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Leila Zhianfar,1 Haidar Nadrian,2 Mohammad Asghari Jafarabadi,3 Fatemeh Espahbodi,4 Abdolreza Shaghaghi1 1Health Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Epidemiology and Biostatistics Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 4Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IranCorrespondence: Abdolreza ShaghaghiHealth Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Golgasht Ave, Tabriz, P.C 516667411, IranTel +98 41 33376227Email ar.shaghaghi@gmail.comPurpose: A multimodal intervention designed and executed to improve therapeutic regimen adherence and quality of life in a sample of Iranian hemodialysis patients. Its feasibility and impact was assessed post intervention.Patients and Methods: This randomized controlled trial (RCT) study was conducted at two hemodialysis wards of the Shahrvand hospital located in Sari, the capital city of the Mazandaran province, north of Iran. The study sample included patients with end-stage renal disease (ESRD) receiving outpatient hemodialysis treatment. Considering 10% attrition, 70 registered patients were randomly categorized into intervention and control groups. The proposed intervention included playing of relevant educational video tracks, conducting eight cognitive behavioral therapy (CBT) group sessions, and telephone-based peer support. Data were collected applying a set of questionnaires including sociodemographic, Beck Depression Inventory (BDI-SF), Multidimensional Scale of Perceived Social Support (MSPSS), Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) and the World Health Organization Quality of Life (WHOQOL-SF) scale. Sociodemographic and clinical data were collected at baseline in both groups and the postintervention assessment was performed in the intervention and nonintervention groups after one month and three months.Results: A significant change in the self-reported depression symptoms (P=0.001), mean social support score (P=0.001), nursing care satisfaction score (P=0.001), quality of life score (P=0.001) and interdialytic weight gain (IDWG) (P=0.001) was observed among the participants in the intervention group compared to the baseline measures. The highest rise in the ESRD-AQ scores within the intervention group was observed after one month of intervention (mean difference=131.88) compared to the baseline values. Same pattern of statistically significant changes in mean scores of the intervention group’s attendants in all subscales of the ESRD-AQ were also ascertained.Conclusion: This interventional study revealed that inaugurating of a feasible low-cost intervention without need to add major logistic or financial inputs into existing health-care systems, especially in resource limited contexts, is achievable. Findings of this study could provide insights into scientific basis of evidence-informed interventions applicable in the realm of health-care delivery.Keywords: hemodialysis patients, intervention, adherence

Leila Zhianfar,1 Haidar Nadrian,2 Abdolreza Shaghaghi1 1Health Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Abdolreza ShaghaghiHealth Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Golgasht Ave., Tabriz, IranTel +98 41 33376227Email shaghaghir@tbzmed.ac.irObjective: To systematically retrieve and condense the best possible evidence on the successful interventions that targeted enhancement of therapeutic and lifestyle recommendations adherence in hemodialysis patients (HDPs).Design: An umbrella review of interventional studies.Data Sources: A comprehensive search of the Cochrane Database of Systematic Reviews, Ovid, PubMed, Scopus, EMBASE and Web of science databases to identify relevant publications in 2000– 2018 (June) timeframe.Study Selection: Two reviewers independently applied inclusion criteria to select potential systematic reviews assessing the successful interventions that targeted enhancement of therapeutic and lifestyle recommendations adherence in HDPs. Data were summarized for information about the first author(s)’ names, year of publication, type(s) of the intervention and output variables, main findings and also the applied quality appraisal tools in the retrieved research evidence.Data Extraction: Eligible studies were selected and data were extracted independently by two reviewers. The Joanna Briggs Institute (JBI)’s critical appraisal tool for systematic reviews was used to assess the quality of the identified publications, and discrepancies were resolved by consensus with a third reviewer.Data Synthesis: Thirteen systematic reviews (12 solely systematic reviews and 1 systematic review with meta-analyses) were eligible to be enrolled in the study. The range of interventions that had been reported to boost therapeutic and lifestyle recommendations adherence in HDPs’ included psycho-educational programs, physical activity enhancement initiatives, information technology (IT)-based interventions and aromatherapy. Depression, diet biomarkers and interdialytic weight gain (IDWG) were among the myriad of output variables that had been measured as proxies to assess impacts of the implemented interventions. Psycho-educational interventions were among the prevalent initiatives to boost therapeutic and lifestyle recommendations adherence among the HDPs.Conclusion: This umbrella review revealed that various intervention approaches and strategies can be used for HDPs’ better therapeutic and lifestyle recommendations adherence with considerable methodological heterogeneity. The pinpointed research evidence is also supporting application of multifaceted interventional modalities to reach an improved acquiescence form the patients’ side and their families. Further studies are recommended to address the interactions across various interventions in discordant socio-cultural contexts.Keywords: hemodialysis, intervention, adherence, psychosocial, cognitive, exercise