| Objectives:To evaluate the compliance of maintenance hemodialysis(MHD)patients with treatment(including dialysis,fluid management,medication and diet),the influencing factors of adherence,and the relationship between adherence and clinical indicators,caregiver burden,and social support.Methods: This study used a hybrid study design – a combination of quantitative and qualitative studies.The first stage is a quantitative study,using a cross-sectional survey method.The end-stage renal disease-adherence questionnaire(ESRD-AQ)questionnaire and social support scale were used to survey 244 patients with MHD in a tertiary hospital affiliated to Kunming.Caregivers of MHD patients were surveyed using the Zarit Carer Burden Scale.Descriptive statistical methods were used to describe the status quo of adherence,and the SPearson correlation was used to analyze the relationship between patient adherence and clinical indicators,caregiver burden,and social support.Use logistical regression to analyze independent non-engagement influencers.The second stage is a qualitative study in which 15 patients were selected for semi-structured face-to-face interviews according to quantitative research results,interview data were collected by content analysis,compliance status of patients undergoing maintenance dialysis was examined,the causes of non-compliance were investigated in depth,and adaptation risk factors and structural associations and protective factors were investigated in the individual.Family,community and social levels were determined.Results :1.Among the 244 researchers,Dialysis,medications,fluid management,and dietary adherence were 48.4%,96.3%,62.3%,and 60.7%,respectively.2.Monthly income(OR=0.723,95% CI 0.579～0.901,P=0.004)was an independent risk factor for dialysis non-adherence,and dialysis time(OR=1.333,95% CI1.032～1.721,P=0.027)was an independent risk factor for fluid management non-compliance.Dialysis time(OR=1.377,95% CI 1.067～1.777,P=0.014)was an independent risk factor for dietary non-compliance.No significant predictors were found for medication adherence.3.There was no significant correlation between adherence and clinical measures.4.The mean score of burden of care was(36.73±18.37),which was positively correlated with dialysis treatment non-adherence(r=0.276,P<0.001),fluid management non-adherence(r=0.354,P<0.001),dietary non-adherence(r=0.364,P<0.001),and drug non-adherence.5.The mean social support score was(23.60±7.97),which was significantly negatively correlated with dialysis treatment non-adherence(r=-0.346,P<0.001),significantly negatively correlated with fluid management non-adherence(r=-0.469,P<0.001),significantly negatively correlated with dietary non-adherence(r=-0.447,P<0.001),and not significantly associated with drug non-adherence.6.Poor dialysis adherence in patients emerged with four main themes related to non-adherence:(1)self-efficacy and(2)lack of knowledge about hemodialysis.(3)Anxiety and depression.(4)Economic burden.Conclusions: MHD patients with low monthly incomes and long dialysis periods are poorly adhered to treatment,and the heavier the burden of caregivers and the less social support,the greater their inconsistencies with dialysis,fluid management,and diet.Compliance with hemodialysis patients should be improved;There are a number of factors influencing adherence,and healthcare professionals need to design targeted actions to improve education and improve adherence with patients,thereby improving treatment and quality of life. |
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