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Kidney Week

Abstract: FR-PO452

Cultural Tailoring of Motivational Strategies to Improve Hemodialysis Nonadherence in African Americans

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ma, Melissa, California University of Science and Medicine School of Medicine, Colton, California, United States
  • Bergner, Erin, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Wolever, Ruth Q., 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
  • Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, 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
  • Griffith, Derek M., Georgetown University, Washington, District of Columbia, United States
  • Schlundt, David G., Vanderbilt University, Nashville, Tennessee, United States
  • Iwelunmor, Juliet, Saint Louis University, Saint Louis, Missouri, United States
  • Airhihenbuwa, Collins, Georgia State University, Atlanta, Georgia, United States
  • Umeukeje, Ebele M., Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

African Americans (AA) make up 33% of patients with ESKD and, compared to white patients, have higher hemodialysis (HD) nonadherence rates. Motivational interviewing (MI) improves nonadherence, and cultural tailoring centered on racial minorities reduces racial disparities. Informed by key themes derived from prior qualitative research focused on HD nonadherence in AA, we hypothesize that MI can be culturally tailored to improve HD nonadherence in AA.

Methods

During a facilitated community engagement studio, AA community experts (n = 7) with lived experience across each stage of kidney disease, reviewed key themes on HD nonadherence in AA. Themes were obtained from prior focus groups and interviews of 22 AA on HD, and 34 dialysis providers & researchers; mapped onto the PEN-3 cultural model; categorized as Perceptions (attitudes), Enablers (structural/societal factors), or Nurturers (support systems); and further categorized as Positive (facilitators), Existential, or Negative (barriers). Community experts identified priority targets for an MI intervention. Health equity clinicians and researchers finalized the cultural adaptation process by examining the priority targets and providing additional input.

Results

AA community experts dentified 6 major priority targets: empowerment; support network; understanding kidney disease; communication and health system-related trust/trustworthiness; mental well-being; and transportation. Health equity researchers added racial identity as a priority target. Key themes and illustrative perspectives are shown in Table 1.

Conclusion

Use of the PEN-3 cultural model for the cultural adaptation of MI is novel. Integrating input from AA community experts and content experts with perspectives from AA on HD to identify priority targets of MI, will likely increase the potential efficacy, adoption, and sustainability of MI to improve HD nonadherence in AA.

Mapping of Themes into PEN-3 Cultural Model with Exemplar Quotes
 Perceptions
Patient attitudes and beliefs
Enablers
Structural and societal factors
Nurturers
Patient support systems
Positive
Facilitators of dialysis adherence
**SELF-ADVOCACY & EMPOWERMENT
…people just understanding how motivational interviewing might empower them to think about their health and put them in the driver
**OPTIMAL MENTAL WELLBEING
“Nobody wants to be the person that somebody is pointing their finger at…Because that could be the difference between life and death in some people. Because a person can get bullied for it or talked about it so much…” (Patient)

*Cultural Competency
**SUPPORT NETWORK

“I’m just to the point where I’m tired and I didn’t want to go and I didn’t want to interact. But I have a great support system at home as well as patient care to where they were all hovering with me, talking to me, and motivating me to go back to the clinic.” (Patient)

*Religious Support

*Family Support

*Peer Support
Negative
Barriers to dialysis adherence
**LACK OF UNDERSTANDING OF KIDNEY DISEASE
“…I think if [African Americans] were more educated on dialysis and what it does and how it works before they start dialysis, I think they will be more adherent to what
**COMMUNICATION & TRUST
There may be a lack of trust… that could be a barrier… all that happened at Tuskegee and not getting the right treatment that they needed. So, there may be a cultural and historical precedent to that, in terms of relying on and believing the medical information we're giving to them now...” (Nephrologist)

**TRANSPORTATION
“….transportation can be kind of crazy sometimes, when you get off of dialysis, they might come pick you up a couple of hours later, you never know which way transportation's going to go.”
(Patient)

*Finances

*Representation in Healthcare
*Stigma

*Diet

*Lack of Provider Support

*Major themes specific to HD adherence in AA **Major themes identified as priority targets

Funding

  • NIDDK Support