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

Document Type : Original Article

Authors

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

Abstract

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. 

Keywords

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 https://creativecommons.org/licenses/by/4.0/

References

1) Ammirati AL. Chronic kidney disease. Revista da Associação Médica Brasileira. 2020 Jan 13;66:s03-9.https://doi.org/10.1590/1806-9282.66.s1.3PMid:31939529
2) Molina P, Gavela E, Vizcaíno B, Huarte E, Carrero JJ. Optimizing diet to slow CKD progression. Frontiers in medicine. 2021 Jun 25;8:654250.https://doi.org/10.3389/fmed.2021.654250PMid:34249961 PMCid:PMC8267004
3) Ko GJ, Kalantar-Zadeh K. How important is dietary management in chronic kidney disease progression? A role for low protein diets. The Korean journal of internal medicine. 2021 Jul;36(4):795. https://doi.org/10.3904/kjim.2021.197 PMid:34153180 PMCid:PMC8273814
4) Dageforde LA, Cavanaugh KL. Health literacy: emerging evidence and applications in kidney disease care. Advances in chronic kidney disease. 2013 Jul 1;20(4):311-9. https://doi.org/10.1053/j.ackd.2013.04.005 PMid:23809283 PMCid:PMC3767572
5) Li T, Wilcox CS, Lipkowitz MS, Gordon-Cappitelli J, Dragoi S. Rationale and strategies for preserving residual kidney function in dialysis patients. American journal of nephrology. 2019 Oct 18;50(6):411-21. https://doi.org/10.1159/000503805 PMid:31630148
6) Law JP, Pickup L, Pavlovic D, Townend JN, Ferro CJ. Hypertension and cardiomyopathy associated with chronic kidney disease: epidemiology, pathogenesis and treatment considerations. Journal of Human Hypertension. 2023 Jan;37(1):1-9. https://doi.org/10.1038/s41371-022-00751-4 PMid:36138105 PMCid:PMC9831930
7) Filipska A, Bohdan B, Wieczorek PP, Hudz N. Chronic kidney disease and dialysis therapy: incidence and prevalence in the world. Pharmacia. 2021 May 25;68(2):463-70. https://doi.org/10.3897/pharmacia.68.e65501
8) Masoudiyekta L, Musavi Ghahfarokhii M, Maqsoodi F. Functional, communicative and critical health literacy among patient with diabetes Type2 referred to the diabetes clinic. Journal of Health Literacy. 2021 Dec 1;6(3):55-63
9) Musavi Ghahfarokhi M, Mohammadian S, Mohammadi Nezhad B, Kiarsi M. Relationship between spiritual health and hope by dietary adherence in haemodialysis patients in 2018. Nursing Open. 2020 Mar;7(2):503-11. https://doi.org/10.1002/nop2.412 PMid:32089846 PMCid:PMC7024621
10) Motedayen M, Sarokhani D, Ghiasi B, Khatony A, Dehkordi AH. Prevalence of hypertension in renal diseases in Iran: Systematic review and meta-analysis. International journal of preventive medicine. 2019;10. https://doi.org/10.4103/ijpvm.IJPVM_522_18 PMid:31367287 PMCid:PMC6639851
11) Murali K, Mullan J, Roodenrys S, Lonergan M. Comparison of health literacy profile of patients with end-stage kidney disease on dialysis versus non-dialysis chronic kidney disease and the influencing factors: a cross-sectional study. BMJ open. 2020 Oct 1;10(10):e041404. https://doi.org/10.1136/bmjopen-2020-041404 PMid:33122326 PMCid:PMC7597521
12) Elisabeth Stømer U, Klopstad Wahl A, Gunnar Gøransson L, Hjorthaug Urstad K. Health literacy in kidney disease: Associations with quality of life and adherence. Journal of renal care. 2020 Jun;46(2):85-94. https://doi.org/10.1111/jorc.12314 PMid:31950601
13) Rezaie M, Hydarzade N, Hydarzade L. The effect of peer education on adherence to diet and medication of dialysis patients referred Urmia educational-medical centers. Journal of Sabzevar University of Medical Sciences. 2022 Jul 16;29(2):291-302.
