Table 1 The 5 A Model Steps in Hemodialysis Patients

Step 2

Advise

In this step, the previous analysis results were considered to inform patients of the diagnosed health risks and emphasize the benefits of behavioral modification.

Step 3

Agree

An agreement was reached between the patients and the researcher. Given the diagnosed problems, appropriate behavioral goals were agreed upon with patients, and a practical program was designed for each goal. The criterial need was set between 0 and 1 for each behavioral goal so that patients could determine their trust in the program implementation. These criteria were registered in the behavioral modification form, and the patients were asked to record their performance status in each behavioral goal weekly for 12 weeks.

Step 4

Assist

The patients were instructed on how to control the consumption of liquids, how to implement care measures through vascular access, the importance of sports and necessary levels of physical activities, how to take care of their skin, and compliance with their diets and prescriptions in face-to-face sessions. The patients were asked to perform the sports exercises daily and then record their performance results. Proportionate to the needs of patients, a personal training session was arranged respecting the patient’s willingness (in-person or via phone calls) to reiterate and emphasize the instructions.

Step 5

Arrange

In this step, the functions of patients were followed-up for three months. In fact, they were followed up via phone calls or SMSs three times a week from the fifth week to the 12th week every week to ensure that the patients complied with the intervention within the first four weeks. These efforts were made to remind patients of the practical program and solve any potential problems. Furthermore, each patient’s progress was followed up every four weeks in one face-to-face session to modify goals or useful programs by reaching new agreements or encouraging patients to keep up the intervention.