A qualitative study exploring self-management behaviour of patients with chronic kidney disease during COVID-19

doi:10.21203/rs.3.rs-2589672/v1

Background

Chronic kidney disease (CKD) is a major public health issue. COVID-19 immensely affects people with chronic diseases including patients with CKD. We aimed to explore the factors that might have an impact on the self-management of patients receiving haemodialysis (HD) and patients with kidney transplant (KTx) during COVID-19 by using the Health Belief Model (HBM).

Methods

A qualitative phenomenology research design was used to build evidence to establish the effects of the COVID-19 pandemic on self-management behaviour of patients with CKD. Data were analysed using framework analysis to identify key factors influencing patients’ perceptions regarding the self-management of their conditions during COVID-19.

Results

Eighteen patients with KTx and seven with HD were interviewed during the lockdown. Having CKD was discussed as a major contributing factor contributing to the perception of susceptibility. The fear of death expressed by the participants had a profound impact on self-management. Delays in check-ups and monitoring, staying at home, financial burden of treatment, lack of trusted information, safety of test sites, and fatalistic attitudes of patients were the barriers identified in the study towards self-management behaviours of patients. External and internal triggers were the motivators of adopting self-management behaviour.

Conclusion

This study provides an in-depth view of factors impacting the adoption of self-management behaviour of patients with CKD during COVID-19 and may provide healthcare providers and policymakers knowledge about factors contributing towards compromised patient care.

COVID-19

chronic kidney disease

health belief model

qualitative research

self-management

Chronic kidney disease (CKD) is defined as abnormalities in kidney structure or function that last longer than three months, with significant health consequences (1). CKD is a major public health issue whose global prevalence is predicted to be 13.4% (2). A study by Süleymanlar et al. shows that the prevalence of CKD in Turkey is around 15.7% (3). According to the 2020 Turkish Society of Nephrology (TSN) (4), the total number of patients receiving chronic hemodialysis (HD) in Turkey were 60,558, and patients with kidney transplantation (KTx) are 19,405.

Based on the 2020 TSN report, the COVID-19 pandemic resulted in remarkable changes in treatment offered to patients with CKD in Turkey. Many kidney transplant centres were forced to halt their operations, resulting in a considerable drop in the number of kidney transplants as well as a disruption in the follow-up of patients with transplants as compared to prior years (4). It is well established that individuals with chronic conditions are more vulnerable to the COVID-19 virus (5). In accordance with the data of the same report, the incidence of COVID-19 was 19.6% in patients receiving HD and 8.7% in patients with KTx, while the mortality rate due to COVID-19 was 24.4% in patients receiving HD and 11.3% in patients with KTx (4). Other studies demonstrated that individuals with CKD were more susceptible to COVID-19 and had a higher risk of death from the virus than healthy individuals (6).

A high level of patient engagement and interest is a requirement for long-term CKD treatment management, both in decision-making and in the implementation of care (7). Treatment adherence is important in patients with CKD, due to the use of excessive medications and the need for frequent hospital visits during the treatment process (8). Many comorbidities including hypertension and diabetes are common in patients with CKD, and people on average are reported to use around 8–10 tablets of medication per day (9). During COVID-19 social distancing, health service disruptions, and lockdowns were reported to impact the treatment, management, and lack of follow-up could result in patient adversity (6, 10, 11). Thus, self-management of patients with CKD gained importance during COVID-19.

Self-management behaviour in patients with chronic diseases is defined as patients’ dedicated commitment towards a healthcare activity to maintain a satisfying quality of life by solving problems, controlling the chronic disease, and adjusting their daily life to monitor their own condition and emotions (12). Self-management in patients with CKD may include spotting initial warnings, self-adjustments of home-care regimes, and adhering to medication, exercise, and diet recommendations (7). Since CKD is irreversible and patients with HD and KTx need lifelong therapy and their self-management behaviours play a critical role in determining their life quality and quantity (12). However, how people value and make changes to adopt these self-management practices is crucial for the success of such management plans.

