MOVE Trial: MOtiVational Strategies to Empower African Americans to Improve Dialysis Adherence

Vanderbilt University Medical Center, Nashville TN

Investigators

Linked publications & trials

Abstract

Hemodialysis treatment non-adherence is a public health issue because of its association with excessive hospitalizations, high morbidity, and mortality, and increased financial costs. Compared to whites, African Americans have a four-fold higher prevalence of end-stage kidney disease (ESKD), higher non-adherence rates to hemodialysis, and higher odds of hospitalizations. Motivational interviewing, an evidence-based intervention that creates a bond between patients and providers, targets improvement in motivation-related psychosocial factors associated with adherence behaviors. Interventions for such factors are typically developed based on the dominant population and may not be valid and generalizable. Tailored interventions lead to more durable change in African Americans yet there is a lack of studies testing the efficacy of such approaches to improve hemodialysis treatment adherence in African Americans. Use of tailored motivational interviewing in African Americans with ESKD will promote population health by improving dialysis treatment adherence, reducing hospitalizations, and enhancing other critical outcomes in kidney disease, to curb the chronic disease crises. Our long-term goal is to establish tailored strategies and multi-level interventions to improve outcomes in kidney disease. The overall objective of this project is to evaluate the efficacy of a tailored motivational interviewing intervention developed using a rigorous theoretical framework on improving hemodialysis treatment adherence in African Americans with ESKD. The central hypothesis is that tailored motivational interviewing will lead to improved hemodialysis treatment adherence. We will test this hypothesis in the following Specific Aims in a randomized clinical trial (RCT) in African American patients with ESKD. Compared to usual dialysis care, we aim to: Evaluate the efficacy of 8 weeks of tailored motivational interviewing (MOVE) on improving hemodialysis treatment adherence at (1) 3 months, and (2) 6 months post- randomization. At the successful completion of the proposed research, the expected outcomes will include evidence of the efficacy of tailored motivational interviewing on improving hemodialysis treatment adherence in African American patients with ESKD. The proposed research is innovative because of the novel application of a tailored, evidence-based behavioral intervention developed using a rigorous theoretical framework (PEN-3); the use of specifically-trained health coaches to optimize intervention delivery; and the focus on African American patients who are overrepresented in the ESKD patient population, to address the public health issue of hemodialysis treatment non-adherence. Study results will provide a strong basis for conducting an effectiveness and implementation trial, which is expected to have a significant impact on hemodialysis adherence, hospitalizations, morbidity, and mortality. This research strongly aligns with NIDDK’s mission to promote population health by using innovative strategies to optimize key outcomes in kidney disease and curb the chronic disease crises.