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Abstract: FR-PO441

Motivational Strategies to Empower African Americans to Improve Dialysis Nonadherence

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Theut, Lindsey, Creighton University School of Medicine, Omaha, Nebraska, United States
  • St. Julien, Zuri Naeem, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Nair, Devika, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Prigmore, Heather Leanne, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Greevy, Robert, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Wallace, Marylou, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Fissell, Rachel B., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Lewis, Julia, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Weinand, Rebecca, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Schlundt, David G., Vanderbilt University, Nashville, Tennessee, United States
  • Tindle, Hilary A., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Airhihenbuwa, Collins, Georgia State University, Atlanta, Georgia, United States
  • Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Resnicow, Kenneth A., University of Michigan School of Public Health, Ann Arbor, Michigan, United States
  • Wolever, Ruth Q., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Umeukeje, Ebele M., Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Compared to whites, African Americans (AA) have four times the risk of ESKD. Hemodialysis (HD) nonadherence is common in AA and driven by low motivation. Motivational interviewing (MI), an evidence-based counseling style increases intrinsic motivation, and if culturally tailored, reduces nonadherence in AA. We hypothesized that culturally tailored MI would be feasible and acceptable for reducing HD nonadherence in AA.

Methods

Parallel arm [usual care (n=15) vs. MI (n=15)] pilot RCT of AA, ≥ 18 years old, who missed HD or shortened HD by 15 minutes/month during the prior 3 months. Patients randomized to MI received 6 sessions over 8 weeks, culturally tailored to prioritize contributors to nonadherence: empowerment; support network; understanding ESKD; communication & trust; mental well-being; transportation; and racial identity. Coaches were assessed via the MI Treatment Integrity (MITI) scale. Coaches and patients provided feedback regarding their experience.

Results

We enrolled 30 AA; 57% male; median age [IQR]= 57[17] years; median HD vintage [IQR] of (6.6[4.3]) and (2.2[4.9]) years in the MI and control groups respectively. Feasibility and acceptability were favorable: 76% enrollment-to-screening ratio; 73% MI attendance; 13% drop-out. Primary outcome was chart-reviewed HD adherence. In month 3 of follow-up, patients were prescribed a median [IQR] of 13 [12, 13] sessions and 2730 [2520, 3120] minutes, and completed 91.7% [80.8%, 99.1%] of prescribed HD. Patients completed 84.6% [63.6%, 92.3%] of prescribed sessions. Empowerment, support network, and understanding ESKD were most frequently discussed during MI per patients’ preference. Patients reported variability in the impact of racial identity on HD adherence. Some noted having low trust in, and feeling intimidated by the health system. Most viewed MI as an effective communication style. Health coaches demonstrated high fidelity on the MITI.

Conclusion

Health coach-delivered culturally tailored MI in AA is feasible and acceptable. Next steps will assess its efficacy in reducing HD nonadherence in AA.

Funding

  • NIDDK Support