背景：重要關鍵人幫忙關係有助於慢性病患者維持健康的生活型態，促進健康行為的執行和慢性疾病的適應，慢性腎臟病高盛行率和高發病率是全球性的挑戰，台灣末期腎臟病盛行率2902人/每百萬人口，為全球之首，國內外研究指出藉由改變及促進健康策略，可減緩慢性腎臟病病情進展，且盛行率呈穩定趨勢，佔13.6%，證實防治計畫有成效，生命延長使得疾病與患者終身共存。另，醫療費用的不斷上漲，健保資源面臨不堪負荷的窘境，台灣透析治療25,576美元/人/年，延緩一年的末期腎臟病發生，減少1.53億美元/人/年，約24%全民健康保險年度預算，故維持慢性腎臟病患者好的生活品質，為未來發展目標。
研究證實重要關鍵人幫忙關係，有助於健康生活型態的建立，重要關鍵人幫忙關係即在罹病過程中與患者有密切互動關係的家人或是其他重要他人，透過關懷、理解、陪伴等方式，協助患者面對疾病，因應危機及提供決策的力量，進而達到執行健康促進行為，而此重要關鍵人需具備可靠性、可信性、正向性來協助病人面對困境、解決危機。幫忙關係的介入可協助患者將醫護人員衛教所提供資訊實際展現於生活中，亦可達到健康行為的維持，但疾病的適應與協助不全然皆是正面支持，同時也會有負向情緒的產生。但目前較少研究瞭解重要關鍵人幫忙關係對健康促進行為之間的關係，故探討其關係。
研究目的：探討慢性腎臟病患重要關鍵人幫忙關係與健康促進生活型態之相關性，有兩個研究問題分別為慢性腎臟病患者重要關鍵人幫忙關係和健康促進生活型態現況為何和慢性腎臟病患者人口學特性、重要關鍵人幫忙關係與健康促進生活型態相關性為何。
研究方法：採橫斷式研究，以立意取樣方式於南部醫學中心及區域醫院之腎臟科門診患者，共120位，收案條件為年滿20歲、慢性腎臟病分期一到四期患者、意識清楚、能以國台與溝通、慢性腎臟病患者能指出至少有一位重要關鍵人、排除條件為精神疾病診斷者、無認知退化或缺損性疾病者，如失智；無失能者，如中風、糖尿病截肢。研究受試者先填寫人口學基本資料，包括年齡、性別、職業狀況、教育程度、婚姻狀況、抽菸、喝酒、身體質量指數、腎絲球過濾率、查爾森共病指數等變項，並使用重要關鍵人幫忙關係量表和健康促進生活型態量表第二版進行相關資料的收集。以描述性統計、皮爾森相關係數及階層迴歸分析，探討重要關鍵人幫忙關係和健康促進生活型態之相關性。
研究結果：共收入120位慢性腎臟病患者，研究對象平均年齡為63.3歲，（SD = 13.12）；男性居多有86人（71.7%），結婚居多有98人（81.7%），無工作者居多有68人（56.7%），未抽菸及未飲酒占多數，分別有108人（90%）、109人（90%），身體質量指數平均為26.2 kg/m2（SD = 4.49），大多數有體重過重情形；腎絲球過濾率平均值為43.3 ml/min/1.73m2（SD = 21.94），多數慢性病第三期的患者；查爾森共病指數平均值為1.5分（SD = 1.09）。慢性腎臟病患者重要關鍵人幫忙關係量表平均得分為70.2分（SD = 12.55），顯示本研究對象有接近中程度的幫忙關係，各分層面依平均得分排序，瞭解體會得分最高，其次依序為關心分享，陪伴指導得分最低。健康促進生活型態量表每題得分平均值為2.62分（SD = 0.394），顯示本研究對象健康促進生活型態介於偶爾如此和時常如此之間，各分層面靈性成長層面得分最高，其次依序為人際關係、健康責任、壓力管理、營養、身體活動。
年齡、身體質量指數、查爾森共病指數、重要關鍵人幫忙關係與健康促進生活型態有顯著的關係，以階層迴歸分析整體模型解釋變異量達24.5%，其中重要關鍵人幫忙關係、查爾森共病指數二自變項與健康促進生活型態為顯著正相關（β = .349, p < .001；β = 234, p < .05），即當重要關鍵人幫忙關係越好或查爾森共病指數越高，建康促進生活形態越好；人口學特性中的年齡、身體質量指數與健康促進生活型態為顯著負相關（β = - 360, p < .01；β = -183, p < .05），即當年齡越小或身體質量指數越小，健康促進生活型態越好。
結論：慢性腎臟病患者重要關鍵人幫忙關係與健康促進生活型態有顯著正相關性，本研究結果可提供醫護人員更多慢性腎臟病患者的健康促進生活型態的相關資訊，希望能提升護理照護品質，另，建議未來可藉由重要關鍵人提供幫忙關係策略，讓重要關鍵人得以發揮監督、陪伴、支持等功能，在日常生活中協助慢性腎臟病患者健康促進生活型態的維持並延緩疾病的惡化，進而提高慢性腎臟病患者生活品質。
關鍵字：慢性腎臟病、重要關鍵人、幫忙關係、健康促進生活型態

