2 diabetes. African Journal of Primary Health Care & Family Medicine, 9(1), e1-e8. https://doi.org/10.4102/phcfm.v9i1.1405
Rathnayake, N., Alwis, G., Lenora, J., & Lekamwasam, S. (2020). Applicability of health promoting lifestylesprofile-II for postmenopausal women in Sri Lanka; a validation study. Health and Quality of Life Outcomes, 18(1), 122. https://doi.org/10.1186/s12955-020-01371-7
Reeves, D., Blickem, C., Vassilev, I., Brooks, H., Kennedy, A., Richardson, G., & Rogers, A. (2014). The Contribution of Social Networks to the Health and Self-Management of Patients with Long-Term Conditions: A Longitudinal Study. PloS One, 9(6), e98340. https://doi.org/10.1371/journal.pone.0098340
Reynolds, W. J., & Scott, B. (1999). Empathy: a crucial component of the helping relationship. Journal of Psychiatric and Mental Health Nursing, 6(5), 363-370. https://doi.org/10.1046/j.1365-2850.1999.00228.x
Ricardo, A. C., Anderson, C. A., Yang, W., Zhang, X., Fischer, M. J., Dember, L. M., Fink, J. C., Frydrych, A., Jensvold, N. G., Lustigova, E., Nessel, L. C., Porter, A. C., Rahman, M., Wright Nunes, J. A., Daviglus, M. L., & Lash, J. P. (2015). Healthy lifestylesand risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. American Journal of Kidney Diseases, 65(3), 412-424. https://doi.org/10.1053/j.ajkd.2014.09.016
Ricardo, A. C., Madero, M., Yang, W., Anderson, C., Menezes, M., Fischer, M. J., Turyk, M., Daviglus, M. L., & Lash, J. P. (2013). Adherence to a healthy lifestylesand all-cause mortality in CKD. Clinical Journal of the American Society of Nephrology, 8(4), 602-609. https://doi.org/10.2215/cjn.00600112
Rogers, C. R. (2004). On Becoming a Person. A therapist’s view of psychotherapy. The Characteristics of a Helping Relationship (pp. 39-58). London: Constable.
Rosenbaum, S., Tiedemann, A., Sherrington, C., Curtis, J., & Ward, P. B. (2014). Physical activity interventions for people with mental illness: a systematic review and meta-analysis. Journal of Clinical Psychiatry, 75(9), 964-974. https://doi.org/10.4088/JCP.13r08765
Salam, R. A., Das, J. K., & Bhutta, Z. A. (2019). Integrating nutrition into health systems: What the evidence advocates. Maternal & Child Nutrition, 15 Suppl 1(Suppl 1), e12738. https://doi.org/10.1111/mcn.12738
Saltzman, L. Y., Hansel, T. C., & Bordnick, P. S. (2020). Loneliness, isolation, and social support factors in post-COVID-19 mental health. Psychological Trauma: Theory, Research, Practice and Policy, 12(S1), S55-s57. https://doi.org/10.1037/tra0000703
Samadian, F., Dalili, N., & Jamalian, A. (2016). LifestylesModifications to Prevent and Control Hypertension. Iranian Journal of Kidney Diseases, 10(5), 237-263. http://www.ijkd.org/index.php/ijkd/article/view/2725
Sanders, K. A., Whited, A., & Martino, S. (2013). Motivational interviewing for patients with chronic kidney disease. Seminars in Dialysis, 26(2), 175-179. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608718/pdf/nihms-434519.pdf
Sevick, M. A., Woolf, K., Mattoo, A., Katz, S. D., Li, H., St-Jules, D. E., Jagannathan, R., Hu, L., Pompeii, M. L., Ganguzza, L., Li, Z., Sierra, A., Williams, S. K., & Goldfarb, D. S. (2018). The Healthy Hearts and Kidneys (HHK) study: Design of a 2×2 RCT of technology-supported self-monitoring and social cognitive theory-based counseling to engage overweight people with diabetes and chronic kidney disease in multiple lifestyleschanges. Contemporary Clinical Trials, 64, 265-273. https://doi.org/10.1016/j.cct.2017.08.020
Shirai, Y., Kuriki, K., Endoh, K., Miyauchi, R., Kasezawa, N., Tohyama, K., & Goda, T. (2016). Positive linear dose-response relationships, but no J-shaped relationship, between drinking habits and estimated glomerular filtration rate in middle-aged Japanese men. Alcohol, 51, 71-77. https://doi.org/10.1016/j.alcohol.2015.12.004
Smith, Mark K. (2008) “Helping relationships”, The encyclopedia of pedagogy and informal education. https://www.infed.org/mobi/helping-relationships-principles-theory-and-practice
Sousa, H., Ribeiro, O., Paúl, C., Costa, E., Miranda, V., Ribeiro, F., & Figueiredo, D. (2019). Social support and treatment adherence in patients with end-stage renal disease: A systematic review. Seminars in Dialysis, 32(6), 562-574. https://doi.org/10.1111/sdi.12831
Sousa, P., Gaspar, P., Vaz, D. C., Gonzaga, S., & Dixe, M. A. (2015). Measuring health-promoting behaviors: cross-cultural validation of the Health-Promoting LifestylesProfile-II. International Journal of Nursing Knowledge, 26(2), 54-61. https://doi.org/10.1111/2047-3095.12065
