Mexican American Women's Adherence to Hemodialysis Treatment: A Social Constructivist Perspective.

Genetic predisposition, lifestyle risks, environmental stressors, and unequal access to health care are among the factors contributing to a growing prevalence of chronic illness among racial and ethnic minorities in the United States. In the absence of a cure, chronic conditions are medically managed through treatment regimens aimed at slowing or stopping disease progression and preventing complications related to the condition. Such regimens typically involve self-administered actions, including following medication schedules, making lifestyle changes (for instance, dietary changes, exercise), and reporting for prescribed treatment sessions. Unfortunately, whenever people are given responsibility for implementing prescribed treatments, nonadherence is common. Failure to adhere to treatment recommendations is a serious problem; it can jeopardize an individual's survival, complicate the illness condition, reduce quality of fife, and require additional medical intervention, increasing physical and financial costs to the individual and increasing demand on health care resources. The extent of the problem is difficult to assess, primarily because measures of nonadherence vary depending on the particular treatment regimen. Nevertheless, the pervasiveness of the problem is evident in research findings indicating that only one-third of patients correctly follow physicians' directions (Becker, 1990). Research on treatment adherence traditionally has reflected a biomedical approach, focusing on the extent to which individuals follow a prescribed set of actions, with scant attention to the context of behavior or the phenomenological and psychosocial concerns of people suffering from chronic illness. As a result, traditional nonadherence research has been criticized as reductionistic, uni-dimensional, practitioner-oriented, and ignorant of motivational factors (Corbin & Strauss, 1988; Karoly, 1993; Trostle, 1988). Studies of treatment nonadherence that focus on how patients experience their illness, treatment regimen, and adherence behavior are limited. The present study seeks to address this research gap and the relative neglect in the literature of the population of Mexican American women. A social constructivist approach is adopted to explore the cognitive, phenomenological, and psychosocial factors influencing Mexican American women's adherence to the hemodialysis treatment regimen. MEXICAN AMERICANS, END-STAGE RENAL DISEASE, AND HEMODIALYSIS Primarily because of a higher incidence of type II diabetes (Pugh, Medina, Cornell, & Basu, 1995) and higher rates of complications from diabetes, Mexican Americans in the United States have as much as a six-times greater risk of end-stage renal disease (ESRD) than non-Hispanic white Americans (Schwab, Meyer, & Merrell, 1994). Additional ESRD risk factors for Mexican Americans include poorer adherence to treatments for diabetes and hypertension (Pugh et al., 1995); lower educational levels (Lafayette, 1995); and lower income levels, which can result in decreased access to health care (Smedley, Stith, & Nelson, 2002). ESRD is a serious, life-threatening disease that affects almost every aspect of a person's life. Physical symptoms include fatigue and weakness, decreased alertness, memory loss, and impaired thought processes (Hener, Weisenberg, & Har-Even, 1996). Inability to maintain employment is common, often resulting in financial pressures and lifestyle modifications. Changes in family and social roles may also occur as a result of employment restrictions and inability to perform usual roles in the home. Feelings related to loss, dependency, disability and issues related to death and dying are among the psychological challenges often faced by people with ESRD. The leading treatment modality for people with ESRD is hemodialysis, accounting for approximately 92 percent of all people undergoing renal replacement therapy (U.S. Renal Data System, 2005). …