title: Understanding the associations between modifying factors, individual health beliefs, and hemodialysis patients' adherence to a low-phosphorus diet.
abstract: OBJECTIVE
  Hyperphosphatemia in end-stage renal disease is associated with significant morbidity and mortality. Because phosphorus is not effectively dialyzed, dietary adherence remains a significant problem. Previous studies have examined the health belief model, but none have looked at stages of change and dietary adherence in patients undergoing hemodialysis (HD).
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Three dialysis centers in Columbus, Ohio, between August 2012 and March 2013.
  
  
  METHODS
  English-speaking patients age 18 or older on HD without dementia or developmental delay.
  
  
  METHODS
  None.
  
  
  METHODS
  Associations between dietary adherence based on the Precaution Adoption Process Model (stages of change) and serum phosphorus levels via a conceptual model incorporating modifying factors and individual health beliefs.
  
  
  RESULTS
  Ninety-five patients completed the survey; 59 (62%) endorsed adherence to a low-phosphorus diet and 32 (34%) had phosphorus values ≤5.5 mg/dL. Modifying factors associated with diet adherence included nonminority status odds ratio (OR), 95%CI 8.99 (1.08-74.60), greater level of education OR 18.23 (1.62-205.00), better quality of life OR 9.28 (1.35-63.71), and time on dialysis OR 1.04 (1.01-1.07). Individual health beliefs associated with diet adherence included perceived benefits OR 3.18 (1.47-6.88) and self-efficacy OR 1.22 (1.09-1.38). Modifying factors associated with phosphorus control included: age OR 0.94 (0.90-0.99), minority status OR 0.11 (0.02-0.68), greater level of education OR 6.60 (1.41-31.04), knowledge about chronic kidney disease OR 1.48 (1.03-2.13), and time on dialysis OR 0.98 (0.96-0.99). Individual health beliefs associated with phosphorus control included self-efficacy OR 1.08 (1.01-1.16).
  
  
  CONCLUSIONS
  HD clinicians and educators may obtain better results with dietary adherence and phosphorus control if they focus not only toward disease and dietary education but also on understanding modifying factors and individual health beliefs. Assessing where the patient is with regard to stages of change may assist health care providers in better matching interventions that build patients' self-efficacy.
authors.affiliation: Department of Medical Education, OhioHealth Riverside Methodist Hospital, Columbus, Ohio. Electronic address: john.elliott@ohiohealth.com.
authors.forename: John O
authors.initials: JO
authors.lastname: Elliott
authors.affiliation: OhioHealth O'Bleness Hospital, Primary Care Athens Castrop Center, Athens, Ohio.
authors.forename: Carl
authors.initials: C
authors.lastname: Ortman
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Salem
authors.initials: S
authors.lastname: Almaani
authors.affiliation: Central Ohio Primary Care, Columbus, Ohio.
authors.forename: Yun Hui
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Medical Education, OhioHealth Riverside Methodist Hospital, Columbus, Ohio.
authors.forename: Kim
authors.initials: K
authors.lastname: Jordan
mesh_terms: D003430:Cross-Sectional Studies; D004032:Diet / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D054559:Hyperphosphatemia / Q000150:complications / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016226:Phosphorus, Dietary / Q000009:adverse effects; D006435:Renal Dialysis
chemical_list: D016226:Phosphorus, Dietary