Tanjani, P. T., Azadbakht, M., Garmaroudi, G., Sahaf, R., & Fekrizadeh, Z. (2016). Validity and Reliability of Health Promoting LifestylesProfile II in the Iranian Elderly. International Journal of Preventive Medicine, 7, 74. https://doi.org/10.4103/2008-7802.182731
Teng, H. L., Yen, M., Fetzer, S., Sung, J. M., & Hung, S. Y. (2021). Tailoring Health-promoting Programs for Patients with Chronic Kidney Disease: Randomized Controlled Trial. Western Journal of Nursing Research, 43(2), 138-150. https://doi.org/10.1177/0193945920942487
Teng, H.-L., Yen, M., Fetzer, S., Sung, J.-M., & Hung, S.-Y. (2013). Effects of targeted interventions on lifestylesmodifications of chronic kidney disease patients: randomized controlled trial. Western journal of nursing research, 35(9), 1107-1127. https://doi.org/10.1177/0193945913486202
Teng, H. L., Yen, M., & Fetzer, S. (2010). Health promotion lifestylesprofile-II: Chinese version short form. Journal of Advanced Nursing, 66(8), 1864-1873. https://doi.org/10.1111/j.1365-2648.2010.05353.x
Tesfaye, W. H., McKercher, C., Peterson, G. M., Castelino, R. L., Jose, M., Zaidi, S. T. R., & Wimmer, B. C. (2020). Medication adherence, burden and health-related quality of life in adults with predialysis chronic kidney disease: A prospective cohort study. International Journal of Environmental Research and Public Health, 17(1), 371.
The official website of the military health system. (2020). COVID-19: lifestyle tips to stay healthy during the pandemic. https://www.health.mil/News/Articles/2020/05/22/COVID-19-lifestyle-tips-to-stay-healthy-during-the-pandemic
Tough, H., Siegrist, J., & Fekete, C. (2017). Social relationships, mental health and wellbeing in physical disability: a systematic review. BMC Public Health, 17(1), 414. https://doi.org/10.1186/s12889-017-4308-6
Traina, G., Martinussen, P. E., & Feiring, E. (2019). Being Healthy, Being Sick, Being Responsible: Attitudes towards Responsibility for Health in a Public Healthcare System. Public Health Ethics, 12(2), 145-157. https://doi.org/10.1093/phe/phz009
Turner-McGrievy, G. M., Dunn, C. G., Wilcox, S., Boutté, A. K., Hutto, B., Hoover, A., & Muth, E. (2019). Defining Adherence to Mobile Dietary Self-Monitoring and Assessing Tracking Over Time: Tracking at Least Two Eating Occasions per Day Is Best Marker of Adherence within Two Different Mobile Health Randomized Weight Loss Interventions. Journal of the Academy of Nutrition and Dietetics, 119(9), 1516-1524. https://doi.org/10.1016/j.jand.2019.03.012
Untas, A., Rascle, N., Idier, L., Lasseur, C., & Combe, C. (2012). Family relations, mental health and adherence to nutritional guidelines in patients facing dialysis initiation. Psychology & Health, 27(7), 753-766. https://doi.org/10.1080/08870446.2011.574699
Uusitupa, M., Khan, T. A., Viguiliouk, E., Kahleova, H., Rivellese, A. A., Hermansen, K., Pfeiffer, A., Thanopoulou, A., Salas-Salvadó, J., Schwab, U., & Sievenpiper, J. L. (2019). Prevention of type 2 diabetes by lifestyles changes: a systematic review and meta-analysis. Nutrients, 11(11). https://doi.org/10.3390/nu11112611
Vincensi, B. B. (2019). Interconnections: spirituality, spiritual care, and patient-centered care. Asia-Pacific Journal of Oncology Nurssing, 6(2), 104-110. https://doi.org/10.4103/apjon.apjon_48_18
Vlaminck, H., Maes, B., Jacobs, A., Reyntjens, S., & Evers, G. (2001). The dialysis diet and fluid non-adherence questionnaire validity testing of a self-report instrument for clinical practice. Journal of Clinical Nursing, 10, 707-715. https://doi.org/10.1046/j.1365-2702.2001.00537.x
Wakasugi, M., Kazama, J., Narita, I., Iseki, K., Fujimoto, S., Moriyama, T., . . . & Watanabe, T. (2017). Association between Overall Lifestyle Changes and the Incidence of Proteinuria: A Population-based, Cohort Study. Internal Medicine, 56(12), 1475-1484. https://doi.org/10.2169/internalmedicine.56.8006
Wakasugi, M., Kazama, J. J., Yamamoto, S., Kawamura, K., & Narita, I. (2013). A combination of healthy lifestylesfactors is associated with a decreased incidence of chronic kidney disease: a population-based cohort study. Hypertension research, 36(4), 328-333. https://www.nature.com/articles/hr2012186.pdf
Walker, S. N., Sechrist, K. R., & Pender, N. J. (1987). The Health-Promoting LifestylesProfile: development and psychometric characteristics. Nursing Research, 36(2), 76-81.
