Motivation Associates with Dialysis Treatment Adherence in African American Patients

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

J Am Soc Nephrol

Keywords

adult, African American, aged, Caucasian, chronic kidney failure, conference abstract, controlled study, end stage renal disease, female, hemodialysis, high school, human, major clinical study, male, medication compliance, motivation, patient attitude, patient compliance, prospective study, questionnaire, renal replacement therapy, self care, self concept

Abstract

Background: African Americans (AA) comprise 33% of end-stage kidney disease (ESKD) patients, and are more likely to be nonadherent to in-center hemodialysis (HD) compared to Whites. Motivation-based factors informed by self-determination theory (SDT) associate with medication adherence. However, the association with HD treatment adherence in AA is unknown. Methods: In a multi-site prospective study, motivation was assessed via SDT surveys: Autonomous Regulation [(AR) range: 1-7], Health Care Climate Questionnaire [(HCCQ) range: 1-7], and Perceived Kidney Disease Self-Management Scale [(PKDSMS) range: 8-40] Higher scores indicate better 'attitudes', perception of autonomy support from providers, and self-efficacy, respectively. Nonadherence was reported as mean proportion of missed HD minutes and shortened (i.e.,>15 minutes less than prescribed HD) and missed HD sessions over 3-month post-baseline survey period. Mean number of sessions was standardized to 36. Results: Among 210 AAs on HD for at least 90 days (56.2% male; mean age 56 (±13.8), about one-third had a high school education or less, an annual income of $10,000 or less, and lived alone. Mean number of missed and shortened HD sessions per 36 sessions was 1.8 (±3.24) and 3.24(±5.04) respectively. All SDT scores significantly associated with shortened HD sessions; AR being the strongest. Higher PKDSMS scores were inversely and significantly associated with all measures of HD non-adherence (Table 1). Conclusions: SDT measures were associated with HD adherence. Optimizing patients' attitudes may be most effective for improving nonadherence due to shortened HD. Enhancing patients' self-efficacy may significantly impact nonadherence for shortened and/or missed HD. Future research will target better understanding of underlying factors affecting patients' attitudes and self-efficacy to inform motivational strategies for improving HD adherence and kidney health equity. (Table Presented).

Volume

35

Issue

10S

First Page

362

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