Cultural Beliefs and Treatment Adherence with Chronic Kidney Disease Patients: A Leininger-Based Study
DOI:
https://doi.org/10.5281/zenodo.23271229Keywords:
Chronic Kidney Disease, Cultural Beliefs, Treatment AdherenceAbstract
Chronic Kidney Disease (CKD) requires rigorous, long-term adherence to complex therapeutic regimens, yet non-adherence remains a persistent challenge that threatens patient health outcomes. This study aimed to examine the influence of cultural beliefs on treatment adherence among CKD patients using Madeleine Leininger’s Transcultural Nursing Theory as the conceptual framework. A quantitative, descriptive correlational research design was employed with 74 CKD patients at Saint Mary Kidney Care in Tabuk, Kalinga. Data were gathered through standardized questionnaires focusing on four cultural domains—spirituality/religion, family roles, folk healing, and food beliefs—and analyzed using descriptive and inferential statistics. The findings revealed very high levels of reported treatment adherence and a strong consensus regarding the very high importance of food beliefs and high importance of spirituality/religion in the healing process. Additionally, the study identified that ethnicity, religion, and the duration of dialysis significantly mediate how patients perceive and engage with their treatment plans. Clinical adherence is deeply embedded in the patient’s cultural lifeworld rather than being solely a matter of biomedical compliance. The study recommends that healthcare institutions transition toward a culturally congruent renal care program that prioritizes cultural care preservation, accommodation, and strategic repatterning to foster sustainable, family-centric outcomes.
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Ahmadi, F., Zandi, S., & Poblete, M.-L. (2024). Religion, culture, and cancer: Insights from a qualitative study on coping experiences of Filipino patients. Frontiers in Psychology. DOI: 10.3389/fpsyg.2024.1457027
Aligado, H. B. (2025). Family Caregivers’ Well-Being and Challenges in Caring for Patients Undergoing Hemodialysis. Science Asia Review, 11(1), 65-79. DOI: https://ejournals.ph/article.php?id=29747#:~:text=Challenges%20encountered%20by%20family%20caregivers,family%20support%2C%20and%20social%20isolation.
Al Rashdi F, Tabche C, Atwan Z, Al-Qanubi H, Al Khaldi S, Al-Zadjali N and Rawaf S (2026) chronic kidney disease in hypertensive patients: the urgent need for targeted interventions in Arab countries: a systematic review. Front. Nephrol. 6:1735217. doi: 10.3389/fneph.2026.1735217
Ampomah, I. G., Malau-Aduli, B. S., Seidu, A.-A., Malau-Aduli, A. E. O., & Emeto, T. I. (2022). Integrating traditional medicine into the Ghanaian health system: perceptions and experiences of traditional medicine practitioners in the Ashanti region. International Health, 15(4), 414–427. https://doi.org/10.1093/inthealth/ihac059
Antoun, J., Brown, D. J., Jones, D. J. W., Clarkson, B. G., Shepherd, A. I., Sangala, N. C., Lewis, R. J., Mcnarry, M. A., Mackintosh, K. A., Mason, L., Corbett, J., & Saynor, Z. L. (2022). Exploring patients’ experiences of the impact of dialysis therapies on quality of life and wellbeing. Journal of Renal Care, 49(1), 15–23. https://doi.org/10.1111/jorc.12416
April-Sanders, A. K., Karaboyas, A., Yunes, M., Norris, K. C., Dominguez, M. J., Kim, R. S., Isasi, C., & Golestaneh, L. (2023). Receiving hemodialysis in Hispanic ethnic dense communities is associated with better adherence and outcomes among young patients. BMC Nephrology. DOI: 10.1186/s12882-023-03297-w
Arcilla, M. E. (2025). Quality of life and treatment-seeking behavior of chronic kidney disease
