J STEVENSON1,2, A TONG1,3, T GUTMAN1,3, K CAMPBELL4, J CRAIG1,3, M BROWN5,6, V LEE1,2,7
1Centre For Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia, 2Westmead Clinical School, The University of Sydney, Sydney, Australia, 3School of Public Health, The University of Sydney, Sydney, Australia, 4Faculty of Health Sciences and Medicine, Bond University, Robina, Australia, 5Department of Renal Medicine, St George Hospital , Sydney, Australia, 6St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia, 7Department of Renal Medicine, Westmead Hospital, Sydney, Australia
Aim: To describe the perspectives and experiences of haemodialysis patients regarding facilitators and barriers to adherence to dietary recommendations and to identify strategies that may improve self-management behaviours.
Background: Whilst appropriate dietary and fluid management can reduce mortality, serious co-morbidities and debilitating symptoms in dialysis patients, non-adherence to dietary recommendations remains high.
Methods: Semi-structured interviews were conducted with 35 haemodialysis patients from six dialysis units in NSW, Australia. Transcripts were analysed thematically.
Results: We identified five major themes. Two reflected barriers to dietary change: 1) exacerbating disruption (adding to treatment burden, contradicting healthy eating, confused by fragmented advice, conflicting cultural norms, changing appetite and palate, isolation from family and friends), and 2) losing control (crises derailing discipline, frustrated by failure, combating bodily need for hydration). Three themes represented facilitators for dietary change: 1) attaining health benefits (avoiding medical catastrophes, enhancing benefits of dialysis, alleviating and managing symptoms, improving health), 2) achieving treatment goals (building familiarity and acceptance, flexibility and moderation, taking personal responsibility), 3) succeeding with support (leaning on family for strength, trusting expert guidance, empowered with flexible and practical advice, relying on reminders and cues, motivation through shared experience).
Conclusions: Patients on haemodialysis believe dietary control is an important component of treatment that helps to reduce symptom burden and enhance general health and well-being. However, competing medical and social issues coupled with contradictory dietary advice prevents them from implementing dietary advice. Patients highlighted the importance of having access to dietary experts and being provided consistent, culturally-relevant dietary information. Interventions involving multi-disciplinary care that includes clinicians with dietetic expertise, and provision of consistent and personalised information may support adherence to dietary recommendations and improve outcomes.
Jess is a renal dietitian and PhD Candidate. Her PhD is evaluating the impact of using eHealth interventions to improve health behaviours through dietary and lifestyle management in patients with chronic kidney disease.