Kidney Week

Abstract: FR-PO1059

Provider Perspectives on Barriers and Facilitators of Hemodialysis Adherence in African American Patients and the Use of Motivational Interviewing to Improve Adherence

Session Information

• Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Dillard, Naomi I., Charles R Drew University of Medicine and Science, Los Angeles, California, United States

Naomi I. Dillard, BS

• Bonnet, Kemberlee R., Vanderbilt University, Nashville, Tennessee, United States

Kemberlee R. Bonnet, MA

• Ejezie, Marylou, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Marylou Ejezie, MPH

• Niter, Daniel C., Meharry Medical College, Nashville, Tennessee, United States

Daniel C. Niter, BS

• Nair, Devika, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Devika Nair, MD, MS, FASN

• Burdick, Rachel B., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Rachel B. Burdick, MD, MS

• Merighi, Joseph R., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States

Joseph R. Merighi, PhD, MSW

• Griffith, Derek M., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Derek M. Griffith, PhD

• Wilkins, Consuelo H., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Consuelo H. Wilkins, MD

• Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Kerri L. Cavanaugh, MD, FASN

• Schlundt, David G., Vanderbilt University, Nashville, Tennessee, United States

David G. Schlundt, PhD

• Umeukeje, Ebele M., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Ebele M. Umeukeje, MD, MPH, FASN

Background

Compared to White patients, African Americans (AA) have a four-fold higher prevalence of end-stage kidney disease and higher rates of hemodialysis (HD) nonadherence, contributing to worse outcomes. Therapeutic alliance (the collaborative relationship between patients and providers) associates with adherence behaviors and is influenced by stakeholder perspectives. Patient perspectives are described, yet provider perspectives remain unexplored. We assessed HD providers’ and researchers’ perspectives on adherence and the use of motivational interviewing (MI) to improve outcomes in AAs.

Methods

HD providers (MDs, NPs, RNs, LCSWs, RDs, HD techs) and researchers (n=34) viewed a brief MI training video and completed semi-structured interviews. Transcripts were analyzed using an inductive/deductive approach and mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) conceptual model.

Results

Per providers (Table 1), patients are often “worn out… don’t see the connection between good dialysis and outcomes” (RD); “...don’t care about living” (LCSW); “want..us to be compassionate” (tech). Providers emphasized engagement, noting a need to “get our patients to be more involved… [and] responsible for their role” (RN). Providers viewed MI as patient-centered and effective for building trust and autonomy. Implementation opportunities include leveraging patient empowerment and social support. Key themes mapped onto COM-B model, a framework highlighting complex factors influencing behavior (Fig. 1).

Conclusion

Provider perspectives offer critical insight into the factors affecting HD adherence among AAs. Integrating these perspectives into MI-based interventions to improve HD adherence in AAs may reduce health disparities and optimize outcomes.

Funding

• NIDDK Support