Effect of Educational Intervention on Knowledge and Level of Adherence among Hemodialysis Patients: A Randomized Controlled Trial

Abstract

Purpose. The purpose of the study was to assess the impact of an educational intervention on the level of knowledge and adherence to the treatment regimen among hemodialysis (HD) patients as well as to describe the association between these variables. Methods. In this randomized controlled trial, 160 HD patients at an HD centre of a 2030-bed tertiary teaching hospital in Southern India were randomly assigned into intervention (N = 80, received education and a booklet) and control (N = 80, received standard care) groups. Knowledge and adherence were measured preintervention and postintervention using a validated questionnaire for knowledge and the ESRD-AQ (End-Stage Renal Disease Questionnaire) for the level of adherence. The statistical analysis of the data was performed with the help of the Statistical Program SPSS version 19.0. The statistical significance level was set at 0.05. Results. The increase in knowledge on disease management, fluid adherence, and dietary adherence in the intervention group was significantly higher compared to the control group. There was no significant correlation between knowledge and adherence. Adherence improved for all the domains, i.e., dialysis attendance, episodes of shortening, adherence to medication, fluid restriction, and dietary restriction. Adherence to fluid and dietary restriction was statistically significant. This trail is registered with https://clinicaltrials.gov/ct2/show/CTRI/2018/05/014166.

Impact of Nutrition Education on Various Health-Related Components of Hemodialysis Patients: A Systematic Review

“…The studies included in this review have demonstrated an increase in adherence to fluid restriction [ 13 , 15 , 39 , 40 , 43 , 44 , 49 ], potassium and phosphate intake [ 13 ], dietary restriction [ 15 , 39 , 40 , 44 , 49 ], specific cooking methods [ 28 ], vegetable preferences [ 28 ], sodium intake adherence [ 13 ], and reduction in the frequency of non-adherence to the diet [ 23 ], frequency of non-adherence to fluid restriction [ 23 ], the score of non-adherence to sweets high in P (phosphorus) [ 27 ], and starch high in P [ 27 ].…”

“…The studies in our review were subject to certain limitations. This included insufficient results to draw any conclusions [ 12 ], challenges in generalizing the findings [ 13 , 15 , 27 , 35 , 48 , 50 , 51 ], language difficulties among patients [ 13 ], a lack of detail on the effect of the intervention elements [ 13 ], the possibility of contamination of information between patient groups [ 14 , 19 , 34 , 44 ], uncontrolled variables [ 14 , 21 , 22 , 26 , 29 , 31 , 37 ], short duration of studies, interventions, or follow-up [ 15 , 19 , 27 , 30 , 35 , 41 , 51 ], the patients already being familiar with educational content [ 17 ], small sample size [ 29 , 30 , 37 , 41 , 46 , 49 , 52 ], self-selection bias [ 52 ], not all information being analyzed [ 20 , 48 ], subjective results linked to patient declarations [ 23 ], inaccurate assessment tools [ 42 ], possible Hawthorne effect [ 30 ], interventions conducted in a single center [ 30 , 41 ], and the possibility of social desirability effect bias [ 39 ,…”