{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:20:12Z","timestamp":1792002012834,"version":"4.4.0"},"reference-count":103,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004530","name":"Universiti Putra Malaysia","doi-asserted-by":"publisher","award":["GP-IPM\/2018\/9615200"],"award-info":[{"award-number":["GP-IPM\/2018\/9615200"]}],"id":[{"id":"10.13039\/501100004530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014723","name":"Malaysian Palm Oil Board","doi-asserted-by":"publisher","award":["PATCH Study"],"award-info":[{"award-number":["PATCH Study"]}],"id":[{"id":"10.13039\/501100014723","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney\/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (\u03b2 = 0.390, p &lt; 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110\u20130.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103\u20130.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.<\/jats:p>","DOI":"10.3390\/ijerph17207479","type":"journal-article","created":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T21:24:39Z","timestamp":1602710679000},"page":"7479","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration using Partial Least Squares Structural Equation Modeling"],"prefix":"10.3390","volume":"17","author":[{"given":"Jun-Hao","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karuthan","family":"Chinna","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Health and Medical Sciences, Taylor\u2019s University, Subang Jaya 47500, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1626-4687","authenticated-orcid":false,"given":"Pramod","family":"Khosla","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202-0340, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilakavati","family":"Karupaiah","sequence":"additional","affiliation":[{"name":"School of Biosciences, Faculty of Health and Medical Sciences, Taylor\u2019s University, Subang Jaya 47500, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4017-107X","authenticated-orcid":false,"given":"Zulfitri Azuan Mat","family":"Daud","sequence":"additional","affiliation":[{"name":"Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia"},{"name":"Research Center of Excellent (RCoE) Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"ref_1","unstructured":"United States Renal Data System (2018). USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1111\/j.1523-1755.2005.09504.x","article-title":"The role of daily dialysis in the control of hyperphosphatemia","volume":"67","author":"Achinger","year":"2005","journal-title":"Kidney Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1056\/NEJMra0902710","article-title":"Hemodialysis","volume":"363","author":"Himmelfarb","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/ndt\/gfx333","article-title":"Pro: The rationale for dietary therapy for patients with advanced chronic kidney disease","volume":"33","author":"Kopple","year":"2018","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_5","first-page":"389","article-title":"Self-management in patients with end stage renal disease: Exploring domains and dimensions","volume":"32","author":"Curtin","year":"2005","journal-title":"Nephrol. Nurs. J."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lambert, K., Mullan, J., and Mansfield, K.J. (2017). An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol., 18.","DOI":"10.1186\/s12882-017-0734-z"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1053\/j.jrn.2016.06.001","article-title":"Modified Nutritional Recommendations to Improve Dietary Patterns and Outcomes in Hemodialysis Patients","volume":"27","author":"Biruete","year":"2017","journal-title":"J. Ren. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12882-019-1622-5","article-title":"Depressive symptoms and dietary non-adherence among end stage renal disease patients undergoing hemodialysis therapy: Systematic review","volume":"20","author":"Gebrie","year":"2019","journal-title":"BMC Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"90","DOI":"10.2215\/CJN.01730215","article-title":"Association between Serum Potassium and Outcomes in Patients with Reduced Kidney Function","volume":"11","author":"Luo","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/S0272-6386(04)01103-5","article-title":"Magnitude and impact of abnormal mineral metabolism in hemodialysis patients in the dialysis outcomes and practice patterns study (DOPPS)","volume":"44","author":"Young","year":"2004","journal-title":"Am. J. Kidney Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1046\/j.1523-1755.2003.00064.x","article-title":"Nonadherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS","volume":"64","author":"Saran","year":"2003","journal-title":"Kidney Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1053\/j.ajkd.2008.03.020","article-title":"Mortality