Relationship between the Level of Health Literacy, Diet Adherence and Dialysis Adequacy in Patients Undergoing Dialysis

Document Type : Original Article


1 Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran.

2 Student Research Committee, Shushtar Medical Sciences Faculty, Shushtar, Iran

3 Research Center for Contaminants (RCEC), Abadan University of Medical Sciences, Abadan, Iran


Background and Objectives: The number of patients affected by Chronic Kidney Disease(ckd) grows every year. Adherence to nutritional restrictions can affect the adequacy of dialysis treatment and also it is heavily dependent on suitable and sufficient health literacy level of patients undergoing dialysis. Considering the progressive increase of dialysis patients in Abadan, present research was performed to investigate the relationship between health literacy and adherence to diet and adequacy of dialysis.

Materials and Methods: The present research is a descriptive- cross-sectional study performed on 207 patients referring to the dialysis ward of the hospitals covered by Abadan University of Medical Sciences via regular systematic randomized method. Data collection was performed using three questionnaires including demographic information, Health Literacy for Iranian Adults (HELIA), ESRD-AQ, and KT/V investigation Data analysis was performed using descriptive and inferential statistical tests plus logistic regression model in SPSS 27. 

Results: Out of 207 patients examined, 28.50% of patients had poor adherence while 71.50% showed strong adherence. Among patients with poor adherence, 58.2% had low health literacy, 40% average and 1.8% high. Furthermore, logistic regression model showed that by increasing in the health literacy level of the patients, the chance of adherence would grow by 6.3 times, which was statistically significant(CI= 3.13).. However, no significant relationship was found between level of health literacy and adequacy of dialysis (CI=1.73).

Conclusion: Considering the significant relationship between health literacy and adherence to the diet, it becomes important to make attempts for showing the significance of enhancing the health literacy of patients undergoing dialysis in order to enhance adherence to the diet and thus support the success of dialysis treatment method and enhance the general care of these patients. 


Acknowledgments: Hereby, the cooperation of the personnel in the dialysis ward of hospitals affiliated with Abadan University of medical sciences as well as all patients in this ward who showed patient and kind cooperation for advancing the research objectives are highly appreciated. 

Availability of data and materials: The authors confirm that the data analyzed during this study are included in this article.

Conflict of interest: There is no conflict.

Consent for publication: All respondents have given consent for publication, provided that anonymity was ensured.

Ethical approval and consent to participate: The entirely of methods are implemented in line with applicable guidelines and regulations defined by the Declaration of Helsinki. This study is an outcome of a research proposal with the ethics code IR.ABADANUMS.REC.1402.084 from ethics committee of Abadan University of medical sciences. All patient and hospital managers gave consent for participation after reviewing the study method and questionnaire items.

Funding: There is no funding.

Author contributions: Tarifi H, Tartifi H, Mousavi Ghahfarokhi M conceptualized the main idea and designed the project. Tartifi H, Tartifi H, Eskandari N and Asakereh Sh participated in the data collection. Kogani M performed the data analysis. Mousavi Ghahfarokhi M conceived the study design and guided the whole process of the study.


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit

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