Background and Aim: Immunosuppressive therapies administered after chronic kidney disease and kidney transplantation are critically important for patients' life adaptation and the continued success of transplantation. However, the process of compliance with immunosuppressive therapy is not limited to regular medication use; it is closely related to multidimensional factors such as disease adjustment, physical adjustment, psychological balance, social functioning, and the individual's level of self-efficacy. This study aimed to examine the effect of Roy's Adaptation Model-based education on the adherence of patients with chronic kidney disease or kidney transplantation undergoing immunosuppressive therapy to immunosuppressive therapy, their adaptation to the disease, and their self-efficacy levels. Material and Methods: This quasi-experimental study with a pretest-posttest control group design was conducted with 78 chronic kidney disease patients who were scheduled to receive immunosuppressive therapy for the first time between November 2024 and June 2025 at the nephrology and transplantation services of a university hospital. Data were collected using the "Patient Information Form," "Immunosuppressive Drug Adherence Scale," "Chronic Disease Coping Scale," and "General Self-Efficacy Scale."
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
78
Developed by researchers in line with the Roy Adaptation Model, this educational material was created to support patients with chronic kidney disease or kidney transplantation who are undergoing immunosuppressive therapy for the first time, helping them adapt more effectively to their disease and treatment process. The content of the training booklet includes topics such as what immunosuppressive treatment is, situations to be aware of during the treatment process, precautions to be taken while undergoing immunosuppressive treatment, problems patients may encounter, and recommendations. The booklet is structured in accordance with the four areas of adaptation in the Roy Adaptation Model: physiological, self-concept, role function, and interdependence.
Trakya University Hospital
Edirne, Edirne, Turkey (Türkiye)
Patient Information Form-1
The Patient Information Form-1 contains questions regarding patients' individual characteristics, such as age, gender, educational status, marital status, and place of residence.
Time frame: at baseline
The Patient Information Form-2
The Patient Information Form-2 contains treatment-related questions, such as types of immunosuppressive drugs, experience of side effects, whether a special diet is being followed, and the level of compliance with the diet.
Time frame: at baseline, and at the first and third months.
Immunosuppressive Drug Compliance Scale
The scale was developed by Özdemir et al. to assess compliance with immunosuppressive drug use in patients who have undergone solid organ transplantation. The scale consists of 11 items in a unidimensional structure and uses both a 5-point Likert-type and a 2-point (Yes-No) rating system for scoring. In the 5-point Likert-type rating, positive items are scored from 1 to 5, while negative items are scored in the opposite direction, from 5 to 1. For items answered with "Yes-No," the 'Yes' response is scored as 1, and the "No" response is scored as 5. All items except the 4th and 6th items are negative and are scored in reverse. The total score that can be obtained from the scale ranges from 11 to 55, with high scores indicating a high level of compliance with immunosuppressive drug use. In the validity-reliability study conducted by Özdemir and colleagues, the Cronbach's alpha coefficient of the scale was found to be 0.611.
Time frame: at baseline, and at the first and third months
Chronic Disease Adjustment Scale
The scale was developed by Atik and Karatepe and consists of three subscales: physical, social, and psychological adjustment. The physical adjustment subscale consists of 11 items (1, 9, 10, 13, 14, 15, 16, 18, 22, 23, 24), the social adjustment subscale consists of 7 items (2, 3, 5, 7, 17, 19, 25), and the psychological adjustment subscale consists of 7 items (4, 6, 8, 11, 12, 20, 21). This scale, consisting of a total of 25 items, is evaluated using a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). The total score that can be obtained from the scale ranges from 25 to 125. High scores on the subscales or the total scale indicate a high level of adaptation to the illness. The Cronbach alpha value reported in the study where the scale was developed is 0.88.
Time frame: at baseline, and at the first and third months.
General Self-Efficacy Scale
The General Self-Efficacy Scale was developed by Aypay to assess individuals' perceptions of their competence in coping with difficulties they encounter. The scale consists of 10 items with a four-point Likert-type rating. Participants respond to each item with options ranging from "Not at all true (1)" to "Completely true (4)". The total score range that can be obtained from the scale is between 10 and 40, and an increase in the score level indicates that the individual's perception of self-efficacy is also high. The Cronbach alpha value of the scale was stated as 0.83 in the study in which it was developed.
Time frame: at baseline, and at the first and third months.
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