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Self-care strategies and barriers among kidney transplant recipients: a qualitative study

Institute for Healthcare Studies, Feinberg School of Medicine, Department of Surgery, Division of Organ Transplantation, Northwestern University, 750 N. Lakeshore Drive, 10th Floor, Chicago, IL 60611, USA, e-gordon{at}northwestern.edu

Thomas R. Prohaska

Institute for Health Research and Policy (MC 275), School of Public Health, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, Chicago, IL 60608, USA

Mary Gallant

Department of Health Policy, Management, & Behavior, School of Public Health, University at Albany, SUNY, One, University Place, Rensselaer, NY 12144-3456, USA

Laura A. Siminoff

Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, PO Box 980149, 1112 E Clay Street, Richmond, VA 23298, USA

Objectives: We investigated kidney transplant recipients' self-reported levels of exercise and fluid intake. We also examined attitudes about, barriers to undertaking, and strategies used to initiate and maintain adequate self-care for fluid intake, exercise and dietary practices.

Methods: A qualitative approach was used and supplemented by quantitative data to examine self-care among kidney transplant recipients (n = 82), including a semi-structured interview and survey of physical activity.

Results: One-third of patients (33%) reported drinking the recommended 3 L of fluid each day. However, the majority (60%) reported not receiving this or any specific fluid intake recommendation. Twenty percent reported engaging in moderate to regular physical activity while 78% were sedentary. However, many reported that clinicians did not specify the amount of exercise (39%) or did not discuss exercise (15%). Attitudes towards fluid intake, exercise and maintaining a low-salt diet were mostly positive; patients expressed relatively more negative attitudes towards maintaining a low-cholesterol diet. Major barriers to fluid intake were not feeling thirsty, difficulty breaking the habit of limiting fluid intake formed while on dialysis, feeling full and limited access to fluids. Patients devised creative strategies to initiate and maintain appropriate hydration, physical activity and dietary levels, including intentionally drinking when not thirsty, modifying the environment, tracking intake and relying on social supports.

Conclusions: Few kidney recipients practiced optimal self-care for fluid intake or physical activity. Most patients encountered barriers to self-care that should be ameliorated to assist patients with managing their transplant. Understanding barriers and strategies is essential for developing educational interventions.

Key Words: Kidney transplantation • Physical activity • Nutrition • Qualitative research • Self-care

Chronic Illness, Vol. 5, No. 2, 75-91 (2009)
DOI: 10.1177/1742395309103558


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