A Qualitative Study of Facilitators and Barriers to Self-Management of CKD

Schrauben, Sarah J.; Rivera, Eleanor; Bocage, Claire; Eriksen, Whitney; Amaral, Sandra; Dember, Laura M.; Feldman, Harold I.; Barg, Frances K.

doi:10.1016/j.ekir.2021.10.021

Cited by 12 publications

(16 citation statements)

References 32 publications

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“… 23 Lack of knowledge and self-confidence in CKD self-management, including HBPM, was identified as a key barrier to behavior prioritization and performance in patient engagement. 5 Therefore, KCC staff need to further clarify how to take BP correctly, what to do with the results, and when to call for support. This is more pertinent as our patients with CKD may not physically come to the clinic and still prefer virtual visits which do not have the safety net of clinic BP checks.…”

Section: Discussionmentioning

confidence: 99%

“…The cost of a self-measurement BP device is consistently cited as a limitation to HBPM adoption in the literature. 5 , 19 , 25 Awareness of unique barriers and facilitators from the patient perspective can better equip staff to advocate for financial support for our patients in acquiring a device and encouraging and teaching HBPM in a more targeted and impactful way.…”

Section: Discussionmentioning

confidence: 99%

“…Patients are empowered through patient-centric autonomous participation in their health. 5 Home BP monitoring can help overcome physician inertia by the provision of multiple readings which allow for better treatment decision-making and informed medication titration thereby improving BP control. 2 , 6 Furthermore, HBPM is an important predictor of target organ damage and provides better prognostic information than office BP and, although the evidence base is still developing, HBPM is suggested by Hypertension Canada to be used in conjunction with standardized office measurement for long-term BP monitoring.…”

Section: Introductionmentioning

confidence: 99%

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The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Borkum

Levin

Williams³

et al. 2023

Can J Kidney Health Dis

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Background: Blood pressure (BP) management can decrease morbidity and mortality in chronic kidney disease (CKD) patients. Evidence-based hypertension guidelines endorse home BP monitoring (HBPM), and the growing use of virtual health has highlighted the need for HBPM. A comprehensive understanding of HBPM adoption in our province is lacking. Objective: To identify the baseline practices, perspectives, barriers, and enablers in both providers and patients in our kidney care clinics regarding HBPM. Ultimately, this will inform the development of a provincial intervention that empowers providers to both increase patient understanding and equip them for accurate and reliable home BP measurement. Design: Cross-sectional, descriptive study using online survey methodology. Setting: Kidney care clinic network in the province of British Columbia, Canada. Patients or Sample or Participants: Kidney care clinic staff and patients who perform HBPM. Methods: Data were collected using semi-structured online surveys, one for staff and one for patients and/or caregivers. These surveys were developed by an interdisciplinary working group that included patient partners and addressed some key components of the implementation of an HBPM program (including perceived barriers to uptake, education, and adoption of best practices). Results: In all, 46 patients and 43 staff responded to the survey from 16 kidney care clinics. Of the patients 53% were women, and the most common age range was 60 to 69 years (25%); 93% of the staff respondents were women and 63% were nurses. We identified numerous areas of discordance between providers and patients and the need for improvement from the perspective of implementing best practices from hypertension guidelines, both in staff teaching and patient usage of HBPM. Blood pressure targets were not known to 18% of patients and 39% of patients had received a BP target from their kidney care clinic team; 89% of patients had not had their upper arm circumference measured for cuff size. Furthermore, 54% of patients knew what to do when their BP is off-target. All recognized the benefits of HBPM, providers were more likely to perceive anxiety as a barrier relative to patients, and patients were more likely to report expense as a barrier than providers. Limitations: This study includes only a single provincial health care system limiting generalizability to other jurisdictions and sampled a small subset of patients and providers. Conclusions: The systematic evaluation of education, understanding, implementation of best practices, and barriers and motivating factors for HBPM from both patient and clinician perspectives is an important step in designing strategies to improve the use of HBPM. Given differences in staff and patient perspectives, targeted interventions based on these responses may lead to improved use of HBPM, and ultimately enhance hypertension self-management and BP control in our CKD patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Borkum

Levin

Williams³

et al. 2023

Can J Kidney Health Dis

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“…Patient goals and needs are not static and will change in an iterative manner along the trajectory of behavior initiation to long-term maintenance. 1 , 25 , 38 “Disagree with treatment” and “lacking information” occur early on in this process. The concept of a patient disagreeing with their treatment plan is inconsistent with the ideas behind shared decision making.…”

Section: Discussionmentioning

confidence: 99%

Treatment Adherence in CKD and Support From Health care Providers: A Qualitative Study

Rivera¹,

Clark-Cutaia²,

Schrauben³

et al. 2022

Kidney Medicine

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“…However, the underlying reasons are not well understood [ 10 ]. A greater understanding of the patient’s everyday lived experiences is necessary for improving CKD self-care behaviors and creating efficient support strategies [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with self-care behavior in patients with pre-dialysis or dialysis-dependent chronic kidney disease

2022

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Self-care behavior plays a pivotal role in the management of chronic kidney disease. Improved self-care behavior in patients with chronic kidney disease is a key factor in health management and treatment adherence. This study aimed to evaluate the participants’ general and medical condition-related characteristics, physiological indices and the level of health literacy affecting self-care behavior in patients with chronic kidney disease in South Korea. The data of 278 participants were analyzed using t-test, analysis of variance, correlation coefficient, and linear multiple regression analysis. There were significant differences in self-care behavior scores depending on participants’ age and cohabitation status, employment, and smoking status as well as having dialysis due to end-stage kidney disease; number of comorbidities; levels of serum hemoglobin, calcium, and creatinine; and estimated glomerular filtration rate. The results of regression analysis revealed that not currently working, non-smoker, end-stage kidney disease, and positive response to the “actively managing my health” scale of the Health Literacy Questionnaire significantly affected self-care behavior in patients with chronic kidney disease, and the explanatory power of the model was 32.7%. Therefore, it is necessary to identify each patient’s barriers or needs according to individual characteristics, such as age, cohabitation and employment status, and daily life circumstances, including smoking habits, comorbidities, social support, and level of health literacy to develop efficient support strategies for promoting adequate self-care behavior with CKD.

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A Qualitative Study of Facilitators and Barriers to Self-Management of CKD

Cited by 12 publications

References 32 publications

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Treatment Adherence in CKD and Support From Health care Providers: A Qualitative Study

Factors associated with self-care behavior in patients with pre-dialysis or dialysis-dependent chronic kidney disease

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