Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations?

Abstract

Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We performed a multicentric cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; response rate: 70.1%; mean age = 63.6 years; males: 60.7%). We assessed the association between nine domains of HL and non-adherence (high serum potassium, high serum phosphate, relative overhydration, and self-reported NADFIR) using general linear models adjusted for age and gender. Moreover, we assessed the moderation by socioeconomic status (SES). We found higher NADFIR among patients with less sufficient information for health management (high serum phosphate level; odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63–0.94), with a lower ability to actively manage their health (self-reported diet non-adherence; OR: 0.74; 95% CI: 0.62–0.89), and those less able to actively engage with healthcare providers (overhydrated; OR: 0.78; 95% CI: 0.65–0.94). Moreover, SES modified this relation. Low HL affects the adherence of dialyzed patients. This shows a need to support patients with low HL and to train healthcare providers to work with these patients, taking into account their SES.

Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration using Partial Least Squares Structural Equation Modeling

“…This is in tune with the previous studies pertaining to the mediating role of health literacy on the relationship between sociodemographic factors and health [ 93 , 94 ]. It also explains why the relationship between health literacy and dietary adherence is more prominent among patients with lower socio-economic status [ 14 ].…”

“…Exclusion criteria were if patients had any physical impairment, present with terminal illness and transfer plan to other RRT option. The selection criteria were based on similar studies [ 14 , 35 ] with some adaptations to the local context and according to expert opinions. A total number of 486 HD patients (83.4%) were found eligible from a total screening population of 583 HD patients.…”

“…A growing body of evidence has supported the essential role of health literacy on patients’ self-care and adherence behaviours in the HD population [ 13 , 14 , 15 , 16 ]. Health literacy is defined as “the skills, knowledge, motivation and the capacity of a person to access, understand, appraise and apply information to make effective decisions about health and health care, and take action” [ 17 ].…”

“…Correspondingly, HD patients in LMIC are suffering from limited access to dietitian services attributed to dietitian shortage (20–45%) [ 25 ]. Limited nutrition education delivery is likely to affect nutrition literacy, leading to suboptimal dietary adherence in the HD population [ 14 ].…”

Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?

“…HL is defined as knowledge, motivation, and competence of patients to access, understand, appraise, and apply health information in order to make judgments and decisions in their everyday life concerning healthcare, disease prevention, and health promotion to maintain or improve their quality of life [4]. Limited HL is associated with adverse health outcomes such as more hospitalizations and cardiovascular events [5], higher mortality [6,7] and worse health related self-management, e.g., missed dialysis sessions [5] and non-adherence to diet and fluid intake recommendations [8]. Increasing a patient's HL is also considered as a cost-effective intervention area to promote and maintain patients' health [9,10].…”