title: Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients.
abstract: OBJECTIVE
  Adherence to immunosuppressive medication is essential for favourable kidney transplant outcomes. The present study aims to investigate how self-efficacy beliefs, health locus of control and religiosity are associated with adherence to immunosuppressives in post kidney transplant recipients.
  
  
  METHODS
  This is a cross-sectional study with 88 recipients with more than 1 year after transplantation. Three methods were used to classify patients as adherent or non-adherent: Basel Assessment of Adherence Scale for Immunosuppressives - BAASIS, the collateral report and blood levels of immunosuppressive medications. Self-efficacy, health locus of control, and religiosity were evaluated applying General Perceived Self-Efficacy Scale, Multidimensional Health Locus of Control Scale and Duke University Religion Index, respectively. Non-adherence was modelled by uni- and multivariated analysis.
  
  
  RESULTS
  Sixty-three percent of the patients were male, age 47.2 ± 12.9 years, and median post-transplant time 108.71 (49.0-266.0) months. We found 70.5% of patients were non-adherent through at least one method. Adherent patients presented higher self-efficacy scores (45.1 ± 4.9 vs 38.3 ± 8.6; P < 0.001) and higher intrinsic religiosity (14.0 ± 1.6 vs. 12.8 ± 2.5; P = 0.016) compared to the non-adherents. Organizational and non-organizational religiosity did not differ between these groups. By logistic regression, non-adherence was associated with lower self-efficacy (OR 0.81, IC 0.70-0.92, P = 0.002), chance locus of control (OR 1.23, IC 1.04-1.45, P = 0.016) and lower intrinsic religiosity (OR 0.56, IC 0.38-0.84, P = 0.006).
  
  
  CONCLUSIONS
  Our study showed that self-efficacy, chance locus of control, and intrinsic religiosity were associated with non-adherence to immunosuppressives. A broader perception of the kidney transplant patient´s integrality can help health professionals to design strategies to promote adherence in this population.
authors.affiliation: Renal Transplantation Unit, Division of Nephrology, University Hospital - Federal University of Juiz de Fora, Minas Gerais, Brazil. Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Brazil.
authors.forename: Andresa Nascimento
authors.initials: AN
authors.lastname: Silva
authors.affiliation: Renal Transplantation Unit, Division of Nephrology, University Hospital - Federal University of Juiz de Fora, Minas Gerais, Brazil. Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Brazil.
authors.forename: Lucas
authors.initials: L
authors.lastname: Moratelli
authors.affiliation: Renal Transplantation Unit, Division of Nephrology, University Hospital - Federal University of Juiz de Fora, Minas Gerais, Brazil. Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Brazil.
authors.forename: Paula Liziero
authors.initials: PL
authors.lastname: Tavares
authors.affiliation: Renal Transplantation Unit, Division of Nephrology, University Hospital - Federal University of Juiz de Fora, Minas Gerais, Brazil. Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Brazil.
authors.forename: Elisa De Oliveira
authors.initials: EO
authors.lastname: Marsicano
authors.affiliation: Renal Transplantation Unit, Division of Nephrology, University Hospital - Federal University of Juiz de Fora, Minas Gerais, Brazil. Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Brazil.
authors.forename: Renata Romanholi
authors.initials: RR
authors.lastname: Pinhati
authors.affiliation: Renal Transplantation Unit, Division of Nephrology, University Hospital - Federal University of Juiz de Fora, Minas Gerais, Brazil. Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Brazil.
authors.forename: Fernando Antonio Basile
authors.initials: FA
authors.lastname: Colugnati
authors.affiliation: Department of Medicine, Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES) Federal University of Juiz de Fora, Juiz de Fora, Brazil.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Lucchetti
authors.affiliation: Renal Transplantation Unit, Division of Nephrology, University Hospital - Federal University of Juiz de Fora, Minas Gerais, Brazil. Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Brazil. heladysanders@gmail.com.
authors.forename: Helady
authors.identifier: http://orcid.org/0000-0001-8603-1331
authors.initials: H
authors.lastname: Sanders-Pinheiro
mesh_terms: D000328:Adult; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007389:Internal-External Control; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods / Q000523:psychology; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D054539:Medication Therapy Management; D008875:Middle Aged; D012067:Religion; D020377:Self Efficacy
chemical_list: D007166:Immunosuppressive Agents
keywords: kidney transplantation; locus of control; medication adherence; religiosity; self-efficacy