A quasi-experimental pre-test, post-test two-group designed study was utilised to attain the aim of the study. The study was conducted in the Dialysis Department at Muljibhai Patel Urological Hospital, Nadiad, India. It was approved by the Institutional Ethical Committee, vide letter number EC/623/2019.

The sample size consisted of 60 CKD patients undergoing haemodialysis in Muljibhai Patel Urological hospital, Nadiad, Gujarat.

This is a two group study design consisting of 30 participants each in both control and experimental group. A preformulated demographic data sheet, structured questionnaire and STP were the tools used for the study.

Description of the tool:

1. Section A: The demographic variable such as age, gender, education, occupation, monthly income in rupees, marital status, family history, habit, religion, other co-morbid conditions, restriction on food or fluid by doctor, number of haemodialysis per week, other illness etc., was used in this study.

2. Section B: The structure questionnaire contained general information on CKD, life style modification like diet and exercise, haemodialysis, and kidney transplantation with STP scheduled for three consecutive days from the day of the pre-test. There are 30 multiple choice questions applied to all attendees of each group before and after training in Gujarati language. The Pre and the Post-tests contained the same questions.

In order to measure the validity of tools i.e., structured knowledge questionnaire and STP was given to a panel of experts which included two doctors and eight nursing staffs who had at least 3 years of experience after MSc. Nursing in medical surgical nursing. The experts were requested to validate the relevancy, objectivity, adequacy, and appropriateness of content areas. Tools and STP was developed under expert guidance. All of them had 100% agreement on the content of the STP. The reliability refers to the degree of consistency, adequacy, accuracy of the tool [9]. The reliability of the tool was checked before pilot study. The reliability of the structured knowledge questionnaire was determined using correlation coefficient formula. The reliability of structured knowledge questionnaire was found to be 0.939. Hence, the structured knowledge questionnaire was deemed to be reliable.

After obtaining the permission from the concerned authorities, the investigator conducted the study with the selected subjects. The data collected were validated by using the reliable tools. The results of the pilot study were used to validate the consistency of the data collected, adequacy of the content, the instruments used, the feasibility and time duration required for the study. The investigator administered pre-test on day one followed by administering a structured teaching programme for three consecutive days starting from the day of the pre-test. On 7^th day post-test was done by the researcher along with the practice assessment. The researcher then compared the level of knowledge among CKD patients who was categorised based on the knowledge score as above 75% adequate knowledge, 50% to 75% moderate knowledge and below 50% inadequate knowledge.

The data obtained were statistically analysed using Statistical Package for Social Sciences (SPSS) version 22. The data obtained from the samples was analysed by using descriptive student’s t-test was used for parametric data. Pearson Chi-square was used to explain the relationship between normally distributed quantitative variable. Descriptive statistics used were expressed as mean and standard deviation for quantitative data.

The study included 60 CKD patients. The study subjects were divided into two groups as experimental group and study group each containing 30 participants. The study included 16 patients (53.33%) is above 49 years of age in the experimental group and 11 (36.66%) in the control group. With regard to gender 18 (60%) of CKD patients were male in the experimental group and 21 (70%) in the control group. Educational status of the participants in the study group also reveals that 10 (33.33%) had education up to higher secondary level and 08 (26.66%) possessed education up to primary level in the control group. Occupational status of the study group reveals that 15 (50%) were unemployed and 11 (36.67%) in the privatesector in the control group [Table/Fig-1].

Along with CKD any other health problems, the study group of 28 (93.33%) had hypertension. In the control group 30 (100%) had hypertension. Regarding restriction on food or fluid by doctor in the study group of 29 (96.67%) was yes. In the control group of 30 (100%) were yes. Regarding number of haemodialysis per week in the study group 29 (96.67%) had three times a week and 30 (100%) in the control group [Table/Fig-1].

Pre-test level of knowledge in the experimental group, 7 (23.33%) of patients had inadequate knowledge and 23 (76.67%) had moderate knowledge and in control group 2 (6.67%) had inadequate knowledge, 27 (90%) had moderate knowledge and 1 (1.67%) had adequate knowledge. The [Table/Fig-2] shows in the post-test level of knowledge in the experimental group of 27 (90%) had adequate knowledge and 3 (10%) had moderately adequate knowledge. In control group, 28 (93.33%) had moderately adequately knowledge and 2 (6.67%) had inadequate knowledge.

Post-test in the experimental group knowledge range was 10, mean was 27.36±2.63 and the Post-test in the control group knowledge range was 09, mean was 17.73±2.37. The paired t-test was 12.90 greater than the tabulated ‘t’ (2.05). This was statistically proved [Table/Fig-3].

In reference to the association of knowledge regarding therapeutic intervention among CKD patients with their demographic variables showed no significant association of knowledge score with their variables [Table/Fig-3].

CKD is one of the common conditions affecting up to 10% of the population in Western societies with limited data available on the prevalence of disease in India. In the present study it was found that many patients suffering from CKD do not have enough knowledge regarding therapeutic intervention. Large numbers of patients below poverty line, low gross domestic products, and low monetary allocations for healthcare have led to suboptimal outcomes. This could be one of major reasons for the higher prevalence observed in India. The present study emphasises the need to implement a program to introduce educational interventions to improve the knowledge and attitude of CKD patients.

Moreover, CKD and many other non-communicable diseases are often ignored in the face of persistent challenge competition for resources from communicable disease and a high infant and maternal mortality [10]. In the course of the present study the investigators opine that there is a need to identify each category of diseases and develop a comprehensive educational program in order to improve the life expectancy of such individuals.

The educative measure studied shows there is a significant improvement in knowledge regarding interventions among CKD patients. The post-test score of knowledge and attitude were highly significant when compared with pre-test score. However, the adequacy of knowledge depends also on the education levels the patients have received and various demographic factors associated with it. The factors such as age, sex, marital status, socioeconomic status and lifestyle habits are some of the confounding factors that influence the overall assessment of an individual.

The study findings were consistent with the findings of Isarannavar GS et al., who described the role of dietary management. According to them 66.6% of dialysis patients had an average knowledge and about 53% of had good attitude regarding their dietary management. Their findings also revealed that 66.66% had moderately adequate knowledge; 20% had highly adequate knowledge about dietary management [11]. In the present study 86.6% of the study population had adequate information regarding the dietary restrictions and about 66% of the study population were in agreement pertaining to improving lifestyle adjustments against CKD.

Present study findings are also supported by the study of Sherly K which was also a quasi-experimental study [12]. The effectiveness of STP on knowledge and attitude regarding lifestyle modification among patients with CKD were established in their study. Their study revealed a significant association of knowledge and attitude of CKD patients to be improved after lifestyle adjustments. The result of present study are in concordance with the use of an effective way to develop a structured teaching programme to improve the knowledge of patients undergoing haemodialysis. This would in turn help in preventing the life threatening disease from further causing complications and prolonging their life expectancy.

A limitation of this study is small sample size and limited duration of time taken into account, all the confounding factors associated with STP.

Providing the structured teaching programme, regarding therapeutic intervention among CKD patients, the level of knowledge was found to have increased in the study subjects. Despite limitations the study provides a meaningful insight into the possible intervention which can be provided to CKD patients. The study emphasises the practical clinical value and provide opportunities for future research. A similar study can be conducted using a larger sample size to develop broad generalisation in different settings using different demographic variables and different teaching techniques.