Risk for Dialysis Patients With Different Levels of Serum Calcium, Phosphorus, and PTH: The Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"52","author":"Tentori","year":"2008","journal-title":"Am. J. Kidney Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1053\/j.ajkd.2012.12.014","article-title":"Associations of Health Literacy With Dialysis Adherence and Health Resource Utilization in Patients Receiving Maintenance Hemodialysis","volume":"62","author":"Green","year":"2013","journal-title":"Am. J. Kidney Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Skoumalova, I., Kolarcik, P., Geckova, A.M., Rosenberger, J., Majernikova, M., Klein, D., Van Dijk, J.P., and Reijneveld, S.A. (2019). Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations?. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16214295"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"26195","DOI":"10.5812\/thrita.26195","article-title":"Health Literacy and Medical Adherence in Hemodialysis Patients: The Mediating Role of Disease-Specific Knowledge","volume":"4","author":"Qobadi","year":"2015","journal-title":"Thrita"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1053\/j.ajkd.2008.12.028","article-title":"Health Literacy and Kidney Disease: Toward a New Line of Research","volume":"53","author":"Devraj","year":"2009","journal-title":"Am. J. Kidney Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen, K., (HLS-EU) Consortium Health Literacy Project European, Broucke, S.V.D., Fullam, J., Doyle, G., Pelikan, J.M., S\u0142o\u0144ska, Z.A., and Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-80"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1177\/2047487317729538","article-title":"Health literacy is associated with health behaviour and self-reported health: A large population-based study in individuals with cardiovascular disease","volume":"24","author":"Aaby","year":"2017","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low Health Literacy and Health Outcomes: An Updated Systematic Review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/j.pec.2016.01.020","article-title":"Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis","volume":"99","author":"Miller","year":"2016","journal-title":"Patient Educ. Couns."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jada.2011.08.042","article-title":"Nutrition and Health Literacy: A Systematic Review to Inform Nutrition Research and Practice","volume":"112","author":"Carbone","year":"2012","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"385.e1","DOI":"10.1016\/j.jneb.2015.04.328","article-title":"The Nuances of Health Literacy, Nutrition Literacy, and Food Literacy","volume":"47","author":"Velardo","year":"2015","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"140","DOI":"10.3148\/cjdpr-2015-010","article-title":"Food Literacy: Definition and Framework for Action","volume":"76","author":"Cullen","year":"2015","journal-title":"Can. J. Diet. Pr. Res."},{"key":"ref_24","unstructured":"World Health Organization (2020, August 24). Health literacy toolkit for low- and Middle-Income Countries: A Series of Information Sheets to Empower Communities and Strengthen Health Systems. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/205244."},{"key":"ref_25","unstructured":"Bello, A.K., Levin, A., Lunney, M., Osman, M.A., Ye, F., Ashuntantang, G., Bellorin-Font, E., Benghanem, G.M., Ghnaimat, M., and Harden, P. (2019). Global Kidney Health Atlas: A Report by the International Society of Nephrology on the Global Burden of End-Stage Kidney Disease and Capacity for Kidney Replacement Therapy and Conservative Care across World Countries and Regions, International Society of Nephrology."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1080\/10810730.2012.713442","article-title":"The Health Literacy Skills Framework","volume":"17","author":"Squiers","year":"2012","journal-title":"J. Health Commun."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1080\/03637750903310360","article-title":"Beyond Baron and Kenney: Statistical Mediation Analysis in the New Millennium","volume":"76","author":"Hayes","year":"2009","journal-title":"Commun. Monogr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1053\/j.jrn.2014.08.006","article-title":"Understanding the Associations Between Modifying Factors, Individual Health Beliefs, and Hemodialysis Patients\u2019 Adherence to a Low-Phosphorus Diet","volume":"25","author":"Elliott","year":"2015","journal-title":"J. Ren. