The study aimed at developing a framework for engagement of Chronic Kidney Disease (CKD) patients with their integrated management in selected tertiary hospitals of eThekwini District, KwaZulu-Natal province, South Africa.
Methods:
The study used a sequential explanatory mixed method design. Quantitative data was collected and analyzed, followed by the collection and analysis of qualitative data. For the quantitative phase, a random sample of 90 participants was selected. Data was collected using five instruments developed by the investigator in the form of structured interview schedules for demographic data, engagement with dialysis, engagement with medication, engagement with fluid restriction and engagement with dietary restriction. Descriptive statistics, the Pearson correlation coefficient, linear regression analysis and chi-square were used to analyze the data.
For the qualitative phase, a purposive sample comprising 12 CKD participants together with their respective caregivers and seven health-care workers was selected according to data saturation. Data was collected using three instruments in the form of semi-structured interview schedules on barriers and promoters to engagement with integrated management, and perceptions of health-care workers and care givers regarding management of CKD patients. Data was analyzed using a thematic framework with six stages: data organization, familiarization, identifying a thematic framework, indexing, charting/displaying and interrelating and description of themes.
Results:
Sixty-six percent of CKD participants showed low engagement with integrated management. There were 32% with moderate and only 2% with high levels of engagement with integrated management. A significant and positive relationship (r = .439, N = 90, p = .00) between age and engagement with integrated management among CKD population was revealed. The effect of age accounted for 19.3% of the variance on engagement with integrated management. In addition, the level of engagement with integrated management was significantly associated with occupation, support systems, monthly income and CKD class.
The revealed barriers to integrated management from the perspectives of CKD patients, caregivers and health-care workers were side-effects of dialysis and renal diet, gastrointestinal problems, false perception of good health, stress and depression, unemployment, and hot weather of the study area, shortage of kidneys for transplant and duration of dialysis procedure. Motivators for integrated management were family support, prospects of kidney transplantation, peer support, being aware of the complications associated with non-engagement with integrated management and fear of being removed from the CKD programme. The contextual factors that affected engagement with integrated management in the study were patient-related, physiological, socioeconomic, psychological, environmental, system-related, cultural, ethical and legal.
Findings from the quantitative and qualitative phases were used to develop a framework for engagement of CKD patients with their integrated management. The framework integrated modifying factors that affect engagement with integrated management, barriers to engagement with integrated management, benefits of engagement with integrated management, and interventions that will promote behavior change among CKD population.
Conclusion:
Problems of engagement with integrated management among chronic kidney disease (CKD) patients have been observed. Therefore, utilizing the developed framework may promote highest levels of engagement behaviors, thus improving effective management and quality of care for patients with CKD.