African American Patients' Perspectives on Determinants of Hemodialysis Adherence and Use of Motivational Interviewing to Improve Hemodialysis Adherence

Key Points African American patients have unique insights on hemodialysis adherence and use of motivational interviewing to promote adherence. Key themes were mental health issues; historical mistrust; social determinants of health; and importance of provider cultural competence. Themes led to a novel conceptual model, which will inform the design of a motivational interviewing-based protocol to improve adherence. Background Compared with White patients, African American (AA) patients have a four-fold higher prevalence of kidney failure and higher hemodialysis nonadherence. Adherence behaviors are influenced by psychosocial factors, including personal meaning of a behavior and self-confidence to enact it. We assessed perspectives of AA hemodialysis patients on unique factors affecting dialysis adherence, and use of motivational interviewing (MI), an evidence-based intervention, to improve these factors, dialysis adherence, and outcomes in AAs. Methods Self-identified AA hemodialysis patients ( N =22) watched a brief video describing MI and then completed a semistructured interview or focus group session. Interview questions explored unique barriers and facilitators of hemodialysis adherence in AAs and perceived utility of MI to address these obstacles. Verbatim transcripts and an iterative inductive/deductive approach were used to develop a hierarchical coding system. Three experienced coders independently coded the same two transcripts. Coding was compared, and discrepancies were reconciled by a fourth coder or consensus. Transcripts, quotations, and codes were managed using Microsoft Excel 2016 and SPSS version 28.0. Results Themes and subthemes emerged and culminated in a novel conceptual model informed by three theoretical models of behavior change: Theory of Self-Care Management for Vulnerable Populations; Social Cognitive Theory; and Self Determination Theory. This conceptual model will inform the design of a culturally tailored, MI-based intervention to improve dialysis adherence in AAs. Conclusions Integrating AA hemodialysis patient perspectives is critical for enhancing dialysis care delivery and the design of effective interventions such as MI to improve dialysis adherence in AA and promote kidney health equity. AA hemodialysis patients view MI as a tool to clarify patient priorities, build trust, and promote patient-provider therapeutic alliance. Cultural tailoring of MI to address unique barriers of AAs with kidney failure will improve adherence and health outcomes in these vulnerable patients.