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/S0020-7489(02)00007-X","article-title":"Dietary and fluid compliance in Chinese hemodialysis patients","volume":"39","author":"Lee","year":"2002","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1053\/j.jrn.2010.03.007","article-title":"Relationship Between Beliefs Regarding a Low Salt Diet in Chronic Renal Failure Patients on Dialysis","volume":"21","author":"Agondi","year":"2011","journal-title":"J. Ren. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/S1051-2276(01)98615-7","article-title":"Identification of the factors associated with compliance to therapeutic diets in older adults with end stage renal disease","volume":"11","author":"Thomas","year":"2001","journal-title":"J. Ren. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"694","DOI":"10.2215\/CJN.07680715","article-title":"Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care","volume":"11","author":"Narva","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1053\/j.ajkd.2017.09.014","article-title":"Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis","volume":"71","author":"Griva","year":"2018","journal-title":"Am. J. Kidney Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1177\/1470785320915686","article-title":"Beyond a tandem analysis of SEM and PROCESS: Use of PLS-SEM for mediation analyses!","volume":"62","author":"Sarstedt","year":"2020","journal-title":"Int. J. Mark. Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Chan, Y.M., Zalilah, M.S., and Hii, S.Z. (2012). Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0041362"},{"key":"ref_36","unstructured":"Kline, R. (2016). Principles and Practice of Structural Equation Modeling, Guilford Publications. [4th ed.]."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/isj.12131","article-title":"Minimum sample size estimation in PLS-SEM: The inverse square root and gamma-exponential methods","volume":"28","author":"Kock","year":"2016","journal-title":"Inf. Syst. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A power primer","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol. Bull."},{"key":"ref_39","unstructured":"Hair, J.F., Hult, G.T., Ringle, C.M., and Sarstedt, M. (2017). A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM), SAGE."},{"key":"ref_40","unstructured":"Pelikan, J.M., Rothlin, F., and Boltzmann, K. (2014, January 3\u20134). Measuring comprehensive health literacy in general population: Validation of instrument, indices and scales of the HLS-EU study. Proceedings of the 6th Annual Health Literacy Research Conference, Bethesda, MD, USA."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.je.2016.09.005","article-title":"Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries","volume":"27","author":"Duong","year":"2017","journal-title":"J. Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.17576\/jsm-2020-4905-07","article-title":"Health Literacy Research in Malaysia: A Scoping Review","volume":"49","author":"Abdullah","year":"2020","journal-title":"Sains Malays."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1093\/heapro\/15.3.259","article-title":"Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century","volume":"15","author":"Nutbeam","year":"2000","journal-title":"Health Promot. Int."},{"key":"ref_44","first-page":"2","article-title":"Using Likert Type Data in Social Science Research: Confusion, Issues and Challenges","volume":"3","author":"Subedi","year":"2016","journal-title":"Int. J. Comtemporary Appl. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"396","DOI":"10.9734\/BJAST\/2015\/14975","article-title":"Likert Scale: Explored and Explained","volume":"7","author":"Joshi","year":"2015","journal-title":"Br. J. Appl. Sci. Technol."},{"key":"ref_46","first-page":"2","article-title":"Analyzing Likert Data","volume":"50","author":"Boone","year":"2012","journal-title":"J. Ext."},{"key":"ref_47","first-page":"106","article-title":"Ten Common Misunderstandings, Misconceptions, Persistent Myths and Urban Legends about Likert Scales and Likert Response Formats and their Antidotes","volume":"3","author":"Carifio","year":"2007","journal-title":"J. Soc. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/nur.20147","article-title":"The content validity index: Are you sure you know what\u2019s being reported? critique and recommendations","volume":"29","author":"Polit","year":"2006","journal-title":"Res. Nurs. Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3893","DOI":"10.1111\/jocn.13804","article-title":"Contributing factors for therapeutic diet adherence in patients receiving haemodialysis treatment: An integrative review","volume":"26","author":"Oquendo","year":"2017","journal-title":"J. Clin. Nurs."