Psychosocial Mediators between Socioeconomic Status and Dietary Restrictions among Patients Receiving Hemodialysis in Japan

Abstract

The generalizability of differences in dietary restrictions (DRs) as function of socioeconomic status (SES) and the pathways of the associations between SES and DRs remain unclear. Therefore, we aimed to explore SES differences in DRs and psychosocial mediators between SES and DRs in Japanese patients receiving hemodialysis. This study was a cross-sectional survey of 6,644 outpatients (average age = 66.5 years; 65% males) of hemodialysis facilities across Japan. DRs were assessed by self-reported and objective measures, and SES was assessed based on education and income. Three psychosocial mediators were used: self-efficacy, control expectancy, and social support. Indirect influences of SES through the mediators were evaluated with a multiple mediator model. Although higher education was significantly associated with higher self-reported DRs, higher income was significantly associated with lower self-reported DRs. Significant SES differences in objective DRs were not observed. The relationships between education and self-reported DRs and objective DRs were significantly mediated by self-efficacy and/or control expectancy. The influences of income were mediated by social support. It becomes possible to design interventions targeting modifiable psychosocial factors including self-efficacy, control expectancy, and social support in order to reduce SES inequalities in DRs.

Illness Perceptions, Self-Care Management, and Clinical Outcomes According to Age-Group in Korean Hemodialysis Patients

“…Chronological age is a major risk factor for chronic disease and mortality, and it is natural for older people to have higher mortality rates than younger people, even without disease. However, age differences in hemodialysis patients may affect health outcomes as they relate to education levels, income, daily living functions, self-efficacy, and dietary control [30]. The demographic and disease-related characteristics of the participants in this study (gender, education, income, duration of dialysis, hypertension, and diabetes) did not vary among the three groups (younger, middle-older, and older).…”

Discordance between hemodialysis patients' reports and their physicians' estimates of adherence to dietary restrictions in Japan

“…We used duration of dialysis (longer) and psychosocial factors (higher self-efficacy, higher outcome expectancy, and higher social support), which are related to treatment nonadherence in patients undergoing hemodialysis [19,32,33]. We used three psychosocial indicators that have demonstrated both content and predictive validity [19]. Cronbach's alphas for self-efficacy, outcome expectancy, and social support were 0.88, 0.84, and 0.87, respectively.…”

“…This study used patient reports to measure the level of adherence to dietary restrictions. Although patient report scales have been shown to be weakly correlated with indirect measures of dietary adherence, including serum potassium and serum phosphate [19], physicians' understanding of factors that deeply reflect patients' health beliefs, values, and preferences is a fundamental feature of patient-centered care [20].…”

Influences of Financial Strains Over the Life Course Before Initiating Hemodialysis on Health Outcomes Among Older Japanese Patients: A Retrospective Study in Japan

“… 1 , 2 Patients with ESKD have various health problems, such as frailty, 3 , 4 malnutrition, 5 cognitive impairment, 6 and depression, 7 as well as daily-life problems, such as impaired quality of life, 8 low levels of recreational and work activities, 9 , 10 and poor dietary habits. 11 Furthermore, CKD brings a serious financial burden on the society. More than 2–3% of the annual health-care budget is typically spent on ESKD in high-income countries, even though persons receiving ESKD treatment occupy less than 0.03% of the entire population.…”