Walker, S. N., Sechrist, K. R., & Pender, N. J. (1995). Health promotion model-instruments to measure health promoting lifestyle: Health-promoting lifestylesprofile [HPLP II](Adult version). http://hdl.handle.net/2027.42/85349
Wang, M., Yu, S. Y., Lv, Z. T., & Yao, Y. (2018). Betel nut chewing and the risk of chronic kidney disease: evidence from a meta-analysis. International Urology and Nephrology, 50, 1097–1104. https://doi.org/10.1007/s11255-018-1819-8
Wei, C. N., Harada, K., Ueda, K., Fukumoto, K., Minamoto, K., & Ueda, A. (2012). Assessment of health-promoting lifestylesprofile in Japanese university students. Environmental Health and Preventive Medicine, 17(3), 222-227. https://doi.org/10.1007/s12199-011-0244-8
World Health Organization. (2020a). Noncommunicable diseases. https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_2
World Health Organization. (2020b). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
World Health Organization. (2003). Adherence to long-term therapies: evidence for action. Sabaté, E. https://www.who.int/chp/knowledge/publications/adherence_report/en/
World Health Organization. Regional Office for the Western. (2000). The Asia-Pacific perspective: redefining obesity and its treatment: Sydney: Health Communications Australia. https://apps.who.int/iris/handle/10665/206936
World Health Organization. Regional Office for Europe. (‎1999)‎. Healthy living: what is a healthy lifestyle? Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/108180
Wilkinson, T. J., Shur, N. F., & Smith, A. C. (2016). "Exercise as medicine" in chronic kidney disease. Scandinavian Journal of Medicine and Science in Sports, 26(8), 985-988. https://doi.org/10.1111/sms.12714
Wouters, O. J., O'Donoghue, D. J., Ritchie, J., Kanavos, P. G., & Narva, A. S. (2015). Early chronic kidney disease: diagnosis, management and models of care. Nature reviews. Nephrology, 11(8), 491-502. https://doi.org/10.1038/nrneph.2015.85
Xenaki, N., Bacopoulou, F., Kokkinos, A., Nicolaides, N. C., Chrousos, G. P., & Darviri, C. (2018). Impact of a stress management program on weight loss, mental health and lifestylesin adults with obesity: a randomized controlled trial. Journal of Biochemical and Molecular Toxicology, 7(2), 78-84. https://www.researchgate.net/publication/328965709_Impact_of_a_stress_management_program_on_weight_loss_mental_health_and_lifestyle_in_adults_with_obesity_a_randomized_controlled_trial
Yakush Williams, J. K. (2017). Management Strategies for Patients with Diabetic Kidney Disease and Chronic Kidney Disease in Diabetes. Nursing Clinics of North America, 52(4), 575-587. https://doi.org/10.1016/j.cnur.2017.07.007
Yen, M., Lee, P. Y., & Tsai, H. C. (2016). Applying the strategies of helping relationship from significant others in patients with chronic kidney disease. The Journal of Nursing, 63(2), 19–25. http://dx.doi.org/10.6224/JN.63.2.19
Yoshida, Y., Broyles, S., Scribner, R., Chen, L., Phillippi, S., Jackson-Thompson, J., Simoes, E. J., & Tseng, T. S. (2020). Social support modifies the negative effects of acculturation on obesity and central obesity in Mexican men. Ethnicity and Health, 25(8), 1103-1114. https://doi.org/10.1080/13557858.2018.1492708
Zucconi, A. (2011). The politics of the helping relationship: Carl Rogers' contributions. Person-Centered & Experiential Psychotherapies, 10, 2-10. https://doi.org/10.1080/14779757.2011.564759