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Naalweh, K.S., Barakat, M.A., Sweileh, M.W., Al-Jabi, S.W., Sweileh, W.M., and Zyoud, S.H. (2017). Treatment adherence and perception in patients on maintenance hemodialysis: A cross\u2014Sectional study from Palestine. BMC Nephrol., 18.","DOI":"10.1186\/s12882-017-0598-2"},{"key":"ref_52","first-page":"561","article-title":"Adherence to Treatment by African Americans Undergoing Hemodialysis","volume":"45","author":"Daniels","year":"2018","journal-title":"Nephrol. Nurs. J."},{"key":"ref_53","first-page":"12","article-title":"Assess the Illness Perception and Treatment Adherence among Patients with End-Stage Renal Disease","volume":"25","author":"Suganthi","year":"2019","journal-title":"Iran. J. Nurs. Midwifery Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s41100-019-0237-4","article-title":"Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya: A mixed-methods survey","volume":"5","author":"Opiyo","year":"2019","journal-title":"Ren. Replace. Ther."},{"key":"ref_55","first-page":"377","article-title":"The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): Testing the psychometric properties in patients receiving in-center hemodialysis","volume":"37","author":"Kim","year":"2010","journal-title":"Nephrol. Nurs. J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1080\/01488376.2017.1329775","article-title":"Can Likert Scales be Treated as Interval Scales?\u2014A Simulation Study","volume":"43","author":"Wu","year":"2017","journal-title":"J. Soc. Serv. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1053\/ajkd.2001.20748","article-title":"National kidney foundation K\/DOQI clinical practice guidelines for nutrition in chronic renal failure","volume":"37","author":"Kopple","year":"2001","journal-title":"Am. J. Kidney Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1038\/sj.ijo.0801376","article-title":"Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations","volume":"24","year":"2000","journal-title":"Int. J. Obes."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.jada.2003.10.016","article-title":"Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance","volume":"104","author":"DuRose","year":"2004","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_60","unstructured":"Medical Nutrition Therapy Guidelines for Chronic Kidney Disease Working Group Committee (2020, May 24). Medical Nutrition Therapy Guidelines for Chronic Kidney Disease: Malaysian Dietitians\u2019 Association. Available online: http:\/\/storage.unitedwebnetwork.com\/files\/290\/8a1062a0d440dde5c9b5aa3317bb9e89.pdf."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1177\/0193945905282323","article-title":"Benefits of and Barriers to Dietary Sodium Adherence","volume":"28","author":"Welch","year":"2006","journal-title":"West. J. Nurs. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S1051-2276(03)00115-8","article-title":"Differences in perceptions by stage of fluid adherence","volume":"13","author":"Welch","year":"2003","journal-title":"J. Ren. Nutr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3664","DOI":"10.1111\/jocn.13739","article-title":"Dietary and fluid restriction perceptions of patients undergoing haemodialysis: An exploratory study","volume":"26","author":"Hong","year":"2017","journal-title":"J. Clin. Nurs."},{"key":"ref_64","first-page":"347","article-title":"Instrument development: Cardiac diet and exercise self-efficacy","volume":"41","author":"Hickey","year":"1992","journal-title":"Nurs. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/nur.21539","article-title":"Using a mobile application to self-monitor diet and fluid intake among adults receiving hemodialysis","volume":"36","author":"Welch","year":"2013","journal-title":"Res. Nurs. Health"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1016\/j.kint.2017.03.018","article-title":"The Perceived Medical Condition Self-Management Scale can be applied to patients with chronic kidney disease","volume":"92","author":"Wild","year":"2017","journal-title":"Kidney Int."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jbusres.2019.11.069","article-title":"Assessing measurement model quality in PLS-SEM using confirmatory composite analysis","volume":"109","author":"Hair","year":"2020","journal-title":"J. Bus. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s11747-014-0403-8","article-title":"A new criterion for assessing discriminant validity in variance-based structural equation modeling","volume":"43","author":"Henseler","year":"2014","journal-title":"J. Acad. Mark. Sci."