Predictors Influencing of Medication Adherence in Hemodialysis Patients

Hana Kim; Eunha Kim

doi:10.7475/kjan.2019.31.3.283

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Kim and Kim: Predictors Influencing of Medication Adherence in Hemodialysis Patients

Original Article

Korean J Adult Nurs 2019;31(3):283-292.

Published online: 21 June 2019

DOI: https://doi.org/10.7475/kjan.2019.31.3.283

Predictors Influencing of Medication Adherence in Hemodialysis Patients

Hana Kim¹, Eunha Kim^2,

¹Nurse, Pusan National University Yangsan Hospital, Yangsan, Korea

²Associate Professor, College of Nursing, Catholic University of Pusan, Busan, Korea

Corresponding author: Kim, Eunha https://orcid.org/0000-0003-1233-6954 College of Nursing, Catholic University of Pusan, 57 Oryundae-ro, Geumjung-gu, Busan 46252, Korea. Tel: +82-51-510-0728, Fax: +82-51-510-0747, E-mail: hake1114@cup.ac.kr

Received 26 February 20197 April 2019 Accepted 13 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to investigate factors affecting medication adherence in hemodialysis patients.

Methods

A convenience sample of 140 patients receiving hemodialysis was selected. Data were collected from December. 1. 2016 to January. 15. 2017 using a self-reported questionnaires including the eight-item Morisky's Medication Adherence Scale Korean version (K-MMAS-8). The collected data were analyzed with a descriptive test, independent t-test, one-way ANOVA, Pearson's correlation coefficient and stepwise multiple regression with SPSS/WIN 23.0.

Results

The patients showed a low level of medication adherence (M± SD=5.75±1.65). There were significant differences in medication adherence according to subjective health status (F=6.88, p=.001) and discomfort in taking medication (t=-4.59, p<.001). Expectation of medication (r=.42, p<.001) and disgust of medication (r=-.36, p<.001) were the significant factors related to medication adherence. It was explained by expectation of medication (β=.30, p<001), disgust of medication (β=-.21, p=.007), discomfort in taking medication (β=.20, p=.010) and subjective health status (β=-.18, p=.016).

Conclusion

It is necessary not only to regularly monitor patients’ medication behavior but also develop and implement an individualized nursing intervention that reflects expectation and disgust of medication.

Keywords: Renal hemodialysis, Renal insufficiency, Kidney failure, chronic, Medication adherence

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Table 1.

Difference of Medication Adherence according to General Characteristics (N=140)

Characteristics	Categories	n (%) or M± SD	M± SD	t or F (p)	Scheffé
Gender	Men	78 (55.7)	5.44±1.54	0.12 (.905)
	Women	62 (44.3)	5.41±1.49
Age (year)	50	31 (22.1)	5.18±1.70	1.90 (.131)
	50~59	46 (32.9)	5.28±1.44
	60~69	41 (29.3)	5.41±1.63
	70~79	22 (15.7)	6.10±0.95
		57.9±11.48
Living together	No	38 (27.1)	5.39±1.50	-0.16 (.872)
	Yes	102 (72.9)	5.44±1.52
Education	Middle school and under	48 (34.3)	5.63±1.35	0.77 (.461)
	High school	67 (47.9)	5.37±1.63
	College or more	25 (17.8)	5.19±1.50
Occupation	Yes	23 (16.4)	4.98±1.81	-1.56 (.119)
	No	117 (83.6)	5.52±1.44
Type of insurance	Medical benefit	51 (36.4)	5.43±1.51	0.02 (.987)
	Health insurance	89 (63.6)	5.43±1.52
Monthly income	≤149	82 (58.6)	5.52±1.58	0.43 (.650)
(1,000 won)	150~299	32 (22.9)	5.23±1.46
	≥300	26 (18.5)	5.39±1.38
Subjective health status	Good ^a	23 (16.4)	6.05±0.89	6.88 (.001)	a, b＞ c
	Medium ^b	84 (60.0)	5.55±1.43
	Bad ^c	33 (23.6)	4.67±1.79
Duration of renal	≤3	53 (37.9)	5.59±1.24	0.65 (.519)
hemodialysis (year)	4~9	55 (39.2)	5.40±1.65
	≥10	32 (22.9)	5.20±1.69
Prescription of drug	Yes	127 (90.7)	5.45±1.49	0.59 (.556)
	No	13 (9.3)	5.19±1.73
Number of drugs	≤10	50 (35.7)	5.26±1.59	0.84 (.472)
	11~15	46 (32.9)	5.42±1.55
	16~20	28 (20.0)	5.81±1.31
	≥21	16 (11.4)	5.29±1.50
Supporter of medication	No	123 (87.9)	5.47±1.54	0.86 (.391)
	Yes	17 (12.1)	5.13±1.35
Comorbidities^†	Diabetes mellitus	56 (40.0)
	Hypertension	54 (38.6)
	Glomerulonephritis	27 (19.3)
	Others	23 (16.5)
Side effects when taking	Yes	37 (26.4)	4.97±1.64	-2.16 (.031)
medication	No	103 (73.6)	5.59±1.44
Discomfort in taking	Yes	63 (45.0)	4.82±1.55	-4.59 (＜.001)
medication	No	77 (55.0)	5.93±1.29

