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The impact of education on knowledge, adherence and quality of life among patients on haemodialysis

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Abstract

Purpose

The purpose of the study was to assess the impact of an educational intervention on the level of knowledge, quality of life (QoL) and adherence to the treatment regimen among haemodialysis (HD) patients as well as to describe the association between these variables.

Methods

In this quasi-experimental interventional study, 50 HD patients at a HD centre in Western Attica were randomly assigned into intervention (N = 25, received education and a booklet) and control (N = 25, received only the booklet) groups. Knowledge, adherence and quality of life were measured pre- and post-intervention using the Kidney Disease Questionnaire, the GR-Simplified Medication Adherence Questionnaire-HD and Missoula Vitas Quality of Life Index—15, respectively. 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 up at 0.05.

Results

The increase of knowledge, adherence and QoL levels in the intervention group was significantly higher compared to the control group. There was no significant correlation between knowledge and adherence scores after the intervention. However, a significant positive correlation was found between the change in the overall QoL and the changes in the total adherence score as well as the adherence to the fluids and dietary behaviour.

Conclusions

An educational intervention can improve knowledge, adherence and QoL among HD patients. The increase of knowledge level is not associated with increased adherence. However, the increase of adherence may improve some dimensions of QoL.

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References

  1. Zyga, S., Alikari, V., Sachlas, A., Stathoulis, J., Aroni, A., Theofilou, P., et al. (2015). Management of pain and quality of life in patients with chronic kidney disease undergoing hemodialysis. Pain Management Nursing, 16(5), 712–720.

    Article  PubMed  Google Scholar 

  2. Rayner, H. C., Larkina, M., Wang, M., Graham-Brown, M., van der Veer, S. N., Ecder, T., et al. (2017). International comparisons of prevalence, awareness, and treatment of pruritus in people on hemodialysis. Clinical Journal of American Society of Nephrology, 12(12), 2000–2007.

    Article  Google Scholar 

  3. Weiss, M., Mettang, T., Tschulena, U., & Weisshaar, E. (2016). Health-related quality of life in haemodialysis patients suffering from chronic itch: Results from GEHIS (German Epidemiology Haemodialysis Itch Study). Quality of Life Research, 25(12), 3097–3106.

    Article  PubMed  Google Scholar 

  4. Zyga, S., Alikari, V., Sachlas, A., Fradelos, E. C., Stathoulis, J., Panoutsopoulos, G., et al. (2015). Assessment of fatigue in end stage renal disease patients undergoing hemodialysis: Prevalence and associated factors. Medical Archives, 69(6), 376–380.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wanner, C., Amann, K., & Shoji, T. (2016). The heart and vascular system in dialysis. Lancet, 388(10041), 276–284.

    Article  PubMed  Google Scholar 

  6. Jiang, H., Wang, L., Zhang, Q., Liu, D. X., Ding, J., Lei, Z., et al. (2015). Family functioning, marital satisfaction and social support in hemodialysis patients and their spouses. Stress Health, 31(2), 166–174.

    Article  PubMed  Google Scholar 

  7. Finnegan-John, J., & Thomas, V. J. (2013). The psychosocial experience of patients with end-stage renal disease and its impact on quality of life: Findings from a needs assessment to shape a service. ISRN Nephrology. https://doi.org/10.5402/2013/308986.

    Article  PubMed  Google Scholar 

  8. Estrella, M. M., Jaar, B. G., Cavanaugh, K. L., Fox, C. H., Perazella, M. A., Soman, S. S., et al. (2013). Perceptions and use of the National Kidney Foundation KDOQI guidelines: A survey of U.S. renal healthcare providers. BMC Nephrology, 14, 230.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dantas, L. G., Cruz, C., Rocha, M., Moura, J. A. Jr., Paschoalin, E., Paschoalin, S., et al. (2013). Prevalence and predictors of nonadherence to hemodialysis. Nephron Clinical Practice, 124(1–2), 67–71.

