-The qualitative findings showed that patients were greatly challenged by the effort to manage the upcoming instability, which has a persistent broad impact on their lives. Managing emotions comprised dealing with uncertainty, disappointment, and frustration. Additionally, patients had to manage changes in self-perception. Managing life roles mainly involved an adaptation of relationships, occupational changes, and interactions with health care providers. Taking medications, managing symptoms, integrating new behaviors, and understanding one's course of disease were further tasks. Quantitatively, self-management tasks that were perceived as a challenge by at least half of the patients were primarily tasks from the questionnaire section "managing stressful emotions and self-perception." The synthesis of qualitative and quantitative findings indicates that self-management programs for kidney transplant recipients should focus on strengthening patients' self-management of emotional tasks and on regaining stability in daily life.

Forgetfulness is the most powerful barrier against adherence. Intention to adhere plays a minor role in non-adherence in renal transplant recipients.

Supplement 1: Further description of the intervention At the beginning of each counselling session, the APN assessed the patient's general wellbeing to learn about individual difficulties and challenges. Then she asked about the patient's weight and degree of physical activity. Moving on, she explored patients' attitudes towards medically desired behaviors and assigned the corresponding stage of change as described in the transtheoretical model 1 :

After cultural adaptations the German version of the ACIC is applicable as a tool to guide quality improvement in chronic illness care in German speaking countries in Europe.