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1108\/EBR-11-2018-0203","article-title":"When to use and how to report the results of PLS-SEM","volume":"31","author":"Hair","year":"2019","journal-title":"Eur. Bus. Rev."},{"key":"ref_70","unstructured":"Hayes, A.F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis, Guilford Publications."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1053\/j.jrn.2015.10.002","article-title":"Exploring Problems in Following the Hemodialysis Diet and Their Relation to Energy and Nutrient Intakes: The BalanceWise Study","volume":"26","author":"Woolf","year":"2016","journal-title":"J. Ren. Nutr."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator\u2013mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.2215\/CJN.09761110","article-title":"Prevalence and demographic and clinical associations of health literacy in patients on maintenance hemodialysis","volume":"6","author":"Green","year":"2011","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1681\/ASN.2009111163","article-title":"Low health literacy associates with increased mortality in ESRD","volume":"21","author":"Cavanaugh","year":"2010","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.kint.2016.05.033","article-title":"Limited health literacy in advanced kidney disease","volume":"90","author":"Taylor","year":"2016","journal-title":"Kidney Int."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Khor, B.-H., China, K., Halim, A.G., Zaher, Z.M.M., Ahmad, G., Bavanandan, S., Visvanathan, R., Yahya, R., Goh, B.L., and Bee, B.-C. (2018). The state of nutrition care in outpatient hemodialysis settings in Malaysia: A nationwide survey. BMC Health Serv. Res., 18.","DOI":"10.1186\/s12913-018-3702-9"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1053\/j.jrn.2006.10.016","article-title":"Perspectives on the Nutritional Management of Renal Disease in Asia: People, Practice, and Programs","volume":"17","author":"Karupaiah","year":"2007","journal-title":"J. Ren. Nutr."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.clnesp.2019.03.005","article-title":"Phosphorus nutritional knowledge among dialysis health care providers and patients: A multicenter observational study","volume":"31","author":"Pafili","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e020023","DOI":"10.1136\/bmjopen-2017-020023","article-title":"Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: An interview study","volume":"8","author":"Stevenson","year":"2018","journal-title":"BMJ Open"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s10157-015-1212-1","article-title":"Additional benefit of dietitian involvement in dialysis staffs-led diet education on uncontrolled hyperphosphatemia in hemodialysis patients","volume":"20","author":"Tsai","year":"2015","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"50","DOI":"10.3949\/ccjm.69.1.50","article-title":"Cultural and clinical issues in the care of Asian patients","volume":"69","author":"Jin","year":"2002","journal-title":"Clevel. Clin. J. Med."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Easton, P.M., Entwistle, V., and Williams, B. (2013). How the stigma of low literacy can impair patient-professional spoken interactions and affect health: Insights from a qualitative investigation. BMC Health Serv. Res., 13.","DOI":"10.1186\/1472-6963-13-319"},{"key":"ref_83","first-page":"355","article-title":"A systematic evaluation of websites offering information on chronic kidney disease","volume":"41","author":"Lutz","year":"2014","journal-title":"Nephrol. Nurs."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1053\/j.ackd.2013.04.005","article-title":"Health literacy: Emerging evidence and applications in kidney disease care","volume":"20","author":"Dageforde","year":"2013","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Chesser, A.K., Woods, M.N.K., Smothers, K., and Rogers, N. (2016). Health Literacy and Older Adults. Gerontol. Geriatr. Med., 2.","DOI":"10.1177\/2333721416630492"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Cutilli, C.C. (2007). Health Literacy in Geriatric Patients. Orthop. Nurs., 26.","DOI":"10.1097\/00006416-200701000-00014"},{"key":"ref_87","unstructured":"Weiss, B.D. (2007). Health Literacy and Patient Safety: Help Patients Understand. Manual for Clinicians, American Medical Association Foundation."