    Article  CAS  PubMed  Google Scholar 

  10. Karamanidou, C., Clatworthy, J., Weinman, J., & Horne, R. (2008). A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease. BMC Nephrology, 9, 2. https://doi.org/10.1186/1471-2369-9-2.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Saran, R., Bragg-Gresham, J., Rayner, H., Goodkin, D., Keen, M., Van Dijk, P., et al. (2003). Non-adherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney International, 64(1), 254–262.

    Article  PubMed  Google Scholar 

  12. Block, G. A., Wheeler, D. C., Persky, M. S., Kestenbaum, B., Ketteler, M., Spiegel, D. M., et al. (2012). Effects of phosphate binders in moderate CKD. Journal of the American Society of Nephrology, 23(8), 1407–1415.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Flythe, J. E., Curhan, G. C., & Brunelli, S. M. (2013). Shorter length dialysis sessions are associated with increased mortality, independent of body weight. Kidney International, 83(1), 104–113.

    Article  PubMed  Google Scholar 

  14. Amany, Y. S. (2016). The impact of educational interventions on hemodialysis patients’ adherence to fluid and sodium restrictions. Journal of Nursing and Health Science, 5(3), 55–60.

    Google Scholar 

  15. Milazi, M., Bonner, A., & Douglas, C. (2017). Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(4), 971–1010.

    Article  PubMed  Google Scholar 

  16. Parvan, K., Hasankhani, H., Seyyedrasooli, A., Riahi, S. M., & Ghorbani, M. (2015). The effect of two educational methods on knowledge and adherence to treatment in hemodialysis patients: Clinical trial. Journal of Caring Sciences, 4(1), 83–93.

    PubMed  PubMed Central  Google Scholar 

  17. Wells, J. R. (2011). Hemodialysis knowledge and medical adherence in African Americans diagnosed with end stage renal disease: Results of an educational intervention. Nephrology Nursing Journal, 38(2), 155–162.

    PubMed  Google Scholar 

  18. Falvo, D. R. (2010). Patient adherence as an outcome of effective patient teaching. In In Effective patient education: A guide to increased adherence (4th edn., pp. 1–32). Sudbury: Jones and Bartlett Publishers.

    Google Scholar 

  19. Ebrahimi, H., Sadeghi, M., Amanpour, F., & Dadgari, A. (2016). Influence of nutritional education on hemodialysis patients’ knowledge and quality of life. Saudi Journal of Kidney Disease & Transplantation, 27(2), 250–255.

    Article  Google Scholar 

  20. Bahrami Nejad, N., Hanifi, N., & Mousavi Nasab, N. (2008). Comparing the effects of two family-and individual-based intervention on blood pressure and lifestyle. Journal of Qazvin University of Medical Sciences, 12(1), 62–79.

    Google Scholar 

  21. Shi, Y. X., Fan, X. Y., Han, H. J., Wu, Q. X., Di, H. J., Hou, Y. H., et al. (2013). Effectiveness of a nurse-led intensive educational programme on chronic kidney failure patients with hyperphosphataemia: Randomised controlled trial. Journal of Clinical Nursing, 22(7–8), 1189–1197.

    Article  PubMed  Google Scholar 

  22. Hemmati Maslakpak, M., & Shams, S. (2015). A comparison of face to face and video-based self care education on quality of life of hemodialysis patients. International Journal of Community Based Nursing Midwifery, 3(3), 234–243.

    PubMed  Google Scholar 

  23. Baraz, S., Zarea, K., & Dashtbozorgi, B. (2014). Comparing the effect of two educational programs on the quality of life of hemodialysis patients in Iran. Iranian Red Crescent Medical Journal, 16(8), e19368. https://doi.org/10.5812/ircmj.19368.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Alikari, V., Tsironi, M., Matziou, V., Tzavella, F., Fradelos, E., & Zyga, Z. (2018). Reliability and validity of the Kidney Disease Questionnaire among Greek patients undergoing hemodialysis. American Journal of Nursing Science, 7(3-1), 97–102.

