Abstract
Chronic Kidney Disease (CKD) is progressively increasing in South Asian countries like Pakistan. This
case study is describing, the psycho social factors of non-adherence (medication, fluid and dietary). The
patient was 19 years un-married male, diagnosed with End Stage Renal Disease (ESRD) and was on
Hemodialysis for 3 years i.e. 2013 on thrice a week basis. He was rickshaw driver and first born among 2
siblings; 1 sister and 1 brother. He was referred to psychological assessment for notHdherence
(medication, dietary and fluid). He had developed Drug Induced i.e. NSAID (Non-Steroidal Anti-
Inflammatory Drugs) ESRD at the age of 16 years. He had secondary Hypertension and was presented
with the physical complaints of fatigue, shortening of breath due to low Hb level. Psychosocial
assessment was done by taking detailed case history interview assessing illness perceptions, health
locus of control, health beliefs, perceived health status, doctor-patient relationship, adherence
(medication, dietary and fluid) and life orientation. Target areas identified as result of psychosocial
assessment, included non-adherence (medication, fluid and dietary), dissatisfactory doctor patient
relationship, poor health status, pessimistic life orientation, mal-adaptive health beliefs and low socio-
economic status. 12 sessions have been conducted with the patients. He was psycho-educated relevant
to his financial management plan due to distress of low socio-economic status. Insight in patient about
the non-adherence (medication, dietary and fluid) was developed through CBT specific technique i.e.
cost and benefits analysis. Counseling was given to him by maximizing the positive aspect of his life for
his pessimistic life orientation. He was psycho-educated for his dissatisfactory doctor patient
relationship. Coping statements was given to him to improve his self-efficacy relevant to his condition.
Ghulam Ishaq, Fatima Kamran, Rafia Rafique, Shiza Sheerazi. (2020) Impact of Psycho-Social Factors on Non-Adherence: A Case Study of Chronic Kidney Disease (CKD), Journal of Liaquat University of Medical and Health Sciences, Volume-19, Issue-2.
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