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. Cavanaugh

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1104-1114
Number of pages11
JournalJournal of Behavioral Medicine
Issue number6
StatePublished - Dec 1 2016

Bibliographical note

Funding Information:
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.

Publisher Copyright:
© 2016, Springer Science+Business Media New York.


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


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