Clinical Nutrition

Abstract

Background Patients compare and discuss their treatment regimens with other patients to obtain informal peer support. (1) A social comparison model (2) suggests these behaviours involve making comparisons to other patient's dietary behaviours to obtain feedback on the success of their own dietary behaviours. The result of this comparison can either enhance or lower self-esteem, depending on how the person perceives their situation. A self-enhancement comparison i.e. discounting the other person's behaviour helps maintain positive self-esteem through positive self-talk. A negative comparison will make them feel inferior to the person they have compared themselves too. Social comparison has been studied in obesity and eating disorders.(3) But little exists in renal. It is important to understand how people deal with social interactions around diet as inappropriate renal peer support and dietary advice giving may be detrimental to dietary adherence. Therefore it is important that patients can maintain self-esteem around following their own dietary advice. The aim of this study was to explore informal peer support experiences on self-management of individual dietary recommendations in chronic kidney disease. Methods Qualitative semi-structured interviews using a free response narrative approach were undertaken with patients with end-stage renal failure on heamodialysis. An interview topic guide, informed by current literature, was used to guide the data collection. Interview questions covered experiences of informal peer support and the affect these had on participants own behaviour around following renal dietary advice. Interviews were transcribed verbatim and underwent interpretative phenomenological analysis (4) within the framework of social comparison theory.(2) Internal peer review, member checking and reflexivity were under taken to increase rigour. UHCW NHS Trust gave ethical approval. Results 12 caucasian adults took part (6 male, 6 female). Themes represented social comparison between patients within the dialysis unit. Patients gradually entered the social more of the “renal family” (Participant 3) when starting hemodialysis. Within this social more; self-enhancement comparisons protected the self by discounting peers incongruent “unsafe” (P6) dietary advice, describing patients who were non-compliant to low potassium advice as being “on rocky ground” (P4). This helped maintain positive self-esteem by “feeling good about my own choices” (P10), identity around food, and food literacy. Peers who undertook positive self-talk were more likely to offer appropriate support to others. These coping strategies and “decent” (P1) peer support maintained defense against well-meant informal peer support by lessening the comparison to “those patients who don't know what they're doing with their diet” (P16). Discussion Positive upwards comparisons helped patients make dietary changes and self-manage their diet as reported in self-restrained eaters. (4) This led to high levels of self-efficacy to cope with renal restrictions and maintained patients’ food literacy. These individuals were more likely to offer appropriate support to others. Downward comparison resulted in individuals feeling their self-efficacy was threatened by negative influences of peers. Limitations to this study include that self-efficacy was not measured, but implied through in-depth descriptions. Conclusion The findings suggest that a formal peer support programme should be explored for renal dietetics. A formal peer support programme may help lessen the anxiety around informal and inappropriate nutritional peer support.