Effects of Self-Efficacy and Heatlh Literacy on Adherence to Self-Care Behaviors in Kidney Transplant Patients

Abstract

Kidney transplant recipients (KTRs) have to take multiple daily medications, look for signs of acute rejection, have frequent blood draws and often manage additional chronic conditions. Appropriate management of the transplanted kidney is crucial to minimize the potential for graft failure and a return to the transplant wait list. There is a limited knowledge on underlying behavioral factors that may influence KTRs' adherence to self-care behaviors and the impact of adherence to self-care behaviors on the occurrence of patient safety events. This study aims to 1) Describe variations of self-efficacy based on individual KTRs'characteristics, 2) Explore the association between self-efficacy, health literacy and adherence to self-care behaviors and 3) Explore the association between adherence to self-care behaviors and patient safety events (diarrhea and hypoglycemia). Four hundred and thirty-five eligible KTRs received a survey inquiring about self-efficacy, health literacy, social support, medication adherence, self-care behaviors and patient safety events. Linear regression analyzed variations of self-efficacy in KTRs. Self-efficacy was tested as a mediator or as a moderator of health literacy on adherence to self-care behaviors. Logistic regression analyzed associations between adherence to self-care behaviors and patient safety events. One hundred and eighty-two KTRs completed the survey (42% participation rate). Mean age of responders was 59.5 (+/-12.1) years; 61.0% were male; and 38.1% were African American. The mean time since transplant was 38.0 (+/- 18.1) months. Being African American was associated with lower self-efficacy (β= -0.61, p=0.03) while an increase in functional health literacy was associated with an increase in self-efficacy (β=0.72, p<0.01). Self-efficacy was a partial mediator of functional and communicative health literacy on adherence to self-care behaviors (functional: αβ=0.32, CI: 0.11-0.60; communicative: αβ=0.37,CI: 0.11-0.71). There was no association between adherence to self-care behaviors and patient safety events. Clinicians need to monitor patients with low self-efficacy and low health literacy. Teach-back method and frequent communication can help increase self-efficacy. Use of larger font, photos and visual cues will help patients with limited health literacy. These methods may optimize KTRs' adherence to self-care behaviors.