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. Author manuscript; available in PMC: 2022 Jan 11.
Published in final edited form as: Semin Nephrol. 2021 Nov;41(6):487–504. doi: 10.1016/j.semnephrol.2021.10.002

Table 2.

Psychological Drivers of Kidney Disease Self-Management Behaviors

Patient-Reported Self-Management Behavior(s) Study Study Population,Sample Size (N), Study Design Additional Notes andDetails of Effect Size if Reported
Subjective health literacy
Summary of self-management behaviors Chen et al, 201837 CKD (N = 410)
Cross-sectional; quantitative		 Standardized β = 0.26
R2 = 0.50
R2 = 0.52 for health literacy, age, social support, and marital status
Medication adherence Patzer et al, 201662 Kidney transplant (N = 99)
Cross-sectional; quantitative		 OR, 2.93 (95% CI, 1.13–7.56) for association between health literacy and tacrolimus adherence, measured by either self-report or serologic level
Demian et al, 201663 Kidney transplant (N = 96)
Cross-sectional; quantitative		 Unstandardized β = −0.31
R2 = 0.08 for health literacy, age, sex, employment, depressive symptoms
Diet adherence Thomas et al, 200174 Hemodialysis (N = 276)
Cross-sectional; quantitative		 OR, 1.09 (95% CI, 1.00–1.19) for association between higher dietary knowledge and higher dietary adherence
Patients all age >50
Visit adherence Green et al, 201364 Hemodialysis (N = 260)
Prospective (2y); quantitative
(study was part of a larger randomized controlled trial)		 Missed, 0.6% versus 0.3%; adjusted incidence rate ratio, 2.14 (95% CI, 1.10–4.17) adjusted for age, sex, self-reported race, employment, income, comorbid conditions, dialysis vintage in years, dialysis schedule, type of vascular access, dialysis unit, randomization group
Perceived knowledge
Summary of self-management behaviors Martin et al, 201072 Kidney transplant (N = 38)
Cross-sectional; qualitative		 NA
Schmidt-Mohler et al, 201473 Kidney transplant (N = 12)
Cross-sectional; mixed-methods		 NA
Kahn et al, 201569 CKD (N = 34)
Cross-sectional; qualitative		 NA
Many participants were uninsured and underinsured
Baay et al, 201967 CKD (N = 37)
Cross-sectional; qualitative		 NA
Hwang et al, 202068 CKD (N = 20)
Cross-sectional; qualitative		 NA
Knowledge related to diet was a barrier to self-management
Ranahan et al, 202071 Kidney transplant (N = 20)
Cross-sectional; qualitative		 NA
Schrauben et al, 202075 CKD (N = 401)
Cross-sectional; quantitative		 Standardized β = 1.07 (95% CI, 0.50–1.63) adjusted for sex, self-reported race, education, income, estimated glomerular filtration rate, diabetes, urine protein-creatinine ratio, hypertension awareness of CKD diagnosis, body mass index, number of times seen by nephrologist in 1 y
Nair et al, 20217 CKD (N = 50)
Cross-sectional; qualitative		 NA
Exercise and physical activity Goodman et al, 200446 Hemodialysis (N = 50)
Cross-sectional; quantitative		 16% reported a lack of knowledge regarding benefits of exercise
Painter et al, 201447 Hemodialysis (N = 15 staff; 6 patients)
Cross-sectional; qualitative		 NA
Jayaseelan et al, 201876 Hemodialysis (N = 274)
Cross-sectional; quantitative		 30%−50% scored incorrectly on various questions related to benefits of exercise
Medication adherence Sontakke et al, 201570 CKD (N = 150)
Cross-sectional; qualitative		 68% reported a lack of knowledge related to the importance of medication adherence
Dietary adherence Thomas et al, 200174 Hemodialysis (N = 276)
Cross-sectional; quantitative		 OR, 1.09 (95% CI, 1.00–1.19) for association between higher dietary knowledge and higher dietary adherence
patients all age >50
Depressive symptoms
Summary of self-management behaviors Sakraida et al, 201679 CKD (N = 29)
Cross-sectional; quantitative		 r = −0.42 for association between depressive symptoms and blood sugar checks, agitation and fruit/vegetable intake (−0.38), sadness and foot-washing or exercise frequency (−0.38, −0.40)
r = −0.53 for association between total depressive symptom score and foot checks
Xie et al, 201978 Kidney transplant (N = 483)
Cross-sectional; quantitative		 r = −0.16
Ranahan et al, 202071 Kidney transplant (N = 20)
Cross-sectional; qualitative		 NA
