Barriers and Facilitators of Fruit and Vegetable Consumption in Renal Transplant Recipients, Family Members and Healthcare Professionals—A Focus Group Study

Abstract

Low fruit and vegetable consumption is associated with poor outcomes after renal transplantation. Insufficient fruit and vegetable consumption is reported in the majority of renal transplant recipients (RTR). The aim of this study was to identify barriers and facilitators of fruit and vegetable consumption after renal transplantation and explore if certain barriers and facilitators were transplant-related. After purposive sampling, RTR (n = 19), their family members (n = 15) and healthcare professionals (n = 5) from a Dutch transplant center participated in seven focus group discussions (three each for RTR and family members, one with healthcare professionals). Transcripts were analyzed using social cognitive theory as conceptual framework and content analysis was used for identification of themes. Transplant-related barriers and facilitators were described separately. In categorizing barriers and facilitators, four transplant-related themes were identified: transition in diet (accompanied by, e.g., fear or difficulties with new routine), physical health (e.g., recovery of uremic symptoms), medication (e.g., cravings by prednisolone) and competing priorities after transplantation (e.g., social participation activities). Among the generic personal and environmental barriers and facilitators, food literacy and social support were most relevant. In conclusion, transplant-related and generic barriers and facilitators were identified for fruit and vegetable consumption in RTR. The barriers that accompany the dietary transition after renal transplantation may contribute to the generally poorer fruit and vegetable consumption of RTR. These findings can be used for the development of additional nutritional counseling strategies in renal transplant care.

Protein Intake, Fatigue and Quality of Life in Stable Outpatient Kidney Transplant Recipients

“…This may be a consequence of continuation of a previous protein restriction at time of ESKD. While such dietary restrictions are no longer required after transplantation and recovery of kidney function, this dietary transition may function as a barrier to resume a diet with sufficient protein [41].…”

Malnutrition according to GLIM criteria in stable renal transplant recipients: Reduced muscle mass as predominant phenotypic criterion

“…However, QoL is still lower and long-term outcomes are worse in renal transplant recipients (RTR) compared with the general population [3,4]. Post-transplant weight gain and obesity are well-known and common health problems, related to transplant-specific factors such as cessation of dietary restrictions [5,6], side effects of prednisolone [5] and low physical activity levels [7], and are associated with adverse long-term outcomes in RTR [8e12]. However, less attention is paid to the, possibly concomitant, high risk of malnutrition.…”

Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway

“…To assure that disease-specific concerns are taken into account, screening and treatment can be tailored by addressing specific symptoms (e.g., a module about itch may be relevant for a patient with ESKD, but may be left out for someone with CKD or lung complaints). Furthermore, as unhealthy lifestyle behaviors are interrelated and often occur together, the multifactorial approach in which multiple behaviors can be addressed at once could result in a greater reduction of health risks than a focus on a single lifestyle issue [ 47 , 48 ]. An additional advantage of our intervention is that it addresses (not necessarily disease-specific) psychosocial and lifestyle-related difficulties simultaneously.…”