Page 157 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

patients were on average older and in worse condition, which may have made self-monitoring kidney function supported by an online system less attractive to them.
High levels of satisfaction with self-monitoring kidney function after transplantation were expressed in both the pilot study (described in chapter 2) and RCT (described in chapter 5). The use of both the creatinine and blood pressure meter was considered pleasant and useful, despite level of trust in the accuracy of the creatinine device being relatively low. In the interviews with patients on their experience with self-monitoring kidney function after transplantation, patients were shown to be very positive taking into account the nearly unanimous (95%) recommendation of self-monitoring to other kidney transplant patients. Further, 75% of the interviewees said they would have liked to continue self-monitoring beyond the first year post-transplantation. The high levels of satisfaction with self- monitoring that we found in both studies aligns with what has been described before [9, 11, 13, 21, 22].
Factors related to patients’ satisfaction with self-monitoring
The high response rates and levels of satisfaction that were found in both the pilot study and RCT suggest that many kidney transplant patients are eager to perform self-monitoring tasks. Still, eleven patients (18% of the intervention group) decided to quit self-monitoring. In all 7 cases with a known reason for quitting, the reason was study-related. Four patients indicated they had too little trust in the accuracy of the used creatinine device to continue using it. The importance of perceived reliability was also shown in the pilot study, where a positive relationship was found between level of satisfaction and level of trust in the accuracy of the creatinine device. This corresponds with existing literature, showing that patients’ confidence in the accuracy and perceived reliability of devices is an important prerequisite to the acceptance of these devices[23, 24]. One patient did not want to continue self- monitoring as he experienced difficulties when trying to log on to the SMSS for the first time. Although extra support was offered, he seemed to have concluded that online registration of measurements would be too difficult. Difficulty being the main reason for not wanting to continue may refer to two other findings. It may underline the importance of self-efficacy that was found in the pilot study, where patients were more satisfied if they had a higher level of self-efficacy regarding their own self- monitoring skills. The correlation between level of self-efficacy and level of satisfaction has been described before[25, 26] suggesting that thoroughly instructing and supporting patients is important for successful and satisfactory self-monitoring. Difficulty in this case may also refer to the effort someone is willing to invest, which corresponds to our finding that the expected additional burden of self-monitoring was the main reason for not wanting to participate in the RCT.
General discussion 155
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