title: Perceived Barriers and Support Strategies for Reducing Sodium Intake in Patients with Chronic Kidney Disease: a Qualitative Study.
abstract: BACKGROUND
  Reducing sodium intake can prevent cardiovascular complications and further decline of kidney function in patients with chronic kidney disease. However, the vast majority of patients fail to reach an adequate sodium intake, and little is known about why they do not succeed.
  
  
  OBJECTIVE
  This study aims to identify perceived barriers and support strategies for reducing sodium intake among both patients with chronic kidney disease and health-care professionals.
  
  
  METHODS
  A purposive sample of 25 patients and 23 health-care professionals from 4 Dutch medical centers attended 8 focus groups. Transcripts were analyzed thematically and afterwards organized according to the phases of behavior change of self-regulation theory.
  
  
  RESULTS
  Multiple themes emerged across different phases of behavior change, including the patients' lack of practical knowledge and intrinsic motivation, the maladaptive illness perceptions and refusal skills, the lack of social support and feedback regarding disease progression and sodium intake, and the availability of low-sodium foods.
  
  
  CONCLUSIONS
  The results indicate the need for the implementation of support strategies that target specific needs of patients across the whole process of changing and maintaining a low-sodium diet. Special attention should be paid to supporting patients to set sodium-related goals, strengthening intrinsic motivation, providing comprehensive and practical information (e.g., about hidden salt in products), increasing social support, stimulating the self-monitoring of sodium intake and disease progression, and building a supportive patient-professional relationship that encompasses shared decision making and coaching. Moreover, global programs should be implemented to reduce sodium levels in processed foods, introduce sodium-related product labels, and increase consumer awareness.
authors.affiliation: Department of Medical Psychology, Leiden University Medical Center, p/a Wassenaarseweg 52, 2300 RB, Leiden, The Netherlands, Y.Meuleman@lumc.nl.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Meuleman
authors.forename: Lucia
authors.initials: L
authors.lastname: Ten Brinke
authors.forename: Arjan J
authors.initials: AJ
authors.lastname: Kwakernaak
authors.forename: Liffert
authors.initials: L
authors.lastname: Vogt
authors.forename: Joris I
authors.initials: JI
authors.lastname: Rotmans
authors.forename: Willem Jan W
authors.initials: WJ
authors.lastname: Bos
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: van der Boog
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.forename: Gert A
authors.initials: GA
authors.lastname: van Montfrans
authors.forename: Tiny
authors.initials: T
authors.lastname: Hoekstra
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010465:Perception; D011369:Professional-Patient Relations; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012944:Social Support; D012964:Sodium / Q000008:administration & dosage*
chemical_list: D012964:Sodium