title: Chronic kidney disease (CKD) treatment burden among low-income primary care patients.
abstract: OBJECTIVE
  This study explored the self-management strategies and treatment burden experienced by low-income US primary care patients with chronic kidney disease.
  
  
  METHODS
  Semi-structured interviews were conducted with 34 patients from two primary care practices on Buffalo's East Side, a low-income community. Qualitative analysis was undertaken using an inductive thematic content analysis approach. We applied normalization process theory (NPT) to the concept of treatment burden to interpret and categorize our findings.
  
  
  RESULTS
  The sample was predominantly African-American (79%) and female (59%). Most patients (79%) had a diagnosis of stage 3 CKD. Four major themes were identified corresponding to NPT and treatment burden: (1) coherence--making sense of CKD; (2) cognitive participation--enlisting support and organizing personal resources; (3) collective action--self-management work; and (4) reflexive monitoring--further refining chronic illness self-care in the context of CKD. For each component, we identified barriers hindering patients' ability to accomplish the necessary tasks.
  
  
  CONCLUSIONS
  Our findings highlight the substantial treatment burden faced by inner-city primary care patients self-managing CKD in combination with other chronic illnesses. Health care providers' awareness of treatment burden can inform the development of person-centered care plans that can help patients to better manage their chronic illnesses.
authors.affiliation: Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY, USA lskahn@buffalo.edu.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kahn
authors.affiliation: Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY, USA.
authors.forename: Bonnie M
authors.initials: BM
authors.lastname: Vest
authors.affiliation: School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
authors.forename: Nethra
authors.initials: N
authors.lastname: Madurai
authors.affiliation: Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY, USA.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Singh
authors.affiliation: School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
authors.forename: Trevor R M
authors.initials: TR
authors.lastname: York
authors.affiliation: Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY, USA School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
authors.forename: Charlotte W
authors.initials: CW
authors.lastname: Cipparone
authors.affiliation: Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Reilly
authors.affiliation: Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY, USA.
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Malik
authors.affiliation: Primary Care Research Institute, Department of Family Medicine, University at Buffalo, Buffalo, NY, USA.
authors.forename: Chester H
authors.initials: CH
authors.lastname: Fox
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003071:Cognition; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D011203:Poverty / Q000191:economics* / Q000523:psychology; D011320:Primary Health Care / Q000191:economics*; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000523:psychology; D012648:Self Care / Q000191:economics* / Q000379:methods / Q000523:psychology; D060685:Sense of Coherence; D012944:Social Support
keywords: Chronic kidney disease; health disparities; multimorbidities; practice-based research networks; treatment burden