A formative research as the groundwork for designing evidence-based adherence promotion campaigns for patients on peritoneal dialysis

Background: Peritonitis is a leading, fatal complication of bacterial infection with significant health and social consequences to end-stage kidney disease patients on peritoneal dialysis (PD). Adherence to a therapeutic regimen is crucial to prevent peritonitis. Therefore, to develop an evidence-based and patient-centered communication campaign to improve patients' adherence, a formative research is essential to understand patients' beliefs. Objective: The authors used the health belief model (HBM) as the framework to examine Hong Kong PD patients' risk perception of peritonitis and the factors that accounted for their adherence to the therapeutic regimen. Method: Thirty-four PD patients in Hong Kong participated in focus group discussions to investigate patients' perceived susceptibility and severity of peritonitis, perceived barriers and benefits associated with adherence, their self-efficacy to perform PD-related regimens, their motivational cues to adhere, and potential persuasive strategy and communication channels for adherence promotion. Results: The findings revealed that perceived susceptibility varied across patients' peritonitis experience, and that they perceived peritonitis to be associated with physical, psychological, and social consequences. Patients considered maintaining their independence and minimizing their sense of guilt as the benefits of adherence. Perceived barriers to adherence included social activities and work, treatment expenses, fatigue, and environmental constraints. Since adaptation to PD treatment and imitation of other patients' practices appeared to influence patients' self-efficacy, narrative communication was identified as a potential persuasive strategy for guiding the development of campaign messages. Conclusion: The HBM-guided formative research has provided useful insights into designing evidence-based adherence communication campaigns.