BackgroundAfter a kidney transplantation, patients have to visit the hospital often to monitor for early signs of graft rejection. Self-monitoring of creatinine in addition to blood pressure at home could alleviate the burden of frequent outpatient visits, but only if patients are willing to self-monitor and if they adhere to the self-monitoring measurement regimen. A prospective pilot study was conducted to assess patients’ experiences and satisfaction.Materials and methodsFor 3 months after transplantation, 30 patients registered self-measured creatinine and blood pressure values in an online record to which their physician had access to. Patients completed a questionnaire at baseline and follow-up to assess satisfaction, attitude, self-efficacy regarding self-monitoring, worries, and physician support. Adherence was studied by comparing the number of registered with the number of requested measurements.ResultsPatients were highly motivated to self-monitor kidney function, and reported high levels of general satisfaction. Level of satisfaction was positively related to perceived support from physicians (P<0.01), level of self-efficacy (P<0.01), and amount of trust in the accuracy of the creatinine meter (P<0.01). The use of both the creatinine and blood pressure meter was considered pleasant and useful, despite the level of trust in the accuracy of the creatinine device being relatively low. Trust in the accuracy of the creatinine device appeared to be related to level of variation in subsequent measurement results, with more variation being related to lower levels of trust. Protocol adherence was generally very high, although the range of adherence levels was large and increased over time.ConclusionPatients’ high levels of satisfaction suggest that at-home monitoring of creatinine and blood pressure after transplantation offers a promising strategy. Important prerequisites for safe implementation in transplant care seem to be support from physicians and patients’ confidence in both their own self-monitoring skills and the accuracy of the devices used.

Capillary blood testing with the StatSensor® is not advisable for determining current renal function with a single creatinine measurement in kidney transplant patients, mainly due to excessive analytical imprecision. However, our results suggest that capillary blood testing with the StatSensor® can be used for daily trend monitoring of kidney function after renal transplantation.

BackgroundSelf-management support systems (SMSS) have been proposed for renal transplant patients to increase their autonomy and reduce the number of hospital visits. For the design and implementation of such systems, it is important to understand factors influencing patients’ acceptance of a SMSS. This paper aims to identify these key factors.MethodsFrom literature, possible factors and related questionnaire items were identified. Afterwards, focus groups with experts and patients were conducted to adapt the items to the application domain. To investigate acceptance of a SMSS and the influencing factors, fifty renal transplant patients answered the questionnaire before and after using the SMSS for 4 months.ResultsAll the questionnaire constructs had a satisfactory or higher level of reliability. After using the SMSS for 4 months, trust and performance expectancy could explain part of the variation in behavioural intention of using the SMSS, but not beyond the explanation given by patients’ affect towards the system, which accounted for 26% of the variance.ConclusionsWe anticipate that in future caregivers implementing a SMSS will benefit from taking steps to improve patients’ affect as this was found to correlate with patients use intention.Trial registrationThe study was registered in ToetsingOnline, a registry held by the Dutch Central Committee on Research Involving Human Subjects. The registration number is NL33387.058.11, and the date of registration is 31st July 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-017-0456-y) contains supplementary material, which is available to authorized users.

BackgroundThe high frequency of outpatient visits after kidney transplantation is burdensome to both the recovering patient and health care capacity. Self-monitoring kidney function offers a promising strategy to reduce the number of these outpatient visits.ObjectiveThe objective of this study was to investigate whether it is safe to rely on patients’ self-measurements of creatinine and blood pressure, using data from a self-management randomized controlled trial.MethodsFor self-monitoring creatinine, each participant received a StatSensor Xpress-i Creatinine Meter and related test material. For self-monitoring blood pressure, each participant received a Microlife WatchBP Home, an oscillometric device for blood pressure self-measurement on the upper arm. Both devices had a memory function and the option to download stored values to a computer. During the first year post transplantation, 54 patients registered their self-measured creatinine values in a Web-based Self-Management Support System (SMSS) which provided automatic feedback on the registered values (eg, seek contact with hospital). Values registered in the SMSS were compared with those logged automatically in the creatinine device to study reliability of registered data. Adherence to measurement frequency was determined by comparing the number of requested with the number of performed measurements. To study adherence to provided feedback, SMSS-logged feedback and information from the electronic hospital files were analyzed.ResultsLevel of adherence was highest during months 2-4 post transplantation with over 90% (42/47) of patients performing at least 75% of the requested measurements. Overall, 87.00% (3448/3963) of all registered creatinine values were entered correctly, although values were often registered several days later. If (the number of) measured and registered values deviated, the mean of registered creatinine values was significantly lower than what was measured, suggesting active selection of lower creatinine values. Adherence to SMSS feedback ranged from 53% (14/24) to 85% (33/39), depending on the specific feedback.ConclusionsPatients’ tendency to postpone registration and to select lower creatinine values for registration and the suboptimal adherence to the feedback provided by the SMSS might challenge safety. This should be well considered when designing self-monitoring care systems, for example by ensuring that self-measured data are transferred automatically to an SMSS.

Background Personalization of eHealth systems is a promising technique for improving patients' adherence. This paper explores the possibility of personalisation based on the patients' medical health situation and on their health literacy. The study is set within the context of a self-management support system (SMSS) for renal transplant patients. Methods A SMSS is designed with layering, nudging, emphaticizing, and focusing principles. It has two communication styles: (1) a guided style that provided more interpretation support and addressed emotional needs; and (2) a factual style that showed only measurement history, medical information, and recommendations. To evaluate the design, 49 renal transplant patients with three different experience levels participated in a lab study, in which they used the system in imaginary scenarios to deal with three medical health situations (alright, mild concern, and concern). Results A 96% understanding and 87% adherence rate was observed, with a significant interaction effect on adherence between patient group and health situation. Furthermore, compared to recently transplanted patients, not recently transplanted patients were relatively more positive towards the factual than the guided communication style in the "alright" condition. Furthermore, additional medical information was searched more often in health situations that causes mild concern and a majority of patients did not change the communication style to their preferred styles. Conclusion By attuning the communication style to patient's experience and medical health situation according to the applied principles and acquired insights, SMSSs are expected to be better used.