title: Community perspectives on kidney disease and health promotion from at-risk populations in rural North Carolina, USA.
abstract: BACKGROUND
  Chronic kidney disease (CKD) and its progression to end-stage kidney disease (ESKD), requiring lifelong dialysis or kidney transplant, has become a public health epidemic and a financial burden on healthcare systems. The lack of available and appropriately targeted kidney disease education may account for the low awareness of kidney disease, especially among high risk populations. This low awareness can lead to late detection of CKD and an increased likelihood of progression to ESKD. This study utilized focus groups to assess community perceptions of kidney disease, barriers to health care, and educational interventions.
  
  
  METHODS
  Seventeen focus groups were conducted with 201 participants in 5 rural North Carolina counties to assess perceptions of kidney disease, barriers to health care and strategies for raising awareness. Qualitative data analysis was performed based on a grounded theory approach.
  
  
  RESULTS
  Of the 201 participants, 74% were African-American, 96% knew someone with diabetes or hypertension, and 76% of groups contained at least one participant with a family member or friend diagnosed with ESKD. Participants were aware that kidneys acted as filters and mechanisms to cleanse the blood, and stated that alcohol, soda, obesity, diet, and urination problems were risk factors for developing CKD. Participants consistently mentioned that symptoms and risk factors for CKD were key pieces of knowledge. Affordability of health services, medicine, and insurance was seen as the biggest barrier to health care in the communities studied; knowing how to better communicate with physicians was also important. Television and word-of-mouth were mentioned most often as the best tools for outreach and education. Wal-Mart (a chain of large, discount department and grocery stores) and community churches were most commonly mentioned as potential places for screenings.
  
  
  CONCLUSIONS
  Results indicate that there is some basic community knowledge about kidney disease but the risk of developing kidney disease is often directly attributed to lifestyle behaviors rather than diabetes, hypertension, or cardiovascular disease. Future educational interventions need to be focused on the risk factors for kidney disease, and must address financial and geographic barriers to health care and poor communication between consumers and healthcare professionals.
authors.affiliation: UNC Kidney Center, Chapel Hill, North Carolina, USA. caroline_jennette@med.unc.edu
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Jennette
authors.forename: Suma
authors.initials: S
authors.lastname: Vupputuri
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hogan
authors.forename: David A
authors.initials: DA
authors.lastname: Shoham
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Falk
authors.forename: Donna H
authors.initials: DH
authors.lastname: Harward
mesh_terms: D001741:Black or African American; D048909:Diabetes Complications; D017144:Focus Groups; D006266:Health Education / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000150:complications; D008019:Life Style; D009657:North Carolina; D010465:Perception; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology*; D012307:Risk Factors; D012424:Rural Population; D044465:White People