A Novel Behavioral Intervention to Promote Adherence in Individuals with End-stage Renal Disease: Proof-of-Concept Trial

Background/Significance: Despite the known health benefits, most individuals with end-stage renal disease (ESRD) do not adhere to one or more health behaviors. Positive psychology (PP) interventions, which aim to cultivate well-being through systematic exercises, are effective at increasing well-being and—when combined with established health behavior interventions, such as motivational interviewing (MI)—may lead to improvements in adherence. In a single-arm proof-of-concept trial, we assessed the feasibility, acceptability, and preliminary efficacy of a 12-week, phone-delivered, PP-MI intervention in 10 individuals with ESRD on hemodialysis.

Methods: Each week, participants completed a PP activity and worked towards one or more goals related to physical activity, low phosphorous diet, and/or medication adherence, then reviewed their progress with a study trainer. Intervention feasibility was assessed by the number of sessions completed, while acceptability was measured by ease and utility ratings of the PP and MI components. The intervention’s impact on psychological, adherence-related, and functional outcomes was measured with validated scales and accelerometers. We performed descriptive statistics for feasibility and acceptability outcomes and paired t-tests for efficacy outcomes.

Results: Participants completed 9.4 of 12 (78%) of sessions and rated the ease and utility of the PP and MI components between 8.3 and 8.8 out of 10, surpassing our thresholds for feasibility and acceptability. The intervention led to small (modified Cohen’s d=0.28) improvements in positive affect, medium-sized reductions in depression (d=-0.56) and anxiety (d=-0.53), and large improvements in overall adherence (d=0.80) and objectively measured physical activity (d=0.74), though none of these were statistically significant. It had mixed effects on other outcomes.

Discussion: A 12-week, phone-delivered, PP-MI intervention was feasible, well-accepted, and associated with non-significant improvements in psychological constructs, self-reported adherence, and objectively measured physical activity. These findings should be confirmed in a larger, randomized trial that is powered to detect differences in psychological and health behavior outcomes.

Conclusions/Implications: If effective, this intervention has the potential to improve adherence, quality of life, and renal outcomes in this high-risk population.