78 Patients also shared to fall for temptations or lacked social support. Some of these patients did not live very healthy before, making it more difficult to fulfil all the needed changes. A lack of rewards was another reason maintaining selfmanagement was difficult. On the short-term, self-management led to losing weight or stabilization of lab values. On the long-term, when kidney function kept decreasing, patients could lose motivation. Treatment or life aims helped to succeed in self-management. For example, one woman stated to live healthier to qualify for transplantation. Some patients ended up in arguments, for example if HCPs kept trying to advice on lifestyle when patients wanted to discuss other problems, or when relatives repeatedly tried to convince patients to follow doctor’s advices. PERSPECTIVES OF PROFESSIONALS Theme 1: Not recognizing HL problems HCPs were unsure if they were able to identify patients with LHL. They based identification on clearly manifesting clues, such as weak language ability, or on information, that was part of their basic patient assessment, such as hygienic impression. They were concerned on knowing all indicators of LHL, and on missing patients who hide their LHL. They also said identification of HL problems could take several consultations. Especially nephrology specialists mentioned to have problems to understand why LHL patients, even after serious warnings, did not self-manage well. They mostly mentioned lacking knowledge or motivation as barriers for selfmanagement. They shared to pay less attention to lacking social support, mental barriers or the feasibility of advices. All HCPs said self-management problems triggered their doubts, because they were risky for the patient’s health. Stories emerged about risk behaviours, such as not picking up medications or maintaining a dangerously high weight. As a result, HCPs sometimes felt powerless or took over responsibility.
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