patients: A sequential explanatory study as a basis for bedside mental healthcare initiative. International Journal for Multidisciplinary Research. DOI: 10.36948/ijfmr. 2025.v07i02.40045
Aryal, S., Bennett, P. N., & Bloomer, M. J. (2024). Culturally responsive care in haemodialysis: A scoping review. Journal of Clinical Nursing. DOI: 10.1111/jocn.17373
Bridi, L., Kaki, D. A., Albahsahli, B., Abu Baker, D., Khan, X., Aljenabi, R., Bencheikh, N., Schiaffino, M. K., Moore, A. A., & Al-Rousan, T. (2023). The influences of faith on illness representations and coping procedures of mental and cognitive health among aging Arab refugees: a qualitative study. Frontiers in Psychiatry, 14, 1083367. https://doi.org/10.3389/fpsyt.2023.1083367
Cardona-Arango D, Santacruz-Restrepo V, Rendón-Montoya A, Madrigal-Cadavid J, Segura-Cardona A and Estrada-Acevedo JI (2026) Medication adherence in older adults with chronic diseases: a scoping review of barriers, facilitators, and effective interventions. Front. Aging 7:1642652. doi: 10.3389/fragi.2026.1642652
Cui, Y., Li, X., Liu, N., Li, J., Feng, Y., Li, S., Bai, X., Li, F., Liu, H., Zhang, Y., & Lv, H. (2026). Development and Validation of the Treatment Adherence Scale for Non-Dialysis Chronic Kidney Disease Patients in China: A Mixed-Methods Study. Patient preference and adherence, 20, 573282. https://doi.org/10.2147/PPA.S573282
Ekholm, M., Aulbach, M., Walsh, S., Phipps, D., Rauta, V., & Knittle, K. (2024). Behavioral interventions targeting treatment adherence in chronic kidney disease: A systematic review and meta-analysis. Social Science & Medicine. DOI: 10.1016/j.socscimed.2024.117594
Farooq, A., Chamari, K., Sayegh, S., El Akoum, M., & Al-Mohannadi, A. S. (2021). Ramadan daily intermittent fasting reduces objectively assessed habitual physical activity among adults. BMC Public Health, 21(1), 1912. https://doi.org/10.1186/s12889-021-11961-9
Flandez, K. I., Imbayarte, S. M., Canoy, H. G., Lapinid, M. K., Pacheco, M., Pamplina, J. A., Ramirez, E. L., Collera, M. M., & Quinte, J. L. (2025). Development and validation of the Folk Healing Perception Scale (FHPS): Assessing the reliability and validity of a novel measurement instrument. Journal of Interdisciplinary Perspectives. DOI: 10.69569/jip.2025.569
Fradelos, E., & Alikari, V. (2025). Influence of social determinants on wellbeing in chronic kidney disease patients. Frontiers in Public Health. DOI:10.3389/fpubh.2025.1719473
Gan, X., Shu, Z., Wang, X., Yan, D., Li, J., Ofaim, S., Albert, R., Li, X., Liu, B., Zhou, X., & Barabási, A.-L. (2023). Network medicine framework reveals generic herb-symptom effectiveness of traditional Chinese medicine. Science Advances, 9(43), eadh0215. https://doi.org/10.1126/sciadv.adh0215
Gutierrez, M., & Sakulbumrungsil, R. (2021). Factors associated with medication adherence of hypertensive patients in the Philippines: A systematic review. Clinical Hypertension, 27, Article 19. DOI: 10.1186/s40885-021-00176-0
Jardeleza, K. D., Delcano, M. B., Delmo, A., Eugalca, J. M., Siojo, R. R. J., & Pedroso, J. E. P. (2025). Mental habits behind seeking folk healing in rural Philippines. Sosyal ve Kültürel Araştırmalar Dergisi. DOI: 10.25306/skad.1658394
Kalantzi, V., Kalafati, I., Belitsi, V., Tsiampalis, T., Koutsonasios, I., Androutsos, O., Bonoti, F., Panagiotakos, D., & Kosti, R. (2023). Cardiometabolic Patient-Related Factors Influencing the Adherence to Lifestyle Changes and Overall Treatment: A Review of the Recent Literature. Life, 13(5), 1153. https://doi.org/10.3390/life13051153
Kasahun, A. E., Sendekie, A. K., Mekonnen, G. A., Sema, F. D., Kemal, L. K., & Abebe, R. B.
