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

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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