Effectiveness of Educational Program on Knowledge and Adherence to Treatment Among Hemodialysis Patients: A Quasi-Experimental Study

Abstract

Background: Hemodialysis patients require comprehensive knowledge about disease and strict adherence to complex treatment regimens. Knowledge deficits and non-adherence contribute to poor clinical outcomes, increased complications, and reduced quality of life. Structured educational interventions are essential to bridge knowledge gaps and improve adherence behaviors.

Objective: To evaluate the effectiveness of a structured educational program on improving knowledge and adherence to treatment across multiple domains among hemodialysis patients.

Methods: A quasi-experimental study was conducted with 110 hemodialysis patients (55 study group, 55 control group) at hemodialysis centers. The study group received a comprehensive educational program. Knowledge was assessed using kidney disease knowledge questionnaire and another three validated questionnaires measuring fluid control knowledge (FCHPS knowledge subscale), dietary knowledge (SDKHP), and exercise perceptions (benefits and barriers). Adherence was measured using four validated instruments: Hemodialysis Adherence Scale (HAS), Morisky Medication Adherence Scale (MMAS), Fluid Control Habits- Scale (FCHPS) with behavior and attitude subscales, and Scale of Dietary Behavior in Hemodialysis Patients (SDBHP). All assessments were conducted at three time points: pre-test, post-test 1, and post-test 2. Data were analyzed using SPSS version 27.

Results: The educational program produced significant improvements in both knowledge and adherence domains. Knowledge outcomes showed substantial gains in the study group: kidney disease knowledge increased from 7.04±2.40 to 17.22±2.78 (p<0.001), fluid control knowledge improved from 11.64±3.41 to 16.80±1.84 (p<0.001), dietary knowledge increased dramatically from 0.75±1.14 to 12.29±2.63 (p<0.001), perceived exercise benefits increased from 23.25±5.91 to 40.62±3.67 (p<0.001), and perceived exercise barriers decreased from 37.95±5.75 to 19.13±3.38 (p<0.001). Adherence outcomes demonstrated parallel improvements: hemodialysis treatment adherence (HAS) improved from 15.96±3.66 to 22.98±2.40 (p<0.001), medication adherence (MMAS) improved from 3.42±1.78 to 2.05±0.93 (p<0.001), fluid control behavior improved from 17.93±5.17 to 27.09±2.15 (p<0.001), fluid control attitudes improved from 13.27±4.44 to 7.85±2.57 (p<0.001), and dietary adherence improved from 36.00±6.21 to 50.65±4.46 (p<0.001). All improvements were sustained at follow-up assessment, while the control group showed no significant changes, confirming the effectiveness of the educational intervention.

Conclusion: The structured educational program was highly effective in enhancing both knowledge and adherence to treatment among hemodialysis patients across all critical domains. Significant improvements in knowledge domains translated into measurable adherence domains improvements Integration of structured educational programs into routine hemodialysis care is strongly recommended to optimize patient outcomes.