(2022). Impact of personal, cultural and religious beliefs on medication adherence among patients with chronic diseases at University Hospital in Northwest Ethiopia. Patient Preference and Adherence, 16, 2101–2113. DOI: DOI: 10.2147/PPA.S370178
Komariah, E. D., Novia, K., Beda, N. S., & Situngkir, R. (2023). Beliefs of chronic kidney disease patient: A phenomenology study. Babali Nursing Research, 4(1), 1–9. DOI: 10.37363/bnr.2023.42227
Leininger, M. (1988). Leininger’s theory of nursing: Cultural care diversity and
universality. Nursing Science Quarterly, 1(4), 152–160. DOI: 10.1177/089431848800100408
Li, J., Xue, L., & Pan, H. (2022). Social Support and Spiritual Well-Being of Patients With Esophageal Cancer Aged Over 50 Years: The Mediating Role of Rumination. Frontiers in Psychiatry, 13, 805380. https://doi.org/10.3389/fpsyt.2022.805380
Lunardi, L. E., Matricciani, L. A., Le Leu, R. K., Bastin, R., Myers, D., Bradbrook, M.,
Bradbrook, D., Lester, R., Johns, E., Britton, A., Jesudason, S., Muthuramalingam, S., Dumuid, D., & Bennett, P. N. (2026). "Understanding Chronic Kidney Disease Self-Management Barriers and Facilitators: A Consumer-Led Qualitative Study". Journal of renal care, 52(1), e70055. https://doi.org/10.1111/jorc.70055
Markossian, T. W., Boyda, J., Taylor, J., Etingen, B., Modave, F., Price, R., & Kramer, H. J. (2021). A Mobile App to Support Self-management of chronic kidney disease: Development Study. JMIR Human Factors, 8(4), e29197. https://doi.org/10.2196/29197
Masupe, T., Onagbiye, S., Puoane, T., Pilvikki, A., Alvesson, H. M., & Delobelle, P. (2022). Diabetes self-management: a qualitative study on challenges and solutions from the perspective of South African patients and health care providers. Global Health Action, 15(1), 2090098. https://doi.org/10.1080/16549716.2022.2090098
Mazzi, L., Benksim, A., Amane, M., & Cherkaoui, M. (2025). Overall adherence in hemodialysis patients and associated factors: A cross-sectional study from Morocco. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 29(1), 52–60. https://doi.org/10.1111/1744-9987.14196
Mercado, M. A. (2024). The development of a family support program for caregivers of hemodialysis patients. Jurnal Ners dan Kebidanan, 11(2), 317–329. DOI: 10.26699/jnk.v11i2.art.p175-188
Mohammadnezhad, G., Ehdaivand, S., Sebty, M., Azadmehr, B., Ziaie, S., & Esmaily, H. (2024). Chronic kidney disease and adherence improvement program by clinical pharmacist-provided medication therapy management; a quasi-experimental assessment of patients' self-care perception and practice. BMC nephrology, 25(1), 463. https://doi.org/10.1186/s12882-024-03902-6
Movahedi, M., Nehrir, B., Moayed, M., & Sirati Nir, M. (2023). Structural equation modeling of treatment adherence based on general health and demographic characteristics in patients undergoing hemodialysis. Nephro-Urology Monthly. DOI: 10.5812/numonthly-140108
Naber, T., & Purohit, S. (2021). Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease. Nutrients, 13(9), 3277. https://doi.org/10.3390/nu13093277
Nizet, P., Touchefeu, Y., Pecout, S., Cauchin, E., Beaudouin, E., Mayol, S., Fronteau, C., & Huon, J.-F. (2021). Exploring the factors influencing adherence to oral anticancer drugs in patients with digestive cancer: a qualitative study. Supportive Care in Cancer, 30(3), 2591–2604. https://doi.org/10.1007/s00520-021-06663-2
Prest, M., & Marder, A. (2025). A guide to Filipino foods while on dialysis. Journal of Renal Nutrition. DOI: 10.1053/j.jrn.2025.04.004
