MO598: Coping Strategies During the COVID-19 Pandemic: Influence of Patient Activation in People Living With Kidney Disease

Abstract

BACKGROUND AND AIMSPatient activation refers to the knowledge, skills and confidence needed to manage one's health [1]. Higher patient activation is associated with better health outcomes in long-term conditions [2] such as kidney disease (KD). The COVID-19 pandemic has presented a myriad of additional challenges for people living with KD. Individuals may display different coping strategies in response to stressful and difficult circumstances such as health management during the pandemic [3]. Our group conducted a multicentre survey to evaluate the impact of the pandemic on kidney patient experiences, lifestyle and health care. As part of this larger study, we hypothesized that higher patient activation may be associated with more effective coping strategies. The purpose of this analysis was to explore coping styles utilised during the pandemic across different levels of patient activation in people with nondialysis CKD (ND-CKD) and kidney transplant recipients (KTR).METHOD214 ND-CKD and KTR participants [50.9% male, mean age 60.71 (SD 14.15) years, 56.1% KTRs] completed the Patient Activation Measure (PAM-13). Participants were categorised into ‘low’ and ‘high’ activation based on their PAM-13 score (levels 1–2 as low; 3–4 as high). Coping strategies were assessed using the Brief-COPE questionnaire and categorised into adaptive coping (active coping, information support, positive reframing, planning, emotional support, humour, acceptance and religion) and maladaptive coping (venting, self-blame, self-distraction, denial, substance use and behavioral disengagement) strategies. Chi-square tests were conducted to compare coping strategies used by low- and high-activated patients.RESULTSMost participants were classified as having ‘high’ activation levels (n = 164, 77%). Table 1 shows the three most frequently used adaptive and maladaptive coping strategies across activation levels. A significantly greater proportion of those with high activation used acceptance (P = 0.006), active coping (P = 0.045) and positive reframing (P = 0.031) as coping strategies. No significance was observed between maladaptive coping strategies and activation level.Adaptive coping strategiesMaladaptive coping strategiesHigh activationLow activationHigh activationLow activation1Acceptance (79.5%)Acceptance (58.5%)Self-distraction (53%)Self-distraction (47.6%)2Religion (60.5)Religion (30.8%)Behaviour Disengagement (37.5%)Substance Use (40%)3Active Coping (48.2%)Information Support (30%)Substance Use (31.6%)Self-Blame (37.5%)CONCLUSIONThe most commonly reported coping strategy was ‘acceptance’ for individuals with high and low activation. The findings suggest that a higher proportion of people with high patient activation used adaptive coping strategies. Worryingly, regardless of activation level, about a third of participants used substance use (i.e. alcohol and drugs) as a form of coping. Identifying people with lower activation in KD can indicate the need for additional support to help them cope in challenging circumstances. Interventions to improve activation may assist in developing effective coping strategies.