Barriers And Facilitators To Hemodialysis Access And Utilization Among Patients With End-Stage Kidney Disease In Ghana: A Mixed-Methods Study From The Perspectives Of Patients, Providers, And Administrators.

Abstract

ABSTRACT Background: Chronic kidney disease (CKD) is a major and growing public health issue in Ghana, with a prevalence of 13.3%. Many individuals with CKD progress to end-stage kidney disease (ESKD), for which hemodialysis is the principal lifesaving treatment. However, access to and utilization of hemodialysis remain severely limited by financial, geographic, and systemic barriers, including high out-of-pocket costs, inadequate insurance coverage, and the uneven distribution of dialysis centers. Despite the increasing burden of ESKD, limited evidence explores the multifaceted barriers to hemodialysis in Ghana from the perspectives of patients, healthcare providers, and hospital administrators. Purpose: This dissertation aims to explore and identify the barriers and facilitators to delivering quality care for individuals with ESKD, with a focus on access to and utilization of hemodialysis in Ghana. Methods: A sequential explanatory mixed-methods design was employed. The quantitative phase involved a cross-sectional study of 264 patients with ESKD, using structured questionnaires. Predictors of hemodialysis access and utilization were identified through bivariate and multivariate logistic regression analyses using SPSS version 27. The qualitative phase employed maximum variation purposive sampling to recruit 16 adults with ESKD (receiving or in need of hemodialysis) and 16 healthcare providers/administrators from two teaching hospitals. Data from semi-structured interviews were analyzed thematically using Braun and Clarke’s framework with NVivo 14. Results: Among the 264 patients, 74.2% had hemodialysis access, but only 38.8% regularly adhered to all prescribed sessions. Greater access and utilization were associated with higher income, urban residence, longer duration since diagnosis, and distance to dialysis centers. Qualitative findings revealed shared perspectives across stakeholder groups: individual factors (resilience, family support) facilitated care, while systemic challenges high treatment costs, facility shortages, workforce constraints, limited insurance coverage, and geographic disparities, impeded consistent hemodialysis access. Participants emphasized the need for coordinated multi-level interventions to address these interlinked barriers. Conclusion: Access to and utilization of hemodialysis in Ghana are shaped by intersecting financial, geographic, systemic, and sociocultural challenges. Addressing these issues requires comprehensive reforms, including increased public investment, infrastructure expansion, targeted health education, and equity-focused health policies to ensure sustainable and equitable dialysis care for patients with ESKD. Keywords: Hemodialysis; access; utilization; barriers; Ghana; chronic kidney disease; mixed methods; equity; health services.