Relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the Klang Valley, Malaysia
Limited health literacy and dietary non-adherence are significant public health issues in the hemodialysis (HD) population, especially in low-and-middle-income countries, where health resources and dietitians are limited. Nutrition literacy is a specific type of health literacy concerning eating...
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2021
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Mat Daud, Zulfitri 'Azuan |
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Diet Nutrition Surveys |
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Diet Nutrition Surveys Lim, Jun Hao Relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the Klang Valley, Malaysia |
| description |
Limited health literacy and dietary non-adherence are significant public health issues in
the hemodialysis (HD) population, especially in low-and-middle-income countries,
where health resources and dietitians are limited. Nutrition literacy is a specific type of
health literacy concerning eating practices. It has recently been recognised as a plausible
predictor of dietary adherence in HD patients. Yet, information pertaining to nutrition
literacy and dietary adherence among Malaysian HD patients is scant. Importantly,
theoretical frameworks have posited the putative mechanisms that explain the
relationship continuum from health literacy and its determinants to dietary adherence
through patient’s related factors (i.e., knowledge, health belief, and self-management
skills). Nevertheless, empirical study to address such a mechanism is scarce. Thus, this
study aimed to explore an existing health literacy skills framework to (1) determine the
prevalence rates of limited nutrition literacy and dietary non-adherence, (2) identify the
determinants of nutrition literacy, (3) examine the relationship between nutrition literacy
and dietary adherence, and (4) investigate the mediation effects of patient-related factors
on the relationship between nutrition literacy and dietary adherence among Malaysian
HD patients.
A multi-centre, cross-sectional study was conducted at nine convenient and accessible
dialysis centres in Klang Valley, Malaysia. A total of 250 multi-ethnic Malaysian HD
patients who aged ≥ 18 years, dialysed thrice-weekly ≥ six months, absence of physical
impairment, cognitive problem, terminal illness, and other conditions that might bias the
study outcome, were randomly selected. Data collection was conducted via face-to-face
interview using pretested and validated semi-structured questionnaire. Dietary adherence
was measured using the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ)
and serum potassium and phosphate levels. At the same time, self-management skills
were assessed by the Perceived Kidney/Dialysis Self-Management Scale (PKDSMS).
While self-developed and validated scales were used to gauge nutrition literacy (i.e.,
Dialysis Specific Nutrition Literacy Scale, DSNLS), dietary knowledge (i.e., Dialysis Diet Knowledge Questionnaire, DDKQ) and five health belief model (HBM) constructs
(i.e., Dialysis Diet-Related Health Belief Questionnaire, DDHBQ), including perceived
benefits, perceived barrier, perceived seriousness, perceived susceptibility, and
perceived self-efficacy. Data analyses were performed using IBM SPSS version 25 and
Smart PLS version 3. Null hypotheses were tested based on the results of multiple linear
regression and partial least squares structural equation modeling.
A total number of 218 HD patients were recruited. They consisted of 53.2% male and
had a mean age of 54.8 ± 12.8 years. The ethnicity distribution was 56.4% Malay, 29.8%
Chinese, and 12.8% Indians, resembling the Malaysian HD population. The majority of
the study respondents have completed secondary education (46.3%). The mean dialysis
vintage was 67.2 ± 54.3 months. Most of them had rarely received dietary advice from
healthcare professional (44.5%), high level of dietary knowledge (52.3%), high
perceived benefit (72.5%), moderately high perceived barrier (38.1%), high perceived
seriousness (74.3%), moderately low perceived susceptibility (35.3%), and moderately
low perceived self-efficacy (42.0%) of dietary adherence as well as moderately high selfmanagement
skills (55.5%).
