Effects of motivational interviewing and an education programme based on Watson’s theory of human caring on adults receiving haemodialysis: randomised controlled trial
Restricted accessResearch articleFirst published online February, 2025
Effects of motivational interviewing and an education programme based on Watson’s theory of human caring on adults receiving haemodialysis: randomised controlled trial
Effective haemodialysis management is crucial, and behavioural change interventions are essential for good haemodialysis self-management. However, no study explores the effects of Watson’s theory such as the humanistic approach to behavioural change in haemodialysis.
Aims:
To evaluate the effects of motivational interviewing and an education programme based on Watson’s theory on adherence to treatment, satisfaction and health-related quality of life (HRQOL) on haemodialysis.
Methods:
This study was conducted in Turkey. Intervention group received four sessions of motivational interviewing and an education programme based on Watson’s theory, and the control group received routine care. The primary outcomes were adherence to fluid intake, diet and medication, attendance at haemodialysis sessions, satisfaction and HRQOL. The secondary outcomes were laboratory parameters.
Results:
Participants were randomly assigned to the intervention (n = 32) or the control group (n = 28). There were statistically significant between-group differences in adherence to fluid intake, diet and medication, and the kidney disease burden sub-dimension of HRQOL, with medium to large effect sizes. There was no difference in laboratory parameters. Participants showed high levels of satisfaction with this programme.
Conclusions:
This study provides evidence for nurses regarding Watson’s theory-based programme in a haemodialysis population. Results will help nurses to develop and practice customised effective interventions for haemodialysis.
AbbasiAbianeh NAbdollahZargar SAmirkhaniA, et al. (2020) The effect of self-care education through teach back method on the quality of life in hemodialysis patients. Néphrologie & Thérapeutique16: 197–200. DOI: 10.1016/j.nephro.2020.01.002.
2.
Al-KhattabiGH (2023) Adherence of hemodialysis patients to fluid, diet, medications, and hemodialysis sessions, Makkah, Saudi Arabia. Saudi Journal of Kidney Diseases and Transplantation34(Suppl. 1): 31–43. DOI: 10.4103/sjkdt.sjkdt_351_22
3.
Allande-CussóRFernández-GarcíaEGómez-SalgadoJ, et al. (2022) Understanding the nurse-patient relationship: A predictive approach to caring interaction. Collegian29: 663–670.
4.
AlshogranOYShatnawiEAAltawalbehSM, et al. (2022) Medication non-adherence and the achievement of therapeutic goals of anemia therapy among hemodialysis patients in Jordan. Hospital Practice50: 82–88. DOI: 10.1080/21548331.2022.2032073.
5.
AlzahraniAMA (2022) Prevalence of non-adherence to prescribed medications among hemodialysis patients in Makkah City. Saudi Journal of Kidney Diseases and Transplantation33: 526–534. DOI: 10.4103/1319-2442.388187.
6.
BarelloSAndersonGAcamporaMBosioC, et al. (2023) The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: A systematic review and a meta-analysis. International Urology and Nephrology55: 897–912. DOI: 10.1007/s11255-022-03374-3.
7.
BaşerEMollaoğluM (2019) The effect of a hemodialysis patient education program on fluid control and dietary compliance. Hemodialysis International23: 392–401. DOI: 10.1111/hdi.12744.
8.
BeerappaHChandrababuR (2019) Adherence to dietary and fluid restrictions among patients undergoing hemodialysis: An observational study. Clinical Epidemiology and Global Health7: 127–130. DOI: 10.1016/j.cegh.2018.05.003.
9.
BelloAKOkpechiIGOsmanMA, et al. (2022) Epidemiology of haemodialysis outcomes. Nature Reviews Nephrology18: 378–395. DOI: 10.1038/s41581-022-00542-7.
CohenJ (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd edn.Hillsdale, NJ: Lawrence Erlbaum Associates.
12.
CoşarAAPakyüzÇS (2016) Scale development study: The fluid control in hemodialysis patients. Japan Journal of Nursing Science13: 174–182. DOI: 10.1111/jjns.12083.
13.
CrownSVogelJAHurlock-ChorosteckiC (2017) Enhancing self-care management of interdialytic fluid weight gain in patients on hemodialysis: A Pilot study using motivational interviewing. Nephrology Nursing Journal44: 49–55.
14.
DelaneyCBarrereCHelmingM (2011) The influence of a spirituality-based intervention on quality of life, depression, and anxiety in community-dwelling adults with cardiovascular disease: A pilot study. Journal of Holistic Nursing29: 21–32. DOI: 10.1177/0898010110378356.
15.
DüzalanÖBPakyüzSÇ (2017) Scale development: Dietary knowledge and behaviors assessment in hemodialysis patients. Acta Medica Mediterranea33: 457–463. DOI: 10.19193/0393-6384_2017_3_067.
