title: Motivations, Challenges, and Attitudes to Self-management in Kidney Transplant Recipients: A Systematic Review of Qualitative Studies.
abstract: BACKGROUND
  Kidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication nonadherence remains a leading cause of transplant loss, and inadequate self-management undermines transplantation and other health outcomes. We aimed to describe kidney transplant recipients' motivations, challenges, and attitudes toward self-management.
  
  
  METHODS
  Systematic review and thematic synthesis of qualitative studies.
  
  
  METHODS
  Kidney transplant recipients.
  
  
  METHODS
  MEDLINE, EMBASE, PsycINFO, and CINAHL were searched to October 2014.
  
  
  METHODS
  Thematic synthesis.
  
  
  RESULTS
  50 studies involving 1,238 recipients aged 18 to 82 years across 19 countries were included. We identified 5 themes: empowerment through autonomy (achieving mastery, tracking against tangible targets, developing bodily intuition, routinizing and problem solving, and adaptive coping), prevailing fear of consequences (inescapable rejection anxiety, aversion to dialysis, minimizing future morbidity, trivialization and denial, and defining acceptable risks), burdensome treatment and responsibilities (frustrating ambiguities, inadvertent forgetfulness, intrusive side effects, reversing ingrained behaviors, and financial hardship), overmedicalizing life (dominating focus, evading patienthood, and succumbing to burnout), and social accountability and motivation (demonstrating gratitude toward medical team, indebtedness to donor, and peer learning).
  
  
  CONCLUSIONS
  Non-English articles were excluded.
  
  
  CONCLUSIONS
  Self-efficacy and social accountability are motivators for self-management, although adherence can be mentally and physically taxing. Multicomponent interventions incorporating personalized care planning, education, psychosocial support, decision aids, and self-monitoring tools may foster self-management capacity and improve transplantation outcomes.
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Jamieson
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Camilla S
authors.initials: CS
authors.lastname: Hanson
authors.affiliation: Department of Medicine, The University of Chicago, Chicago, IL.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Josephson
authors.affiliation: Center for Healthcare Studies and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Gordon
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Department of Nephrology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Halleck
authors.affiliation: Department of Nephrology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. Electronic address: allison.tong@sydney.edu.au.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D006084:Graft Rejection / Q000517:prevention & control / Q000523:psychology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000523:psychology / Q000534:rehabilitation; D055118:Medication Adherence / Q000523:psychology; D009042:Motivation; D036301:Qualitative Research; D012648:Self Care / Q000379:methods / Q000523:psychology
keywords: Self-management; chronic condition; end-stage renal disease (ESRD); kidney transplantation; medication adherence; patient-centered care; qualitative research; transplant recipient