The HBM was the mostly used model to understand how patients with CKD view health threats, adherence, and self-management behaviour (13–17). The HBM states that an individual’s adoption of appropriate behaviour to prevent a health problem may be influenced by certain individual factors such as perceived susceptibility (beliefs about the possibility of getting a disease or condition), perceived severity (subjective assessment of the severity of a health problem and its possible consequences), perceived benefits (perceived benefits of an action to decrease the risk of disease), perceived barriers (belief about the obstacles of taking action), cues to action (perceived motivators towards taking action), and self-efficacy (an individual's confidence of his or her competence to successfully perform a behaviour (Champion and Skinner, 2008).

The aim of this study was to explore factors that might have an impact on the adoption of self-management behaviour of patients with CKD during COVID-19 by using the HBM in Turkey.

Study Design

As this study aimed to explore in-depth views and perceptions of patients with CKD, this study used a qualitative phenomenology research design to explore the effects of COVID-19 on self-management behaviour of patients with CKD.

Study Population, Setting, and Recruitment Criteria

The study population consisted of patients with CKD who applied for CKD treatment, or follow-up at the Nephrology Clinic of Ibn-i Sina Hospital in Ankara University at the time study began. The patients who met the inclusion criteria of receiving HD or a KTx were included in the study. The participants were informed about the purpose of the study and the expertise of the researchers. Patients under 18 years old and/or who cannot decide for themselves were excluded from the study. The interviews were conducted within the Nephrology Clinic of the Ibn-i Sina Hospital in Ankara, Turkey.

Data Collection

Data collection was carried out with a qualitative method using semi-structured face-to-face interviews between July and December 2021. The semi-structured interview allows for conveying the participants' perceptions or experiences about a certain phenomenon of interest to the researcher(s) (19). The interview guide was designed by three authors (MBU, GG, AP) after reviewing relevant literature, and investigating the impacts of previous pandemics on chronic patients’ behaviour related to disease management (Table. 1). The framework of the HBM also guided the interview guide development as well as was used as a guiding framework for presenting data in this study. The interview guide was piloted by interviewing two patients to assess the face and content validity. No changes were made. These interviews were not included in the study sample for analysis. The interviews were conducted by three authors (MBU, AP, GG) and lasted for 15 minutes to 45 minutes. Participants provided written consent before the interviews. Audio-recording of the interviews was taken after obtaining participants’ consent and participants who did not accept to take part in the study were excluded. Data was collected till data saturation was agreed upon by the authors conducting interviews.

Table 1. General outline of the interview guide mapped onto the Health Belief Model

Theme/HBM Components	Questions
Opening Questions	What do you think about the relationship between COVID-19 and chronic patients?
Perceived Threat	How do you consider the severity of COVID-19 for people who do not have any chronic conditions?
Perceived Severity	How do you consider the severity of COVID-19 for people who have a chronic condition?
Perceived Susceptibility	Have you tested positive before? If yes, please describe your experiences and its effect on your health. If no, if you were to get COVID 19, what would be the impacts of having the virus on your health?
Self-Efficacy	How did you manage your treatment during the pandemic? Can you explain your confidence in managing your treatment? Do you think you were confident in managing your treatment when you were tested positive? Do you think you would be confident in managing your treatment if you were to tested positive?
Perceived barriers to self-management	Have you experienced any barriers to manage your treatment at this time of pandemic? If yes, how did you feel? and how did you solve the problems you faced? If no, what did you need to solve the problems you faced?
Perceived benefits of self-management	What were the benefits of self-managing your treatment during the pandemic?
Cues to Action	What were the driving factors that activate you to engage with your treatment management during the pandemic? Did you get any support from somewhere or somebody?
Closing Questions	Do you think there are missing points you want to bring up?

