The relationship between health literacy, self-management and complications after kidney transplantation

---

L. Maasdam, M.C. van Buren, M. Tielen, M. Cadogan, W. Weimar, E.K. Massey

Chair(s): dr. Robert A. Pol, vaat-en transplantatiechirurg, UMC Groningen & dr. Wojaiech G. Polak, chirurg, Erasmus MC

Thursday 10 march 2016

10:10 - 10:20h at Zaal 5 & 6

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie VIII - Klinisch chirurgisch en acuut

---

Introduction:
Health literacy (HL) and self-management (SM) may influence how patients interpret and act on post-transplant self-care, medication and lifestyle recommendations. Among a sample of our patient population 56% were re-hospitalized within one year after kidney transplantation (KT) . The aim of this study was to investigate whether HL and SM change over time and influence complications after KT.

Methods:
We performed a prospective cohort study. T0 was at discharge from the hospital after KT, T1 was 6 months later and T2 was 12 months later. We measured SM using an adapted Partners in Health scale (PIH, range 1-8) which has 4 subscales (after-care and knowledge, monitoring physical consequences, emotional and social consequences, healthy lifestyle) and HL using the Dutch Newest Vital Sign (NVSD, range 0-6). Change scores were calculated. Number of re-hospitalizations was summed and complications were categorized as rejection, infections and other. Regression (linear and logistic) analyses were conducted.

Results:
154 patients participated. At T1 HL scores were significantly higher (p=.01) than at T0. HL did not change significantly (p=.1) between T1 and T2. After-care and knowledge significantly improved between T0 and T1 (p=.00), emotional and social consequences significantly improved between T1 and T2 (p=.01), but healthy lifestyle significantly decreased between T0 and T1 (p=.00). Higher baseline level of after-care and knowledge and monitor of physical consequences was related to a significantly higher rate of re-hospitalizations at T2 (p=.04, p=.03). Rejection was related to decreasing scores of emotional and social consequences between T0 and T1 (p=.04). Other complications were related to increasing scores of HL between T1 and T2 (p=.04).

Conclusion:
Evidence was found for changes in HL and SM over time. HL and SM were also found to relate to the rate of re-hospitalization, though in the opposite direction than expected. Increasing re-hospitalizations among those who improved in HL and SM skills might be explained by the fact that they respond earlier to symptoms of complications. Also, transplant-specific clinical tests to assess HL and SM is lacking. Future research on the relationship between HL, SM, kidney function and graft survival is needed.