Demographics and Health Beliefs Impact Adherence to Hemodialysis Treatment Regimen

Purpose: Non-adherence to medical treatment regimens is known to lead to increased morbidity and mortality. This study sought to identify factors that contribute to non-adherence for the purpose of devising effective interventions to increase adherence. A search of the literature revealed that demographics, social support and health beliefs are some of the factors that can impact adherence in a variety of health challenges. The research question posed in this study is: what is the relationship between demographics, social support and health beliefs and adherence to hemodialysis treatment regimen? This study hypothesized that demographics (gender, age, socio-economic status, race/ethnicity, marital/significant other status, and education), perceived social support and health beliefs impacted adherence. The dependent variabes are medication, fluid and treatment time adherence, The independent variables are demographics, perceived social support and health beliefs. This study also examined the lived experiences of hemodialysis patients. The theories framing this study are the Health Belief Model and contextual social constructionist theory.

Methods: This study utilized a convenience sample of 145 hemodialysis patients in three dialysis centers. The sample included patients who speak only Spanish, blind patients, and those unable to write--people usually excluded from research studies. Quantitative data were collected using an instrument that captured demographics, perceived social support and health beliefs. Medical chart data were also collected to capture additional demographics, fluid gains, per cent time on treatment compared to prescribed time, and medication adherence as measured by phorphorus levels. The qualitative study asked 22 of the patients open-ended questions about their lived experiences. The quantitative data were analyzed using chi square and hierarchical logistic regression. The qualitative data were analyzed using content analysis.

Results: Significant findings were that hemodialysis patients 65 and older, compared to younger patients, were almost three times more likely to be adherent overall (OR=2.79; 95% CI=1.22-6.42). Patients with moderate levels of self-efficacy (X2(1)=6.21, p<.01) were more than four times (OR=4.42; 95% CI=1.37-14.24) more likely to be adherent. Treatment time adherence was significantly related to moderate to high levels of self-efficacy (X2(1)=12.03, p<.01) and perception of a high degree of benefits (X2(2)=9.36, p<.01). Social support results were not significant. The qualitative results complemented the quantitative results in that most patients accept the benefits of hemodialysis as they struggle with the challenges.

Implications: The results of this study suggest that "buddying" older adherent patients with younger ones who are non-adherent may have a positive impact. Results further suggest that patient education should focus on outcomes (benefits) rather than the process and that those who "think they can" may fare better than those who are self-assured. Further research undertaken with a larger sample that includes a wider demographic could provide more tools with which to address non-adherence.