Data Analysis

The framework analysis was performed for data analysis by three authors manually (MBU, GG, AP). The framework analysis was applied in a six-step approach adopted from(20) : transcription, familiarization, coding, applying a framework, charting the data and interpreting the data. First, all interview recordings were anonymized with a protocol number (the protocol number was coded for haemodialysis patients as “DP” and transplant patients as “TP”) and a sequence number for each interviewee [e.g. TP4]. All the interviews conducted in Turkish were transcribed verbatim. Second, a naive reading of the verbatim transcripts was done to become familiarise with the data. Third, the authors (MBU, GG, AP) independently assigned codes to transcripts capturing underlying concepts of the HBM and charted them into a framework matrix. Charting is where data is deductively coded and summarized, each column being the construct of HBM and each row representing participants. The similar codes of data were grouped into sub-themes and discussed every two weeks. With the consensus of the entire research team, the reviewed sub-themes were mapped to the constructs of the HBM which can be seen in Fig. 1. Finally, a detailed report was drafted by MBU, AP, and GG to give an overview of the exploratory findings of the study. The research principles of COREQ for reporting qualitative research were closely followed in this study (21).

Data Trustworthiness and Validity

Trustworthiness was achieved through credibility, dependability, and transferability. Credibility was attained by using data triangulation by recruiting both HD and KTx patients. Additionally, to ensure credibility, a peer debriefing was used to get feedback not just on data analysis but also on the various details of the research. Dependability was established by reviewing and comparing the research procedure with other studies (22). Additionally, a transparent description of study procedures, data collection, and analysis by three independent authors provides the dependability of this study. In addition, the three authors who analysed the data provide different expertise because they belong to diverse backgrounds such as social pharmacy, clinical pharmacy, and internal medicine specialist (nephrologist) and bring reliability and confirmability to the findings. Thick descriptions of the phenomena, setting, and participants’ quotes have been provided which help researchers to make a transferability judgment (23)and of the study findings to other contexts.

Eighteen patients with KTx and seven patients receiving HD were interviewed. The interviewed patients consisted of nine women and sixteen men. The patient's mean age was 44.7, ranging from 19–74. Considering the employment status of the patients, eleven patients were retired, seven patients were actively working, and seven patients were not working. No participants withdrew from the study. The demographic of the study population has been presented in Table 2.

Table 2

Demographic data of interviewed patients
Patient	Disease state	Gender	Age	Employment status	Education	COVID-19 Vaccination status
1	HD	Male	67	Retired	Elementary	Vaccinated
2	HD	Male	40	Active	University	Vaccinated
3	HD	Male	74	Retired	Elementary	Vaccinated
4	KTx	Female	31	Not working	Elementary	Vaccinated
5	KTx	Male	49	Retired	High School	Vaccinated
6	KTx	Female	33	Active	Elementary	Vaccinated
7	KTx	Male	65	Retired	High School	Vaccinated
8	KTx	Male	51	Active	High School	Vaccinated
9	KTx	Male	55	Retired	University	Vaccinated
10	KTx	Female	37	Active	High School	Vaccinated
11	KTx	Male	46	Retired	High School	Vaccinated
12	KTx	Male	54	Retired	Elementary	Vaccinated
13	KTx	Female	24	Not working	High School	Vaccinated
14	KTx	Female	19	Not working	High School	Vaccinated
15	KTx	Male	24	Not working	High School	Vaccinated
16	HD	Male	30	Not working	University	Not vaccinated
17	HD	Male	69	Retired	Elementary	Vaccinated
18	KTx	Female	19	Not working	High School	Vaccinated
19	KTx	Male	32	Active	High School	Vaccinated
20	KTx	Male	42	Active	University	Not vaccinated
21	KTx	Male	49	Active	Elementary	Vaccinated
22	KTx	Female	21	Not working	High School	Vaccinated
23	KTx	Male	56	Retired	High School	Vaccinated
24	HD	Female	69	Retired	University	Vaccinated
25	HD	Female	61	Retired	University	Vaccinated

The results of the study show the perceived susceptibility due to COVID-19, the perceived severity of COVID-19, the perceived barriers to self-management behaviour, the perceived benefits of self-management, self-efficacy, and cues to action underpinned by the essential components of the HBM.

