Relationship between Caregiver Health Literacy and Treatment Adherence of Patients with Advanced Chronic Kidney Disease Undergoing Hemodialysis: A Cross-sectional Dyadic Study

Document Type : Original Article

Authors

1 Department of Nursing, Nursing and Midwifery Faculty, Bushehr University of Medical Sciences, Bushehr, Iran.

2 Department of Midwifery, Nursing and Midwifery Faculty. Bushehr University of Medical Sciences

3 Department of nephrology, Medical Faculty. Bushehr University of Medical Sciences.

4 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Salmanefarsi Blvd, Bushehr. Iran

Abstract

Background and Objectives: Hemodialysis reduces patients’ ability to perform daily activities and makes them dependent on caregivers. Since the access to and understanding of health information by patients should be ensured by informal caregivers, caregivers' health literacy is of particular importance in treatment adherence. This study determined the relationship between caregivers' health literacy and hemodialysis patients’ treatment adherence.

Material and Methods: This descriptive correlational study was conducted on dyads of hemodialysis patients and their caregivers at all hemodialysis wards in Bushehr Province, Iran (2021) using the census method. Eligible patients and their caregivers were invited to participate (N=259). The data collection instruments were a demographic information form, the End-Stage Renal Disease Adherence Questionnaire, and the Health Literacy Instrument for Iranian Adults. The data were analyzed using SPSS19.0 via descriptive and analytical methods (univariate and multivariate linear regression). P<0.05 was considered statistically significant. 

Results: In total, 78 and 181 of the caregivers were male and female, respectively, with the mean ±SD age of 58.53±12.63 years. Among the patients, 153 were male and the rest were female with the mean ±SD age of 43.47±11.97 years. The mean ±SD of caregivers' health literacy and treatment adherence was 3.42±0.81 and 1063.61±142.11, respectively. There was no significant correlation between caregivers' health literacy and patients' treatment adherence (P<0.89). However, there was a direct correlation between treatment adherence and caregivers' age (P<0.01). Moreover, there was a negative correlation between the number of hours of caregiving per day and the patients' treatment adherence (P<0.04). 

Conclusion: Since caregivers' health literacy was not associated with patients’ treatment adherence, if healthcare providers, provide appropriate information to informal caregivers even based on their health literacy, it may not be transferred well to their patients. Therefore, these results can be considered a warning for healthcare providers to pay attention to providing training in health promotion programs to both the patient and the caregiver. 

Keywords

Correction Notic : A Correction notice to this article was published on 17  June 2024

Availability of data and materials: The anonymized datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


Conflict of interest: The authors have no conflict of interest to declare.

Consent for publication: Not applicable


Ethical consideration:  This study was conducted after obtaining a permit from the committee of research and ethics of Bushehr University of Medical Sciences (IR.BPUMS.REC.1399.048). Study objectives description, confidentiality participation and completing the consent form were considered. Furthermore, the study was performed in line with the principles of the Declaration of Helsinki.


Funding: This research received grant from funding agencies in the public, commercial, or not-for-profit sectors


Authors' contributions: HV, RB and MM designed the study. Data collection: SD and FH. Data analysis: RB. HV and SD drafted the manuscript and R.B prepared tables. HV and RB read, edited for scientific accuracy. All authors read and approved the final manuscript

References

. Beerappa H, Chandrababu R. Adherence to dietary and fluid restrictions among patients undergoing hemodialysis: An observational study. Clinical Epidemiology and Global Health. 2019;7(1):127-30.
https://doi.org/10.1016/j.cegh.2018.05.003
 
2. Bello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, et al. Epidemiology of haemodialysis outcomes. Nature Reviews Nephrology. 2022;18(6):378-95.
https://doi.org/10.1038/s41581-022-00542-7
PMid:35194215 PMCid:PMC8862002  
 
3. Sultan BO, Fouad AM, Zaki HM. Adherence to hemodialysis and medical regimens among patients with end-stage renal disease during COVID-19 pandemic: a cross-sectional study. BMC nephrology. 2022;23(1):1-9.
https://doi.org/10.1186/s12882-022-02756-0
PMid:35397516 PMCid:PMC8994066  
 
4. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements. 2022;12(1):7-11.
https://doi.org/10.1016/j.kisu.2021.11.003
PMid:35529086 PMCid:PMC9073222  
 
5. Jafari Y, Tehrani H, Esmaily H, Shariati M, Vahedian‐shahroodi M. Family‐centred empowerment program for health literacy and self‐efficacy in family caregivers of patients with multiple sclerosis. Scandinavian journal of caring sciences. 2020;34(4):956-63
https://doi.org/10.1111/scs.12803
PMid:31985862  
 
