Managing treatment for end-stage renal disease – A qualitative study exploring cultural perspectives on facilitators and barriers to treatment adherence

Abstract

Although adherence to hemodialysis (HD) regimes is important to maximise good clinical outcomes, it remains suboptimal and not well understood, particularly for those in non-Western settings and patients from Asian cultures. This qualitative study sought to explore cultural perspectives on facilitators and barriers to treatment adherence in HD patients. A descriptive exploratory design was used for the study, incorporating individual semi-structured interviews (n = 17) and three focus groups (n = 20). Each interview/focus group was audio-taped and transcribed verbatim, and coding was conducted by two coders using an iterative process. Study participants identified personal and social/contextual factors as major barriers or facilitators of treatment adherence. Barriers include time consumption, forgetfulness, concerns about safety, poor knowledge/understanding, poor communication and lack of control/social pressure. Participants also identified facilitators, both internal (self-initiated) and external (initiated by family, health care professional and peers) to ensure treatment adherence. These included support from family members and social obligation towards others, risk perception, establishment of routines and peer support. Internal and external factors can hinder or facilitate adherence to diet, fluid and medications in the context of dialysis. Several of these barriers/facilitators can be effectively addressed in the context of interventions and psycho-educational programmes.

Keywords:

• adherence
• hemodialysis
• barriers
• facilitators

Acknowledgements

This research was supported by grants from NKF Research Fund [NKFRC2008/07/24] and Ministry of Education – NUS Academic Research Fund (start up) [FY2007-FRC5-006] to KG, both of which are gratefully acknowledged. The authors also thank Dr Tonia Griva, the NKF Health Care Professionals (Chor Guek Chua, Dr Rajeswari Moothathamby) and several other Senior Renal Nurse Clinicians (Woon Hoe Tang; Wong Kin Nen; Choo Bee Bee;) and Medical Social Workers from Care and Counseling department in (Chitra Dzalila; Wendy Tan, Angela Loh; Jason Low; Josephine Chua), for their support in the programme.