Patients' Perspectives on Health-Related Social Needs and Recommendations for Interventions: A Qualitative Study

Rationale & Objective: People with low socioeconomic status are disproportionately affected by kidney failure, and their adverse outcomes may stem from unmet health-related social needs. This study explored hemodialysis patient perspectives on health-related social needs and recommendations for intervention. Study Design: Qualitative study using semi- structured interviews. Settings & Participants: Thirty-two people with low socioeconomic status receiving hemodialysis at 3 hemodialysis facilities in Austin, Texas. Analytical Approach: Interviews were analyzed for themes and subthemes using the constant comparative method. Results: Seven themes and 21 subthemes (in parentheses) were identified: fi ed: (1) kidney failure was unexpected (never thought it would happen to me; do not understand dialysis); (2) providers fail patients (doctors did not act; doctors do not care); (3) dialysis is detrimental (life is not the same; dialysis is all you do; dialysis causes emotional distress; dialysis makes you feel sick); (4) powerlessness (dependent on others; cannot do anything about my situation); (5) fi nancial resource strain (dialysis makes you poor and keeps you poor; disability checks are not enough; food programs exist but are inconsistent; eat whatever food is available; not enough affordable housing; unstable housing affects health and well-being); (6) motivation to keep going (faith, support system, will to live); and (7) interventions should promote self-efficacy fi cacy (navigation of community resources, support groups). Limitations: Limited quantitative data such as on dialysis vintage, and limited geographic representation. Conclusions: Dialysis exacerbates fi nancial resource strain, and health-related social needs exacerbate dialysis-related stress. The participants made recommendations to address social needs with an emphasis on increasing support and community resources for this population.