133 table 4.2 continued Objective Determinants Experiences from ambulatory setting Experiences from dialysis setting Overcome barriers for selfmanagement to maintain behaviors 1. HCPs invite patients to share selfmanagement barriers. 2. HCPs seek for solutions for barriers by applying shared decision making. 3. Patients recognize and solve barriers that negatively influence self-management. 4. Patients know strategies to maintain selfmanagement. 5. Patients share their barriers and concerns with HCPs. CKD self-management is no explicit aim Patients from GPs (n = 3) said they did not receive specific self-management advice to stabilize CKD. However, patients (n = 6) experienced barriers to self-management on a daily basis, either for diabetes, cardiovasular disease or CKD. Temptations (n = 5), lack of rewards (n = 2), age or mental problems (n = 3) were reasons to give up on self-management. Half of the patients (n = 4) felt that barriers were not discussed often. Many barriers to maintaining changes All patients (n = 11) shared barriers in the maintenance of self-management. The burden of dialysis (n = 2), age or mental problems (n = 4), and the fact that their kidneys will never get better (n = 5), are all reasons to give up on self-management. Half of the patients (n = 6) felt that barriers were not discussed often. Strengthen the social network 1. HCPs involve the social network in consultation and treatment. 2. HCPs empower the social network to contribute to self-management. 3. Patients involve their social network in the treatment. Social network is a bit important Most patients (n = 5) shared that they had the main responsibility in their lifestyle or medication, although others (n = 2) said their social network was mainly responsible. Patients (n = 3) did not always see the need to involve their social network in the treatment. Social network is really important Half of the patients (n=6) indicated that a significant other was mainly in the lead in lifestyle or medication, although others (n = 2) said they had no support in their self-management. Some said that HCPs do not involve social networks enough (n = 4). CKD = chronic kidney disease, LHL = limited health literacy, HCP = health care professional, GP = general practitioner, n = number of interviewed patients talking about this experience. Experiences that indicate an important difference between ambulatory and dialysis setting are in bold.
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