MON-064 BARRIERS AND FACILITATORS OF ADHERING TO THE TREATMENT REGIMENS AMONG PATIENTS RECEIVING HEMODIALYSIS IN BANDA ACEH, INDONESIA: A QUALITATIVE ECOLOGICAL EVALUATION

Abstract

Both incidence and prevalence of chronic kidney disease (ESRD) and end-stage renal disease (ESRD) is gradually increasing, especially in developing countries where availability, accessibility, affordability of prevention and treatment strategies and policies are still insufficient. Consequences and outcomes of treatment rely heavily on treatment adherence, which includes adhering to dialysis attendance, medication, dietary and fluid, the four standard regimens prescribed, for ESRD patients that also affect a lot to their quality of life while in self-care. However, only a few studies have been conducted in a developing country where hemodialysis is still the dominant modality of choice. This study is to explore patient’s perspectives on the facilitator and barriers when they are taking their treatment regimens and doing self-care. This study used qualitative inquiry to interview purposely six HD patients with a set of the semi-structured interview guide, and open-ended questions and conducted non-participating observations in the dialysis center of a tertiary teaching hospital in Banda Aceh, Indonesia. Fieldnotes were taken and reflected. Interviews were audio-recorded, transcribed and thematically analyzed. While listing of those facilitators and barriers to patients, an ecological framework is chosen as an analysis framework. First, from the individual level, patient's knowledge and education level, symptoms to raise awareness, lesson learned from complications are the facilitators and patient arbitrarily stopping the medication, and patient’s strategy taking medication are the barriers. Second, from interpersonal level, social support, professional advice , socialization are the facilitators and undermining in social support, and special cultural or social occasion are the barriers. Third, from the organizational level, well-trained personnel, laboratory results, community in the center are facilitators and member in training, overloading health staffs, hospital and healthcare service inefficiency, lack of systematic education to patients are barriers. Fourth, from the community level, religious belief is the facilitator and the cultural and contextual myth of medicine taking, and stigma is the barriers. Last, from the policy level, universal health coverage, reform of community primary healthcare center are the facilitators and unemployment, health system information discrepancy are the barriers. Overalls, policy implications suggested patient education applied to each level in the eco-system. Active patient should be enforced with health promotion and information individually. Social support should be considered especially to the public regarding that dialysis patient in need. Reliable source of information should be safeguarded, and those non-formal and alternative choice of health seeking behavior should be handled with cares. In the hospital setting, well explained of everything is strongly recommended. Religious belief could play a significant role. The education programme could be considered to embedded into the current religion courses or religious gathering. Indirect medical and non-medical expense should be recognized as in the universal health coverage. We believe with this analytic ecologic framework, and it could suggest dynamically to fit into the patient's real needs.