Impact of Psycho-Social Factors on Non-Adherence: A Case Study of Chronic Kidney Disease (CKD)

Abstract

Chronic Kidney Disease (CKD) is progressively increasing in South Asian countries like Pakistan. This case study is describing, the psychosocial factors of non-adherence (medication, fluid and dietary). The patient was 19 years un-married male, diagnosed with End Stage Renal Disease (ESRD) and was on Hemodialysis for 3 years i.e. 2013 on thrice a week basis. He was rickshaw driver and first born among 2 siblings; 1 sister and 1 brother. He was referred to psychological assessment for non-adherence (medication, dietary and fluid). He had developed Drug Induced i.e. NSAID (Non-Steroidal Anti-Inflammatory Drugs) ESRD at the age of 16 years. He had secondary Hypertension and was presented with the physical complaints of fatigue, shortening of breath due to low Hb level. Psychosocial assessment was done by taking detailed case history interview assessing illness perceptions, health locus of control, health beliefs, perceived health status, doctor-patient relationship, adherence (medication, dietary and fluid) and life orientation. Target areas identified as result of psychosocial assessment, included non-adherence (medication, fluid and dietary), dissatisfactory doctor patient relationship, poor health status, pessimistic life orientation, mal-adaptive health beliefs and low socio-economic status. 12 sessions have been conducted with the patients. He was psycho-educated relevant to his financial management plan due to distress of low socio-economic status. Insight in patient about the non-adherence (medication, dietary and fluid) was developed through CBT specific technique i.e. cost and benefits analysis.  Counseling was given to him by maximizing the positive aspect of his life for his pessimistic life orientation. He was psycho-educated for his dissatisfactory doctor patient relationship. Coping statements was given to him to improve his self-efficacy relevant to his condition.