Factors Related to Dietary Adherence Among End-Stage Renal Disease Persons Receiving Hemodialysis in Sichuan Province, the People’s Republic of China
Keywords:
Dietary adherence, End-stage renal disease, Health Belief Model, HemodialysisAbstract
Dietary adherence is critical for hemodialysis patients to manage fluid balance; regulate electrolytes and blood pressure; and reduce complication rates. This descriptive correlational study aimed to examine the relationship between the core constructs of dietary adherence and dietary adherence behaviors, guided by the Health Belief Model (HBM). This study was conducted with 193 end-stage renal disease patients undergoing hemodialysis. The research instruments included the Renal Adherence Behavior Questionnaire (RABQ) and the Dietary Health Belief Questionnaire (DHBQ). Data were analyzed using descriptive statistics and Spearman correlation.
Results demonstrated suboptimal dietary adherence (M = 57.70, SD = 6.85), with moderate levels across all health belief domains: perceived susceptibility (M = 12.28, SD = 3.97), perceived severity (M = 15.78, SD = 2.83), perceived benefits (M = 13.13, SD = 3.78), and perceived barriers (M = 21.71, SD = 6.74). Moreover, correlation analyses revealed significant associations: perceived severity (r = .910, p < .001) and perceived benefits (r = .877, p < .001) showed strong positive correlations with adherence; perceived susceptibility demonstrated a moderate positive correlation (r = .429, p < .001); and perceived barriers exhibited a strong negative correlation (r = -.820, p < .001).
These findings suggest that the Health Belief Model can be used to explore factors significantly influencing dietary adherence in end-stage renal disease patients undergoing hemodialysis. Clinical interventions targeting these cognitive factors may enhance adherence behaviors in this population.
References
Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2, 324-473. https://doi.org/10.1177/109019817400200407
Benjamin, R., Mwansisya, T. E., & Lyimo, M. (2021). Determinants of adherence to dietary prescription among patients with end-stage renal disease undergoing hemodialysis in Dar Es Salaam, Tanzania. Research Square. https://doi.org/10.21203/rs.3.rs-729734/v1
Bujang, M. A., & Baharum, N. (2016). Sample size guideline for correlation analysis. World Journal of Social Science Research, 3(1), 37-46. https://doi.org/10.22158/wjssr.v3n1p37
Burrowes, J. (2020). Factors affecting dietary adherence and strategies for improving adherence in chronic kidney disease. In J. Burrowes, C. Kovesdy, & L. Byham-Gray (Eds.), Nutrition in kidney disease. (pp. 625-633). Humana, Cham. https://doi.org/10.1007/978-3-030-44858-5_34
Chen, H. C., Zhu, L., Chan, W. C. S., Cheng, K. F. K., Vathsala, A., & He, H. G. (2023). The effectiveness of a psychoeducational intervention on health outcomes of patients undergoing haemodialysis: A randomized controlled trial. International Journal of Nursing Practice, 29(3), e13123. https://doi.org/10.1111/ijn.13123
Chen, J., Lou, X., Shen, H., Zhao, B., Kang, J., Du, W., Zheng, X., Wang, W., Wang, W., & Wang, S. (2019). Effects of teach-back method on improving dietary adherence and nutritional status in peritoneal dialysis patients. Chinese Journal of Nursing, 54(4), 495-500. https://doi.org/10.3761/j.issn.0254-1769.2019.04.003
Chen, L., Wang, Y., & Zhang, H. (2023). Practical challenges in implementing renal diets in Chinese households: A qualitative study. Journal of Renal Nutrition, 33(2), 145-152. https://doi.org/10.1053/j.jrn.2022
Clark-Cutaia, M. N., Ren, D., Hoffman, L. A., Burke, L. E., & Sevick, M. A. (2014). Adherence to hemodialysis dietary sodium recommendations: Influence of patient characteristics, self-efficacy, and perceived barriers. Journal of Renal Nutrition, 24(2), 92-99. https://doi.org/10.1053/j.jrn.2013.11.007
Crawford, P. W., & Lerma, E. V. (2008). Treatment options for end stage renal disease. Primary Care, 35(3), 407-432. https://doi.org/10.1016/j.pop.2008.05.003
Cuicui, G., Huayun, Z., Hongyun, P., & Yanan, L. (2021). Correlation between low-phosphorus diet compliance, and health beliefs and disease perception in patients with maintenance hemodialysis. Nursing Practice and Research, 18(10), 1447-1450. https://www.hlsjyj.com/uploads/ueditor/file/20220822/1661133800780120.pdf (in Chinese)
Dou, J., Liu, H., Ma, Y., Wu, Y. Y., & Tao, X. B. (2023). Prevalence of post-dialysis fatigue: A systematic review and meta-analysis. BMJ Open, 13(6), e064174. https://bmjopen.bmj.com/content/bmjopen/13/6/e064174.full.pdf
