Patients Differ in Their Ability to Self-Monitor Adherence to a Low-Sodium Diet Versus Medication

Misook L. Chung, Terry A. Lennie, Marla de Jong, Jia Rong Wu, Barbara Riegel, Debra K. Moser

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Objective: Poor adherence to a low-sodium diet (LSD) and prescribed medications increases rehospitalization risk in patients with heart failure (HF). Clinicians have difficulty assessing adherence objectively, so they depend on patients' self-report. The degree to which self-reported adherence reflects actual adherence is unclear. We examined patients' ability to self-monitor adherence to an LSD and medications by comparing self-reported adherence with objective evidence of adherence. Methods: A total of 133 patients with HF (male 71%; ejection fraction 35% ± 14%) completed the Medical Outcomes Study Specific Adherence Scale. Adherence to the LSD and medication were assessed objectively using 24-hour urinary sodium excretion and dose counting with an electronic monitoring device, respectively. On the basis of self-report, patients were divided into adherent and non-adherent groups and evaluated for differences according to objective adherence. Results: There were no differences in urinary sodium levels between the self-reported LSD adherent and non-adherent groups (4560 mg vs. 4333 mg; P = .59). Self-reported adherent and non-adherent medication groups took 92.4% and 80.4% of prescribed doses, respectively (P < .001). Conclusion: Patients were able to accurately estimate adherence to medication, but they failed to estimate LSD adherence. This finding suggests that we need to improve our means of evaluating adherence to the LSD and of educating patients more thoroughly about following the LSD. We speculated that the inability to estimate LSD adherence may be the result of gaps in patients' knowledge that preclude accurate self-assessment.

Original languageEnglish
Pages (from-to)114-120
Number of pages7
JournalJournal of Cardiac Failure
Issue number2
StatePublished - Mar 2008

Bibliographical note

Funding Information:
This study was funded by AACN-Phillips Medical System Outcomes for Clinical Excellence Research grant to Dr. Debra Moser (PI), Dr. Barbara Riegel (co-PI), and Dr. Misook L. Chung (co-PI), a Triservice Nursing Research Award to Dr. Marla De Jong, and the University of Kentucky General Clinical Research Center (M01RR02602).


  • 24-hour urinary sodium excretion
  • Medical Outcomes Study Specific Adherence Scale
  • Medication Event Monitoring System

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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