Gordon and coworkers investigated kidney transplant recipients' self-reported levels of exercise and fluid intake. The investigators also examined attitudes about, barriers to undertaking, and strategies used to initiate and maintain adequate self-care for fluid intake, exercise, and dietary practices. 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. 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%) nor discuss exercise at all (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.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that few kidney recipients practiced optimal self-care for fluid intake or physical activity. This finding cannot be blamed on them as most patients encountered barriers to self-care that could be ameliorated to assist patients with managing their transplant. Understanding barriers and strategies is essential for developing educational interventions.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The investigation is somewhat bleak in that few kidney recipients told what to do to help care for their condition. There is a real need to develop and implement a self-management program for these patients. Such programs would not only improve the health of patients but also permit them, as kidney recipients, to make a major contribution to managing their chronic condition. It appears from this study that patients were developing effective strategies to control their disorder.

EJ Gordon et al. Self-care strategies and barriers among kidney transplant recipients: a qualitative study. Chronic Illness, 2009;5:75-91.