Medication adherence, health outcomes, and perceived social performance in Black Americans receiving hemodialysis.

Abstract

Objective: Social performance-the ability to successfully engage in social interactions-impacts outcomes in end-stage kidney disease (ESKD), including depressive symptoms and low self-efficacy, that are disproportionately experienced by Black Americans. However, the associations between social performance and health behaviors in ESKD are unknown. Social-emotional expertise (SEE) is a construct of individual differences in social performance that may be relevant to ESKD outcomes. Study goals are to establish the relation between SEE and health behaviors in Black American patients with ESKD by (a) examining the association of SEE with depressive symptoms, self-efficacy, and trust-in-physician and (b) the prediction of medication nonadherence and serum phosphorus by SEE.

Method: Ninety-nine Black Americans receiving in-center hemodialysis completed surveys at baseline and two follow-up visits over 12 months. Bayesian regression captured relations among self-efficacy, depressive symptoms, medication nonadherence, serum phosphorus, and SEE scale scores.

Results: SEE was positively associated with self-efficacy and negatively associated with depressive symptoms at baseline. Additionally, baseline SEE significantly predicted 12-month medication nonadherence (R² = .16, 95% credible interval = [.06, .26]) when accounting for self-efficacy and depressive symptoms. SEE at baseline did not predict 12-month serum phosphorus; however, a model with baseline SEE in combination with baseline depressive symptoms did predict 12-month serum phosphorus (R² = .10, 95% credible interval = [.02, .21]).

Conclusions: Higher perceived social performance-as measured by the SEE scale-predicted self-efficacy, depressive symptoms, and medication nonadherence, but not serum phosphorus control, in a cohort of Black Americans with ESKD. Socially focused interventions may have a positive impact on health behaviors among Black patients with ESKD. (PsycInfo Database Record (c) 2025 APA, all rights reserved).