Fung, T. K. F., Ng, Y. L., Lam, M. F., & Lee, K. K. W. (2017). Psychosocial factors predict nonadherence to PD treatment: A Hong Kong survey. Peritoneal Dialysis International, 37(3), 331–337. https://doi.org/10.3747/pdi.2016.00094
Gao, M., Zhu, J., Zhao, W., Jia, C., Lu, M., Wang, Z., & Su, C. (2025). The influencing factors of phosphate control behavior among patients undergoing hemodialysis: Based on the health belief model. Renal Failure, 47(1), 2522969. https://doi.org/10.1080/0886022X.2025.2522969
Glick, A. A., Winham, D. M., Heer, M. M., Shelley, M. C., & Hutchins, A. M. (2024). Health Belief Model predicts likelihood of eating nutrient-rich foods among U.S. adults. Nutrients, 16(14), 2335. https://doi.org/10.3390/nu16142335
Ikizler, T. A., Burrowes, J. D., Byham-Gray, L. D., Campbell, K. L., Carrero, J. J., Chan, W., Fouque, D., Friedman, A. N., Ghaddar, S., Goldstein-Fuchs, D. J., Kaysen, G. A., Kopple, J. D., Teta, D., Yee-Moon Wang, A., & Cuppari, L. (2020). KDOQI clinical practice guideline for nutrition in CKD: 2020 update. American Journal of Kidney Diseases, 76(3 Suppl. 1), S1-S107. https://doi.org/10.1053/j.ajkd.2020.05.006
Kaysen, G. A. (2003). Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy? Kidney International Supplement, 64, S92-S98. https://doi.org/10.1046/j.1523-1755.64.s87.14.x
Keshani, P., Salehi, M., Kaveh, M. H., & Faghih, S. (2018). Self-efficacy and cues to action: Two main predictors of modified version of diet quality index in Iranian adolescents. Progress in Nutrition, 20(2), 197–204. https://doi.org/10.23751/pn.v20i2.6711
Kopple, J. D., & Fouque, D. (2018). Pro: The rationale for dietary therapy for patients with advanced chronic kidney disease. Nephrology Dialysis Transplantation, 33(3), 373-378. https://doi.org/10.1093/ndt/gfx333
Lambert, K. (2018). Exploring the challenges to dietary selfmanagement adherence in end stage kidney disease: Implications for clinical practice. University of Wollongong. https://scispace.com/pdf/exploring-the-challenges-to-dietary-selfmanagement-adherence-37xqymnu54.pdf
Lee, S. H., & Molassiotis, A. (2002). Dietary and fluid compliance in Chinese hemodialysis patients. International Journal of Nursing Studies, 39(7), 695-704. https://doi.org/10.1016/s0020-7489(02)00007-x
Li, C. Y., Hsieh, C. J., Shih, Y. L., & Lin, Y. T. (2021). Spiritual well-being of patients with chronic renal failure: A cross-sectional study. Nursing Open, 8(5), 2461-2469. https://doi.org/10.1002/nop2.1004
Lim, J. H., Zakaria, N. F, Chinna, K., Karupaiah, T., & Daud, Z. A. M. (2019). SUN-313 exploring the relationships between health literacy, dietary adherence and its mediators in hemodialysis patients in Malaysia. Kidney International Reports, 4(7), S290. https://doi.org/10.1016/j.ekir.2019.05.720
Lin, X., Tang, Y., Hu, Y., Lu, Y., Sun, Q., Lv, Y., Zhang, Q., Wu, C., Zhu, M., He, Q., & Chi, Y. (2021). Sodium reduction in traditional fermented foods: Challenges, strategies, and perspectives. Journal of Agricultural and Food Chemistry, 69(29), 8065-8080. https://doi.org/10.1021/acs.jafc.1c01687
Lok, C. E., Huber, T. S., Lee, T., Shenoy, S., Yevzlin, A. S., Abreo, K., Allon, M., Asif, A., Astor, B. C., Glickman, M. H., Graham J, Moist, L. M., Rajan, D. K., Roberts, C., Vachharajani, T. J., & Valentini, R. P. (2020). KDOQI clinical practice guideline for vascular access: 2019 update. American Journal of Kidney Diseases, 75(4 Suppl. 2), S1-S164. https://doi.org/10.1053/j.ajkd.2019.12.001
Loutradis, C., Sarafidis, P. A., Ferro, C. J., & Zoccali, C. (2021). Volume overload in hemodialysis: diagnosis, cardiovascular consequences, and management. Nephrology Dialysis Transplantation, 36(12), 2182-2193. https://doi.org/10.1093/ndt/gfaa210
Lu, Y., Liu, W., Huang, Y., & Li, Z. (2020). Economic and psychosocial factors affecting adherence to hemodialysis in China. BMC Nephrology, 21(1), 142. https://doi.org/10.1186/s12882-020-01805-2
McCullough, K. P., Morgenstern, H., Saran, R., Herman, W. H., & Robinson, B. M. (2019). Projecting ESRD incidence and prevalence in the United States through 2030. Journal of the American Society of Nephrology, 30(1), 127–135. https://doi.org/10.1681/ASN.2018050531
National Health Commission of the People’s Republic of China. (2024). Dietary guidelines for adults with chronic kidney disease. National Health Commission of the People’s Republic of China.
