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Torabikhah M, Farsi Z, Sajadi SA. Comparing the effects of mHealth app use and face-to-face training on the clinical and laboratory parameters of dietary and fluid intake adherence in hemodialysis patients: a randomized clinical trial. BMC Nephrol 2023; 24:194. [PMID: 37386428 PMCID: PMC10308810 DOI: 10.1186/s12882-023-03246-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Numerous factors are likely to result in poor treatment adherence, which is one of the important factors contributing to increased complications and the low efficacy of hemodialysis (HD), particularly inadequate knowledge of patients. This study aimed to compare the effects of a mobile health (mHealth) app (the Di Care app) use and face-to-face training on the clinical and laboratory parameters of dietary and fluid intake adherence in patients undergoing HD. METHODS This single-blinded, two-stage/two-group randomized clinical trial was fulfilled in 2021-22 in Iran. Seventy HD patients were recruited, using the convenience sampling method, and were then randomized into two groups: mHealth (n = 35) and face-to-face training (n = 35). The patients in both groups received the same educational materials via the Di Care app and face-to-face training for one month. Before and 12 weeks after the intervention, the mean interdialytic weight gain (IDWG), potassium (K), phosphorus (P), total cholesterol (TC), triglyceride (TG), albumin (AL), and ferritin (FER) levels were measured and compared. The data were analyzed using the SPSS via descriptive statistics (mean, SD, frequency, and percentage) and analytical tests (independent-samples t-test, paired-samples t-test, Wilcoxon signed-rank test, Mann-Whitney U test, Chi-square test, and Fisher's exact test). RESULTS Prior to the intervention, the mean IDWG and the K, P, TC, TG, AL, and FER levels, were not significantly different in both groups (p > 0.05). The mean IDWG (p < 0.0001), and the K (p = 0.001), P (p = 0.003), TC/TG (p < 0.0001), and FER (p = 0.038) levels in the HD patients in the mHealth group decreased. As well, the mean IDWG (p < 0.0001), and the K (p < 0.0001) and AL (p < 0.0001) levels showed a descending trend in the face-to-face group. The fall in the mean IDWG (p = 0.001) and the TG level (p = 0.034) in the patients in the mHealth group was significantly greater than that in the face-to-face group. CONCLUSIONS The Di Care app use and the face-to-face training could improve dietary and fluid intake adherence in patients. However, mHealth could have more effect on the laboratory parameters than face-to-face training, largely reducing the IDWG. TRIAL REGISTRATION This study was registered in the Iranian Registry of Clinical Trials (No. ID IRCT20171216037895N5).
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Affiliation(s)
- Mohsen Torabikhah
- Medical-Surgical Department, Nursing School, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Farsi
- Research and Community Health Departments, Nursing School, Aja University of Medical Sciences, Tehran, Iran
| | - Seyedeh Azam Sajadi
- Nursing Management Department, Nursing School, Aja University of Medical Sciences, Tehran, Iran
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Torabi Khah M, Farsi Z, Sajadi SA. Comparing the effects of mHealth application based on micro-learning method and face-to-face training on treatment adherence and perception in haemodialysis patients: a randomised clinical trial. BMJ Open 2023; 13:e071982. [PMID: 37270196 DOI: 10.1136/bmjopen-2023-071982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVES Comparing the effects of a mobile health (mHealth) application based on the micro-learning method with face-to-face training on treatment adherence and perception among patients undergoing haemodialysis. DESIGN A single-blind randomised clinical trial. SETTING A haemodialysis centre in Isfahan, Iran. PARTICIPANTS Seventy patients. INTERVENTION Patients were trained individually for 1 month via the mHealth application or face-to-face training. OUTCOME MEASURES Treatment adherence and perception in patients were measured and compared. RESULTS The scores of treatment adherence in the mHealth and the face-to-face training groups were not significantly different at the pre-intervention stage (720.43±209.61 vs 702.861±181.47, p=0.693) and immediately after the intervention (1007.14±134.84 vs 947.86±124.46, p=0.060), while 8 weeks later, treatment adherence in the mHealth group was significantly higher than the face-to-face training group (1018.57±129.66 vs 914.29±126.06, p=0.001). The scores of both groups before the intervention did not differ in various dimensions of treatment adherence and perception (p>0.05). Scores of these variables also elevated significantly after the intervention (p<0.05). CONCLUSIONS The mHealth based on micro-learning and face-to-face training as interventions augmented treatment adherence and perception among the haemodialysis patients, but such improvements were detected much more in the patients trained with mHealth based on the micro-learning method than face-to-face training. TRIAL REGISTRATION NUMBER IRCT20171216037895N5.
