Abstract

According to the United States Renal Data System (USRDS, 2023), Taiwan ranks first among the eight countries with the highest treatment rates for End-Stage Renal Disease (ESRD), leading to significant healthcare costs. ESRD patients rely on lifelong hemodialysis, but proper self-management can slow disease progression and prevent complications. Given the age and declining cognitive functions of most patients, clear, accurate, and user-friendly health education is essential.

This prospective cohort study randomly assigned patients from two hemodialysis units in Eastern Taiwan into two groups: 64 patients in the control group received traditional bedside education, while 66 patients in the experimental group used a 20-page picture book (CVI 0.96) with QR codes linking to digital videos for enhanced learning. Data were collected at baseline (T0), two weeks (T1), and one month (T2) post-intervention, including demographics, biochemical data, and responses to the Hemodialysis Self-Management Instrument (HDSMI-18) and Patient Activation Measure (PAM-13).

The average age of participants was 64.07 (± 10.05) years. Pre-intervention, there were no significant differences between groups. Post-intervention, the experimental group showed significantly greater improvements in self-management (β = 39.98, p < 0.01) and activation (t = 81.95, p < 0.01). The HDSMI-18 and PAM-13 were significantly correlated (r = 0.54 - 0.64, p < 0.01). This study highlights the effectiveness of picture book-based education in improving self-management and activation for elderly patients, as visuals and images effectively support learning, stimulate reflection, and prompt action for older adults with special needs.