Identification of the factors associated with compliance to therapeutic diets in older adults with end stage renal disease.
OBJECTIVE
To identify theory based factors pertinent to compliance with therapeutic diets.


DESIGN
A paper and pencil survey was read to volunteer hemodialysis patients in outpatient dialysis clinics.


SUBJECTS
A convenience sample of 276 hemodialysis patients aged 50 years and older who agreed to be interviewed during treatment.


STATISTICAL ANALYSIS
Descriptive statistics were used to report responses to all survey questions. The Fisher exact test was used to test associations between the dependent variable, dietary compliance, and independent variables, which included knowledge, perceived severity of illness, attitudes toward compliance, environmental factors, perceived barriers, self-efficacy, and perceived health benefits. Principal Components Analysis determined final scale items. Logistic regression was used to develop a model of independent variables profiling the compliant patient.


RESULTS
Subjects were more likely to be compliant if they indicated favorable attitudes toward compliance (P =.0076), a supportive environment (P =.0107), and knowledge about their diet (P =.0014). A logistic regression model of compliance indicated that subjects who followed their special diets were more likely to have higher knowledge (odds ratio [OR] = 1.092, 95% CI = 1.006, 1.186), perceived fewer barriers (OR = 1.094, 95% CI = 0.841, 1.226), being white race (OR = 0.710, 95% CI = 0.399, 1.263), and having gout (OR = 9.349, 95% CI = 1.139, 76.714).


APPLICATION
Health professionals should apply these findings in providing dietary education focused on improving not just knowledge, but attitudes and family support. Nutrition education and health promotion applications geared to non-white populations could be particularly important as tools to improve dietary compliance.