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Affiliation(s)
- Mohsen Torabi Khah
- Medical-Surgical Department, Nursing School, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Farsi
- Research and Community Health Departments, Nursing School, Aja University of Medical Sciences, Tehran, Iran
| | - Seyedeh Azam Sajadi
- Nursing Management Department, Nursing School, Aja University of Medical Sciences, Tehran, Iran
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Sousa H, Ribeiro O, Costa E, Christensen AJ, Figueiredo D. Establishing the criterion validity of self-report measures of adherence in hemodialysis through associations with clinical biomarkers: A systematic review and meta-analysis. PLoS One 2022; 17:e0276163. [PMID: 36256660 PMCID: PMC9578604 DOI: 10.1371/journal.pone.0276163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022] Open
Abstract
Accurate measurement of adherence is crucial to rigorously evaluate interventions aimed at improving this outcome in patients undergoing in-center hemodialysis. Previous research has shown great variability in non-adherence rates between studies, mainly due to the use of different direct (e.g., clinical biomarkers) and indirect (e.g., questionnaires) measures. Although self-reported adherence in hemodialysis has been widely explored, it is still unclear which is the most accurate questionnaire to assess this outcome; therefore, the question of how to optimize adherence measurement in research and clinical practice has emerged as a key issue that needs to be addressed. This systematic review and meta-analysis aimed to explore the criterion validity of self-report measures of adherence in hemodialysis established through the association between test scores and clinical biomarkers (the criterion measure). The protocol was registered in PROSPERO (2021 CRD42021267550). The last search was performed on March 29th, 2022, on Web of Science (all databases included), Scopus, CINHAL, APA PsycInfo, and MEDLINE/PubMed. Twenty-nine primary studies were included, and thirty-eight associations were analyzed. The Hunter-Schmidt's meta-analysis was computed for the associations with more than two studies (n = 20). The results showed that six associations were large (16%), 11 were medium (29%) and the remaining were of small strength. The test scores from the End-Stage Renal Disease Adherence Questionnaire (range: 0.212<rc <0.319) and the Dialysis Diet and Fluid Non-Adherence Questionnaire (range: 0.206<rc <0.359) had medium to large strength associations with interdialytic weight gain, serum phosphorus, and potassium levels, indicating that these questionnaires have reasonable concurrent criterion validity to measure fluid control and adherence to dietary restrictions in patients receiving hemodialysis. The available data did not allow exploring the criterion validity of the test scores in relation to hemodialysis attendance (skipping and/or shortening sessions). These results suggest that the decision to use one questionnaire over another must be made with caution, as researchers need to consider the characteristics of the sample and the objectives of the study. Given that direct and indirect methods have their advantages and disadvantages, the combination of adherence measures in hemodialysis is recommended to accurately assess this complex and multidimensional outcome.
