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Kidney Week

Abstract: PO0826

Perspectives on Motivational Strategies to Improve Hemodialysis Treatment Adherence in African Americans: A Qualitative Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Umeukeje, Ebele M., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Bonnet, Kemberlee R., Vanderbilt University, Nashville, Tennessee, United States
  • Nair, Devika, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Fissell, Rachel B., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Merighi, Joseph R., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Wolever, Ruth Q., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Iwelunmor, Juliet, Saint Louis University, Saint Louis, Missouri, United States
  • Airhihenbuwa, Collins, Georgia State University, Atlanta, Georgia, United States
  • Resnicow, Kenneth A., University of Michigan School of Public Health, Ann Arbor, Michigan, United States
  • Schlundt, David G., Vanderbilt University, Nashville, Tennessee, United States
  • Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Compared to White patients, African American (AA) patients have a four-fold higher prevalence of kidney failure and higher hemodialysis non-adherence. Adherence behaviors are influenced by psychosocial factors, including personal meaning of a behavior and self-confidence to enact it. We assessed perspectives of patients and professionals on using motivational interviewing (MI), an evidence-based intervention to improve these psychosocial factors, hemodialysis adherence, and outcomes in AAs.

Methods

Self-identified AA hemodialysis patients (n=21), dialysis clinicians (MDs, NPs, RNs, LCSWs and RDs) and health equity researchers (n=30) watched a brief video describing MI and then completed a semi-structured interview. Planned questions targeted unique barriers to hemodialysis adherence faced by AAs, and the perceived utility of MI to address these obstacles. Verbatim transcripts and an iterative inductive/deductive approach were used to develop a hierarchical coding system. Two researchers independently identified and coded themes informed by social cognitive theory and the social ecological framework.

Results

See table below:

Conclusion

AA patients receiving hemodialysis, dialysis clinicians, and researchers view MI as a means to build trust, clarify patient priorities, and promote the patient-provider therapeutic alliance. Cultural tailoring of MI to address unique barriers of AAs with kidney failure will improve adherence and health outcomes in these vulnerable patients.

Key Themes And Illustrative Quotes
Barriers 
Mistrust"There's...a lot of mistrust among AAs." (MD)
Amotivation“..a lot of my patients are not motivated…” (RN)
Inconsistent messages[From] “you might not .. do dialysis that long” [to] “you’re on dialysis the rest of your life” (patient)
Poor understanding“A man called me the ‘N’ word…I was sad...my MD said..sorry, I don’t understand..” (patient)
Facilitators 
Engagement“..don’t talk in a condescending manner to an AA, talk to him at his level” (patient)
Empowerment“help them understand…to see they’re in charge” (RN)
Relationship“anybody that has a relationship with a patient, can have a [talk] about not getting off [dialysis]” (LCSW)
Cultural awareness“it would be good if [providers] become more culturally aware of AAs” (patient)
"Not all African Americans are the same.....get a sense of important nuances of your [AA] patients" (researcher)

Funding

  • NIDDK Support