Promoting medication AdheRence and self-management among kidney transplant recipients (MARS-trial): Development of an intervention protocol

• Published in: Journal of psychosomatic research 2019-06, Vol.121, p.143-144
• Main Authors: Beck, Denise, Tielen, Mirjam, Rechards, Marloes, Ismail, Sohal, van de Wetering, Jacqueline, van Gelder, Teun, Boonstra, Charlotte, Versteegh, Josette, Cransberg, Karlien, Weimar, Willem, Buschbach, Jan, van Saase, Jan, Massey, Emma
• Format: Article
• Language: English
• Subjects: Adherence; Clinical trials; Drugs; Health promotion; Health status; Home based; Intervention; Kidney transplantation; Kidney transplants; Lifestyles; Medication adherence; Objectives; Patient compliance; Selfmanagement; Social networks; Social organization; Transplants & implants
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2019.03.132

Aim: Introduction: After kidney transplantation patients must adhere to a lifelong immunosuppressive medication regime in combination with other lifestyle recommendations. Nonadherence to this regimen has been demonstrated to be substantial in all age groups, undermining optimal health outcomes. Current adherence promoting interventions have a few limitations and effective interventions are scarce. We aimed to develop an intervention for enhancing adherence among nonadherent kidney transplant recipients anticipating shortcomings of current interventions. Methods: Method: In order to develop an improved intervention, literature was reviewed to outline shortcomings of current interventions and assess known determinants for nonadherence. Based on these findings, evidence-based theories and methods were selected and translated to the population of nonadherent adolescent and adult kidney transplant recipients (ages >12 yrs). Results: Results: The developed intervention is outreaching (home-based) and multisystemic (involves social network of the transplant recipient). During the intervention sessions, determinants of non-adherence on various ecological levels will be assessed with the patient in dialogue with the social network and treatment goals will be formulated. Based on the intervention protocol the patient works towards achieving treatment goals. Duration and frequency of the intervention are not determined a priori, but will be determined by the achievement of goals. Results from the initial pilot study (n = 8) will be presented. Conclusion: Conclusion: The intervention is unique in that it is outreaching, tailored to the needs and situation of each individual and addresses multiple ecological levels. In an ongoing randomized controlled trial we will test effectiveness.