Indonesian universal health coverage was implemented in 2013 and hemodialysis services became universally accessible, yet few studies have examined patient adherence to hemodialysis schedules. We examined the rates of missed in-center hemodialysis sessions in Banda Aceh and the factors associated with non-attendance. This cross-sectional questionnaire survey included 193 patients receiving in-center hemodialysis. Approximately 28% of the patients missed ≥ 1 hemodialysis session in the month prior to the questionnaire's administration. About 65% reported attending religious activities as the reason for missing hemodialysis. The level of health literacy was generally low with a mean score of 14.38 out of 26 (55.3%). Multivariate logistic regression analyses showed that patients with educational levels higher than elementary school were less likely to miss hemodialysis sessions. Participants who performed more self-care behaviors had lower odds of missing hemodialysis sessions. Every unit increase in the health literacy score was associated with increased odds of missing hemodialysis sessions. Emphasizing the importance of attending hemodialysis sessions and modifying hemodialysis schedules based on patients' needs is essential. Patients who miss hemodialysis sessions should be reminded of all self-care behaviors. Health literacy among hemodialysis patients should be improved, with emphasis on patient safety, advanced knowledge, and critical health literacy.
Keywords: adherence; hemodialysis; kidney-related health literacy; self-care.