113 Signaling / solving problems Risks of medication use Patients not always recognize side effects or adhere properly Recognizing unhealthy food Patients not always know which products are bad for them Recognizing (severe) symptoms If patients encounter physical problems they do not recognize the ones that serious and act on that Overestimation of your own health / abilities Patients overestimate their abilities / health and overstretch themselves in physical activity or show risky behaviors Lack of problem-solving If patients experience self-management problems they let it be Learning from past experiences If something went wrong in the past, patients change their approach of self-management Being confronted by HCPs Patients stated to sometimes need serious warnings to act Ending up in hospital When serious illness or risky behaviors led to hospitalization Patient theme 4: Inability to change Negative emotions Disease / treatment burden Giving up, because the disease or treatment is too much to bear Losing autonomy High age / disease unwantedly leading to dependence of others Thinking of dead The fear for or awareness of dead leads to (not) feeling the need to change behaviors Stress / fear Stress or fear causes that patients do not decide on treatment options or feel certain enough to act Depression / negativity Depression or negativity influences motivation / ability to act Loss because of old age Many people have lost loved ones, influencing life lust Failed attempts Maintaining physical exercising Symptoms problemize physical activivity. It is diffult to persist Maintaining a diet Seeing diet as 'a burden' and finding it difficult to persist Addiction / habits Patients struggle to overcome addiction / replace habits Falling for temptations During groceries / social activities there are many temptations causing 'unhealthy decisions' Socio-economic background If patients have backgrounds where eating is very important or where living unhealthy is normal change is difficult Putting things into practice Knowing what to do, does not mean a patient will succeed Rewards Seeing kidney improvement The importance of seeing the kidneys stable to persist Having life aims Having life aims is an important motivator to change behavior Having health/treatment aims Preventing dialysis, meeting transplant requirements or losing weight. If patients have health /treatment aims it motivates People with worse kidneys as motivator If patients know stories of other kidney patients who ended up worse it can motivate them to self-manage
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