Relationship between Caregiver Health Literacy and Treatment Adherence of Patients with Advanced Chronic Kidney Disease Undergoing Hemodialysis: A Cross-sectional Dyadic Study

Hemodialysis reduces patients’ ability to perform daily activities and makes them dependent on caregivers. Since the access to and understanding of health information by patients should be ensured by informal caregivers, caregivers' health literacy is of particular importance in treatment adherence. This study determined the relationship between caregivers' health literacy and hemodialysis patients’ treatment adherence. This descriptive correlational study was conducted on dyads of hemodialysis patients and their caregivers at all hemodialysis wards in Bushehr Province, Iran (2021) using the census method. Eligible patients and their caregivers were invited to participate (N=259). The data collection instruments were a demographic information form, the End-Stage Renal Disease Adherence Questionnaire, and the Health Literacy Instrument for Iranian Adults. The data were analyzed using SPSS19.0 via descriptive and analytical methods (univariate and multivariate linear regression). P<0.05 was considered statistically significant.  In total, 78 and 181 of the caregivers were male and female, respectively, with the mean ±SD age of 58.53±12.63 years. Among the patients, 153 were male and the rest were female with the mean ±SD age of 43.47±11.97 years. The mean ±SD of caregivers' health literacy and treatment adherence was 3.42±0.81 and 1063.61±142.11, respectively. There was no significant correlation between caregivers' health literacy and patients' treatment adherence (P<0.89). However, there was a direct correlation between treatment adherence and caregivers' age (P<0.01). Moreover, there was a negative correlation between the number of hours of caregiving per day and the patients' treatment adherence (P<0.04).  Since caregivers' health literacy was not associated with patients’ treatment adherence, if healthcare providers, provide appropriate information to informal caregivers even based on their health literacy, it may not be transferred well to their patients. Therefore, these results can be considered a warning for healthcare providers to pay attention to providing training in health promotion programs to both the patient and the caregiver.