9. Discussion
weight gain, cognitive behavior
DISEASE
This study reported that educational intervention can improve knowledge and adherence, by way of improving information, reinforcement, and limiting misconceptions about the disease. Knowledge of disease management and fluid and nutritional adherence improved significantly in the intervention group using an educational/cognitive intervention. Similar other studies using cognitive/educational intervention have improved knowledge on nutritional knowledge and binders, dietary phosphate intake, and weight gain control with a duration of intervention showing effect at minimum 2 months and 6 months with partial positive and positive benefits. The benefits sustained beyond intervention were not reported in these studies [Several studies [There was an improving trend in adherence in HD attendance, duration, and episodes of shortening of HD and a statistically significant improvement in fluid and dietary adherence. At baseline, the scores of the first three domains of adherence were reported as high, and this could be attributed to the dialysis centre being the only tertiary-level hospital delivering high-quality care and the patient's perception of the quality of dialysis, while for fluid and dietary compliance, the scores were low due to a lack of knowledge, the myth about food to be avoided and eaten in moderation for their disease condition and the climatic condition making it difficult to adhere to fluid restriction. The adherence outcome assessment was subjective, i.e., as the patient reported, and the educational intervention was followed by goal setting and cognitive behavior therapy (CBT). Similarly, Brantley et al., Chen et al., Reese p et al., Kartvelian et al., Kauric Klein, and Wong et al. improved adherence through educational intervention and subjective measurements such as vascular access cleaning compliance, protein intake compliance, medication adherence by questionnaire, phosphate intake, self-reported BP medication adherence, self-reported dialysis diet, and fluid adherence, respectively [Several other studies have used objectives such as biochemical parameter measurements, IDWG, and Kt/V with educational interventions for adherence outcome assessment with negative, positive, and partial positive effects [Several studies have proven effective, partially effective, or negative results using educational, behavioral, or mixed interventions to improve patient adherence. The current study used an educational intervention and patient-reported compliance to measure the effectiveness and found that an educational intervention can improve knowledge and adherence positively in Indian HD patients similar to previous authors who have demonstrated the importance of health literacy in health systems [