Effect of Treatment Adherence Improvement Program in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Herein, we performed a meta-analysis evaluating the effects of treatment adherence enhancement programs on treatment adherence and secondary outcomes for hemodialysis patients. Twenty-five Korean and international articles published prior to 31 March 2022 were selected following the PRISMA and Cochrane Systematic Review guidelines. We calculated summary effect sizes, conducted homogeneity and heterogeneity testing, constructed a funnel plot, and performed Egger's regression test, Begg's test, trim-and-fill method, subgroup analyses, and univariate meta-regression. The overall effect of treatment adherence enhancement programs for hemodialysis patients was statistically significant (Hedges' g = 1.10, 95% CI: 0.77, 1.43). On performing subgroup analysis to determine the cause of effect size heterogeneity, statistically significant moderating effects were found for a range of input variables (Asian countries, study centers, sample size, study design, intervention types, number of sessions, quality assessment scores, funding, and evidence-based interventions). On univariate meta-regression, larger synthesized effect sizes were found for a range of study characteristics (Asian populations, single-center studies, studies with <70 participants, quasi-experimental studies, educational interventions, studies with >12 sessions, studies with quality assessment scores above the mean, unfunded studies, and non-theory-based interventions). Our results provide evidence-based information for enhancing program efficacy when designing treatment adherence enhancement programs for hemodialysis patients.