Nephrology · Medical Literature
The Effect of Individualized Teach-Back Education Guided by the Roy Adaptation Model on Treatment Adherence and Coping Skills in Patients Receiving Hemodialysis: A Randomized Controlled Trial.
Abstract
AThis randomized controlled trial evaluated the efficacy of an individualized, nurse-led, teach-back method of education intervention guided by the Roy Adaptation Model on treatment adherence and coping processes among adult patients on hemodialysis. Utilizing a parallel-group pretest-posttest design, 42 outpatients were randomized into intervention (n = 21) or control (n = 21) groups. Data were collected using validated adherence and coping scales. The intervention group received three face-to-face education sessions delivered via the teach-back method. After adjusting for baseline scores, the intervention group demonstrated statistically significant and higher posttest adherence and coping scores compared with the control group. Retrospective analysis confirmed a robust post-hoc power of 0.92. This theoretically guided framework supports multidimensional treatment adherence and coping mechanisms in patients on hemodialysis.
Clinical relevance
Non-adherence to hemodialysis treatment regimens remains a critical driver of morbidity, hospitalization, and mortality in end-stage renal disease. This RCT addresses the gap in evidence-based, theoretically grounded nursing education interventions specifically designed to improve both treatment adherence and coping skills in the outpatient hemodialysis population. Given the chronicity and complexity of hemodialysis management, clinicians need scalable, structured educational strategies that target patient self-efficacy and adaptive coping simultaneously.
Key findings
1. In a parallel-group, pretest-posttest RCT, 42 adult outpatient hemodialysis patients were randomized 1:1 to an individualized teach-back education intervention (n = 21) guided by the Roy Adaptation Model versus a control group (n = 21) receiving usual care. 2. The intervention group demonstrated statistically significant improvements in posttest treatment adherence scores compared with the control group after adjusting for baseline scores (specific effect size and p-value not reported in the abstract). 3. The intervention group also demonstrated statistically significant improvements in posttest coping scores compared with the control group after adjusting for baseline scores (specific effect size and p-value not reported in the abstract). 4. The educational intervention consisted of three structured, face-to-face, individualized sessions delivered by nurses using the teach-back method. 5. Retrospective post-hoc power analysis confirmed a robust statistical power of 0.92, supporting the adequacy of the sample size for detecting the observed between-group differences. 6. Adherence and coping outcomes were measured using validated, standardized scales, lending methodological credibility to the outcome assessment; however, specific scale names and score magnitudes were not detailed in the abstract.
Practice implications
Nephrology nursing teams should consider implementing structured, individualized teach-back education programs — ideally anchored to an adaptive theoretical framework such as the Roy Adaptation Model — across a minimum of three face-to-face sessions to meaningfully improve treatment adherence and coping in adult outpatient hemodialysis patients. Patient selection should prioritize those with known adherence challenges (e.g., fluid or dietary non-compliance, missed sessions) who stand to benefit most from a tailored educational approach. Future clinical adoption should incorporate validated adherence and coping assessment tools at baseline and follow-up to monitor response and guide iterative individualization of the educational content.