Lifestyle Management in Chronic Kidney Disease: The Barriers and Facilitators to Self-Management

Background: Non-Dialysis Dependent Chronic kidney disease (NDD-CKD) is a chronic condition increasingly associated with multi-morbidity, mortality, and symptom burden. Self-management is an integral factor in symptom control and can reduce risk factors of comorbid conditions such as cardiovascular disease, hypertension, and diabetes mellitus. However, there is limited knowledge on the perceptions of people living with NDD-CKD on the barriers and facilitators of self-management, which would enable researchers to identify support needs and priorities and develop more effective self-management support resources which are based on theory and evidence.

Aim: The aim of this project was to identify the barriers and facilitators to self-management in people living with NDD-CKD.

Method: This project involved firstly conducting a literature review to explore the factors influencing self-management behaviours in people living with NDD-CKD. The findings were synthesised using the Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour as a framework. This was followed by a qualitative study to examine the perceived barriers and facilitators to self-management. In this study, 22 participants living with NDD-CKD were recruited to take part in semi-structured interviews. These were professionally transcribed in verbatim and analysed using thematic analysis.

Findings: 22 studies were included in the literature review, which established 21 sub-themes across the domains of the COM-B model. These sub-themes represent the factors influencing NDD-CKD self-management behaviours identified in the papers.

The qualitative interviews elicited five overarching themes: “Knowledge of CKD self-management”, “Psychological factors”, “Physical factors”, “Behavioural factors”, and “Social factors”. Each theme encompassed several sub-themes, with a total of 18 sub-themes. These factors were perceived as either facilitators or barriers; however, this perception differed between individuals based on their contexts.

Conclusion: The findings of this research indicate a need to develop tailored self-management support tools and resources.