SUMMARY
Helping relationships from significant others can contribute to healthy lifestyles in patients with chronic conditions to promote the implementation of health behaviors. This cross-sectional study used purposive sampling. Data were collected using a demographic characteristic questionnaire, the Helping Relationships from Significant Others Instrument and Health-Promoting Lifestyle Profile-II were used to measure the level helping relationships from significant others and health-promoting lifestyle behaviors with adequate reliability and validity. Helping relationships from significant others among patients with CKD were statistically positively associated to the health-promoting lifestyle. Our findings provide valuable information on health-promoting lifestyles of patients with CKD that might facilitate an improvement in the quality of nursing care.
Key words: Chronic kidney disease, Significant others, Helping relationship, Health-promoting lifestyle
INTRODUCTION
Helping relationships from significant others can contribute to healthy lifestyles in patients with chronic conditions to promote the implementation of health behaviors. Improvement of the morbidity and reduction in the high prevalence of chronic kidney disease (CKD) result in the prolonged survival of the patients that has become worldwide challenges for health care system. The prevalence of CKD in Taiwan is 2,902 people per million population, ranking first globally. Researchers have reported that patients with CKD can slow disease progression by implementing and maintaining a healthy lifestyle. The mortality rate of CKD has remained stable at approximately 13.6%. The implementation of an effective prevention plan has been shown to extend survival time. However, rising medical costs have overburdened available healthcare resources. The average cost per dialysis patient in Taiwan is approximately US $25,576/year. Delay of dialysis in patients with CKD can reduce the annual expenditure to US $153 million/year, which is approximately 24% of the National Health Insurance annual budget. Therefore, because the expenditure in dialysis is high, it is important to improve the quality of life of these patients Positive supportive care can improve the daily life of patients with CKD and help them develop a health-promoting lifestyle.

Helping relationships from significant others are defined as family members, relatives, or others helping patients face the disease crisis, enhancing patients’ abilities to make decisions, and facilitating patients to implement health-promoting behaviors through caring, understanding, and accompanying. The necessary characteristics of significant others include dependability, credibility, and positivity. Significant others might help patients face CKD, improve self-care efficacy, and adhere to health care practitioners’ recommendations. Helping relationships may also assist patients in maintaining a health-promoting lifestyle and managing the negative emotional issues experienced during the disease. Few studies have examined the link between helping relationships from significant others and health-promoting lifestyles among patients with CKD.

This study explored the association of helping relationships from significant others with health-promoting lifestyles among patients with CKD. The two research points of this study are 1. exploring the correlation between helping relationships from significant others and health-promoting lifestyle among patients with CKD and 2. verifying the correlation in associated demographic data.
MATERIALS AND METHODS
This cross-sectional study used purposive sampling. Data were collected in a medical center and regional hospital in South Taiwan. The sample size was 120. The criteria for inclusion were age older than 20 years, diagnosis of stage 1 to 4 CKD, clear consciousness, and ability to communicate in Mandarin and Taiwanese. The patients considered themselves having helping relationships from significant others. Patients with a psychological disorder, cognitive deterioration, diseases such as dementia, functional disability such as stroke, or diabetic amputation were excluded. Data were collected using a demographic characteristic questionnaire that included age, gender, occupation, educational level, marital status, smoking, drinking, body mass index (BMI), glomerular filtration rate (GFR), and comorbidity. The Helping Relationships from Significant Others Instrument and Health-Promoting Lifestyle Profile-II were used to measure the level helping relationships from significant others and health-promoting lifestyle behaviors with adequate reliability and validity. Descriptive analysis, Pearson’s correlation, and hierarchical regression were applied to examine the association of helping relationships from significant others with health-promoting lifestyles among patients with CKD.

RESULTS AND DISCUSSION
A total of 120 subjects were recruited. The mean age was 63.3 years old (SD = 13.13). The sample population predominantly comprised males (86, 71.7%). Data also indicated a prevalence of married (98, 81.7%) and unemployed (68, 56.7%) individuals in addition to non-smokers (108, 90%) and individuals who did not consume alcoholic beverages (109, 90%). The average (BMI) was 26.2 km/m2 (SD = 4.49), with a majority of patients being overweight, and the average GFR was 43.3 ml/min/1.73 m2 (SD = 21.94). Most patients had stage 3 CKD and an average Charlson comorbidity index of 1.5 points (SD = 1.09). The mean score of the Helping Relationships from Significant Others Instrument was 70.2 (SD = 12.55), which meant that the patients had a moderate amount of help from significant others. Of the three subscales, “understanding” had the highest score in the Helping Relationships from Significant Others Instrument, followed by “sharing” and “coaching,” which had the lowest score. The mean of Health-Promoting Lifestyle Profile-II was 2.62 (SD = 0.394). The sequential score of six domains from high to low were arranged as spiritual growth, interpersonal relations, health responsibility, stress management, nutrition, and physical activity.

The explained variance of health-promoting lifestyle on the hierarchical regression model accounted for 24.5% . Furthermore, age, BMI, helping relationships from significant others, and Charlson comorbidity index were predictors of health-promoting lifestyles. The score of helping relationships from significant others and Charlson comorbidity index were significantly positively correlated to health-promoting lifestyle (β = 0.349, p < .001 and β = 0.234, p < .05, respectively). This demonstrated that better helping relationships from significant others and higher Charlson comorbidity indices indicated better health-promoting lifestyles in patients with CKD. Age and BMI were both negatively associated with health-promoting lifestyles (β = –360, p < .01 and β = −183, p < .05, respectively).
CONCLUSION
Helping relationships from significant others among patients with CKD were statistically
positively associated to the health-promoting lifestyle. Our findings provide valuable information on health-promoting lifestyles of patients with CKD that might facilitate an improvement in the quality of nursing care. We suggest that health care providers design an intervention program to improve helping relationships from significant others among patients with CKD. By providing supervision, companionship, and support, significant others may help patients live a healthier life, thus postponing disease progression and promoting an improved quality of life for patients with CKD.

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