Running Head: RESEARCH PROPOSAL 1

Barriers to medication adherence and its relationship with outcomes in pediatric dialysis

patients in king Khalid university hospital

Research Proposal

The development of renal replacement therapy and nephrology has paved the way for

pediatric dialysis. Children with chronic or acute renal failure go through this routine to remove

waste from the blood that functional kidneys could remove. Among the factors that determine

the pediatric response to dialysis is medication adherence (Silverstein, Fletcher & Moylan,

2014). Hospitalized pediatric patients experience significant barriers to taking medication which

hinders the clinical outcomes. The extent to which patients stick to the medication schedule can

be termed as medication adherence. It highlights the degree at which patients comply with the

prescribed medical advice.

Failure to take medication is a chronic health concern in pediatric care. Children

undergoing dialysis are in a health category where medication adherence is critical to treatment

outcomes (Vasylyeva et al, 2013). Failure to take the medication in hospitalized pediatric

dialysis can result in adverse outcomes such as acute rejection and acerbated graft failure in

children (Akchurin et al., 2014). The following is a research proposal on why pediatric dialysis

patients in a hospital do not take medication. Studies indicate that approximately 30 to 60 percent

of children with renal failure do not adhere to the prescribed medication.

Research Rationale

Pediatric patients undergoing dialysis need a range of regular medication such as

phosphate binder, antihypertensive, antidiabetic, iron supplements, and vitamin D, among others.

The patients are at high risk of developing anemia, hyperlipidemia, and imbalance between

phosphate and calcium (Ghimire et al., 2015). They need regular medication to prevent these

health risks, improve treatment outcomes and improve their quality of life. If they do not take the

medication as prescribed, the patients are at higher risks of developing more complications.

Examples include possible drug-tolerant that inflate the cost of care and increase the risks of

comorbidity and mortality. Failure to take the administered medication during dialysis influences

an increase in number of patients lost to kidney diseases.

Nonadherence can result in prolonged illness that worsens kidney diseases in children by

weakening their physical strength and immune systems (Ramay et al., 2017). Minor

nonadherence, such as delaying to take medicine, implies that the body is not getting the right

medication leading to poor outcomes, possible increase in hospital stays, visit, and readmission

besides the dialysis schedule for the patients (Ozen et al., 2019). These factors emphasize the

need for establishing the reasons for hospitalized pediatric dialysis patients not to take

medication. The results will be critical to patients' families and healthcare providers in

developing strategies that encourage them to take prescribed medication. The results will support

healthcare providers in promoting medication adherence in this population and improving

treatment outcomes and life quality while reducing care costs.

The specific aim of this study is to understand why dialysis patients in a hospital do not

take medication. The research seeks to identify the barriers to medication in this population and

some applicable methods for evaluating nonadherence in hospitalized pediatric patients

undergoing dialysis.

Research Methodology

I will conduct a qualitative study using interviews to collect data from the target

population. The target population will be all hospitalized patients undergoing dialysis. The

inclusion criteria will be pediatric patients and dialysis, which implies that the study will exempt

hospitalized children with kidney problems but not under dialysis. One of the characteristics of

the target population is the age limit of eighteen years. Patients below this age limit can be

admitted to pediatric care and qualify for the study. Parents to children between 10 to 12 years

will be interviewed to acquire reliable data. The group between 14 to 18 years will respond to the

interview questions to provide well detailed information about their experience. The guardians of

the children (family members) will be included in the study to facilitate data collection. They

will give insight into the children's adherence and possible risk factors for nonadherence.
RESERCH PROPOSAL 4

Data Collection

I will conduct a qualitative study to collect data from the target population using well

structured interviews. This method involves collecting data randomly from an entire cluster. All

hospitalized children undergoing dialysis in king Khalid university hospital will be identified to

form clusters for inclusion in the study. Multiple clusters are indicative of homogeneous

character and have equal chances for selection. The researcher will select one of the pediatric

hospitals with hospitalized children undergoing dialysis in the municipal for study. The hospital

will be the setting of this study from where the researchers will collect data. Cluster sampling

will be selected because it is simple, convenient, and inexpensive.

Data will be collected using well-structured interviews administered to the patients’

guardians between April and May 2021. The study will take place at the local pediatric

nephrology center. Research participant will be required to answer simple questions in an

average of 20 minutes. The simple questions will be developed to evaluate the major causes of

nonadherence by pediatric patients going through dialysis. Data collected from the research

participants will be used to compare the intensity of risk factors identified and associated with

medication adherence.
RESERCH PROPOSAL 5

Timeline for the Study

Activity Timeline

Problem identification April 12-14

Identifying research goals April 15

Preparing the research design April 16-18

IRB approval April 19-23

Data collection April 24-May 3

Data analysis May 4-May 13

Results presentation May 17

Data Analysis

The outcomes will be analyzed through content analysis and grouping of common

themes. This technique entails the analysis of different data sets acquired to establish their

experimental relationships. Data sets acquired from participating children and guardians will be

elaborated to illustrates impact of adherence or nonadherence to medication. I will compare the

patients' demographic information and their family, including education levels, patients' age,

income status, daily routines, and adverse effects of medication to patients with the adherence

level (acceptable or unacceptable).

Ethical Consideration

The research involves human subjects. Therefore, it has to abide by various ethical

considerations such as patients' health information, loyalty, non-maleficence, autonomy,

beneficence, and trust. The research proposal will be submitted to the king Khalid university

hospital Review Board approved by the Office of Human Research Protection (OHRP) for

approval. The research will ensure that any physiology or physical risks are minimized in the

research, and the respondents are equitably selected for the study. Informed consent will be

requested from the respondents (children and their families) and documented appropriately for

possible future reference. In cases where children are involved, I will request the consent from

their parents or guardians. The consent will include possible risks associated with the research,

the research purpose, its duration, and the study's nature. All the respondents will be informed

about their rights to participate and discontinue at any time without restrictions.
RESERCH PROPOSAL 7

References

Akchurin, M. O., Melamed, L. M., Hshim, L., B., Kaskel, J. F., & Rio, D. M. (2014). Medication

adherence in the transition of adolescent kidney transplant recipients to the adult care.

Journal of Pediatric Transplantation, 18(5): 538-548. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106975/

Ghimire, S., Castelion, L. R., Lioufs, M. N., Peterson, M. G., & Zaidi, R. T. S. (2015).

Nonadherence to medication therapy in haemodialysis patients: systematic review.

PLOS ONE Journal, 10(12). Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670103/

Ozen, N., Cinar, I. F., Askin. D., Mut, D., & Turker, T. (2019). Nonadherence in hemodialysis

patients and related factors: A multicenter study. The Journal of Nursing Research, 27(4):

36. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6641098/

Ramay, M. B., Ceron, A., Mendez-Alburez, P. L., & Lou-Med, R. (2017). Factors associated to

acceptable treatment adherence among children with chronic kidney disease in

Guatemala. PLOS ONE Journal, 12(10). Retrieved

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643062/

Silverstein, M. D., Fletcher, A., & Moylan, K. (2014). Barriers to medication adherence and its

relationship with outcomes in pediatric dialysis patients. Journal of Pediatric

Nephrology, 29(2014): 1425-1430. Retrieved from

https://link.springer.com/article/10.1007/s00467-014-2780-0

Vasylyeva, L. T., Singh, R., Sheehan, C., Chennasmudram, P. S., & Hernandez, P. A. (2013).

Self-reported adherence to medications in a pediatric renal clinic: Psychological aspects.

PLOS ONE Journal, 8(7): 1-5. Retrieved from https://journals.plos.org/plosone/article?

id=10.1371/journal.pone.0069060