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


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


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. 


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

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