Diet and physical activity after liver transplant: A qualitative study of barriers and facilitators to following advice

Abstract

Background Liver transplant recipients are given diet and physical activity advice to aid recovery and promote long‐term health. The present study aimed to explore patients’ experiences of receiving and implementing diet and physical activity advice after liver transplant and identify barriers and facilitators to following recommendations. Methods A qualitative descriptive design included purposive sampling of 13 liver transplant recipients. Semi‐structured audio‐recorded interviews and inductive thematic analysis using a framework were undertaken concurrently to enable recruitment until saturation of themes occurred. Results Overall experiences varied between participants and settings, as well as over time. Seven themes emerged, all representing both barriers and facilitators to implementing advice. Poor capability and loss of confidence were barriers that improved in hospital because healthcare professionals enabled participants to set and achieve goals but remained key barriers after discharge from hospital. The format and consistency of advice influenced participants’ confidence in the healthcare team. Social support helped participants to return to and implement advice, although social networks could also have a negative influence. Advice and modelling of behaviour from other transplant recipients were facilitators. Symptoms, side effects, comorbidities and the environment presented barriers and facilitators. The desire to return to normal and coping strategies were drivers of behaviours, which were also influenced by participants’ beliefs and values. Conclusions The variation in experiences indicates a need for individually tailored advice that is consistent across the multidisciplinary team. Interventions for behaviour change that merit further investigation include goal setting, improving coping strategies, peer support and modifying the hospital and home environment.

Physical Activity Behaviour in Solid Organ Transplant Recipients: Proposal of Theory-Driven Physical Activity Interventions

“…The barriers and motivators were classified according to COM-B and TDF (Table 4) and subsequently embedded and discussed below according to the context dimension of CICI. The identified barriers and motivators were related to participation in physical activity and/or exercise [8,11,54,[69][70][71][72][73][74][75][76][77][78][79], exercise-based rehabilitation [80][81][82][83], or participation in the World Transplant Games [84]. The terms physical activity and exercise were often used interchangeably, making it impossible to make a clear distinction between these variables.…”

“…Knowledge Patients (and health care providers) require the knowledge about why, how, when, how often, and with who to be physically activity in a safe way Evaluated in 9/19 records Lack of knowledge about the benefits of physical activity [11,69] (K/M) Lack of knowledge about appropriate exercise [74] or unsure how to exercise safely [81] (K/M) Health care providers' lack of expertise, lack of medical clearance, lack of specific advice, and conflicting or vague advice [11,71,74,77,84] (K/Li/M) Health care providers not recommending or advising against physical activity [79,80] (K/M) Health care providers not providing answers on questions about exercise limitations [74] (K) Desire for (currently lacking) exercise guidelines [74] (K)Desire to three different types of guidance: (i) standardized guidance, (ii) prescriptive (individualized) guidance, and (iii) supervised guidance/sessions both individual and in group [74] (K) Exercise advice and guidance not priority of the National Health Service (UK) [74] (K) Evaluated in 7/19 records Knowing the value and benefits of increased PA [69,79] (K) Having knowledge about PA [72] (M) Receiving information on how to exercise [69] (K) Expertise of personnel [11] (M) Physician recommendations to PA [72,80] (M) Individualized timely advice consistent across the multidisciplinary team [71] (Li) Accessible and comprehensive rehabilitation as a potential source for guidelines around proper exercise and transplant appropriate milestones [77] (M)…”

“…Coping [11,82] (K/M) Physical activity as routine habit [11,79,82] (K/M) Exploration of new capabilities and refine their understanding of their trans liminal, transplanted body-self [54] (N) Self-determination [71] (Li) [73,82], anxiety about physical activity [69], and fear of movement [75] (K/Lu) Fear of damaging the transplanted organ [11,81,83], increasing pain or injury [69,81]; negative effects [69,81]; infection [81]; rejection [73]; making health worse [69], and falling [69] (K/Lu/H/M) General fear of activities outdoors [83], or fear of outdoor activities due to fear for crime [69] or fear of being affected by a certain disease [83] (K/H) Depression [69] and low health-related quality of life [72] (K/M) Heightened sense of self-awareness during exercise and heightened awareness of normal exercise effects (i.e., increased blood pressure, heart rate) [74], insecurity with the body and body signals [11,77], and unpleasant sensations associated with exercise [69] (K/M) Greatened awareness of normal exercise effects, such as dehydration [74]; concerns exercise will make you too thirsty [69] (K) Being cautious about doing too much, feeling fatigued and not wanting to become more fatigued [69,74] (K) Self-consciousness about appearance [69] (K) Emotional trauma, most often as a direct result of transplant experience, including illness, the transplant procedure itself, and post-transplant recovery…”

“…Five studies (six records) focused solely on kidney transplant recipients (n = 741) [69,70,74,75,79,82], one study on liver transplant recipients (n = 13) [71], one study on heart transplant recipients (n = 8) [83], one study on lung transplant recipients (n = 111) [73], and one study did not specify the transplant population (n = 13) [54]. Eight independent studies (nine records) evaluated barriers and motivators in cohorts of various organ transplant recipients, i.e., 531 kidney transplant recipients, 250 liver transplant recipients, 148 lung transplant recipients, 114 heart transplant recipients, and four multi-organ transplant recipients [8,11,72,[76][77][78]80,81,84].…”

“…Based on limited literature data, there are no differences in barriers and motivators between different solid organ transplant groups [11,76]. Various methods were used, with the majority of studies applying semi-structured interviews [11,70,71,74,79,81,83] and others using web-based questionnaires [72,73,80,84] or standardized questionnaires, such as Barriers and Motivators Questionnaire [8,69], the Exercise Benefits/Barriers Scale [82], Tampa Score of Kinesophobia [75], Inventory of Physical Activity Objectives questionnaire [76], Behavioural Regulation in Exercise Questionnaire-2 [78], Perceived Physical Activity Scale (sub-scale of the Physical Self-Efficacy Scale) [75], or Exercise Self-Efficacy Scale [8].…”