14) Murali KM, Mullan J, Roodenrys S, Hassan HC, Lambert K, Lonergan M. Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials. PloS one. 2019 Jan 29;14(1):e0211479. https://doi.org/10.1371/journal.pone.0211479 PMid:30695068 PMCid:PMC6350978
15) Guo A, Jin H, Mao J, Zhu W, Zhou Y, Ge X, Yu D. Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study. BMC Cardiovascular Disorders. 2023 Feb 19;23(1):93. https://doi.org/10.1186/s12872-023-03117-x PMid:36803662 PMCid:PMC9940429
16) Tavakoly Sany SB, Doosti H, Mahdizadeh M, Orooji A, Peyman N. The health literacy status and its role in interventions in Iran: a systematic and meta-analysis. International journal of environmental research and public health. 2021 Apr 17;18(8):4260. https://doi.org/10.3390/ijerph18084260 PMid:33920508 PMCid:PMC8073744
17) Aghsaeifard Z, Zendehdel A, Alizadeh R, Salehnasab A. Chronic hemodialysis: Evaluation of dialysis adequacy and mortality. Annals of Medicine and Surgery. 2022 Apr 1;76:103541. https://doi.org/10.1016/j.amsu.2022.103541 PMid:35495410 PMCid:PMC9052277
18) Steyaert S, Holvoet E, Nagler E, Malfait S, Van Biesen W. Reporting of "dialysis adequacy" as an outcome in randomised trials conducted in adults on haemodialysis. PloS one. 2019 Feb 5;14(2):e0207045. https://doi.org/10.1371/journal.pone.0207045 PMid:30721242 PMCid:PMC6363141
19) Chen MY, Ou SH, Yen MC, Lee MS, Chen NC, Yin CH, Chen CL. Vegetarian diet in dialysis patients: A significant gap between actual intake and current nutritional recommendations. Medicine. 2021 Feb 2;100(6). https://doi.org/10.1097/MD.0000000000024617 PMid:33578571 PMCid:PMC7886433
20) Ozen N, Cinar FI, Askin D, Mut D, Turker T. Nonadherence in hemodialysis patients and related factors: a multicenter study. The Journal of Nursing Research. 2019 Aug;27(4):e36 https://doi.org/10.1097/jnr.0000000000000309 PMid:30720548 PMCid:PMC6641098
21) Rafiei, Mahdieh and Khandan, Maryam, 1400, Health literacy survey of hemodialysis patients regarding diet and its influencing factors, 6th International Conference on Health, Treatment and Health Promotion, https://civilica.com/doc/1261147
22) Harrison's Principles of Internal Medicine. New York :McGraw-Hill, Health Professions Division, 1998.
23) Montazeri AL, Tavousi M, Rakhshani F, Azin SA, Jahangiri K, Ebadi M, Naderimagham S, Solimanian A, Sarbandi F, Motamedi A, Sistani MM. Health Literacy for Iranian Adults (HELIA): development and psychometric properties. Payesh (Health Monitor). 2014 Oct 15;13(5):589-99
24) Kim Y, Evangelista LS, Phillips LR, Pavlish C, Kopple JD. The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): testing the psychometric properties in patients receiving in-center hemodialysis. Nephrology nursing journal: journal of the American Nephrology Nurses' Association. 2010 Jul;37(4):377.
25) 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 Jan 10;2(4):17-25.
26) Sheikh V, Barati M, Khazaei S, Jormand H. Factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan, Iran: the application of the extended theory of planned behavior during Covid-19 pandemic. BMC Nephrol. 2022 Feb 7;23(1):58. doi: 10.1186/s12882-022-02694-x. PMID: 35130871; PMCID: PMC8821849. https://doi.org/10.1186/s12882-022-02694-x PMid:35130871 PMCid:PMC8821849
27) Qobadi M, Besharat M, Rostami R, Rahiminezhad A, Pourgholami M. Health literacy, negative emotional status, and self-care behaviors in dialysis. Journal of Fundamentals of Mental Health. 2015 Jan 1;17(1).
28) Rafiei M, Khandan M, Investigating the health literacy of hemodialysis patients in relation to diet and transition factors affecting it. The 6th International Conference on Health, Treatment and Health Promotion. 2021. https://civilica.com/doc/1261147.
