The Role of Nurse-led Health Education in Enhancing Treatment Adherence among Hemodialysis Patients: A Randomized Controlled Trial Authors Zainab Saeed

Background: For patients with end-stage renal disease, hemodialysis may be the only way to sustain life. However, it requires strict adherence to treatment to avoid its biopsychosocial burdens. Objectives: This study aims to estimate the efficacy of nursing health education based on the Theory of Planned Behavior (TPB) in improving treatment adherence among hemodialysis patients. Methods: This randomized controlled trial study involved 60 hemodialysis patients from the dialysis center of Telafer General Hospital, Nineveh, Iraq, from October 2024 to May 2025. The study participants were randomly divided into two groups (experimental group = 30 subjects and control group = 30 subjects). A specialized questionnaire consisting of the End-Stage Renal Disease-Adherence Questionnaire (ESRD-AQ) and TPB constructs scale was used in pre- and post-intervention tests to determine changes in adherence behavior, knowledge/perception, and TPB constructs over three time points (T0, T1, T2). Data was analyzed by descriptive and inferential statistics using the Statistical Package for Social Science (SPSS) software. Results: Most participants were in the age group of 60–69 years (21.7%). Statistically significant positive changes were noted among experimental group participants’ adherence behavior, knowledge/perceptions, and TPB constructs at post-tests 1 and 2 (p < 0.05). Intention was associated with attitude and perceived behavioral control (r = 0.442, 0.471; p < 0.05), respectively. In addition, intention was associated with treatment adherence behavior (r = 0.391). No significant changes or correlations in the study variables were observed among the control group participants over time. Conclusion: This study suggests that nursing health education based on TPB effectively improves treatment adherence among hemodialysis patients.