    Google Scholar 

  25. Devins, G. M., Binik, Y. M., Mandin, H., Letourneau, P. K., Hollomby, D. J., Barre, P. E., et al. (1990). The Kidney Disease Questionnaire: A test for measuring patient knowledge about end-stage renal disease. Journal of Clinical Epidemiology, 43(3), 297–307.

    Article  CAS  PubMed  Google Scholar 

  26. Alikari, V., Matziou, V., Tsironi, M., Kollia, N., Theofilou, P., Aroni, A., et al. (2017) A modified version of the Greek Simplified Medication Adherence Questionnaire for hemodialysis patients. Health Psychology Research, 5, 6647.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Theofilou, P., Aroni, A., Ralli, M., Gouzou, M., & Zyga, S. (2013). Measuring health: Related quality of life in hemodialysis patients. Psychometric properties of the Missoula-VITAS Quality of Life Index (MVQOLI-15) in Greece. Health Psychology Research, 1, e17.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tsiamis, G., Alikari, V., Fradelos, E., Papapetrou, S., & Zyga, S. (2015). Assessment of quality of life and fatigue among haemodialysis patients. American Journal of Nursing Science, 4 (2-1), 66–73.

    Google Scholar 

  29. Skelton, S. L., Waterman, A. D., Davis, L. A., Peipert, J. D., & Fish, A. F. (2015). Applying best practices to designing patient education for patients with end-stage renal disease pursuing kidney transplant. Progress in Transplantation, 25(1), 77–84.

    Article  PubMed  Google Scholar 

  30. Narva, A. S., Norton, J. M., & Boulware, L. E. (2016). Educating Patients about CKD: The path to self-management and patient-centered care. Clinical Journal of the American Society of Nephrology, 11(4), 694–703.

    Article  CAS  PubMed  Google Scholar 

  31. Alikari, V. (2017). Hemodialysis. Answers to common questions. Athens, Ed. BHTA. ISBN: 960-452-236-1. [Αλικάρη, Β. (2017). Αιµοκάθαρση. Απαντήσεις σε συνήθη ερωτήµατα. Αθήνα, Εκδ. ΒΗΤΑ. ISBN: 960-452-236-1 (In Greek Language)].

  32. Stumm, E. M., Kirchner, R. M., Guido, L. A., Benetti, E. R., Belasco, A. G., Sesso, R. C., et al. (2017). Educational nursing intervention to reduce the hyperphosphatemia in patients on hemodialysis. Revista Brasileira de Enfermagem, 70(1), 31–38.

    Article  PubMed  Google Scholar 

  33. Brown, R. (2015). Asthma patient education: Partnership in care. International Forum of Allergy & Rhinology, 5(Suppl 1), S68–S70.

    Article  Google Scholar 

  34. Jakovenko, D. (2016). Doctor-nurse cooperation in a therapeutic education pathway at home. Soins, 61(809), 23–26.

    Article  PubMed  Google Scholar 

  35. Narimani, K. (2009). A study of the effect of self-care training on the hemodialysis patients’ quality of life. Journal of Shahed University, 16(79), 63–70.

    Google Scholar 

  36. Sandlin, K., Bennett, P., Ockerby, C., & Corradini, A. (2013). The impact of nurse-led education on haemodialysis patients’ phosphate binder medication adherence. Journal of Renal Care, 39(1), 12–18.

    Article  PubMed  Google Scholar 

  37. Barnett, T., Li Yoong, T., Pinikahana, J., & Si-Yen, T. (2008). Fluid compliance among patients having haemodialysis: Can an educational programme make a difference? Journal of Advanced Nursing, 61(3), 300–306.

    Article  PubMed  Google Scholar 

  38. Ragnarson Tennvall, G., & Apelqvist, J. (2000). Health-related quality of life in patients with diabetes mellitus and foot ulcers. Journal of Diabetes and its Complications, 14(5), 235–241.