6. Moazzeni SS, Arani RH, Hasheminia M, Tohidi M, Azizi F, Hadaegh F. High incidence of chronic kidney disease among Iranian diabetic adults: using CKD-EPI and MDRD equations for estimated glomerular filtration rate. Diabetes & Metabolism Journal. 2021;45(5):684-97.
https://doi.org/10.4093/dmj.2020.0109
PMid:33715338 PMCid:PMC8497933  
 
7. Eirini G, Georgia G. Caregivers of patients on haemodialysis. Caregiving and home care. 2018;14:75.
https://doi.org/10.5772/intechopen.72400  
 
8. Naalweh KS, Barakat MA, Sweileh MW, Al-Jabi SW, Sweileh WM, Zyoud SeH. Treatment adherence and perception in patients on maintenance hemodialysis: a cross-sectional study from Palestine. BMC nephrology. 2017;18(1):1-9.
https://doi.org/10.1186/s12882-017-0598-2
PMid:28558719 PMCid:PMC5450383  
 
9. Naderifar M, Tafreshi MZ, Ilkhani M, Akbarizadeh MR, Ghaljaei F. Correlation between quality of life and adherence to treatment in hemodialysis patients. Journal of Renal Injury Prevention. 2018;8(1):22-7.
https://doi.org/10.15171/jrip.2019.05  
 
10. Zakiyeh A, Mostafa R, Reza BH, Akram S, Leila J, Azadeh K. The effects of foot reflexology on the level of depression in patients under hemodialysis. Journal of Nursing Education (JNE). 2017;5(6):31-38.
https://doi.org/10.21859/jne-05065  
 
11. Farahani MA, Ghane G, Sydfatemi N, Hagani H. Effect of educational program on the burden of family caregivers of hemodialysis patients. Evidence Based Care. 2016;6(1):7-17.
https://doi.org/10.15412/J.JCCNC.04010401  
 
12. Khiyali Z, Khani M. survey of Caregiver Burden and its related factors in Caregiver of hemodialysis patients referring to Shahid Mohammadi Hospital in Bandar Abbas. Nursing Journal of the vulnerable. 2018; 5(16): 35-44  
 
13. Yuen EY, Knight T, Ricciardelli LA, Burney S. Health literacy of caregivers of adult care recipients: A systematic scoping review. Health & Social Care in the Community. 2018;26(2):e191-e206.
https://doi.org/10.1111/hsc.12368
PMid:27426731  
 
14. Yuen E, Knight T, Dodson S, Chirgwin J, Busija L, Ricciardelli LA, et al. Measuring cancer caregiver health literacy: Validation of the Health Literacy of Caregivers Scale-Cancer (HLCS‐C) in an Australian population. Health & social care in the community. 2018;26(3):330-44.
https://doi.org/10.1111/hsc.12524
PMid:29210140  
 
15. Surendran P, Venugopal V, Dongre A, Paninjukunnath R. Perceived challenges faced by family caregivers of chronic kidney disease patients and suggested solutions: a qualitative study. Int J Med Sci Public Health. 2018;7(6).
https://doi.org/10.5455/ijmsph.2018.0307819032018  
 
16. Moshavvegh S, Goodarzi N, Emamipour S, Sepah Mansour M. Development of a health model in patients with type 2 diabetes based on psychological toughness, health literacy, self-efficacy and health beliefs mediated by self-management behaviors and social support. Journal of Research in Behavioural Sciences. 2021;19(1):24-34.
https://doi.org/10.52547/rbs.19.1.24  
 
17. Trivedi R, Slightam C, Fan VS, Rosland A-M, Nelson K, Timko C, et al. A couples' based self-management program for heart failure: results of a feasibility study. Frontiers in public health. 2016;4:171.
https://doi.org/10.3389/fpubh.2016.00171
PMid:27626029 PMCid:PMC5004799  
 
18. Jafari Y, Vahedian-Shahroodi M, Tehrani H, Esmaily H, Haresabadi M, Shariati M. The relationship between caregivers' health literacy and the behavior of women with Multiple Sclerosis. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2018;21(7):64-71.  
 
19. Levin JB, Peterson PN, Dolansky MA, Boxer RS. Health literacy and heart failure management in patient-caregiver dyads. Journal of Cardiac Failure. 2014;20(10):755-61
https://doi.org/10.1016/j.cardfail.2014.07.009
PMid:25072623  
 
20. Høeg BL, Frederiksen MH, Andersen EAW, Saltbæk L, Friberg AS, Karlsen RV, et al. Is the health literacy of informal caregivers associated with the psychological outcomes of breast cancer survivors? Journal of Cancer Survivorship. 2021;15(5):729-37.
https://doi.org/10.1007/s11764-020-00964-x
PMid:33169190  
 
21. Montazeri A, Tavousi M, Rakhshani F, Jahangiri K, et al. Health Literacy for Iranian Adults (HELIA): Development and Psychometric Properties. PAYESH. 2014;13(5):589-600.  
 
