Socioecological Factors Affecting Fluid Restriction Adherence Among Korean Patients Receiving Hemodialysis: A Qualitative Study

Abstract

Introduction: To reduce morbidity and mortality rates, hemodialysis patients are advised to restrict their fluid intake. However, fluid restriction is the biggest stressor for the patients. This study explored the barriers and facilitators of fluid restriction among Korean hemodialysis patients. Method: This qualitative descriptive study was guided by the ecological model of health behavior. This study involved five focus group (23 patients) and individual interviews (4 patients) at two hospitals in Korea. Audio-recorded transcripts were analyzed using qualitative content analysis. Results: Six intrapersonal, three interpersonal, and four organization factors affecting fluid restriction adherence were identified. Barriers included physiological symptoms, lack of self-control, social relationships, social stigma, lack of practical education, Korean food culture, and lack of public health and policy support. Facilitators included risk perception, self-assessment, knowledge, stimulated sweating, and social support. Discussion: The findings suggest that socioecological factors should be considered when designing fluid restriction programs for hemodialysis patients.