Hemodialysis (HD) patients face a common problem of malnutrition due to poor appetite. This study aims to verify the appetite alteration model for malnutrition in HD patients through quantitative data and the International Classification of Functioning, Disability, and Health (ICF) framework. This study uses the Mixed Method-Grounded Theory (MM-GT) method to explore various factors and processes affecting malnutrition in HD patients, create a suitable treatment model, and validate it systematically by combining qualitative and quantitative data and procedures. The demographics and medical histories of 14 patients were collected. Based on the theory, the research design is based on expansion and confirmation sequence. The usefulness and cut-off points of the creatinine index (CI) guidelines for malnutrition in HD patients were linked to significant categories of GT and the domain of ICF. The retrospective CIs for 3 months revealed patients with 3 different levels of appetite status at nutrition assessment and 2 levels of uremic removal. In the same way, different levels of dry mouth, functional support, self-efficacy, and self-management were analyzed. Poor appetite, degree of dryness, and degree of taste change negatively affected CI, while self-management, uremic removal, functional support, and self-efficacy positively affected CI. This study identified and validated the essential components of appetite alteration in HD patients. These MM-GT methods can guide the selection of outcome measurements and facilitate the perspective of a holistic approach to self-management and intervention.
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Hemodialysis (HD) patients can experience appetite alterations that affect meals and nutritional status. Few qualitative studies have assessed the chronic impact of HD on the everyday diet. This study aimed to characterise comprehensively the experiences of HD patients adapting to appetite alteration. Semi-structured, face-to-face interviews were conducted in a unit of a tertiary hospital to understand patient experiences with appetite alteration. An interview guide was used to consider adaptive processes developed after reviewing the literature and based on the researchers’ clinical experiences. A single researcher conducted all interviews to maintain consistency in data collection. The interview content was analysed using Nvivo 11 based on grounded theory and constant comparison analysis. As a results, the mean age and HD vintage of 14 participants were 60 and 5.8 years, respectively. We developed a self-care model based on HD patient experiences with appetite alteration based on axial and selective coding. Differences in urea sensitivity, taste alteration, and social support could be explained by timing of transitions, life events, and responses to stress. Self-care processes are adapted through the processes of “self-registration” and “self-reconstruction,” starting with “disruption.” At the stage of adjustment, 4 self-management types were derived based on pattern of self-care: self-initiator, follower, realist, and pessimist. The results of this study provide unique qualitative insight into the lived experiences of HD patients experiencing appetite alteration and their self-care processes. By recognising dietary challenges, health teams can better support HD patients in the transition from dietary education to self-care.
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