Perceived Susceptibility to COVID-19

Having chronic kidney disease

Most of the participants were aware of the symptoms of COVID-19, and they had a perception that having a KTx or receiving HD would increase the risk of experiencing the symptoms of COVID-19 worse. Patients shared that they felt susceptible to the worsened effects of COVID-19:

“This is a fearful process for us! Lots of drugs like immunosuppressants make us delicate. For instance, if I’m caught… I think I have only a ten percent chance to survive.” (TP23)

Perceived Severity of COVID-19

The more the participants perceived COVID-19 as severe the more they might adopted self-management behaviour. Two sub-themes were identified that had an impact on the participants’ perception of the severity of having caught COVID-19.

Fear of death

Participants highlighted that they had to cope with the constant feeling of losing their lives due to COVID-19:

“I have been on dialysis for seventeen years and in the end had a chance to be transplanted... There were times that I have been finding myself in fear… If I get this virus, would I hospitalize? Maybe I will die before losing my kidney…” (TP11).

Past experiences of own and others

Patients who had bad memories such as kidney transplant rejection in their past were more likely to perceive COVID-19 as severe. Moreover, losing friends or loved ones due to COVID-19 had an impact on the perception of severity:

“A friend next to my bed got COVID-19. He passed away... it wasn’t easy to handle. We, all in the dialysis unit, were very negatively affected... This was a turning point for me!” (HD24)

Perceived Barriers to Self-Management Behaviour During COVID-19

The followings were the factors identified by the participants that could have an impact on the patient's self-management behaviour during COVID-19.

Delays in check-ups and monitors

Some patients shared that they had to either delay or cancel their regular hospital visits due to the fear of catching COVID-19. This led to a disruption in their treatment, and they felt that they had failed to self-manage the process on their own:

“The last time I came for a check-up was in October 2019. I haven't been here [means hospital] since the pandemic started. I tried to control my urine at home just not using the toilet and gathering it in a bottle to see if its colour is abnormal, but at home, these were hard to sort out!” (TP23)

Staying at home

Patients shared the impact of staying at home voluntarily or being in quarantine due to COVID-19 on self-management behaviour. They shared that changes in dietary habits, sedentary lifestyles, and lack of exercise caused them to gain weight. Patients felt that being unhealthy was a factor they perceived was going to become an obstacle toward CKD self-management:

“I am always eating across the TV and do not want to go outside even for shopping.” (TP11)

Some of the patients expressed that staying at home impacted their mental health and shared:

“…very boring, depressing atmosphere at home. You cannot see your friends and go out for a dinner. When you become stressed, it hits your whole body, especially us.” (TP13)

Financial burdens of treatment

Participants shared that increased health-related expenditures due to COVID-19 was a barrier against self-management. Some patients shared the financial burden of COVID-19. They experienced this whilst traveling and trying to find a suitable place to settle down near the hospital where their treatment took place:

“I took out a loan and bought a car, which put me in a tight spot… and when we come to this city for hospital bits, we must stay at a hotel… There's no other place to stay in a pandemic. Some of our friends who cannot afford to stay at a hotel had to spend the night in the hospital garden, what a shame!” (TP22)

Lack of trusted information

Patients shared that too much information on COVID-19 left them uncertain about what information to believe. People shared that having access to information from various sources seemed to have a negative impact on the self-management including whether to be vaccinated or to use alternative medicines to boost their immune systems:

“I have congenital kidney disease. Someone says the vaccine causes infertility, the other says it damages the kidney, and I'm a little bit nervous about what to believe.” (TP14)

Safety of test sites

Participants expressed that they were self-managing their testing to continue their dialysis during COVID-19. They mentioned that they were aware that they had to be tested to continue their dialysis during COVID-19. Patients shared that while getting dialysis, because of the high risk of COVID-19, they were advised against using testing sites that were conveniently located inside the hospital. This was an additional challenge and patients believed to have impacted their usual care:

