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New concepts of non-adherence among patients undergoing hemodialysis - a qualitative study exploring specific types of adherence/nonadherence

Yuki Tamaura, Yui Kawasaki, Rie Akamatsu


Rationale, aims and objectives: To determine more effective intervention, this qualitative study explores the specific behaviors of adult patients undergoing hemodialysis with regard to dietary and fluid restrictions. Additionally, to understand their characteristics, identified behaviors were categorized as being either intentional or unintentional.

Methods: This study employed a descriptive exploratory design comprising individual semi-structured interviews. It was conducted from July to September 2014 in one private dialysis facility treating 73 outpatients in Tokyo, Japan. Forty-three patients receiving hemodialysis treatment consented to participate. Behaviors identified in the interviews were categorized by considering “the motivation behind them (intentional/unintentional)” and their “adequacy (if the behavior seems to lead adherence or not).”

Results: This study identified 32 categories of “intentional behaviors” and 14 categories of “unintentional behaviors”. Intentional behaviors included general behaviors of “making adjustments in diet” and non-adherence behaviors of “taking halfway measures” and “abandonment”. Unintentional behaviors comprised general behaviors practiced after the initiation of HD therapy, in addition to non-adherence behaviors due to “habituation” and “dietary environments”.

Conclusions: A total of 46 categories of specific behaviors regarding dietary and fluid restrictions in patients receiving HD were identified. Categories were then divided into two different types: intentional and unintentional. Though certain characteristics were similar to other adherence behaviors such as those toward medication, the current study also proposes some unique aspects of dietary behaviors with respect to diversity and habitual strength. Understanding the characteristics of different types of non-adherence behaviors, such as whether they are intentional or unintentional, could be a potentially important contribution to interventions.


Adherence, adherence assessment, dietary behaviours, fluid restriction, health literacy, hemodialysis, person-centered healthcare, qualitative research, types of non-adherence

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