Bonnet Kemberlee, Bergner Erin M, Ma Melissa, Taylor Kathryn, Desantis Emily, Pena Maria A, Henry-Okafor Queen, Liddell Toddra, Nair Devika, Fissell Rachel, Iwelunmor Juliet, Airhihenbuwa Collins, Merighi Joseph, Resnicow Kenneth, Wolever Ruth Q, Cavanaugh Kerri L, Schlundt David, Umeukeje Ebele M
Department of Psychology, Vanderbilt University, Nashville, TN.
Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN.
Clin J Am Soc Nephrol. 2025 Jan 1;20(1):88-100. doi: 10.2215/CJN.0000000580. Epub 2024 Oct 16.
African American patients have unique insights on hemodialysis adherence and use of motivational interviewing to promote adherence. Key themes were mental health issues; historical mistrust; social determinants of health; and importance of provider cultural competence. Themes led to a novel conceptual model, which will inform the design of a motivational interviewing-based protocol to improve adherence.
Compared with White patients, African American (AA) patients have a four-fold higher prevalence of kidney failure and higher hemodialysis nonadherence. Adherence behaviors are influenced by psychosocial factors, including personal meaning of a behavior and self-confidence to enact it. We assessed perspectives of AA hemodialysis patients on unique factors affecting dialysis adherence, and use of motivational interviewing (MI), an evidence-based intervention, to improve these factors, dialysis adherence, and outcomes in AAs.
Self-identified AA hemodialysis patients (=22) watched a brief video describing MI and then completed a semistructured interview or focus group session. Interview questions explored unique barriers and facilitators of hemodialysis adherence in AAs and perceived utility of MI to address these obstacles. Verbatim transcripts and an iterative inductive/deductive approach were used to develop a hierarchical coding system. Three experienced coders independently coded the same two transcripts. Coding was compared, and discrepancies were reconciled by a fourth coder or consensus. Transcripts, quotations, and codes were managed using Microsoft Excel 2016 and SPSS version 28.0.
Themes and subthemes emerged and culminated in a novel conceptual model informed by three theoretical models of behavior change: Theory of Self-Care Management for Vulnerable Populations; Social Cognitive Theory; and Self Determination Theory. This conceptual model will inform the design of a culturally tailored, MI-based intervention to improve dialysis adherence in AAs.
Integrating AA hemodialysis patient perspectives is critical for enhancing dialysis care delivery and the design of effective interventions such as MI to improve dialysis adherence in AA and promote kidney health equity. AA hemodialysis patients view MI as a tool to clarify patient priorities, build trust, and promote 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.
非裔美国患者对血液透析依从性以及运用动机性访谈来促进依从性有着独特见解。关键主题包括心理健康问题、历史上的不信任、健康的社会决定因素以及医疗服务提供者文化能力的重要性。这些主题促成了一个新颖的概念模型，该模型将为基于动机性访谈的改善依从性方案的设计提供指导。
与白人患者相比，非裔美国（AA）患者肾衰竭患病率高出四倍，血液透析不依从率更高。依从行为受心理社会因素影响，包括行为的个人意义以及实施该行为的自信心。我们评估了非裔美国血液透析患者对影响透析依从性的独特因素的看法，以及运用动机性访谈（MI）这一循证干预措施来改善这些因素、透析依从性以及非裔美国患者的治疗结果。
自我认定的非裔美国血液透析患者（=22）观看了一段描述动机性访谈的简短视频，然后完成了一次半结构化访谈或焦点小组会议。访谈问题探讨了非裔美国患者血液透析依从性的独特障碍和促进因素，以及动机性访谈在解决这些障碍方面的感知效用。逐字记录稿和迭代归纳/演绎方法被用于开发一个分层编码系统。三位经验丰富的编码员独立对相同的两份记录稿进行编码。对编码进行比较，差异由第四位编码员协调或通过达成共识解决。记录稿、引语和编码使用Microsoft Excel 2016和SPSS 28.0版本进行管理。
主题和子主题浮现出来，并最终形成了一个由行为改变的三个理论模型所启发的新颖概念模型：弱势群体自我护理管理理论；社会认知理论；以及自我决定理论。这个概念模型将为设计一种针对文化定制的、基于动机性访谈的干预措施提供指导，以改善非裔美国患者的透析依从性。
整合非裔美国血液透析患者的观点对于加强透析护理服务以及设计有效的干预措施（如动机性访谈）以改善非裔美国患者的透析依从性和促进肾脏健康公平性至关重要。非裔美国血液透析患者将动机性访谈视为一种明确患者优先事项、建立信任以及促进患者 - 医疗服务提供者治疗联盟的工具。对动机性访谈进行文化定制以解决非裔美国肾衰竭患者的独特障碍，将改善这些弱势群体患者的依从性和健康结果。
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