“Hospital staff warned me that the test place was extremely contagious as there were a lot of COVID-19 patients inside. He said, “We can't get your test here, because you have kidney disease. Let's direct you to the dialysis unit, they can take the test and send your sample to us”. When I got the unit, they turned me down. They referred me to give my test in the emergency room at midnight. I was tired of rushing around and became angry. It shouldn’t take too long to find a suitable place!” (HD25)

Perception of fatalism

Patients shared that the perception of fatalism negatively affected their self-management behaviour towards CKD. If patients believed that there is nowhere to run from destiny, this behaviour has been called the fatalism effect. This attitude also impacted their behaviours to get vaccinated, paying attention to social distancing, and following home-care regimens. Some patients shared a resignation and shared there might be no escape from COVID-19:

“There was fear in the first three months of the pandemic, but now I am relaxed… Allah Almighty has given me this life and will take it back. No matter how cautious you are, COVID-19 will find you anyway.” (TP13)

Perceived Benefits of Self-Management Behaviour During COVID-19

Some of the participants shared that they believed in the benefits of practicing self-management behaviours such as exercising and following a proper diet during the pandemic:

“I know monitoring myself has benefits for my chronic conditions… I am also trying to maintain my diet to live healthier.” (TP6)

Self-efficacy of Self-management Behaviour During COVID-19

Participants shared that as they have been coping with CKD for many years, they feel more in control and self-efficient to handle unfortunate circumstances and difficulties in assessing care pathways and facilities:

“The pandemic did not affect my treatment process much. I could manage… have trust … because I have been diagnosed for a long time.” (TP14)

Cues to Action

The following subthemes show participants' views on external and internal factors triggering their self-management behaviours:

External stimuli

Participants reported that getting moral support from families, relatives, and their workplaces helped them to cope with the burden of the pandemic and its effect on their health. Some of the participants who were employed shared they needed a supportive approach regarding flexibility of working hours when their work performance decreased due to COVID-19:

“I feel so lucky that my colleagues at work, especially our managers, are not complaining while putting up with me as I couldn’t come to the office several times. We need to see tolerance (patience) for our decreased work performance.” (P10)

CKD patients expressed that due to COVID-19 related impact on their ability to work and earn a livelihood, having government funds for chronic patients might help support them financially and avoid any health-related impact:

“If the government helped us to cover some of our expenses, that would have been nice!” (P10)

Internal stimuli

Self-perceived sickness

Self-perception of illness had an impact on one’s motivation to adopt self-management behaviour during the pandemic. Patients who considered themselves in a more high-risk situation felt obliged to adhere to routine check-ups, COVID-19 protective behaviours, and develop a healthy lifestyle.

“I am a newly transplanted patient and I know I am at risk. My values are constantly fluctuating. I had to come to the hospital every weekend, I couldn't put off my visits… I am coming with a double mask, with these things [means face coverings and shields]” [TP10]

Deeply exploring the factors affecting the self-management of patients with CKD has allowed us to understand the needs of patients during the pandemic as well as the barriers and triggers that have an impact on the adoption of self-management behaviour.

Perceived susceptibility to COVID-19

In the study, patients with CKD had a strong sense of perceived susceptibility toward getting infected with COVID-19 and were found to be seemed anxious during this period due to their susceptibility to COVID-19 (24, 25). This is congruent to other study findings who also report being a patient with CKD increased patients’ perception of susceptibility to COVID-19 (26, 27). This has been reported in a study that shows that patients with CKD in COVID-19 experienced an increased risk of hospitalization, severity in COVID–19 symptoms, admission to intensive care units, and high mortality rates (28).