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Affiliation(s)
- Helena Sousa
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Oscar Ribeiro
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Elísio Costa
- Research Unit on Applied Molecular Biosciences (UCIBIO–REQUIMTE), Faculty of Pharmacy and Competence Center on Active and Healthy Ageing (Porto4Ageing), University of Porto, Porto, Portugal
| | - Alan Jay Christensen
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States of America
| | - Daniela Figueiredo
- CINTESIS@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
- * E-mail:
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Kim H, Jeong IS, Cho MK. Effect of Treatment Adherence Improvement Program in Hemodialysis Patients: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19:11657. [PMID: 36141929 PMCID: PMC9517018 DOI: 10.3390/ijerph191811657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Herein, we performed a meta-analysis evaluating the effects of treatment adherence enhancement programs on treatment adherence and secondary outcomes for hemodialysis patients. Twenty-five Korean and international articles published prior to 31 March 2022 were selected following the PRISMA and Cochrane Systematic Review guidelines. We calculated summary effect sizes, conducted homogeneity and heterogeneity testing, constructed a funnel plot, and performed Egger's regression test, Begg's test, trim-and-fill method, subgroup analyses, and univariate meta-regression. The overall effect of treatment adherence enhancement programs for hemodialysis patients was statistically significant (Hedges' g = 1.10, 95% CI: 0.77, 1.43). On performing subgroup analysis to determine the cause of effect size heterogeneity, statistically significant moderating effects were found for a range of input variables (Asian countries, study centers, sample size, study design, intervention types, number of sessions, quality assessment scores, funding, and evidence-based interventions). On univariate meta-regression, larger synthesized effect sizes were found for a range of study characteristics (Asian populations, single-center studies, studies with <70 participants, quasi-experimental studies, educational interventions, studies with >12 sessions, studies with quality assessment scores above the mean, unfunded studies, and non-theory-based interventions). Our results provide evidence-based information for enhancing program efficacy when designing treatment adherence enhancement programs for hemodialysis patients.
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Alshogran OY, Hajjar MH, Muflih SM, Alzoubi KH. The role of clinical pharmacist in enhancing hemodialysis patients' adherence and clinical outcomes: a randomized-controlled study. Int J Clin Pharm 2022. [PMID: 35821552 DOI: 10.1007/s11096-022-01453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adherence to treatment recommendations is challenging in hemodialysis (HD) patients, yet it has been found to be extremely crucial in obtaining positive clinical and health outcomes. AIM To evaluate the influence of implementing an educational process provided by the clinical pharmacist on HD patients' adherence to treatment recommendations and clinical outcomes. METHOD A randomized controlled trial was conducted in which patients from three HD units in Jordan were randomly allocated to either an intervention (n = 60) or a control group (n = 60). During a three-month period, the intervention group received a monthly educational approach from a clinical pharmacist with recommendations for improving medication, nutrition, and fluid adherence, whereas the control received standard medical care. The primary outcome was patient adherence to HD-related recommendations. Quality of life (QOL), disease awareness, hospitalization, and changes in biochemicals were secondary outcomes. RESULTS The final analysis included 114 patients (n = 57/group). In the intervention group, there was a significant improvement in total adherence score versus control (1170.6 ± 44.1 vs. 665.8 ± 220.7, p < 0.001), and adherence to various aspects including episodes/duration of shortening HD, dietary guidelines, fluid restriction, and prescription medications. The clinical pharmacist intervention enhanced patients' QOL and improved awareness and perspective of the disease. Following the intervention, laboratory values for urea, creatinine, phosphorus, and hemoglobin were considerably improved. Additionally, the intervention group had fewer hospitalizations than the control group (0.54 ± 0.07 vs. 0.78 ± 0.26, p < 0.001). CONCLUSION Providing clinical pharmacy education to HD patients improved adherence behavior and clinical outcomes. This illustrates the importance of clinical pharmacists as interdisciplinary team members in dialysis care. Trial registration This trial has been registered in ISRCTN Register (ISRCTN75517095). https://clinicaltrials.gov/ct2/show/ISRCTN75517095.
