*Vital notice: Research Square publishes preliminary scientific reports that aren’t peer-reviewed and, subsequently, mustn’t be considered conclusive, guide clinical practice/health-related behavior, or treated as established information.

In a recent study posted to the Research Square* preprint server and under review at BMC Nephrology, researchers assessed the self-management practices of chronic kidney disease patients in the course of the coronavirus disease 2019 (COVID-19) pandemic.

Study: A qualitative study exploring self-management behaviour of patients with chronic kidney disease during COVID-19. Image Credit: Kateryna Kon/Shutterstock

Background

Chronic kidney disease (CKD) is characterised by abnormalities within the structure or function of the kidneys that persist for a minimum of three months and have serious health repercussions. The COVID-19 pandemic is reported to have led to many significant modifications within the treatment delivered to CKD patients in Turkey. Long-term CKD therapy management requires a high level of patient engagement in addition to interest in decision-making and care execution.

Throughout the pandemic, it was observed that social isolation, healthcare disruptions, and lockdowns impacted therapy and management, with an absence of follow-up potentially resulting in patient adversity. Hence, the importance of CKD patient self-management increased in the course of the COVID-19 pandemic.

Concerning the study

In the current study, researchers investigated the variables that may influence self-management in patients receiving hemodialysis (HD) in addition to kidney transplant (KTx) patients in the course of the COVID-19 pandemic.

The study population comprised CKD patients who sought therapy or follow-up on the Nephrology Clinic of Ibn-i Sina Hospital, Ankara University. These participants met the inclusion criteria of KTx or receiving HD. Participants were informed of the study’s goal and the researchers’ qualifications.

From July to December 2021, semi-structured face-to-face interviews were used to gather data using a qualitative approach. Three authors devised the interview guide after evaluating pertinent literature and investigating the consequences of prior pandemics on the disease management behavior of chronic patients. The framework evaluation was implemented in six steps: (1) transcription, (2) familiarization, (3) coding, (4) framework application, (5) data charting, and (6) data interpretation.

Results

Interviews were conducted with 18 KTx patients and 7 patients receiving HD. The patients who were interviewed included nine women and 16 men. The common age of the patients was 44.7 years. The study results revealed the perceived susceptibility due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, the perceived severity of SARS-CoV-2 infections, the perceived obstacles to self-management behavior, the perceived benefits of self-management, cues to motion, and self-efficacy.

Most participants were aware of COVID-19 symptoms and believed that receiving a KTx or HD would raise the probability of affected by more severe SARS-CoV-2 symptoms. Patients reported feeling vulnerable to the exacerbated COVID-19 symptoms. The more severe participants judged COVID-19 to be, the more likely they were to interact in self-management. The team found two subthemes influencing the participants’ perceptions of COVID-19 severity. Participants also emphasized that that they had to cope with a persistent sense of impending death as a consequence of COVID-19.

Patients with negative memories, corresponding to kidney transplant rejection, were more more likely to perceive COVID-19 as severe. Moreover, the lack of family members or friends due to COVID-19 affected the perception of COVID-19 severity. Some patients disclosed that that they had to postpone or cancel their routine hospital visits out of concern about contracting COVID-19. This resulted in a disturbance of their treatment, they usually thought they were unsuccessful in self-managing the treatments.

Participants reported that, after years of living with CKD, they feel more on top of things and able to handling negative circumstances and challenges in evaluating care paths and facilities. The next subthemes illustrated the participants’ perspectives on the external and internal causes that motivate their self-management actions. Participants said that receiving moral strength from their families, relatives, and employers assisted them in coping with the pandemic’s impact on their health.

As their work performance suffered as a consequence of COVID-19, some employed subjects expressed the necessity for a supportive approach with respect to flexible working hours. Throughout the pandemic, one’s motivation to develop self-management behaviors was influenced by their impression of the disease. Patients who perceived themselves at a greater risk felt obligated to stick to COVID-19 preventive practices and follow a healthy lifestyle.

Conclusion

The study findings showed that CKD patients believed they were vulnerable to severe harm as a consequence of COVID-19 and have expressed dread of death. Internal and external patient care route elements may influence the self-management behavior of CKD patients. This study underscores the necessity for healthcare teams to think about patient diversity and their respective requirements while establishing therapeutic regimens. Within the event of emergencies corresponding to COVID-19, policymakers should set protocols and suggestions for individuals with chronic diseases and make sure that patients have full access to treatment and lifesaving resources.

*Vital notice: Research Square publishes preliminary scientific reports that aren’t peer-reviewed and, subsequently, mustn’t be considered conclusive, guide clinical practice/health-related behavior, or treated as established information.