Understanding diuretic nonadherence among patients with heart failure: A mixed-methods study

ObjectivesThe purpose of this study was to assess the extent of diuretic nonadherence and to understand the reasons for diuretic nonadherence among patients with a 90-day heart failure hospital readmission.MethodsThis study utilized a convergent parallel mixed-method design. The extent and reasons for medication nonadherence were measured using the Domains of Subjective Extent of Nonadherence scale. Semi-structured interviews were used to understand patients' reasons for nonadherence. Descriptive and regression tests were used to analyze quantitative data. Thematic analysis was used for qualitative data analysis. Meta-inferences were developed from merged data.ResultsEighty-two adults participated in the study. The merged data indicated that 61% of participants were diuretic nonadherent. The analysis of merged data revealed 3 meta-inferences: (1) Diuretic nonadherence may not be entirely unintentional or intentional; (2) Fearing a loss of dignity contributes to diuretic nonadherence; and (3) Diuretic nonadherence is an act of self-determination.DiscussionIn this study, diuretic nonadherence was a complex mix of unintentional and intentional reasons, a strategy to protect against dignity loss, and an effort to gain control over diuretic effects. A need for dignity and self-determination may be important drivers of nonadherence and should be considered by clinicians and researchers.