Development of Self-Management Scale for Kidney Transplant Recipients, Including Management of Post-Transplantation Chronic Kidney Disease

An evaluation scale is indispensable for the promotion of continuing, effective postkidney transplantation self-management behaviors. We aimed to develop and validate a new self-management scale for kidney transplant recipients to improve their long-term outcomes and prevent the recurrence of CKD complications. Two hundred and thirty-nine Japanese patients who had undergone kidney transplantation were recruited from three hospitals. The scale’s validity and reliability were evaluated using exploratory factor analysis and intraclass correlation coefficients. Scale items were selected by considering the findings of a clinical importance survey of 17 experts. Four subscales were identified by the factor analysis: “Self-monitoring” (six items), “Self-care behavior in daily living” (seven items), “Early detecting and coping with abnormalities after kidney transplantation” (four items), and “Stress management” (three items). Cronbach’s alpha coefficients for the subscales ranged from 0.61 to 0.87. A further four items with high clinical importance were added to the scale. The final scale comprised 24 items within four subscales and four single items. The intraclass correlation ranged from 0.88 to 0.95 in each subscale and the weighted kappa coefficient for the single items ranged from 0.33 to 0.72. The validity and reliability of our new self-management scale were confirmed by a patient-based field survey. 1. Introduction The incidence of acute rejection after kidney transplantation has decreased due to dramatic progress in immunosuppressive drug therapy. However, despite recent improvements in short-term survival rates, long-term survival remains unchanged [1] and improving this remains a challenge for the future. Kidney transplantation outcomes relate not only to immunosuppressive factors such as rejection but also to nonimmunosuppressive factors such as nonadherence and post-transplantation chronic kidney disease (CKD) [2]. Required recipient self-management measures include taking immunosuppressive drugs, monitoring for adverse events, preventing infections, self-monitoring, physical activity, managing nutrition, and regular consultation with specialists [3–5]. These multiple self-management requirements are considered valuable for maintaining good health and minimizing the recurrence of CKD complications [6, 7]. However, our previous study [8] showed that the degree of adherence to self-management regimens is negatively correlated with time since transplantation, and we must therefore continuously promote effective self-management, taking into account