title: Socioeconomic deprivation and barriers to live-donor kidney transplantation: a qualitative study of deceased-donor kidney transplant recipients.
abstract: OBJECTIVE
  Socioeconomically deprived individuals with renal disease are less likely to receive a live-donor kidney transplant than less-deprived individuals. This qualitative study aimed to identify reasons for the observed socioeconomic disparity in live-donor kidney transplantation.
  
  
  METHODS
  A qualitative study using face-to-face in-depth semistructured interviews.
  
  
  METHODS
  A UK tertiary renal referral hospital and transplant centre.
  
  
  METHODS
  Purposive sampling was used to select deceased-donor transplant recipients from areas of high socioeconomic deprivation (SED) (19 participants), followed by a low SED comparison group (13 participants), aiming for maximum diversity in terms of age, gender, ethnicity, primary renal disease and previous renal replacement therapy.
  
  
  METHODS
  Participants were interviewed following their routine transplant clinic review. Interviews were digitally audio-recorded and transcribed verbatim. Transcripts were coded using NVivo software and analysed using the constant comparison method described in Grounded Theory.
  
  
  RESULTS
  Themes common and distinct to each socioeconomic group emerged. 6 themes appeared to distinguish between individuals from areas of high and low SED. 4 themes were distinct to participants from areas of high SED: (1) Passivity, (2) Disempowerment, (3) Lack of social support and (4) Short-term focus. 2 themes were distinct to the low SED group: (1) Financial concerns and (2) Location of donor.
  
  
  CONCLUSIONS
  Several of the emerging themes from the high SED individuals relate to an individual's lack of confidence and skill in managing their health and healthcare; themes that are in keeping with low levels of patient activation. Inadequate empowerment of socioeconomically deprived individuals by healthcare practitioners was also described. Financial concerns did not emerge as a barrier from interviews with the high SED group. Interventions aiming to redress the observed socioeconomic inequity should be targeted at both patients and clinical teams to increase empowerment and ensure shared decision-making.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Phillippa K
authors.initials: PK
authors.lastname: Bailey
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Ben-Shlomo
authors.affiliation: Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Charles R V
authors.initials: CR
authors.lastname: Tomson
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Owen-Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046148:Donor Selection / Q000191:economics*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D016030:Kidney Transplantation / Q000191:economics*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012923:Social Class; D012944:Social Support; D062606:Tertiary Care Centers; D006113:United Kingdom; D055815:Young Adult
keywords: NEPHROLOGY; QUALITATIVE RESEARCH; SOCIAL MEDICINE