A formative research as the groundwork for designing evidence-based adherence promotion campaigns for patients on peritoneal dialysis

Self-efficacy and home dialysis: An integrative review

BACKGROUND

Enhancing patient confidence in their ability (self-efficacy) is vital to ensure people are equipped to maintain home dialysis protocols. Bandura's social cognitive theory provided a framework for understanding the role of self-efficacy in patients managing home dialysis.

OBJECTIVES

To identify self-reported levels of self-efficacy, the measurements used to assess self-efficacy and the effectiveness of interventions to enhance self-efficacy in patients undergoing home dialysis.

DESIGN

An integrative review approach was employed using Whittemore and Knafl's methodology.

METHODS

A comprehensive search was conducted to identify literature on self-efficacy in patients managing home dialysis. Searches were conducted in CINAHL, MEDLINE, Embase and Scopus databases without a date limit. The included literature was critically appraised for methodological quality. Data extraction was conducted to report the study characteristics, measurement tools used and interventions conducted along with the synthesis of findings in a narrative format.

RESULTS

Fifteen studies were included in the review were predominantly quantitative examining training programmes promoting self-efficacy in adults conducting home dialysis. The finding that self-efficacy builds over time was structured into two themes; gaining skills to develop self-efficacy and building and maintaining knowledge of self-efficacy.

CONCLUSION

The findings highlighted the importance of employing multifaceted strategies with support from health professionals including nurses, families and peer support to develop self-efficacy in patients undergoing home dialysis.

The Role of Counterfactual Thinking in Narrative Persuasion: Its Impact on Patients' Adherence to Treatment Regimen

The purpose of this study is twofold: (1) to explicate the underlying process of how narratives, accompanied with counterfactual thinking, exert cognitive and affective influence on audiences and (2) to examine how counterfactual thinking and regulatory focus, as story characteristics, enhance the persuasiveness of the narrative. Participants in the experiment were exposed to animated narratives in which the protagonist described her nonadherence to the peritoneal dialysis treatment regimen that resulted in her hospitalization. One hundred thirty-six patients undergoing peritoneal dialysis participated in a 2 (Goal failure framing: promotion-framed failure versus prevention-framed failure) by 2 (Counterfactual thinking: additive counterfactuals versus subtractive counterfactuals) between-subject factorial experiment. The analyses showed that narratives with additive counterfactuals, as opposed to those with subtractive counterfactuals, elicited greater anticipated regret and mental simulation, and, in turn, influenced the audience's attitude toward and intention of adherence. More important, promotion-/prevention-framed failure and additive/subtractive counterfactuals jointly influenced the audience's anticipated regret and mental simulation. Specifically, in the prevention-framed goal failure condition, narratives with additive counterfactuals elicited greater anticipated regret and mental simulation; however, in the promotion-framed goal failure condition, there was no significant difference on anticipated regret and mental simulation between narratives with subtractive counterfactuals and those with additive counterfactuals. The theoretical and practical implications were discussed.

Psychosocial Factors Predict Nonadherence to PD Treatment: A Hong Kong Survey

Background

Nonadherence to hand hygiene and aseptic regimen, dialysis environment guidelines, and catheter and exit-site care guidelines are risk factors of peritonitis. However, little is known about the psychosocial factors that account for the nonadherent behavior of patients undergoing peritoneal dialysis (PD). Applying the health belief model, this study seeks to enhance the understanding of psychosocial influences on patients’ nonadherent behavior to the 3 regimen components.

Methods

Through referrals by 7 Hong Kong renal patient support groups, we surveyed patients undergoing PD treatment.

Results

A total of 244 Hong Kong PD patients completed the questionnaires. About 90% of the patients reported no deviation from catheter and exit-site care guidelines. However, the nonadherence rates of hand hygiene and aseptic regimen and of dialysis environment guidelines were 30.3% and 23%, respectively. Longer time on PD treatment and lower family monthly income were associated with nonadherence to dialysis environment guidelines. Employed patients tended toward nonadherence to catheter and exit-site care guidelines twice as much as unemployed patients. Of the 5 health beliefs, perceived benefits, perceived barriers, and efficacy belief were significant predictors of nonadherence to the 3 regimen components.

Conclusions

The findings of this study inform the design of intervention to change patients’ behavior in regimen nonadherence for preventing peritonitis. To identify the target audience for adherence intervention based on the 3 regimen components, the results suggest dividing patients into subgroups according to their sociodemographic background. To foster behavioral change, health communicators should address patients’ health beliefs when formulating intervention strategies.