Adherence to hemodialysis among end stage renal disease patients(ESRD) in selected nephrology units in Rwanda

Abstract

iv Introduction End stage renal disease (ESRD) becomes an alarming problem in the world increasing the number of patients maintained on dialysis and renal transplantation. Poor adherence to hemodialysis has been reported in other countries but less informations are available in Rwanda and Africa continent. Factors contributing to non-adherence to hemodialysis are not well explained in literature. Purpose of the study The purpose of this study was to explore adherence to hemodialysis among end stage renal disease patients (ESRD) in selected nephrology units in Rwanda. The specific objectives were to assess the level of adherence to hemodialysis among end stage renal disease patients, toidentify the barriers to adherence to hemodialysis among end stage renal disease patients and to identify motivating factors of adherence to hemodialysis among end stage renal disease (ESRD) patients. Methods A mixed method approach was used. An explanatory sequential mixed method design was employed where quantitative data was collected and analyzed first, then followed by collection and analysis of qualitative data. For the quantitative stage, a total sample of 41 participants was selected. Data for quantitative research wascollected in the form of structured interview schedules into sections namely demographic data and adherence to haemodialysis.Quantitative data was collected to determine the level of adherence to hemodialysis among end stage renal disease (ESRD) patients.Descriptive statistics and inferential statistics of chi-square were used to analyse the data. For the qualitative stage, a purposive sample of study participants was selected from the sample of quantitative. Those with high, moderate and low level of adherence to haemodialysis were selected. Data was collected using a semi-structured interview schedule which elicited barriers to and motivators of adherence to haemodialysis. Data for qualitative was analysed using a thematic framework approach. The health belief model was used as a conceptual framework to guide the study. Results: Twenty one (51%) of ESRD participants scored above 80%, meaning that their adherence to HD scores was high. Seventeen (42%) scored between 70 and 79% meaning that the level of these participants was moderate. Three (7%) scored below 70% meaning that their level of adherence to HD score was low. A significant association between age(p=.038) and religion (p=.003) and adherence to hemodialysis was found. The identified motivators of adherence to hemodialysis were Family support, hope for renal transplant, alleviation of symptoms, to prolong life and improved quality of life, and fear of death. Barriers to adherence to hemodialysis were poverty, uncertain transport, treatment related complications and long distance. Conclusion: Adherence to hemodialysis is a concern in Rwanda, these implying nurses in four aspects, nursing practice, nursing education, nursing research and nursing administration, for better management of ESRD.