Culturally Adapted Acceptance and Commitment Therapy to Improve Quality of Life, Self-Care and Treatment Adherence among Indonesian Hemodialysis Patients
DOI:
https://doi.org/10.31674/mjn.2026.v17i04.011Abstract
Background: Hemodialysis patients in Indonesia face multidimensional burdens impairing quality of life, self-care, and treatment adherence. While Acceptance and Commitment Therapy (ACT) show efficacy in chronic illness, culturally adapted interventions integrating local values remain scarce. Objectives: This study evaluated the effectiveness of a culturally adapted ACT module integrating Sundanese values (silih asih, silih asah, silih asuh) in improving quality of life, self-care, and treatment adherence among Indonesian hemodialysis patients. Methods: A quasi-experimental pre-test/post-test controlled study was conducted in a West Java hospital hemodialysis unit. Sixty adults on maintenance hemodialysis (≥3 months) were assigned to intervention (n=30) or control (n=30) groups by dialysis shift. The intervention group received eight 90-minute ACT sessions Acceptance and Commitment Therapy-Health & Depression - Sundanese (ACT-HD-Sunda) module over four weeks plus usual care; controls received only usual care. Primary outcomes included quality of life measured by the Kidney Disease Quality of Life Short Form (KDQOL-SF™) and self-care assessed using the End-Stage Renal Disease Self-Care Scale (ESRD-SCP). Secondary outcomes comprised treatment adherence measured by the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) and psychological distress evaluated using the Depression Anxiety Stress Scales (DASS-21). Data analysis was performed using Multivariate Analysis of Covariance (MANCOVA) followed by Analysis of Covariance (ANCOVA) with Bonferroni correction. Results: MANCOVA revealed a significant multivariate effect, Wilks' Λ = 0.547, F (4, 51) = 10.57, p<0.001, partial η²=0.453. Follow-up analyses showed large effect sizes for quality of life physical (partial η²=0.373, Cohen's d=1.23), mental (partial η²=0.459, d=1.47), self-care (partial η²=0.521, d=1.78), and moderate-to-large for adherence (partial η²=0.311, d=0.98). All p<0.001. Adherence partially mediated quality of life improvement (20%). Intervention was 93.5%. Conclusion: The culturally adapted (ACT-HD-Sunda) module effectively improved quality of life, self-care, adherence, and psychological distress, supporting culturally responsive, family-centered nursing interventions in chronic disease management.
Keywords:
Acceptance and Commitment Therapy;, Hemodialysis;, Quality of LifeDownloads
References
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