29) Skoumalova I, Kolarcik P, Madarasova Geckova A, Rosenberger J, Majernikova M, Klein D, van Dijk JP, Reijneveld SA. Is health literacy of dialyzed patients related to their adherence to dietary and fluid intake recommendations? International journal of environmental research and public health. 2019 Nov;16(21):4295. https://doi.org/10.3390/ijerph16214295 PMid:31694265 PMCid:PMC6862452
30) Chen YC, Chang LC, Liu CY, Ho YF, Weng SC, Tsai TI. The roles of social support and health literacy in self‐management among patients with chronic kidney disease. Journal of Nursing Scholarship. 2018 May;50(3):265-75. https://doi.org/10.1111/jnu.12377 PMid:29569423
31) Beerappa H, Chandrababu R. Adherence to dietary and fluid restrictions among patients undergoing hemodialysis: An observational study. Clinical Epidemiology and Global Health. 2019 Mar 1;7(1):127-30. https://doi.org/10.1016/j.cegh.2018.05.003
32) Kutner NG, Zhang R, McClellan WM, Cole SA. Psychosocial predictors of non-compliance in haemodialysis and peritoneal dialysis patients. Nephrol Dial Transplant. 2002 Jan;17(1):93-9. doi: 10.1093/ndt/17.1.93. PMID: 11773470. https://doi.org/10.1093/ndt/17.1.93 PMid:11773470
33) Nerbass FB, Morais JG, Santos RG, Krüger TS, Koene TT, Luz Filho HA. Adherence and knowledge about hyperphosphatemia treatment in hemodialysis patients with hyperphosphatemia. Brazilian Journal of Nephrology. 2010;32:149-55. https://doi.org/10.1590/S0101-28002010000200003 PMid:21103674
34) Zakeri MA, Tavan A, Nadimi AE, Bazmandegan G, Zakeri M, Sedri N. Relationship Between Health Literacy, Quality of Life, and Treatment Adherence in Patients with Acute Coronary Syndrome. HLRP: Health Literacy Research and Practice. 2023 Apr 1;7(2):e71-9. https://doi.org/10.3928/24748307-20230320-01 PMid:37053051 PMCid:PMC10104679
35) Aghajanloo R, Nadrian H, Baraei B, Shirzadi S, Sarbakhsh P, Keshavarzian K, Ghassab-Abdollahi N, Chattu VK. Health literacy, treatment adherence, bone mass density and health-related quality of life among Iranian older adults with osteoporosis. International Journal of Health Promotion and Education. 2023 Sep 3;61(5):227-42. https://doi.org/10.1080/14635240.2022.2052145
36) Ebadi A, Balouchi A, Parvizy S, Nia HS. Dialysis adequacy among haemodialysis patients in eastern Mediterranean region: A systematic review and meta-analysis. Asia Pacific Journal of Health Management. 2021 Dec 1;16(4):96-115. https://doi.org/10.24083/apjhm.v16i4.1139
37) Ebrahimi H, Sadeghi M, KHATIBI MR. The relationship between quality of life with dialysis efficacy and laboratory parameters in Shahroud'hemodialysis patients.
38) Arzhangi R, Ghasemi S, Mohammadi S, Norouzi M, Norouzi K. Investigating the relationship between health literacy and quality of life on hemodialysis patients in selected medical centers under the auspices of Ardabil University of Medical Sciences. IJRN. 2022 Mar 10;8(2):21-31.
39) Taylor DM, Bradley JA, Bradley C, Draper H, Johnson R, Metcalfe W, Oniscu G, Robb M, Tomson C, Watson C, Ravanan R. Limited health literacy in advanced kidney disease. Kidney international. 2016 Sep 1;90(3):685-95. https://doi.org/10.1016/j.kint.2016.05.033 PMid:27521115
40) Mirzaei-Alavijeh M, Hamzeh B, Omrani H, Esmailli S, Khakzad S, Jalilian F. Determinants of medication adherence in hemodialysis patients: a cross-sectional study based on capability-opportunity-motivation and behavior model. BMC Nephrol. 2023 Jun 14;24(1):174. doi: 10.1186/s12882-023-03231-0. PMID: 37316774; PMCID: PMC10266875. https://doi.org/10.1186/s12882-023-03231-0 PMid:37316774 PMCid:PMC10266875
41) Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC nephrology. 2017 Dec;18:1-20. https://doi.org/10.1186/s12882-017-0734-z PMid:29061163 PMCid:PMC5653982

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