title: Resilience, religiosity and treatment adherence in hemodialysis patients: a prospective study.
abstract: Resilience and religiosity have received attention as an important process in the experience and management of chronic comorbidities; however, there is no study evaluating resilience in hemodialysis patients and its association with other psychological dimensions or with treatment adherence. This observational prospective study assessed resilience (25 item Wagnild and Young Resilience Scale), religiosity under three dimensions (organizational, non-organizational and intrinsic) using DUREL scale, depressive symptoms (Patient Health Questionnaire-9) and health-related quality of life (Short Form-36 questionnaire). The main outcomes were medication adherence using the Morisky Medication Adherence Scale-8 (MMAR-8) and the missing/shortened dialysis sessions in the following six months. Of 208 patients approached, 202 (97.1%) agreed to participate. One hundred twenty-three patients (60.9%) were males and mean age was 52.8 ± 14.8 years-old. The median time on hemodialysis was 36 months (IQR, 12, 84). 82 (40.6%) patients obtained a MMAS-8 score <6 and were considered as having 'poor adherence'. Overall, the mean score of medication adherence was low (5.7 ± 2.1). About adherence to hemodialysis sessions, patients missed a total of 234 (1.6%) hemodialysis sessions. Forty-eight patients (23.7%) missed an average of at least three sessions in six months. Regarding adherence to medication, there was no association in the uni- or multivariate analysis between religiosity dimensions and MMAS-8 score. After adjustment, resilience was positively associated with MMAS-8 score (standardized β coefficient .239, p = .016). Organized and intrinsic religiosity were associated with adherence to dialysis sessions (standardized β coefficient .258, p = .004 and .231, p = .026, respectively). Interestingly, opposite to medication adherence, more resilient patients were associated with less adherence to hemodialysis sessions (standardized β coefficient -.296, p = .001). Religiosity was associated with dialysis adherence but not with medication adherence. Resilience was associated with higher medication adherence but lower adherence to dialysis sessions.
authors.affiliation: a Medical Sciences Post-graduate Program, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza , Brazil.
authors.forename: Camila Maroni Marques
authors.initials: CM
authors.lastname: Freire de Medeiros
authors.affiliation: a Medical Sciences Post-graduate Program, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza , Brazil.
authors.forename: Eder Pinheiro
authors.initials: EP
authors.lastname: Arantes
authors.affiliation: a Medical Sciences Post-graduate Program, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza , Brazil.
authors.forename: Rafael Dib de Paulo
authors.initials: RD
authors.lastname: Tajra
authors.affiliation: a Medical Sciences Post-graduate Program, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza , Brazil.
authors.forename: Hendrio Reginaldo
authors.initials: HR
authors.lastname: Santiago
authors.affiliation: a Medical Sciences Post-graduate Program, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza , Brazil.
authors.forename: André Ferrer
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: a Medical Sciences Post-graduate Program, Department of Clinical Medicine , Universidade Federal do Ceará , Fortaleza , Brazil.|b Medical Sciences Post-graduate Program , Universidade de Fortaleza - UNIFOR , Fortaleza , Brazil.|c Service of Nephrology , Instituto Dr. José Frota , Fortaleza , Brazil.
authors.forename: Alexandre Braga
authors.initials: AB
authors.lastname: Libório
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000523:psychology; D000073222:Patient Health Questionnaire; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D012067:Religion; D006435:Renal Dialysis; D055500:Resilience, Psychological; D011795:Surveys and Questionnaires
keywords: Resilience; adherence; hemodialysis