Abstract

End-stage kidney disease (ESKD) is a growing public health concern in Oman, with an increasing number of adults requiring hemodialysis and facing complex dietary restrictions. Adequate nutrition knowledge and nutrition literacy are essential for effective dietary self-management, yet their relationship with dietary adherence in the Omani hemodialysis population remains underexplored. To determine the level of dialysis-specific nutrition literacy among Omani adults with end-stage kidney disease undergoing hemodialysis and to identify socio-demographic and clinical factors that predict acceptable nutrition literacy in this population. A cross-sectional study was conducted among 140 adults with ESKD receiving hemodialysis in Oman. Data were collected using a structured, self-administered questionnaire comprising socio-demographic and clinical items, the Dialysis-Specific Nutrition Literacy Scale (DSNLS), the Dialysis-Related Diet Knowledge Questionnaire (DDKQ), and adherence/health-belief subscales (perceived benefits, barriers, seriousness, susceptibility, and self-efficacy). Descriptive statistics summarized sample characteristics and scale scores. Correlation analyses assessed relationships between nutrition literacy, diet knowledge, and adherence-related perceptions. Multiple logistic regression identified independent predictors of acceptable nutrition literacy. Participants had a mean age of 48.19 years and a mean dialysis duration of 5.46 years. Overall, 60.7% had acceptable dialysis-specific nutrition literacy and 39.3% had limited literacy. Dialysis-related diet knowledge was low in 10.7%, moderate in 46.4%, and high in 42.9% of participants. Perceived benefits of dietary adherence were high, whereas perceived barriers, seriousness, and susceptibility were moderate and self-efficacy was relatively low. Nutrition literacy was positively correlated with perceived benefits, seriousness, susceptibility, and self-efficacy, while diet knowledge showed weaker associations with these beliefs. In the logistic regression model, living in the city (OR = 0.17, p = 0.01) and having diabetes mellitus as a comorbidity (OR = 0.17, p = 0.01) were associated with lower odds of acceptable nutrition literacy, whereas higher hemoglobin levels (OR = 1.51, p = 0.04) and self-rated “very good” overall health (OR = 5.80, p = 0.03) were associated with higher odds. Most Omani adults on hemodialysis demonstrated acceptable nutrition literacy and at least moderate renal-diet knowledge, but a substantial subgroup had limited literacy and low self-efficacy for dietary adherence. Nutrition literacy was more strongly linked to adherence-related beliefs than factual knowledge alone and was influenced by place of residence, comorbid diabetes, hemoglobin level, and perceived health. These findings highlight the need for culturally tailored, literacy-sensitive nutrition education in Omani dialysis units, with particular attention to urban patients and those with diabetes, to strengthen self-efficacy, address perceived barriers, and ultimately improve dietary adherence and clinical outcomes.

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