Perceived severity of COVID-19

In our study, the perceived severity of COVID-19 was a major concern among the study population and was reported to have an impact on the adoption of self-management behaviour, which was mostly related to the fear of death. This is also reported in a study exploring the self-management of people with diabetes which states that COVID-19 was found related to an increase in the fear of death and impact on the self-management of individuals (29). Even though there are studies (30, 31) showing fear as a motivator of adopting a self-management behaviour in the face of COVID-19, further research is needed to explore the difference in the perception of the severity of COVID-19. In this study, patients who had witnessed people suffering due to COVID-19 were more likely to perceive and fear death from COVID-19. This is shown in another study where the perceived severity of leptospirosis was reported to be reinforced by seeing other patients die or having experienced severe consequences due to leptospirosis infection (32).

Perceived barriers to self-management during COVID-19

This study reports that people might delay follow-up or monitoring for CKD during COVID-19. People with CKD also shared that they might be able to self-manage their CKD despite the inability to visit hospitals regularly (24, 25, 33). Our study reports that people with CKD might be experiencing mental health issues due to COVID_19, which remains consistent with other studies reporting the negative effect of COVID-19 on mental health during quarantine (34–36).

Besides from delayed follow-ups mental consequences of quarantine, patients shared that the reduction of physical activity and a healthy diet were inhibiting their self-management. This has also been reported in other studies, which discuss how staying in quarantine may be inhibiting people from adopting and practice of better health behaviours (36, 37).

COVID-19-related financial burden was also a barrier to self-management in this study. This is also reported in another study from Turkey, which reported that patients receiving HD with high incomes were better at managing their treatment (38). Similar challenges have been reported in people with cancer, where financial incompetence was related to reduced healthcare visits during the pandemic and recommended government support vital for chronic patients (39, 40).

People in this study also shared their confusion and mistrust in available information compromising their ability to self-manage their disease, which is also reported by other studies, (41). As a unique finding of our study, the perception of fatalism caused patients with CKD to be unresponsive to events and feeling a state of belief, of not having control over their lives. This was reported to be a sign of a lack of interest in self-management and losing the opportunity to self-manage their condition and could potentially lead to patient harm.

Perceived benefits of self-management behaviour during COVID-19

Previous studies show the perceived benefits of self-management might have a direct impact on self-care behaviours (42). Self-management can enhance the well-being of patients with CKD by helping with weight and blood pressure control, encouraging regular exercise, and improving mental health (43, 44). Since perceived benefits are one of the predictors of engaging in positive health behaviour (45), thus informing patients with CKD about the benefits of self-management is crucial.

Self-efficacy of self-management behaviour during COVID-19

Previous studies examining the self-efficacy of patients with CKD patients to self-manage reveal that several factors including age, marital status, family support, stage of disease, and education level have an impact on self-efficacy (46, 47). This study adds that years of experience with CKD might be another factor affecting the self-efficacy of patients with CKD in self-management during COVID-19. Furthermore, studies exploring how fatalism might lead to low self-efficacy, which in turn affects perceived severity (41) might be a future direction for researchers to understand the causality between self-efficacy, perceived fatalism, and severity among CKD patients.

Cues to action

Supportive behaviour from family and relatives was determined to positively encourage patients to adopt self-management behaviours (46). Moreover, having flexibility in the employment sector is more likely to prompt patients with CKD to be able to self-manage. Although some are in favour of flexibility in the working environment (48), others mentioned that shifts in work hours and flexibility can lead to increased work stress, fatigue, burnout, and time conflict (49). New studies should look at understanding the relationship between flexibility in work schedules and employee well-being in CKD and other chronic patients. Internally, self-perception of illness might be an activator of adopting a new behaviour such as self-management. In a study exploring diabetes patients’ decision-making process regarding contraceptive usage by using HBM, patients who identified themselves as having poor health are avoiding pregnancy and have a likelihood to use contraceptives as a cue to action (50).

Further research

This study provides useful insights into the self-management of patients with CKD during COVID-19. The findings in this study have shed some light on the factors affecting the adoption of self-management behaviours in patients with CKD. This study was conducted amidst COVID-19, therefore factors impacting self-management behaviour may be examined differently today when COVID-19 has alleviated its impact on individuals, societies, and cultures. Future studies should also carefully consider the factors identified in the study to help inform policymakers to develop scientific emergency measures. New interventions, self-management care pathways and virtually supporting and monitoring of people with chronic conditions could lead to reduced patient-related mortality and morbidity and help reach better patient outcomes.