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Filho JCA, Rocha LP, Cavalcanti FC, Marinho PE. Relevant functioning aspects and environmental factors for adults and seniors undergoing hemodialysis: A qualitative study. Chronic Illn 2022; 18:206-217. [PMID: 32727201 DOI: 10.1177/1742395320945200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify which functioning, personal and environmental factors are more relevant to adults in hemodialysis treatment. MATERIALS AND METHODS Data was collected by semi-structured interview, recorded, transcribed in full, verified and produced by Bardin Thematic content analysis. Two independent researchers identified the relevant themes and named the thematic categories found according to the coding of the International Classification of Functioning, Disability and Health (ICF). RESULTS Six men and three women aged between 32-65 years were interviewed, with per capita family income between 1-2.9 minimum salaries and hemodialysis treatment time between 5 to 26 years. Fifty-seven ICF categories were listed: 17 Body Functions, 9 Body Structures, 21 Activities and Participation, and 10 Environmental Factors. Health, transportation and general social support services, systems and policies; doing housework; recreation and leisure; emotional functions, temperament and personality functions; energy and drive functions; sensation of pain; and structures of the cardiovascular system, lower extremity and musculoskeletal structures related to movement were the most reported aspects by the participants. CONCLUSION Patients' need for physical/emotional support from their partners, friends and health professionals, including emotional and social support, with health policies, transportation and job maintenance, in order to increase their survival and quality of life.
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Affiliation(s)
- José C Araújo Filho
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brasil
| | - Luana P Rocha
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brasil
| | | | - Patrícia Em Marinho
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brasil
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Vijay VR, Kang HK. The worldwide prevalence of non-adherence to diet and fluid restrictions among hemodialysis patients: A systematic review and meta-analysis. J Ren Nutr 2021; 32:658-669. [PMID: 34923113 DOI: 10.1053/j.jrn.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Non-adherence to diet and fluid restrictions in hemodialysis (HD) patients can lead to undesired health outcomes. This systematic review and meta-analysis aim to estimate the pooled prevalence of non-adherence to diet and fluid restrictions in HD patients. METHODS Research papers from PubMed, CINAHL, and Google Scholar on non-adherence to diet and fluid restrictions in HD patients published between 2000 and 2020 were selected for this study. The methodological quality of each study was graded, and the estimates were pooled using the random-effects model of meta-analysis. Analyses of subgroups and meta-regression were carried out. Egger's test and visual analysis of the symmetry of funnel plots were used to assess the publication bias. RESULTS Eight hundred sixty-eight potential records were identified during the search. Twenty-three studies that met inclusion criteria were considered for meta-analysis and comprised 11,209 HD patients (mean age 55.85 years± SD 6.86, males 57.74%). The estimated worldwide prevalence of non-adherence to diet and fluid restrictions was 60.2% (95% CI: 47.3- 72.5) and 60.6% (95% CI: 50- 70.7), respectively. The meta-regression found that the income category was negatively, and the risk of bias score was positively associated with the prevalence of non-adherence to fluid restrictions (p<0.05). The funnel plot of studies included pooling the prevalence of non-adherence to fluid restrictions revealed asymmetry, and a significant publication bias was also noted as assessed by Egger's test (P = 0.004). However, the pooled estimate should be interpreted with caution because the prevalence of individual studies varies considerably due to methodological or measurement discrepancies. CONCLUSION The pooled prevalence of non-adherence to diet (47.3 - 72.5%) and fluid (50 - 70.7%) restrictions were substantially high. The health care team must recognize the factors and barriers influencing adherence behavior and develop holistic interventions to improve it.
