title: Adherence to clean intermittent self-catheterization procedures: determinants explored.
abstract: OBJECTIVE
  The aim of the current study was to explore factors that hinder or promote adherence to clean intermittent self-catheterization (CISC) procedures in adults.
  
  
  BACKGROUND
  Clean intermittent self-catherization is associated with favourable patient outcomes, but adherence to the procedure is not addressed in the international literature.
  
  
  METHODS
  Relevant factors were explored in two studies. The first study (n = 10) addressed mastery and short-term adherence, whereas the second study (n = 20) addressed long-term adherence in these patients. Determinants of patient adherence were derived from pre-structured interviews with patients, using a content-analysis procedure.
  
  
  RESULTS
  A list of 16 determinants of mastery and short-term adherence and a list of 12 determinants of long-term adherence was found. Most of these determinants were found in both older (>or=65 years of age) and younger patients. However, five determinants of mastery and short-term adherence and six determinants of long-term adherence were specific to patients under the age of 65.
  
  
  CONCLUSIONS
  Our findings give a first insight into CISC adherence. General determinants of adherence relate to knowledge, complexity of the procedure, misconceptions, fears, shame, motivation and quality and continuity of professional care. Furthermore integrating CISC in everyday life can be difficult. In younger patients, availability of materials, physical impairments and resistance to a sickness role can further compromise adherence.
  
  
  CONCLUSIONS
  Issues of knowledge, fears, motivation and potential psychological impact of performing CISC should be addressed prior to deciding on CISC and instructing patients. Follow-up care should be improved to include re-evaluations of skills, discussing adherence, integrating CISC in daily activities and general coping issues.
authors.affiliation: Centre for Quality of Care Research, Nursing Science Section, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. t.vanachterberg@kwazo.umcn.nl
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
authors.forename: Gerda
authors.initials: G
authors.lastname: Holleman
authors.forename: Hanny
authors.initials: H
authors.lastname: Cobussen-Boekhorst
authors.forename: Rita
authors.initials: R
authors.lastname: Arts
authors.forename: John
authors.initials: J
authors.lastname: Heesakkers
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D001207:Asepsis / Q000379:methods / Q000592:standards*; D003266:Continuity of Patient Care; D003717:Denial, Psychological; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D012648:Self Care / Q000379:methods / Q000523:psychology*; D020377:Self Efficacy; D012752:Shame; D012803:Sick Role; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods / Q000523:psychology*