Page 158 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 7
Further, 2 patients indicated they experienced too little benefit of self-monitoring creatinine post- transplantation, perhaps due to the limited number of outpatients that were actually replaced by telephone appointments. The remaining 4 patients did not provide a reason for quitting but did not perform or register any measurements and were therefore considered voluntary dropouts. If self- monitoring creatinine would become an integrative part of transplant aftercare, with the alternation of outpatient and telephone consults embedded in everyday practice, this would probably increase the perceived benefit of self-monitoring on the one hand and the perceived importance of patients to perform and register their measurements on the other. Considering this, the level of integration or implementation of procedures into care appears to be an important factor for patient satisfaction. This corresponds to one of our pilot study results, showing that a higher level of perceived autonomy support from physicians was related to a higher level of patient satisfaction. This finding also suggests that patients consider self-monitoring to be part of a care system in which their physicians keep playing an important role. It has indeed been shown before that patients consider self-monitoring a less attractive option if this automatically implies a substantial loss of human interaction with the clinical staff[23].
The importance of experienced self-efficacy, involvement of physicians and autonomy support corresponds to Self-Determination Theory[27], where competence, relatedness and autonomy are considered basic human needs. Taking this into account, the experience and result of self-monitoring kidney function can be optimized if patients feel competent to perform the required actions, experience a connection with their healthcare professionals and feel supported by them to play an important role in their own care.
Patients’ acceptance of a self-monitoring support system
During the RCT (described in chapter 5), patients used a self-management support system (SMSS), that included the creatinine and blood pressure devices, eLearning, personal health record to register self- measured values and a feedback system that advised patients on their next action (continue regular schedule, measure again or contact the hospital). To study factors related to acceptance of the SMSS, we used a self-developed questionnaire that was based on the Technology Acceptance Model (TAM,[28]) and one of its’ extensions, the Unified Theory of Acceptance and Use of Technology, (UTAUT, [29]). Both the TAM and UTAUT are well-known theories that explain people’s acceptance of technology. In these theories, several factors are described to explain behavioural intention, the degree to which an individual intends to use a new system. Behavioural intention has been widely used to evaluate user acceptance of technology [28-32]. In TAM and UTAUT, effort expectancy is usually