Nooriani, N., Mohammadi, V., Feizi, A., Shahnazi, H., Askari, G., & Ramezanzade, E. (2019). The effect of nutritional education based on health belief model on nutritional knowledge, Health Belief Model constructs, and dietary intake in hemodialysis patients. Iranian Journal of Nursing and Midwifery Research, 24(5), 372-378. https://doi.org/10.4103/ijnmr.IJNMR_124_18
Özkan, G. L. M., & Ulusoy, S. U. K. (2011). Acute complications of hemodialysis. In M. G. Penido (Ed.), Technical problems in patients on hemodialysis (pp. 251-294). IntechOpen. https://cdn.intechopen.com/pdfs/24624/intech-acute_complications_of_hemodialysis.pdf
Pajimna, J. A. T., Orpilla, G. A. L., Milan, M. J. D., Virtucio, C. T. S., & Pamatian, J. V. M. (2023). Gaps and challenges in the provision of treatment for patients with end-stage renal disease: Perspectives from the Philippines. The Lancet Regional Health–Western Pacific, 38, 100889. https://doi.org/10.1016/j.lanwpc.2023.100889
Rushe, H., & Mcgee, H. M. (1998). Assessing adherence to dietary recommendations for hemodialysis patients: The renal adherence attitudes questionnaire (RAAQ) and the renal adherence behaviour questionnaire (RABQ). Journal of Psychosomatic Research, 45(2), 149-157. https://doi.org/10.1016/S0022-3999(97)00228-6
Sabzmakan, L., Kamalikhah, T., Kordasiabi, M. C., & Nourian, M. (2021). Associated factors with dietary adherence among people with cardiovascular metabolic risk factors based on precede framework: A mixed-method study. Journal of Education and Community Health, 8(2), 97-104. https://doi.org/10.52547/jech.8.2.97
Song, Y., Wang, J., Liu, H., Chen, X., & Zhan, M. (2022). Diet and culture among Chinese patients undergoing hemodialysis: A qualitative study. Frontiers in Nutrition, 9, 876179. https://doi.org/10.3389/fnut.2022.876179
Tao, Y., Zhuang, K., Liu, T., Li, H., & Feng, X. (2023). Effects of perceived stress, self-acceptance and social support on insomnia in hemodialysis patients: A cross-sectional study. Journal of Psychosomatic Research, 172, 111402. https://doi.org/10.1016/j.jpsychores.2023.111402
Wang, X., Deng, S., & Peng, H. (2023). Specialist nurse-led family co-decision-making precision dietary care in maintenance hemodialysis patients: Application analysis. China Academic Journal Electronic Publishing House, 27(36), 67-69+93. https://link.oversea.cnki.net/doi/10.19435/j.1672-1721.2023.36.023
Yang, C.W., Harris, D. C. H., Luyckx, V. A., Nangaku, M., Hou, F. F., Garcia, G. G., Abu-Aisha, H., Niang, A., Sola, L., Bunnag, S., Eiam-Ong, S., Tungsanga, K., Richards, M., Richards, N., Goh, B. L., Dreyer, G., Evans, R., Mzingajira, H., Twahir, A., … Tonelli, M. (2020). Global case studies for chronic kidney disease/end-stage kidney disease care. Kidney International Supplements, 10(1), e24-e48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031689/pdf/main.pdf
Zhang, Y., Chen, X., Zhang, X., Zhu, J., Men, H., Zhao, W., & Su, C. (2022). Development and validation of a dietary health belief questionnaire for hemodialysis patients. Chinese Nursing Management, 22(6), 846-851. https://doi.org/10.3969/j.issn.1672-1756.2022.06.010
Zhang, Y., & Huang, J. (2013). The development of medical treatment adherence scale for the end-stage renal disease patients with maintenance hemodialysis. Chinese General Practice, 16(34), 3312-3316.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Nursing Journal CMU
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของวารสารพยาบาลสาร
ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับมหาวิทยาลัยเชียงใหม่ และคณาจารย์ท่านอื่นๆในมหาวิทยาลัยฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว