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Affiliation(s)
- V R Vijay
- Tutor, College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Harmeet Kaur Kang
- Professor cum Principal, Chitkara School Of Health Sciences,Chitkara University, Punjab, India
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Abstract
BACKGROUND The factors related to fluid intake adherence among patients undergoing hemodialysis have been explored in many studies. However, most of these were conducted in Western countries and have produced inconsistent results. A study of this issue in Indonesia, a tropical country with strong herbal medicine traditions, may show different results. In addition to demographic characteristics, self-efficacy is a standard measurement used in chronic care management activities such as hemodialysis treatment. Understanding the reasons behind patient nonadherence in Indonesia may help nurses better manage the fluid intake of patients. PURPOSE This study was designed to determine the factors that predict patient adherence to fluid intake restrictions. METHODS A cross-sectional study was conducted on 153 patients undergoing hemodialysis at two hospitals. Intradialytic weight gain over a 1-month period was recorded to assess the participants' adherence to fluid intake restrictions. Intradialytic weight gains of more than 2 kg was considered to be nonadherent. A daily urine output and level of thirst were also recorded. The participants completed an adapted self-efficacy questionnaire, Swedish Fluid Intake Appraisal Inventory, and the data were analyzed together with demographic characteristic and clinical parameters using hierarchical multiple regression. RESULTS The results revealed that most of the respondents did not adequately adhere to fluid intake restrictions (59.5%). Intradialytic weight gain was shown to strongly correlate with self-efficacy (p < .05, β = -.201), gender (p < .05, β = -.179), educational background (p = .05, β = .159), and urine output (p < .05, β = -.168). Demographic characteristic explained 10.6% and self-efficacy explained 3.9% of the variance in fluid adherence. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Female participants with higher self-efficacy scores reported the lowest average level of intradialytic weight gain, indicating better adherence to fluid intake restrictions. Several demographic factors as well as self-efficacy were identified as potential predictors of fluid intake restriction adherence. Therefore, measuring self-efficacy periodically is a good initial step toward detecting those patients who are at higher risk of noncompliance with fluid intake restrictions.
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Affiliation(s)
- Melyza Perdana
- MS, Lecturer, Department of Medical Surgical Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Yangöz ŞT, Özer Z, Boz İ. Comparison of the effect of educational and self-management interventions on adherence to treatment in hemodialysis patients: A systematic review and meta-analysis of randomized controlled trials. Int J Clin Pract 2021; 75:e13842. [PMID: 33220132 DOI: 10.1111/ijcp.13842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Adherence to fluid intake, diet, and drug management is very important in hemodialysis patients. Educational and self-management interventions are frequently used to improve adherence to treatment in hemodialysis patients. OBJECTIVES To synthesize a comparison of the effect of educational and self-management interventions on adherence to treatment in hemodialysis patients in randomized controlled trials. METHODS Systematic searches were conducted using 11 multidisciplinary databases in June 2020. The PRISMA checklist was used. The subgroup analysis was used to compare the effect of educational and self-management interventions on adherence to fluid intake, diet, and drug management. RESULTS In the included studies, educational interventions were performed ranging from 15 to 60 minutes, in 1-72 sessions. Self-management interventions were performed ranging from 10 to 120 minutes, in 1-84 sessions. The overall effect of educational interventions was small on adherence to fluid intake (P = .019, Hedges' g = -0.39), diet in serum phosphorus level (P = .001, Hedges' g = -0.35), drug management (P = .002, Hedges' g = -0.44), and not significant on adherence to diet in serum potassium level (P = .181). The overall effect of self-management interventions was small on adherence to fluid intake (P = .001, Hedges' g = -0.19) and diet in serum phosphorus level (P < .001, Hedges' g = -0.42). Additionally, the overall effect of self-management interventions was moderate on adherence to diet in serum potassium level (P = .002, Hedges' g = -0.75) and drug management (P < .001, Hedges' g = -0.55). There was no difference between the educational and self-management interventions on adherence to fluid intake, diet, and drug management (P > .05). CONCLUSIONS The analysis shows that educational and self-management interventions had a beneficial effect on adherence to fluid intake, diet, and drug management and no difference between these interventions. Therefore, these interventions can be used by healthcare professionals. It is also recommended that these interventions be well defined and transferable to routine clinical practice.