Ranganathan, N., & Anteyi, E. (2022). The Role of Dietary Fiber and Gut Microbiome Modulation in Progression of Chronic Kidney Disease. Toxins, 14(3), 183. https://doi.org/10.3390/toxins14030183
Remonte, E., De Leon, D. F., & Gutierrez, S. (2024). Quality of life and burden of care of family caregivers of Filipino patients on hemodialysis and peritoneal dialysis. Kidney International Reports, 9(4), S205. https://storage.unitedwebnetwork.com/files/1099/40baf3fca40819ad52a21532495da13e.pdf
Sakaguchi, Y., Kaimori, J.-Y., & Isaka, Y. (2023). Plant-Dominant Low Protein Diet: A Potential Alternative Dietary Practice for Patients with Chronic Kidney Disease. Nutrients, 15(4), 1002. https://doi.org/10.3390/nu15041002
Shen, H., van der Kleij, R. M., van der Boog, P. V. D., Wang, W., Song, X., Li, Z., Lou, X., & Chavannes, N. (2021). Patients’ and healthcare professionals’ beliefs, perceptions and needs towards chronic kidney disease self-management in China: A qualitative study. BMJ Open, 11(3), e044059. DOI: 10.1136/bmjopen-2020-044059
Sierra, P., Pérez-Jiménez, J. M., Espinoza Quezada, D. P., Lucchetti, G., & De-Diego-Cordero, R. (2025). Association between religious/spiritual coping and quality of life among hemodialysis patients in Ecuador. Frontiers in public health, 13, 1510329. https://doi.org/10.3389/fpubh.2025.1510329
Suarilah, I., Widyawati, I. Y., Umam, K., Lin, C.-C., Purwanti, R., Supriyono, S., & Mundt, K. (2024). The Javanese cultural beliefs and practices among patients with end-stage renal disease undergoing hemodialysis. Journal of Transcultural Nursing, 35(2), 210–219. DOI: 10.1177/10436596241239304
Taylor, K. S., Umeukeje, E. M., Santos, S. R., McNabb, K. C., Crews, D. C., & Hladek, M. D. (2023). Context Matters: A Qualitative Synthesis of Adherence Literature for People on Hemodialysis. Kidney360, 4(1), 41–53. https://doi.org/10.34067/KID.0005582022
Torres, G., Sumile, E., Rebueno, M. C. D., Parial, L. L., Malong-Consolacion, C. P., Estrada, M. G., Macindo, J., & Hendrix, C. (2021). Exploring the challenges and needs of home caregivers of hemodialysis patients in the Philippines: A mixed methods study. Nursing Forum, 56(3), 676–688. DOI: 10.1111/nuf.12618
Wang, T., Kang, H.-C., Chen, C.-C., Lai, T.-S., Huang, C.-F., & Wu, C.-C. (2024). The Effects of Pharmacist-Led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-Inflammatory Drug in Patients with Pre-End Stage Renal Disease. Patient Preference and Adherence, 18, 267–274. https://doi.org/10.2147/ppa.s436952
Wehbe-Alamah, H. B. (2018). Leininger’s culture care diversity and universality theory: Classic and new contributions. Annual Review of Nursing Research, 36(1), 153–174. DOI: 10.1891/0739-6686.37.1.1
Win, K. C. M., Zhou, H., Patton, V., Steen, M., & Della, P. (2025). Factors contributing to non-adherence to treatment among adult patients with long-term haemodialysis: An integrative review. Nursing Reports. DOI: 10.3390/nursrep15090314
Yasin, F., Khraim, F., Santos, M., Forgrave, D., & Hamad, A. (2024). Factors influencing self-care management in adult hemodialysis patients: An integrative review. Qatar Medical Journal. DOI: 10.5339/qmj.2024.12
Yoon, S., Kwan, Y., Yap, W. L., Lim, Z., Phang, J. K., Loo, Y., Aw, J., & Low, L. (2023). Factors influencing medication adherence in multi-ethnic Asian patients with chronic diseases in Singapore: A qualitative study. Frontiers in Pharmacology, 14, 1036993. DOI: 10.3389/fphar.2023.1124297
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