title: Self-care strategies and barriers among kidney transplant recipients: a qualitative study.
abstract: OBJECTIVE
  We investigated kidney transplant recipients' self-reported levels of exercise and fluid intake. We also examined attitudes about, barriers to undertaking, and strategies used to initiate and maintain adequate self-care for fluid intake, exercise and dietary practices.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%) or did not discuss exercise (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.
  
  
  CONCLUSIONS
  Few kidney recipients practiced optimal self-care for fluid intake or physical activity. Most patients encountered barriers to self-care that should be ameliorated to assist patients with managing their transplant. Understanding barriers and strategies is essential for developing educational interventions.
authors.affiliation: Institute for Healthcare Studies, Feinberg School of Medicine, Department of Surgery, Division of Organ Transplantation, Northwestern University, Chicago, IL 60611, USA. e-gordon@northwestern.edu
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Gordon
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Prohaska
authors.forename: Mary
authors.initials: M
authors.lastname: Gallant
authors.forename: Laura A
authors.initials: LA
authors.lastname: Siminoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015444:Exercise; D005260:Female; D005440:Fluid Therapy; D007722:Health Knowledge, Attitudes, Practice; D006305:Health Status Indicators; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D036301:Qualitative Research; D012648:Self Care; D012982:Sodium, Dietary; D014882:Water-Electrolyte Balance; D055815:Young Adult
chemical_list: D012982:Sodium, Dietary