Journal of Behavioral Medicine

, Volume 39, Issue 6, pp 1104–1114 | Cite as

Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease

  • Ebele M. Umeukeje
  • Joseph R. Merighi
  • Teri Browne
  • Marcus Wild
  • Hafez Alsmaan
  • Kausik Umanath
  • Julia B. Lewis
  • Kenneth A. Wallston
  • Kerri L. CavanaughEmail author


This study was designed to assess dialysis subjects’ perceived autonomy support association with phosphate binder medication adherence, race and gender. A multi-site cross-sectional study was conducted among 377 dialysis subjects. The Health Care Climate (HCC) Questionnaire assessed subjects’ perception of their providers’ autonomy support for phosphate binder use, and adherence was assessed by the self-reported Morisky Medication Adherence Scale. Serum phosphorus was obtained from the medical record. Regression models were used to examine independent factors of medication adherence, serum phosphorus, and differences by race and gender. Non-white HCC scores were consistently lower compared with white subjects’ scores. No differences were observed by gender. Reported phosphate binder adherence was associated with HCC score, and also with phosphorus control. No significant association was found between HCC score and serum phosphorus. Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.


Autonomy support Self-determination theory Medication adherence Bone mineral disorder Dialysis Race Gender 



This work was presented in part as an abstract and oral presentation at the 13th Annual Southern Society for Clinical Investigation Nephrology Young Investigator Forum in February 2014, (New Orleans) and the Journal of Investigative Medicine, 62(2), p. 547. It was also presented in part as an oral presentation at the Nephrology Young Investigator National Forum during the National Kidney Foundation Clinical Meeting 2014 (Las Vegas). This work was supported in part by NIH NIDDK grants F32DK102366 and T32DK007569 (Umeukeje), and K23DK080952 (Cavanaugh). Dr. Cavanaugh is also supported by NIH R01 DK103935-01A1. We acknowledge the use of the licensed Morisky Medication Adherence Scale for this study, which was authorized by Prof. Donald Morisky at the University of California, Los Angeles. The project described was supported by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with ethical standards

Conflict of interest

Ebele M. Umeukeje, Joseph R. Merighi, Teri Browne, Marcus Wild, Hafez Alsmaan, Kausik Umanath, Julia B. Lewis, Kenneth A. Wallston and Kerri L. Cavanaugh declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures used in this study conform to the ethical standards of the institutional review board of all the three sites. The procedures followed were also in accordance with the Helsinki Declaration of 1975 (revised in 2000). Written informed consent was obtained from all the subjects prior to their participation in this study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ebele M. Umeukeje
    • 1
    • 2
  • Joseph R. Merighi
    • 3
  • Teri Browne
    • 4
  • Marcus Wild
    • 1
    • 2
  • Hafez Alsmaan
    • 5
  • Kausik Umanath
    • 5
  • Julia B. Lewis
    • 1
    • 2
  • Kenneth A. Wallston
    • 6
  • Kerri L. Cavanaugh
    • 1
    • 2
    Email author return OK on get
  1. 1.Division of Nephrology and HypertensionVanderbilt University Medical CenterNashvilleUSA
  2. 2.Vanderbilt Center for Kidney DiseaseNashvilleUSA
  3. 3.School of Social WorkUniversity of MinnesotaSaint PaulUSA
  4. 4.College of Social WorkUniversity of South CarolinaColumbiaUSA
  5. 5.Division of Nephrology and HypertensionHenry Ford HospitalDetroitUSA
  6. 6.Vanderbilt University School of NursingNashvilleUSA

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