Abstract: TH-PO857
Motivation Associates with Dialysis Treatment Adherence in African American Patients
Session Information
- Race, Ethnicity, and Gender in Kidney Health and Care
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Wallace, Marylou, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Forbess, Julianna, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Roche, Meaghan Sarah, Henry Ford Health System, Detroit, Michigan, United States
- Prigmore, Heather Leanne, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Greevy, Robert, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Faulkner, Marquetta L., Meharry Medical College, Nashville, Tennessee, United States
- Tindle, Hilary A., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Nair, Devika, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Fissell, Rachel B., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Umeukeje, Ebele M., Vanderbilt University Medical Center, Nashville, Tennessee, United States
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).
Conclusion
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 1
| Missed minutes | Missed minutes | Missed HD sessions | Missed HD sessions | Shortened HD sessions | Shortened HD sessions | |
| Variables | Spearman Rho | p-value | Spearman Rho | p-value | Spearman Rho | p-value |
| AR | -0.16 | 0.024 | -0.04 | 0.554 | -0.31 | <0.001 |
| HCCQ | 0.01 | 0.942 | 0.08 | 0.261 | -0.19 | 0.005 |
| PKDSMS | -0.35 | <0.001 | -0.30 | <0.001 | -0.23 | 0.001 |
Funding
- NIDDK Support