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Abstract: PO0493

Facilitators and Barriers to Self-Management of CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Schrauben, Sarah J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Rivera, Eleanor, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Amaral, Sandra, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Dember, Laura M., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Barg, Frances K., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Self-management is integral for the treatment of chronic kidney disease (CKD). Despite low adherence to self-management behaviors, few studies provide insight into barriers and facilitators of self-management from the perspective of patients.


Semi-structured interviews were conducted with 30 participants who were purposively recruited for representation by CKD stage (3 or 4), age (<65, ≥65 yrs), race (white, non-white), and sex. Interviews focused on patient experiences with CKD and efforts to follow treatment recommendations. They were recorded, transcribed, and entered into NVivo 12.0 for coding and analysis. Transcripts were coded inductively and analyzed thematically.


We identified three key phases of CKD self-management behavior engagement: prioritization, participation, and maintenance. Facilitators and barriers were organized according to these phases. Participants needed to prioritize the behavior to consider engagement, which was favorably influenced by optimism, stress management, and effective patient-provider communication. Prioritization was impeded by fatalism and competing priorities. One of the most widely reported impediments to behavior performance was comorbid conditions that caused treatment burden and adverse symptoms. Notable facilitators of behavior performance included the presence of motivating factors, self-efficacy, social support, low cost, and convenience. For maintenance, participants’ ability to integrate and sustain behaviors in their lives was influenced by the aforementioned behavior performance factors, but also by behavior-specific factors, such as pets and physical therapy (for physical activity) and pharmacy assistance (for medication adherence). Key elements of effective maintenance included the use of memory aids, goal-setting, self-monitoring, and proactive preparation.


Individuals who adhered to CKD self-management behaviors viewed them as a priority, and developed strategies that fit their life to allow for behavior performance and maintenance. To increase self-management behavior prioritization, performance, and maintenance, we need to assess patients’ attitudes and beliefs, improve patient-provider communication, help patients overcome barriers such as high costs and conflicting treatment regimens, and leverage facilitators such as memory aids and goal-setting.


  • NIDDK Support