Abstract
Background: Medication nonadherence to immunosuppressants is a well-known risk factor for suboptimal health outcomes in kidney transplant recipients (KTRs). This study examined the relationship between illness perceptions and medication nonadherence in prevalent Dutch KTRs and whether this relationship depended on post-transplant time. Methods: Eligible KTRs transplanted in Leiden University Medical Center were invited for this cross-sectional study. The illness perceptions and medication nonadherence were measured via validated questionnaires. Associations between illness perceptions and medication nonadherence were investigated using multivariable logistic regression models. Results: For the study, 627 participating KTRs were analyzed. 203 (32.4%) KTRs were considered nonadherent to their immunosuppressants with “taking medication more than 2 h from the prescribed dosing time” as the most prevalent nonadherent behaviour (n = 171; 27.3%). Three illness perceptions were significantly associated with medication nonadherence: illness identity (adjusted odds ratio [ORadj] = 1.07; 95% confidence interval [CI], 1.00–1.14), concern (ORadj = 1.07; 95%CI,1.00–1.14), and illness coherence (ORadj = 1.11; 95%CI,1.01–1.22). The relationships between illness perceptions and medication nonadherence did not differ depending on post-transplant time (p-values ranged from 0.48 to 0.96). Conclusion: Stronger negative illness perceptions are associated with medication nonadherence to immunosuppressants. Targeting negative illness perceptions by means of psychoeducational interventions could optimize medication adherence and consequently improve health outcomes in KTRs.
Highlights
Successful kidney transplantation requires strict adherence to chronic immunosuppressive regimens [1]
Of the 1700 adult kidney transplant recipients (KTRs) who were transplanted before 1 April 2019, at LUMC and met study inclusion criteria, 743 (43.7%) KTRs responded via email (n = 606) or via postal service (n = 137). 39 responders filled out the questionnaires but did not want to participate in this study
After excluding another 77 patients who received simultaneous pancreas-kidney transplantation, 627 KTRs were left to be included in the main analysis (Figure 1)
Summary
Successful kidney transplantation requires strict adherence to chronic immunosuppressive regimens [1]. Failure to take immunosuppressants as prescribed has been identified as a risk factor for adverse clinical outcomes among kidney transplant recipients (KTRs), including graft loss and reduced patient survival [2, 3]. Leventhal’s widely-used Common Sense Model (CSM) of Selfregulation provides us with explanations for patients’ behaviour when facing health threats and may aid our understanding of the behavioural mechanism explaining medication nonadherence [6]. According to the CSM, patients’ illness perceptions directly influence their coping behaviour (e.g., medication adherence) with the medical condition; thereafter, they appraise the effect of such behavioural adaptions and the result of the appraisal therof can shape their illness perceptions [6]. Medication nonadherence to immunosuppressants is a well-known risk factor for suboptimal health outcomes in kidney transplant recipients (KTRs). This study examined the relationship between illness perceptions and medication nonadherence in prevalent Dutch KTRs and whether this relationship depended on post-transplant time
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