Limited nutrition literacy was evident in 46.3% of HD patients. Older age (β=-0.212,
p=0.017), lower education level [no formal education (β=-0.143, p=0.039), primary
education (β=-0.462, p<0.001), and secondary education (β=-0.277, p=0.001), as
compared to tertiary education], shorter dialysis vintage (β=0.159, p=0.016), and have
never received dietary advice from healthcare professional [as compared to “every 2-3
months” (β=0.160, p=0.040) and “when blood tests showed abnormal results” (β=0.160,
p=0.040)], were the determinants of nutrition literacy. Overall the multiple regression
model explained 34.4% of variance of the nutrition literacy. The prevalence of dietary nonadherence
was estimated at 65.1% based on patients’ self-report. Age (β=0.185, p=0.024),
gender (βfemale=0.227, p=0.001), and nutrition literacy (β=0.372, p<0.001) were
independent predictors of dietary adherence. Nutrition literacy appeared as a stronger
predictor than sociodemographic factors, explaining about 10% variance of the selfreported
dietary adherence. The relationship between nutrition literacy and dietary
adherence was mediated comparably 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). Conversely,
dietary knowledge, perceived benefits, barrier, seriousness and susceptibility could not
explain the relationship between nutrition literacy and dietary adherence.
In conclusion, limited nutrition literacy and dietary non-adherence are prevalent in
Malaysian HD patients. Patients with older age, lower education level, shorter dialysis
vintage and have never received dietary advice from healthcare professionals are at risk
of limited nutrition literacy. Nutrition literacy is an independent predictor of dietary
adherence in Malaysian HD patients. It is causally linked to dietary adherence through
self-efficacy and self-management skills. Therefore, nutrition literacy-enhancing
interventions targeting on self-efficacy and self-management skills should be considered
in promoting dietary adherence among Malaysian HD patients. |
| format |
Thesis |
| qualification_level |
Master's degree |
| author |
Lim, Jun Hao |
| author_facet |
Lim, Jun Hao |
| author_sort |
Lim, Jun Hao |
| title |
Relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the Klang Valley, Malaysia |
| title_short |
Relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the Klang Valley, Malaysia |
| title_full |
Relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the Klang Valley, Malaysia |
| title_fullStr |
Relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the Klang Valley, Malaysia |
| title_full_unstemmed |
Relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the Klang Valley, Malaysia |
| title_sort |
relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the klang valley, malaysia |
| granting_institution |
Universiti Putra Malaysia |
| publishDate |
2021 |
| url |
http://psasir.upm.edu.my/id/eprint/93081/1/FPSK%20%28m%29%202021%203%20-%20IR.1.pdf |
| _version_ |
1776100267641536512 |
| spelling |
my-upm-ir.930812022-10-18T04:53:44Z Relationship between nutrition literacy and dietary adherence among hemodialysis patients from selected dialysis centers in the Klang Valley, Malaysia 2021-01 Lim, Jun Hao Limited health literacy and dietary non-adherence are significant public health issues in the hemodialysis (HD) population, especially in low-and-middle-income countries, where health resources and dietitians are limited. Nutrition literacy is a specific type of health literacy concerning eating practices. It has recently been recognised as a plausible predictor of dietary adherence in HD patients. Yet, information pertaining to nutrition literacy and dietary adherence among Malaysian HD patients is scant. Importantly, theoretical frameworks have posited the putative mechanisms that explain the relationship continuum from health literacy and its determinants to dietary adherence through patient’s related factors (i.e., knowledge, health belief, and self-management skills). Nevertheless, empirical study to address such a mechanism is scarce. Thus, this study aimed to explore an existing health literacy skills framework to (1) determine the prevalence rates of limited nutrition literacy and dietary non-adherence, (2) identify the determinants of nutrition literacy, (3) examine the relationship between nutrition literacy and dietary adherence, and (4) investigate the mediation effects of patient-related factors on the relationship between nutrition literacy and dietary adherence among