Exercise and physical activity Goodman et al, 200446 Hemodialysis (N = 50)
Cross-sectional; quantitative		 34% reported depressive symptoms; 26% reported anxious mood
Painter et al, 201447 Hemodialysis (N = 15 staff; 6 patients)
Cross-sectional; qualitative		 NA
Fiaccadori et al, 201418 Hemodialysis (N = 104)
Cross-sectional; quantitative		 50% reported sadness
OR, 2.59 (95% CI, 1.10–6.09) for physical inactivity adjusted for age and sex
Medication adherence Cukor et al, 200977 Hemodialysis (N = 65)
Cross-sectional; quantitative		 Standardized β = −0.28
R2 = 0.51 for depressive symptoms, sex, hospitalizations, education, age, ethnicity, use of dialysis versus transplant
Diet adherence Khalil et al, 201134 Hemodialysis (N = 100)
Cross-sectional; quantitative		 Unstandardized β = 0.84
OR, 2.3 (95% CI, 1.07–4.95)
Fluid adherence Washington et al, 201835 Hemodialysis (N = 107)
Cross-sectional; quantitative		 Unstandardized β = 0.94
OR, 2.6 (95% CI, 1.16–5.7)
Spiritual well-being
Summary of kidney disease self-management behaviors Ranahan et al, 202071 Kidney transplant (N = 20)
Cross-sectional; qualitative		 NA
Nair et al, 20217 CKD (N = 50)
Cross-sectional; qualitative		 NA
Exercise and physical activity Sieverdes et al, 201582 Hemodialysis (N = 22)
Cross-sectional; qualitative		 OR, 0.82 (95% CI, 0.67–0.99)
Self-efficacy
Summary of self-management behaviors Wu et al, 201690 CKD (N = 247)
Cross-sectional; quantitative		 r = 0.44 for association between self-efficacy and self-management
The association between perceived kidney disease knowledge and self-management was fully mediated by self-efficacy (Z = 4.82) and the effect was 50%
Jamieson et al, 201685 Kidney transplant
Systematic review and thematic analysis of 50 qualitative studies		 NA
Donald et al, 20194 CKD(N = 37 + 15 caregivers)
Cross-sectional; qualitative		 NA
Chuang et al, 202189 Hemodialysis (N = 130)
Cross-sectional; quantitative		 Unstandardized β = 0.29 SE, 0.01
Exercise and physical activity Goodman et al, 200446 Hemodialysis (N = 50)
Cross-sectional; quantitative		 60% reported a lack of motivation
r = −0.31 for association between motivation and exercise
r = 0.40 for association between self-efficacy and exercise
Medication adherence Curtin et al, 200886 CKD (N = 174)
Cross-sectional; quantitative		 Unstandardized β = 0.13 (SE, 0.036)
R2 = 0.13 for self-efficacy, age, education, hypertension, diabetes, serum creatinine, mental component summary and physical component summary of the 36-item Short Form Survey85
Paterson et al, 201888 Kidney transplant (N = 211)
Cross-sectional; quantitative		 Self-efficacy had direct effects on adherence via structural equation modeling
Regression coefficient, 0.93; effect size, 4.59
Adherence was measured via self-report, immunosuppressant level, and pill refills
Motivation
Exercise and physical activity Goodman et al, 200446 Hemodialysis (N = 50)
Cross-sectional; quantitative		 60% reported a lack of motivation
r = −0.31 for association between motivation and exercise
r = 0.40 for association between self-efficacy and exercise
Kontos et al, 200744 Hemodialysis (N = 17)
Cross-sectional; qualitative		 NA
Fiaccadori et al, 201418 Hemodialysis (N = 104)
Cross-sectional; quantitative		 42% reported a lack of motivation
Painter et al, 201447 Hemodialysis (N = 15 staff; 6 patients)
Cross-sectional; qualitative		 NA
Jhamb et al, 201643 Hemodialysis (N = 16)
Cross-sectional; qualitative		 NA
Song et al, 201992 Hemodialysis (N = 44)
Cross-sectional; qualitative		 NA
Liu et al, 202091 Hemodialysis (N = 10)
Cross-sectional; qualitative		 NA
Visit adherence Goldade et al, 201194 Kidney transplant (N = 39)
Cross-sectional; qualitative		 NA
Motivation was a barrier to visit adherence
Chenitz et al, 201493 Hemodialysis (N = 30)
Cross-sectional; qualitative		 NA
Motivation was a barrier to visit adherence
Patient activation
Summary of self-management behaviors Zimbudzi et al, 201797 CKD (N = 317)
Cross-sectional; quantitative		 Patient activation was associated with a summary of self-management behaviors as well as the specific behaviors of diet and blood sugar checking

Abbreviations: CI, confidence interval; CKD, chronic kidney disease; NA, not applicable; OR, odds ratio.