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"147","DOI":"10.5527\/wjn.v5.i2.147","article-title":"Health literacy in kidney disease: Review of the literature and implications for clinical practice","volume":"5","author":"Jain","year":"2016","journal-title":"World J. Nephrol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/15265160701638520","article-title":"Health Literacy, Health Inequality and a Just Healthcare System","volume":"7","author":"Volandes","year":"2007","journal-title":"Am. J. Bioeth."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1007\/s11096-013-9895-4","article-title":"Investigating the association between health literacy and non-adherence","volume":"36","author":"Ostini","year":"2013","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s11606-011-1886-3","article-title":"Relationship of Health Literacy to Intentional and Unintentional Non-Adherence of Hospital Discharge Medications","volume":"27","author":"Lindquist","year":"2011","journal-title":"J. Gen. Intern. Med."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Health literacy: Report of the Council on Scientific Affairs (1999). Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. JAMA, 281, 552\u2013557.","DOI":"10.1001\/jama.281.6.552"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Lastrucci, V., Lorini, C., Caini, S., and Bonaccorsi, G. (2019). Florence Health Literacy Research Group Health literacy as a mediator of the relationship between socioeconomic status and health: A cross-sectional study in a population-based sample in Florence. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0227007"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/1757975918788300","article-title":"Health literacy as a determinant, mediator and\/or moderator of health: Empirical models using the European Health Literacy Survey dataset","volume":"25","author":"Pelikan","year":"2018","journal-title":"Glob. Health Promot."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5993\/AJHB.31.s1.4","article-title":"The Causal Pathways Linking Health Literacy to Health Outcomes","volume":"31","author":"Wolf","year":"2007","journal-title":"Am. J. Health Behav."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1007\/s11606-009-1086-6","article-title":"Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices","volume":"24","author":"Boulware","year":"2009","journal-title":"J. Gen. Intern. Med."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Khawnekar, D., Jeanes, Y., Gibson, E., Held, I., and Rutherford, P. (2008, January 4\u20135). Does Dietary Knowledge in Patients on Haemodialysis Influence Compliance?. Proceedings of the OCE Malnutrition Matters, Joint BAPEN and Nutrition Society, Harrogate, UK.","DOI":"10.1017\/S0029665109002092"},{"key":"ref_98","unstructured":"DeWalt, D.A., Callahan, L.F., Hawk, V.H., Broucksou, K.A., Hink, A., Rudd, R., Brach, C., and Health Literacy Universal Precautions Toolkit (2020, June 28). Prepared by North Carolina Network Consortium. The Cecil G. USA: Sheps Center for Health Services Research, Available online: https:\/\/www.ahrq.gov\/sites\/default\/files\/wysiwyg\/professionals\/quality-patient-safety\/quality-resources\/tools\/literacy-toolkit\/healthliteracytoolkit.pdf."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"147","DOI":"10.18773\/austprescr.2017.050","article-title":"Encouraging Adherence to Long-Term Medication","volume":"40","author":"Usherwoord","year":"2017","journal-title":"Aust. Prescr."},{"key":"ref_100","first-page":"762","article-title":"Intentional and unintentional medication non-adherence in hypertension: The role of health literacy, empowerment and medication beliefs","volume":"5","author":"Galimberti","year":"2016","journal-title":"J. Public Health Res."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1023\/A:1015866415552","article-title":"Intentional and Unintentional Nonadherence: A Study of Decision Making","volume":"25","author":"Wroe","year":"2002","journal-title":"J. Behav. Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1093\/pubmed\/fdi031","article-title":"Mode of questionnaire administration can have serious effects on data quality","volume":"27","author":"Bowling","year":"2005","journal-title":"J. Public Health"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: A critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J. Appl. Psychol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/20\/7479\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:21:17Z","timestamp":1760178077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/20\/7479"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,14]]},"references-count":103,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["ijerph17207479"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17207479","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,14]]}}}