Malaysian HD patients. A multi-centre, cross-sectional study was conducted at nine convenient and accessible dialysis centres in Klang Valley, Malaysia. A total of 250 multi-ethnic Malaysian HD patients who aged ≥ 18 years, dialysed thrice-weekly ≥ six months, absence of physical impairment, cognitive problem, terminal illness, and other conditions that might bias the study outcome, were randomly selected. Data collection was conducted via face-to-face interview using pretested and validated semi-structured questionnaire. Dietary adherence was measured using the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) and serum potassium and phosphate levels. At the same time, self-management skills were assessed by the Perceived Kidney/Dialysis Self-Management Scale (PKDSMS). While self-developed and validated scales were used to gauge nutrition literacy (i.e., Dialysis Specific Nutrition Literacy Scale, DSNLS), dietary knowledge (i.e., Dialysis Diet Knowledge Questionnaire, DDKQ) and five health belief model (HBM) constructs (i.e., Dialysis Diet-Related Health Belief Questionnaire, DDHBQ), including perceived benefits, perceived barrier, perceived seriousness, perceived susceptibility, and perceived self-efficacy. Data analyses were performed using IBM SPSS version 25 and Smart PLS version 3. Null hypotheses were tested based on the results of multiple linear regression and partial least squares structural equation modeling. A total number of 218 HD patients were recruited. They consisted of 53.2% male and had a mean age of 54.8 ± 12.8 years. The ethnicity distribution was 56.4% Malay, 29.8% Chinese, and 12.8% Indians, resembling the Malaysian HD population. The majority of the study respondents have completed secondary education (46.3%). The mean dialysis vintage was 67.2 ± 54.3 months. Most of them had rarely received dietary advice from healthcare professional (44.5%), high level of dietary knowledge (52.3%), high perceived benefit (72.5%), moderately high perceived barrier (38.1%), high perceived seriousness (74.3%), moderately low perceived susceptibility (35.3%), and moderately low perceived self-efficacy (42.0%) of dietary adherence as well as moderately high selfmanagement skills (55.5%). Limited nutrition literacy was evident in 46.3% of HD patients. Older age (β=-0.212, p=0.017), lower education level [no formal education (β=-0.143, p=0.039), primary education (β=-0.462, p<0.001), and secondary education (β=-0.277, p=0.001), as compared to tertiary education], shorter dialysis vintage (β=0.159, p=0.016), and have never received dietary advice from healthcare professional [as compared to “every 2-3 months” (β=0.160, p=0.040) and “when blood tests showed abnormal results” (β=0.160, p=0.040)], were the determinants of nutrition literacy. Overall the multiple regression model explained 34.4% of variance of the nutrition literacy. The prevalence of dietary nonadherence was estimated at 65.1% based on patients’ self-report. Age (β=0.185, p=0.024), gender (βfemale=0.227, p=0.001), and nutrition literacy (β=0.372, p<0.001) were independent predictors of dietary adherence. Nutrition literacy appeared as a stronger predictor than sociodemographic factors, explaining about 10% variance of the selfreported dietary adherence. The relationship between nutrition literacy and dietary adherence was mediated comparably 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). Conversely, dietary knowledge, perceived benefits, barrier, seriousness and susceptibility could not explain the relationship between nutrition literacy and dietary adherence. In conclusion, limited nutrition literacy and dietary non-adherence are prevalent in Malaysian HD patients. Patients with older age, lower education level, shorter dialysis vintage and have never received dietary advice from healthcare professionals are at risk of limited nutrition literacy. Nutrition literacy is an independent predictor of dietary adherence in Malaysian HD patients. It is causally linked to dietary adherence through self-efficacy and self-management skills. Therefore, nutrition literacy-enhancing interventions targeting on self-efficacy and self-management skills should be considered in promoting dietary adherence among Malaysian HD patients. Diet Nutrition Surveys 2021-01 Thesis http://psasir.upm.edu.my/id/eprint/93081/ http://psasir.upm.edu.my/id/eprint/93081/1/FPSK%20%28m%29%202021%203%20-%20IR.1.pdf text en public masters Universiti Putra Malaysia Diet Nutrition Surveys Mat Daud, Zulfitri 'Azuan |