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.
