Measuring kidney patients’ motivation to pursue living donor kidney transplant: Development of Stage of Change, Decisional Balance and Self-Efficacy measures

Abstract

While educational interventions to increase patient motivation to pursue living donor kidney transplant have shown success in increasing living donor kidney transplant rates, there are no validated, theoretically consistent measures of Stage of Change, a measure of readiness to pursue living donor kidney transplant; Decisional Balance, a weighted assessment of living donor kidney transplant’s advantages/disadvantages; and Self-Efficacy, a measure of belief that patients can pursue living donor kidney transplant in difficult circumstances. This study developed and validated measures of these three constructs. In two independent samples of kidney patients (N1= 279 N2= 204), results showed good psychometric properties and support for their use in the assessment of living donor kidney transplant interventions.

Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates

“…We recently validated a brief assessment of LDKT readiness measuring the following stages: “I am not considering taking actions in the next 6 months to pursue living donation” (Precontemplation); “I am considering taking actions in the next 6 months to pursue living donation” (Contemplation); “I am preparing to take actions in the next 30 days to pursue living donation” (Preparation); and “I am taking actions to pursue living donation” (Action) [19•]. A Maintenance stage was not included, since after receiving LDKT, no stage regression could occur.…”

“…After being assessed as to their readiness stage, patients also can rate when they have “Already done,” “Are planning to do,” or “Don't plan to do” smaller behaviors relevant to pursuing LDKT. In previous validation analyses for the LDKT readiness measure, a series of χ2 tests revealed that, compared to patients in earlier stages, patients in later stages of readiness were more likely to have done or were planning to take behaviors like asking another person directly to be evaluated as a donor candidate and accepting another's offer to donate (p < 0.05) [19•]. …”

“…Patients move from early to later stages of LDKT readiness as their Decisional Balance, or comparative value of the pros and cons of taking a health behavior, change [20]. Across more than 12 health behaviors, including pursuit of LDKT [19•] and deceased donor kidney transplant [25], as patients move from Precontemplation into Action, their perception of the pros of making a behavior change increases, while their perception of the cons decreases [20]. Conversations about what is uniquely important to a kidney patient, including the possibilities of get- ting off dialysis, being able to eat restricted types of food, or being able to travel more, can help increase patients’ perceptions of the pros to pursuing LDKT.…”

Understanding the Associations Between Modifying Factors, Individual Health Beliefs, and Hemodialysis Patients' Adherence to a Low-Phosphorus Diet

“…[26][27][28][29][30] To date, few studies have incorporated stages of change models with HD patient outcomes, particularly when evaluating fluid intake and understanding patients' intention to receive a donor transplant. [31][32][33] In this study, we set out to explore P control as related to a patient's reported stage of change (defined by the PAPM) and serum P levels via a conceptual model, see Figure 1 13,24 that includes modifying factors and individual health beliefs.…”

Investigating and Promoting the Decision towards Signing an Organ Donation Card

“…Study 1-Predicting goal setting to donate an organ: a test of the HAPA's assumptions So far, only one stage theory, the Transtheoretical Model (TTM) [24], has been applied to analyze motivation to living donor kidney transplant [25], or motivation to agree to become a potential postmortem organ donor [26]. Keller and colleagues reported results comparable with those which are derived from the HAPA: individuals in the precontemplation stage, which is similar to the HAPA's non-intentional stage, showed lower self-efficacy in deciding to become a potential organ donor.…”