22. Kim Y, Evangelista LS. Relationship between illness perceptions, treatment adherence, and clinical outcomes in patients on maintenance hemodialysis. Nephrology nursing journal: journal of the American Nephrology Nurses' Association. 2010;37(3):271.  
 
23. Rafiee Vardanjani L, Parvin N, Mahmoodi Shan GR, Molaie E, Shariati A, Hasheminia MA. Adherence to hemodialysis treatment and some related factors in hemodialysis patients admitted in Shahrekord Hajar hospital. Journal of Clinical Nursing and Midwifery. 2014;2(4):17-25.  
 
24. Belice PJ, Mosnaim G, Galant S, Kim Y, Shin H-W, Pires-Barracosa N, et al. The impact of caregiver health literacy on healthcare outcomes for low income minority children with asthma. Journal of Asthma. 2020;57(12):1316-22.
https://doi.org/10.1080/02770903.2019.1648507
PMid:31340703  
 
25. Rak EC, Hooper SR, Belsante MJ, Burnett O, Layton B, Tauer D, et al. Caregiver word reading literacy and health outcomes among children treated in a pediatric nephrology practice. Clinical kidney journal. 2016;9(3):510-5.
https://doi.org/10.1093/ckj/sfw015
PMid:27274841 PMCid:PMC4886911  
 
26. Rahman TTA. Health literacy: prevalence among elderly care givers and its impact on the frequency of elderly hospitalization and elderly health related quality of life. Advances in Aging Research. 2014;3(05):380.
https://doi.org/10.4236/aar.2014.35048  
 
27. Ramezannia P, Vahedian Shahroudi M, Tehrani H, Esmaili H. Relationship between the Behavior of Patients with Tuberculosis and the Health Literacy of Mashhad Caregivers. Journal of Advanced Biomedical Sciences. 2020;10(4):2926-35.  
 
28. Samadbeik M, Garavand S, Sohrabi Zadeh M, Koshki N, Mohammadi Z. Health Literacy Instruments for Computer-Based Applications: A Review Article. Journal of Health and Biomedical Informatics. 2015;2(3):195-203.  
 
29. Tavousi M, Ebadi M, Fattahi E, Jahangiry L, Hashemi A, Hashemiparast M, et al. Health literacy measures: A systematic review of the literature. Payesh (Health Monitor). 2015;14(4):485-96.  
 
30. Hayden S. An Analysis of Factors Which Affect Self-Management in Language-Diverse Patients with Type 2 Diabetes. Doctorate of Nursing Practice (DNP), Health Sciences & Nursing Belmont University, 2018.  
 
31. Kugbey N, Meyer-Weitz A, Asante KO. Access to health information, health literacy and health-related quality of life among women living with breast cancer: Depression and anxiety as mediators. Patient education and counseling. 2019;102(7):1357-63.
https://doi.org/10.1016/j.pec.2019.02.014
PMid:30772116  
 
32. Ahmadi S, Hamidpoor K, Sedaghat H, Karami F. Violence against Women: The Rule of Patriarchal Ideology and the Hegemony of Male Domination (Case study: Women in Bushehr. Women in Development & Politics. 2021;19(4):545-72.  
 
33. Salehitali S, Ahmadi F, Dehkordi AH, Noorian K, Fereidooni-Moghadam M, Zarea K. Progressive exhaustion: A qualitative study on the experiences of Iranian family caregivers regarding patients undergoing hemodialysis. International Journal of Nursing Sciences. 2018;5(2):193-200.
https://doi.org/10.1016/j.ijnss.2018.01.005
PMid:31406824 PMCid:PMC6626230  
 
34. Liew EWK, Low EMJ, Ho GLL. Perceived risk, fear of Covid-19, and resilience on mental health among Malaysian emerging adults during the Covid-19 pandemic. IJRICE, 2021; 5(2).
https://doi.org/10.24036/00456za0002  
 
35. Hoang VL, Green T, Bonner A. Informal caregivers of people undergoing haemodialysis: Associations between activities and burden. Journal of Renal Care. 2019;45(3):151-8.
https://doi.org/10.1111/jorc.12280
PMid:31297973  
Journal of Health Literacy
Volume 8, Issue 3 - Serial Number 31
September 2023
Pages 43-54

Files

Share

How to cite

Statistics