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Affiliation(s)
- Şefika Tuğba Yangöz
- Faculty of Nursing, Department of Internal Medicine Nursing, Akdeniz University, Antalya, Turkey
| | - Zeynep Özer
- Faculty of Nursing, Department of Internal Medicine Nursing, Akdeniz University, Antalya, Turkey
| | - İlkay Boz
- Faculty of Nursing, Department of Obstetrics and Gynecology Nursing, Akdeniz University, Antalya, Turkey
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Vijay VR, Kang HK. Efficacy of nurse-led-interventions on dialysis related diet and fluid non-adherence and morbidities: protocol for a randomized controlled trial. Journal of Global Health Reports 2019. [DOI: 10.29392/joghr.3.e2019083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Bright T, Kuper H. A Systematic Review of Access to General Healthcare Services for People with Disabilities in Low and Middle Income Countries. Int J Environ Res Public Health 2018; 15:ijerph15091879. [PMID: 30200250 PMCID: PMC6164773 DOI: 10.3390/ijerph15091879] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/17/2018] [Accepted: 08/29/2018] [Indexed: 12/30/2022]
Abstract
Background: A systematic review was undertaken to explore access to general healthcare services for people with disabilities in low and middle-income countries (LMICs). Methods: Six electronic databases were searched in February 2017. Studies comparing access to general healthcare services by people with disabilities to those without disabilities from LMICs were included. Eligible measures of healthcare access included: utilisation, coverage, adherence, expenditure, and quality. Studies measuring disability using self-reported or clinical assessments were eligible. Title, abstract and full-text screening and data extraction was undertaken by the two authors. Results: Searches returned 13,048 studies, of which 50 studies were eligible. Studies were predominantly conducted in sub-Saharan Africa (30%), Latin America (24%), and East Asia/Pacific (12%). 74% of studies used cross-sectional designs and the remaining used case-control designs. There was evidence that utilisation of healthcare services was higher for people with disabilities, and healthcare expenditure was higher. There were less consistent differences between people with and without disabilities in other access measures. However, the wide variation in type and measurement of disability, and access outcomes, made comparisons across studies difficult. Conclusions: Developing common metrics for measuring disability and healthcare access will improve the availability of high quality, comparable data, so that healthcare access for people with disabilities can be monitored and improved.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Van Bulck L, Claes K, Dierickx K, Hellemans A, Jamar S, Smets S, Van Pottelbergh G. Patient and treatment characteristics associated with patient activation in patients undergoing hemodialysis: a cross-sectional study. BMC Nephrol 2018; 19:126. [PMID: 29859047 PMCID: PMC5984733 DOI: 10.1186/s12882-018-0917-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Patient activation is associated with better outcomes and lower costs. Although the concept is widely investigated, little attention was given to patient activation and its predictors in patients undergoing hemodialysis. Hence, we aimed to investigate the level of patient activation and aimed to determine patient- and treatment-related predictors of activation in patients undergoing hemodialysis. Methods This cross-sectional observational study recruited patients undergoing hemodialysis in three Flemish hospitals. Participants were questioned about patient characteristics (i.e., age, sex, education, employment, children, social support, leisure-time, living condition, and care at home), treatment- and health-related characteristics (i.e., hospital, time since first dialysis, transplantation, self-reported health (EQ-VAS) and depressive symptoms (PHQ-2)), and patient activation (PAM-13). Univariate and multiple linear regression analyses with dummy variables were conducted to investigate the associations between the independent variables and patient activation. Results The average patient activation-score was 51. Of 192 patients, 44% patients did not believe they had an important role regarding their health. Multiple linear regression showed that older patients, who reported being in bad health, treated in a particular hospital, without leisure-time activities, and living in a residential care home, had lower patient activation. These variables explained 31% of the variance in patient activation. Based on literature, we found that activation of patients on hemodialysis is low, compared to that of other chronic patient groups. Conclusion It could be useful to implement patient activation monitoring, since the level of activation is low in patients undergoing hemodialysis. Older patients, who reported being in bad health, treated in a particular hospital, without leisure-time activities, living in a residential care home, are at higher risk for lower activation. Electronic supplementary material The online version of this article (10.1186/s12882-018-0917-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liesbet Van Bulck
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35 (box 7001), B-3000, Leuven, Belgium.