^† Multiple response.

Table 2.

Degree of Medication Adherence of Patients (N=140)

variable	n (%)	M± SD	Min~Max
Medication adherence	140 (100.0)	5.75±1.65	1.50~8.00
High	18 (12.9)	8.00±0.00	8.00~8.00
Middle	56 (42.1)	6.61±0.47	6.00~7.00
Low	66 (45.0)	4.29±1.24	1.50~5.75

Table 3.

Degree of Medication Behavior of Patients (N=140

Questions of sub-domains	M± SD
1. Expectation of medication	2.61±0.56
As I take my medication, I believe I will get better.	2.49±0.92
I feel comfortable when I take a medication without forgetting to do so	2.91±0.84
I feel cheerful as I take a medication	1.56±0.89
When it comes to a treatment taking medication is the most important task	3.25±0.82
I would like to take current medication for a while without changing it	2.88±0.91
2. Disgust of medication	1.89±0.59
I am concerned about the side effects of medication	1.63±0.91
I get anxious when I get a new medication	1.56±0.79
I hope to get better with non-medication therapy	2.24±1.04
I hope to reduce medication prescription	2.24±1.02
I believe I will not get an enough information about my medication	1.77±0.95
3. Knowledge of medication	2.56±0.60
I know the name of the medication	2.26±1.05
I know the efficacy of the medication	2.79±0.78
I know how to take medication	3.44±0.60
I know the side effect of the medication	1.76±0.93
4. Attitude of medication	2.10±0.95
I have asked about the efficacy of current medication	2.35±1.02
I ask medical personnel about coping mechanism when I forgot to take my medication	2.02±1.11
I consult with medical personnel about taking multiple medication	2.05±1.09
I consult with medical personnel about the side effect of the medication	1.99±1.11
Total	2.29±0.41

Table 4.

Correlation between Medication Adherence and Medication Behavior of Patients (N=140)

Variables	Categories	Medication adherence
Variables	Categories	r (p)
Medication	Expectation for medication	.42 (＜.001)
behavior	Disgust of medication	-.36 (＜.001)
	Knowledge of medication	.12 (.147)
	Attitude of medication	.09 (.270)

Table 5.

Factors influencing Medication Adherence of Patients (N=140)

Variables	B	SE	β	t	p	95% CI
(Constant)	4.36	0.79		5.55	.001
Expectation for medication	0.88	0.24	.30	3.92	.001	1.32~0.43
Disgust of medication	-0.58	0.21	-.21	-2.75	.007	-0.16~-1.00
Discomfort of medication (ref. no)	0.64	0.25	.20	2.60	.010	1.12~0.16
Subjective health status (ref. good)	-0.69	-0.28	-.18	-2.45	.016	-0.13~-1.24
		R²=.50, Adjusted R²=.31, F=15.40, p＜.001
		Durbin-watson=1.96, Tolerance=.88~.96, VIF=1.04~1.13

B=unstandardized coefficients; SE=standard error; β=standard estimates; CI=confidence interval.

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