A Retrospective Study of Knowledge, Attitude, and Practice Interventions Based on the Transtheoretical Model on...

To investigate the application of the knowledge, attitude, and practice (KAP) intervention based on the transtheoretical model (TTM) in the perioperative nursing of patients undergoing vaginal natural orifice transluminal endoscopic surgery (vNOTES) and to examine its relationship with indicators related to the perioperative experience.

91 patients who underwent vNOTES were retrospectively selected as the study subjects. Based on differences in nursing interventions, the patients were divided into a study group (n = 49, receiving KAP intervention based on the TTM) and a control group (n = 42, receiving routine perioperative interventions). This was a non-randomized observational study with time-sequential grouping. It primarily compared surgical indicators (operative time, intraoperative blood loss), intraoperative body temperature, postoperative recovery indicators (time to bowel sound recovery, anal exhaust time, defecation time, and time to ambulation), the incidence of perioperative adverse events, nursing satisfaction, anxiety and depression scores, and VAS scores within 72 h postoperatively. Multivariate logistic regression analysis was used to identify factors associated with the occurrence of perioperative adverse events.

(1) Intraoperative blood loss in the study group was significantly lower than in the control group (p < 0.05). (2) Body temperature at time points T1, T2, T3, and T4 was higher in the study group compared to the control group (p < 0.05). (3) The study group showed earlier anal exhaust time, defecation time, and time to ambulation than the control group (p < 0.05). (4) The incidence of adverse reactions was lower, while the nursing satisfaction rate was higher in the study group than in the control group (p < 0.05). (5) After nursing, anxiety and depression scores were lower in the study group compared to the control group (p < 0.05). These findings should be interpreted cautiously in view of potential residual confounding.

In this retrospective observational study, the KAP intervention based on the TTM was associated with perioperative temperature maintenance, improved postoperative recovery, reduced pain and negative emotions, and increased nursing satisfaction in patients undergoing vNOTES, suggesting that it may have clinical value. However, because of the non-randomized design with time-sequential grouping, further validation is needed through prospective, multicenter, or randomized controlled trials.