https://orcid.org/0000-0002-2166-3933
Abstract
Purpose
After organ transplantation, adherence to immunosuppressive medication (ISM) is crucial to prevent organ rejection. To enable adherence, patients need to be well informed about the different aspects associated with their ISM. However, literature suggests that knowledge regarding ISM is often inadequate.
Patients and Methods
In a cross-sectional study, 702 patients after kidney transplantation participating in a structured multimodal follow-up program (KTx360°) were evaluated. We utilized a self-developed questionnaire which has been successfully used before to measure patients’ knowledge about the ISM. Above that we aimed to evaluate potential associations between sociodemographic, medical, donation-specific, and psychosocial variables including adherence, levels of depression and anxiety, perceived social support, and cognitive functioning with the knowledge level.
Results
The mean age of the patients was 52.4 years, 58.1% were men, and 66.6% were living in a partnership. The mean time since transplantation was 65.1 months. On average, patients answered 70.9% of the questions correctly. The percentage of correct answers per question differed considerably (54%–92%). In univariate analyses, knowledge levels were positively associated with female gender, current partnership, German as first language and better cognitive functioning. However, the effect sizes were small.
Conclusion
Taking into account that the patients after KTx can be expected to answer all questions correctly as they aim at basic knowledge, an average result of 70.9% corresponds to a moderate knowledge level. Consequently, the current educational approaches do not seem to be sufficient to inform all patients adequately. Further research is necessary on how to improve health knowledge in the long term.
Abbreviations
CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; F-SozU K7, Questionnaire for Perceived Social Support; HADS-D, Hospital Anxiety and Depression Scale; HL, health literacy; IQR, interquartile range; ISM, immunosuppressive medication; KTx, kidney transplantation; MARS-D, Medication Adherence Report Scale; SD, standard deviation; WHO, World Health Organisation.
Data Sharing Statement
Where patient data can be anonymized, data that underlie the results reported in this article are available on request to the corresponding author. Data are available beginning 6 months and ending 5 years after publication.
Ethics Approval and Informed Consent
The studies involving human participants were reviewed and approved by the Institutional Ethics Review Board of Hannover Medical School (Number 3464–2017). The patients/participants provided their written informed consent to participate in this study.
In Germany, transplantation of human organs is governed by the German Transplant Act (TPG, http://www.gesetze-im-internet.de/tpg/index.html) on “organ and tissue donation, removal and transplantation”. In general, in Germany the so-called decision solution is in place, ie, the organs of a deceased person may only be retrieved if the person in question gave permission for organ donation (§ 3 para. 1 no. 1 TPG), eg, in the form of an organ donor card, or if the next of kin consent to the donation (§ 4 TPG). The legal principals are in line with the Declaration of Istanbul.
Acknowledgments
We thank Melanie Hartleib-Otto and Raoul Gertges for their management support. Additionally, we thank the Department of General Practice and Health Services Research and Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany” for providing the translation of the MARS-D.
Disclosure
The authors declare that the research was conducted in the absence of any commercial, financial, or other relationships that could be construed as a potential conflict of interest.