| | - Kathleen Claes
- University Hospitals Leuven, Department of Nephrology and Renal Transplantation, Herestraat 49, B-3000, Leuven, Belgium.,KU Leuven, Department of Microbiology and Immunology, Laboratory of Nephrology, Minderbroederstraat 10 (box 1030), B-3000, Leuven, Belgium
| | - Katrien Dierickx
- University Hospitals Leuven, Department of Nephrology and Renal Transplantation, Herestraat 49, B-3000, Leuven, Belgium
| | - Annelies Hellemans
- University Hospitals Leuven, Department of Nephrology and Renal Transplantation, Herestraat 49, B-3000, Leuven, Belgium
| | - Sofie Jamar
- Imeldaziekenhuis, Nephrology, Imeldalaan 9, B-2820, Bonheiden, Belgium
| | - Sven Smets
- Sint-Trudo Ziekenhuis, Nephrology, Diestersteenweg 100, B-3800, Sint-Truiden, Belgium
| | - Gijs Van Pottelbergh
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for General Practice, Kapucijnenvoer 33 (box 7001), B-3000, Leuven, Belgium
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Beerendrakumar N, Ramamoorthy L, Haridasan S. Dietary and Fluid Regime Adherence in Chronic Kidney Disease Patients. J Caring Sci 2018; 7:17-20. [PMID: 29637052 PMCID: PMC5889793 DOI: 10.15171/jcs.2018.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/03/2017] [Indexed: 12/24/2022] Open
Abstract
Introduction: Patients
with Chronic Kidney Disease (CKD) needs to modify their lifestyle chiefly
focusing on diet and fluid intake as the prognosis of these patients largely
depends on adherence to the recommended nutritional regime. Non adherence to
the suggested diet and fluids regime leads to rapid worsening of the
condition.
Methods: Cross
sectional survey was conducted to determine the level of adherence to the
dietary and fluids restriction among CKD patients. Inclusion criteria’s was,
age between 18- 65 years, patients with CKD for at least 6 months and
received dietary counseling. Consecutive sampling technique was used to
select 100 patients. Data was collected with self-reported Dialysis Diet and
Fluid non adherence Questionnaire (DDFQ).
Results: Majority (73%) of the subjects was
males, 64% belongs to 40-60 years age, majority of them were unemployed. Mean
Body Mass Index (BMI) was 20.52 kg/m2, the mean duration of the
treatment is 2.15 years and mean fluid intake was 2153ml ml/day and
inter-dialytic weight gain was 1.48 kg. Regarding adherence, 20% of them had
mild deviation and 69% of them had moderate deviation from dietary
restrictions and similarly 69 % of the participants had moderate deviation,
and 22% of them had mild deviation from fluid restriction guidelines. Low
level of adherence to fluid and diet restrictions was noted in illiterate
patients which was significant P<0.05.
Conclusion: In
spite of the dietary counseling, considerable proportions of the patients
were non adherent to the diet and fluid restrictions which necessitate regular
counseling to patient and family members.
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Tapolyai MB, Faludi M, Berta K, Szarvas T, Lengvárszky Z, Molnar MZ, Dossabhoy NR, Fülöp T. The effect of ambient temperature and humidity on interdialytic weight gains in end-stage renal disease patients on maintenance hemodialysis. Int Urol Nephrol 2016; 48:1171-6. [DOI: 10.1007/s11255-016-1297-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
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Fan JL, Kong Y, Shi SH, Cheng YH. Positive correlations between the health locus of control and self-management behaviors in hemodialysis patients in Xiamen. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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