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Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration using Partial Least Squares Structural Equation Modeling

Author

Listed:
  • Jun-Hao Lim

    (Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia)

  • Karuthan Chinna

    (School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia)

  • Pramod Khosla

    (Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202-0340, USA)

  • Tilakavati Karupaiah

    (School of Biosciences, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia)

  • Zulfitri Azuan Mat Daud

    (Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia
    Research Center of Excellent (RCoE) Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia)

Abstract

Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy ( β = 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110–0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103–0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.

Suggested Citation

  • Jun-Hao Lim & Karuthan Chinna & Pramod Khosla & Tilakavati Karupaiah & Zulfitri Azuan Mat Daud, 2020. "Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration using Partial Least Squares Structural Equation Modeling," IJERPH, MDPI, vol. 17(20), pages 1-21, October.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:20:p:7479-:d:428012
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    References listed on IDEAS

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    1. Ivana Skoumalova & Peter Kolarcik & Andrea Madarasova Geckova & Jaroslav Rosenberger & Maria Majernikova & Daniel Klein & Jitse P. van Dijk & Sijmen A. Reijneveld, 2019. "Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations?," IJERPH, MDPI, vol. 16(21), pages 1-10, November.
    2. Hair, Joe F. & Howard, Matt C. & Nitzl, Christian, 2020. "Assessing measurement model quality in PLS-SEM using confirmatory composite analysis," Journal of Business Research, Elsevier, vol. 109(C), pages 101-110.
    3. Leting Isabella Hong & Wenru Wang & Ee Yuee Chan & Fatimah Mohamed & Hui‐Chen Chen, 2017. "Dietary and fluid restriction perceptions of patients undergoing haemodialysis: an exploratory study," Journal of Clinical Nursing, John Wiley & Sons, vol. 26(21-22), pages 3664-3676, November.
    4. Yoke Mun Chan & Mohd Shariff Zalilah & Sing Ziunn Hii, 2012. "Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-7, August.
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