Strengths and Limitations

This study extends previous work by exploring the self-management behaviour of patients receiving a KTx and HD during COVID-19. The thick rich descriptions give exemplars that may be valuable to clinicians, researchers, and health policymakers who might wish to reflect on their daily practices.

The study was conducted across a single hospital in Turkey and hence the findings may not be transferable to the other parts of the country. Due to the sampling methodology used to recruit patients the data collection phase of this study was executed at the dialysis units and the researchers could not spend a long time with the participants due to the COVID-19 restrictions at that time in the hospital. The participants’ expressions might have been limited due to restrictions on both interviewer and interviewees.

Patients with CKD perceive themselves as susceptible to excessive harm from COVID-19 and expressed a fear of death. Many factors in a patient care pathway; both external and internal may impact the self-management behaviour of people with CKD. The knowledge of this study highlights the need for patient inclusivity and their respective needs to be considered by healthcare teams while designing therapeutic regimes. Policymakers should develop protocols and guidelines for people with chronic conditions in case of emergencies like COVID-19 and ensure patients are offered full access and support to treatment and lifesaving facilities.

CKD – chronic kidney disease

HD – haemodialysis

HBM – Health Belief Model

KTx – kidney transplant

TSN – Turkish Society of Nephrology

Ethics approval and consent to participate

This study received ethical approval from the Ankara University School of Medicine Human Research Ethics Committee (approval date: 17/06/2021; protocol number: İ6-397-21). Written informed consent was obtained from each participant. Data confidentiality was ensured, and all data is anonymized. The study complies with the Declaration of Helsinki.

Consent for publication

Not applicable.

Availability of data and materials

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

The authors of this study declare that they received no funding or financial support for the research, authorship, and/or publication of this article.

Authors' contributions

MBU: Conceptualization, Methodology, Investigation, Interviewing, Data Curation, Data Analysis, Writing—Original Draft Preparation

GG: Conceptualization, Methodology, Investigation, Interviewing, Data Curation, Data Analysis, Writing— Review & Editing

AP: Conceptualization, Methodology, Investigation, Interviewing, Data Curation, Writing— Review & Editing

ŞŞ: Conceptualization, Writing— Review & Editing Supervision

Acknowledgements

The authors declare that no funds, grants, or other support were received for this work. We would like to thank the patient who volunteered to participate in this study, especially during COVID-19. We would also like to thank the physicians and the staff of the Department of Nephrology at Ibn-i Sina Hospital who helped facilitate the research team in data collection and Dr. Ayesha Iqbal for providing feedback for the whole research project design and data analysis.

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No competing interests reported.

A qualitative study exploring self-management behaviour of patients with chronic kidney disease during COVID-19

Status:

Version 1

Abstract

Background

Methods

Results

Conclusion

Figures

Background

Methods

Study Design

Study Population, Setting, and Recruitment Criteria

Data Collection

Data Analysis

Data Trustworthiness and Validity

Results

Perceived Susceptibility to COVID-19

Having chronic kidney disease

Perceived Severity of COVID-19

Fear of death

Past experiences of own and others

Perceived Barriers to Self-Management Behaviour During COVID-19

Delays in check-ups and monitors

Staying at home

Financial burdens of treatment

Lack of trusted information

Safety of test sites

Perception of fatalism

Perceived Benefits of Self-Management Behaviour During COVID-19

Self-efficacy of Self-management Behaviour During COVID-19

Cues to Action

External stimuli

Internal stimuli

Self-perceived sickness

Discussion

Perceived susceptibility to COVID-19

Perceived severity of COVID-19

Perceived barriers to self-management during COVID-19

Perceived benefits of self-management behaviour during COVID-19

Self-efficacy of self-management behaviour during COVID-19

Cues to action

Further research

Strengths and Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1