16.
EvansV (2019) Frequent home hemodialysis: More is better. Kidney Medicine1: 41–42. DOI: 10.1016%2Fj.xkme.2019.03.003.
17.
García-LlanaHRemorEdel PesoG, et al. (2014) Motivational interviewing promotes adherence and improves wellbeing in pre-dialysis patients with advanced chronic kidney disease. Journal of Clinical Psychology in Medical Settings21: 103–115. DOI: 10.1007/s10880-013-9383-y.
18.
GrivaKNandakumarMJo-anHN, et al. (2018) Hemodialysis self-management intervention randomized trial (HED-SMART): A practical low-intensity intervention to improve adherence and clinical markers in patients receiving hemodialysis. American Journal of Kidney Diseases71: 371–381. DOI: 10.1053/j.ajkd.2017.09.014.
19.
HalleMPNelsonMKazeFF, et al. (2020) Non-adherence to hemodialysis regimens among patients on maintenance hemodialysis in sub-Saharan Africa: An example from Cameroon. Renal Failure42: 1022–1028. DOI: 10.1080/0886022X.2020.1826965.
20.
HaysRDKallichJDMapesDL, et al. (1994) Development of the kidney disease quality of life (KDQOL TM) instrument. Quality of Life Research3: 329–338. DOI: 10.1007/BF00451725.
21.
HtayHBelloAKLevinA, et al. (2021) Hemodialysis use and practice patterns: An international survey study. American Journal of Kidney Diseases77: 326–335. DOI: 10.1053/j.ajkd.2020.05.030.
22.
IdierLUntasAKoleckM, et al. (2011) Assessment and effects of therapeutic patient education for patients in hemodialysis: A systematic review. International Journal of Nursing Studies48: 1570–1586. DOI: 10.1016/j.ijnurstu.2011.08.006.
23.
JiXYanY (2023) Effect of using the active cycle of breathing technique combined with Watson’s theory of human caring in rapid patient rehabilitation following lung cancer surgery. Alternative Therapies in Health and Medicine29: 14–20.
24.
KaraB (2009) A validity and reliability study of the nonadherence questionnaire with dialysis diet and fluid restrictions. Journal of Anatolia Nursing and Health Sciences12: 20–27.
25.
LeeM-CWuS-FVHsiehN-C, et al. (2016) Self-management programs on eGFR, depression, and quality of life among patients with chronic kidney disease: A meta-analysis. Asian Nursing Research10: 255–262. DOI: 10.1016/j.anr.2016.04.002
26.
LewisRLiuYGrohMPicardR (2021). Habit formation dynamics: finding factors associated with building strong mindfulness habits. HCI International 2021 – Posters, Cham.
27.
LiuMW-CSyukriMAbdullahA, et al. (2021) Missing in-center hemodialysis sessions among patients with end stage renal disease in Banda Aceh, Indonesia. International Journal of Environmental Research and Public Health18: 9215. DOI: 10.3390/ijerph18179215.
28.
MatetiUVNagappaANAtturRP, et al. (2017) Impact of pharmaceutical care on the health-related quality of life among hemodialysis patients–a multicenter randomized controlled study. Saudi Journal of Kidney Diseases and Transplantation28: 1293–1306. DOI: 10.4103/1319-2442.220879.
29.
MechtaNielsen TMarottTHornumM, et al. (2023) Non-adherence, medication beliefs and symptom burden among patients receiving hemodialysis – a cross-sectional study. BMC Nephrology24: 321. DOI: 10.1186/s12882-023-03371-3
30.
MillerWRRollnickS (2013) Motivational Interviewing: Helping People Change, 3rd edn.Guilford Press, New York, USA.
31.
MoattariMEbrahimiMSharifiN, et al. (2012) The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: A randomized controlled trial. Health and Quality of Life Outcomes10: 1–10. DOI: 10.1186/1477-7525-10-115.
32.
MuraliKMMullanJRoodenrysS, et al. (2019) Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials. PLoS One14: 1–27. DOI: 10.1371/journal.pone.0211479.
33.
Naseri-SalahshourVSajadiMNikbakht-NasrabadiA, et al. (2020) The effect of nutritional education program on quality of life and serum electrolytes levels in hemodialysis patients: A single-blind randomized controlled trial. Patient Education and Counseling103: 1774–1779. DOI: 10.1016/j.pec.2020.03.021.
34.
OkEKutluY (2021) The effect of motivational interviewing on adherence to treatment and quality of life in chronic hemodialysis patients: A randomized controlled trial. Clinical Nursing Research30: 322–333. DOI: 10.1177/1054773820974158.
35.