    Article  CAS  PubMed  Google Scholar 

  39. Moshtagh, Z., Naeeni, K., Hamzezade, M., & Arasteh, A. (2013). The effects of nutrition education on mental health of the hemodialysis patients in Maragheh, East-Azerbaijan, Iran. Life Science Journal, 10(6 s), 382–386.

    Google Scholar 

  40. García-Llana, H., Remor, E., & Selgas, R. (2013). Adherence to treatment, emotional state and quality of life in patients with end-stage renal disease undergoing dialysis. Psicothema, 25(1), 79–86.

    PubMed  Google Scholar 

  41. Bhavana, S., Ushadevi, C., & Prashant, G. K. (2014). Impact of knowledge, attitude and behavior among maintenance hemodialysis patients for adherence to dietary regimen—A single centre experience. International Journal of Humanities and Social Science, 4(12), 257–262.

    Google Scholar 

  42. Nerbass, F. B., Morais, J. G., dos Santos, R. G., Krüger, T. S., Koene, T. T., & da Luz Filho, H. A. (2010). Adherence and knowledge about hyperphosphatemia treatment in hemodialysis patients with hyperphosphatemia. Journal Brasileiro de Nefrologia, 32(2), 149–155.

    Article  Google Scholar 

  43. Hain, D., Calvin, D. J., & Simmons, D. E. Jr. (2009). CKD education: An evolving concept. Nephrology Nursing Journal, 36(3), 317–319.

    PubMed  Google Scholar 

  44. Jankowska-Polańska, B., Uchmanowicz, I., Dudek, K., & Mazur, G. (2016). Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient Preference and Adherence, 10, 2437–2447.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Cavanaugh, K. L., Wingard, R. L., Hakim, R. M., Eden, S., Shintani, A., Wallston, K. A., et al. (2010). Low health literacy associates with increased mortality in ESRD. Journal of American Society of Nephrology, 21(11), 1979–1985.

    Article  CAS  Google Scholar 

  46. Cavanaugh, K. L., Wingard, R. L., Hakim, R. M., Elasy, T. A., & Ikizler, T. A. (2009). Patient dialysis knowledge is associated with permanent arteriovenous access use in chronic hemodialysis. Clinical Journal of American Society Nephrology, 4(5), 950–956.

    Article  Google Scholar 

  47. Nabolsi, M., Wardam, L., & Al-Halabi, J. (2015). Quality of life, depression, adherence to treatment and illness perception of patients on haemodialysis. International Journal of Nursing Practice, 21(1), 1–10.

    Article  PubMed  Google Scholar 

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Nursing, University of Peloponnese, Efstathiou & Stamatikis Valioti and Plateon, 23100, Sparta, Greece

    Victoria Alikari, Maria Tsironi, Foteini Tzavella, John Stathoulis, Evangelos Fradelos & Sofia Zyga

  2. Department of Nursing, National & Kapodistrian University of Athens, Papadiamantopoulou 123, 11527, Athens, Greece

    Vasiliki Matziou

  3. Department of Nursing, Technological Educational Institute of Athens, St.Spyridonos, Egaleo, 12243, Athens, Greece

    Fotoula Babatsikou

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  1. Victoria Alikari
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  2. Maria Tsironi
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Correspondence to Victoria Alikari.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was granted by the Authority for Personal Data Protection (Number: //240-3/11-02-2016) and the Scientific Council of “Iatriko Therapeutirio Iliou, Dialysis Centre in Athens MEDIFIL A.E.”, (http://medifil.gr/index-en.html) on 25 November 2015. All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Alikari, V., Tsironi, M., Matziou, V. et al. The impact of education on knowledge, adherence and quality of life among patients on haemodialysis. Qual Life Res 28, 73–83 (2019). https://doi.org/10.1007/s11136-018-1989-y

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