OzanYDOkumuşH (2017) Effects of nursing care based on Watson’s theory of human caring on anxiety, distress, and coping, when infertility treatment fails: A randomized controlled trial. Journal of Caring Sciences6: 95–109. DOI: 10.15171%2Fjcs.2017.010.
36.
RaimondiM (2011) Utilizing the Stages of Change Model and Motivational Interviewing Techniques to Improve Interdialytic Weight Gain in Hemodialysis Patients. College of Saint Elizabeth]. USA.
RussellCLCronkNJHerronM, et al. (2011) Motivational interviewing in dialysis adherence study (MIDAS). Nephrology Nursing Journal38: 229–236.
39.
SchulzKFAltmanDGMoherD (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials11: 1–8. DOI: 10.4103/0976-500X.72352.
40.
SharmaSGreenTAlexanderKE, et al. (2020) Educational or behavioural interventions for symptoms and health-related quality of life in adults receiving haemodialysis: A systematic review. Journal of Renal Care46: 233–249. DOI: 10.1111/jorc.12329.
41.
StonesT (2023) The 7-Day challenge: Taking steps towards a learning habit. Studies in Self-Access Learning Journal14: 185–200. DOI: 1037237/140205.
42.
SulimanWAWelmannEOmerT, et al. (2009) Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment. Journal of Nursing Research17: 293–300. DOI: 10.1097/JNR.0b013e3181c122a3.
43.
UmeukejeEMNgankamDBeachLB, et al. (2022) African Americans’ hemodialysis treatment adherence data assessment and presentation: A precision-based paradigm shift to support quality improvement activities. Kidney Medicine4: 1–10. DOI: 10.1016/j.xkme.2021.10.007.
44.
Van CampYPHuybrechtsSAVan RompaeyB, et al. (2012) Nurse-led education and counselling to enhance adherence to phosphate binders. Journal of Clinical Nursing21(9–10): 1304–1313. DOI: 10.1111/j.1365-2702.2011.03967.x.
45.
VlaminckHMaesBJacobsA, et al. (2001) The dialysis diet and fluid non-adherence questionnaire: validity testing of a self-report instrument for clinical practice information point: Kendall’s Tau. Journal of Clinical Nursing10: 707–715. DOI: 10.1046/j.1365-2702.2001.00537.x.
46.
VrVKaurKang H (2022) The worldwide prevalence of nonadherence to diet and fluid restrictions among hemodialysis patients: A systematic review and meta-analysis. Journal of Renal Nutrition32: 658–669. DOI: 10.1053/j.jrn.2021.11.007.
47.
VujanićJMikšićŠBaraćI, et al. (2022) Patients’ and nurses’ perceptions of importance of caring nurse–patient interactions: Do They Differ?Healthcare2022; 10: 554.
48.
VuralBAcarÖTTopseverP, et al. (2012). Reliability and validity of Turkish version of modified Morisky scale. The Journal of Turkish Family Physician3: 17–20.
49.
WangJYuePHuangJ, et al. (2018) Nursing intervention on the compliance of hemodialysis patients with end-stage renal disease: A meta-analysis. Blood purification45(1–3): 102–109. DOI: 10.1159/000484924.
50.
WatsonJ (2012) Human Caring science. A Theory of Nursing, 2nd edn.Sudbury, MA: Jones & Barlett Learning.
51.
WatsonJ (2018) Unitary Caring Science: Philosophy and Praxis of Nursing. Louisville, CO: University Press of Colorado.
52.
WatsonJBrewerBBD’AlfonsoJ (2010) Watson Caritas Patient Score (WCPS)W. C. S. Institute, Deerfield Beach, FL, USA.
53.
YangözŞTÖzerZBozİ (2021) Comparison of the effect of educational and self-management interventions on adherence to treatment in hemodialysis patients: A systematic review and meta-analysis of randomized controlled trials. International Journal of Clinical Practice75: 1–19. DOI: 10.1111/ijcp.13842.
54.
YıldırımAOgutmenBBektasG, et al. (2007) Translation, cultural adaptation, initial reliability, and validation of the Kidney Disease and Quality of Life–Short Form (KDQOL-SF 1.3) in Turkey. Transplantation Proceedings39: 51–54. DOI: 10.1016/j.transproceed.2006.10.196.
55.
YounasAQuennellS. (2019) Usefulness of nursing theory-guided practice: an integrative review. Scandinavian Journal of Caring Sciences33: 540–555. DOI: 10.1111/scs.12670.
56.
ZhianfarLNadrianHJafarabadiMA, et al. (2020) Effectiveness of a multifaceted educational ıntervention to enhance therapeutic regimen adherence and quality of life amongst Iranian hemodialysis patients: A randomized controlled trial (MEITRA Study). Journal of Multidisciplinary Healthcare13: 361–372. DOI: 10.2147/JMDH.S247128.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
