Examination of the Effect of Health Perception on Adherence to Immunosuppressive Medication Use in Kidney Transplant Patients

Yıl 2025, Cilt: 15 Sayı: 2, 678 - 686, 30.05.2025

Ufuk Akkurt , İsa Çelik , Ayşe Özkan , Ebru Dizdar , Tuğba Özcan , Dilek Çilingir

https://doi.org/10.31020/mutftd.1618788

Öz

Objective: Adherence to immunosuppressive medication is critical for the successful maintenance of kidney transplant therapy. Patients’ health perceptions are influenced by their lived experiences and cultural contexts. This study aimed to examine the impact of health perception on adherence to immunosuppressive medication among kidney transplant patients.
Methods: This descriptive, correlational, and cross-sectional study was conducted in a private hospital located in western Turkey. The data were collected from 165 kidney transplant patients aged between 19 and 69. The data collection tools included a Sociodemographic Data Collection Form, the Perception of Health Scale, and the Immunosuppressive Medication Adherence Scale. Data were analyzed using simple linear regression analysis.
Results: The mean scores of the participants on the Perception of Health Scale and the Immunosuppressive Medication Adherence Scale were 53.84 ± 10.04 and 48.18 ± 5.60, respectively. It was found that the level of health perception explained 8.8% of the variance in adherence to immunosuppressive medication (F = 16.909, p < 0.001, R² = 0.094, Adjusted R² = 0.088).
Conclusion and Recommendations: The study revealed that 8.8% of the variation in adherence to immunosuppressive medication was associated with health perception levels. Identifying health perception levels before kidney transplantation could help predict the risk of nonadherence to immunosuppressive medication, thereby preventing a significant proportion of rejections. Nursing interventions should focus on enhancing patients' health perception by addressing the focus on Center of Control sub-dimension and considering cultural contexts and beliefs.

Anahtar Kelimeler

Kidney transplantation , Medication adherence , Immunosuppressive medication , Perception , Health

Böbrek Nakli Olan Hastalarda Sağlık Algısının İmmünsupresif İlaç Kullanımına Uyum Üzerine Etkisinin İncelenmesi

Öz

Amaç: Böbrek nakli tedavisinin başarılı bir şekilde sürdürülebilmesi için immünsupresif ilaç kullanımına uyum kritik öneme sahiptir. Hastaların sağlık algıları ise yaşadıkları deneyimler ve kültürel yapıdan etkilenmektedir. Çalışmamız böbrek nakli olan hastalarda sağlık algısının immünsupresif ilaç kullanımına uyum üzerine etkisinin incelenmesi amacıyla gerçekleştirildi.
Metod: Çalışmamız tanımlayıcı, ilişki arayıcı ve kesitsel bir tasarıma sahipti. Veriler, Türkiye’nin batısında bulunan bir özel hastanede kayıtlı 19-69 yaş arası 165 böbrek nakli olan hastadan elde edildi. Veri toplama formu Sosyodemografik Veri Toplama Formu, Sağlık Algısı Ölçeği ve İmmünsupresif İlaç Kullanımına Uyum Ölçeği’ni içeriyordu. Veriler, basit doğrusal regresyon analizi ile incelendi.
Bulgular: Katılımcıların Sağlık Algısı Ölçeği ve İmmünsupresif İlaç Kullanımına Uyum Ölçeği puan ortalamaları sırasıyla 53.84±10.04 ve 48.18±5.60 idi. Katılımcıların sağlık algısı düzeylerinin, immünsüpresif ilaç kullanımına uyum düzeylerindeki varyansın %8.8’ini açıkladığı saptandı (F = 16.909, p < 0.001, R2 = 0.094, Adjusted R2 = 0.088).
Sonuç ve Öneriler: Çalışmamızda immünsüpresif ilaç kullanımına uyum düzeyi üzerindeki değişikliğin %8.8 oranında sağlık algısı düzeyi ile ilişkili olduğu belirlendi. Böbrek nakli olan hastalarda, sağlık algı düzeyleri böbrek nakli öncesi belirlenerek, immünsüpresif ilaç uyumsuzluk riski öngörülebilir. Bu şekilde rejeksiyonların önemli bir kısmının önüne geçilebilir. Hastaların sağlık algısını olumlu yönde etkilemek için Kontrol Merkezi alt boyutuna odaklanılmalı, kültürel yapı ve inançları ele alan hemşirelik yaklaşımları yapılmalıdır.

Anahtar Kelimeler

Böbrek nakli , İlaç uyumu , İmmünsuresif ilaçlar , Algı , Sağlık

Kaynakça

• 1. Chen G, Gao L, Li X. Effects of exercise training on cardiovascular risk factors in kidney transplant recipients: a systematic review and meta-analysis. Ren Fail 2019;41(1):408-18.
• 2. Transplant Observatory [Internet]. Geneva: Transplant Observatory; c2021 [updated 2023 Mar 10; cited 2025 Mar 10]. Available from: https://www.transplant-observatory.org/countkidney/.
• 3. Shi YX et al. Efficacy of adherence-enhancing ınterventions for ımmunosuppressive therapy in solid organ transplant recipients: a systematic review and meta-analysis based on randomized controlled trials. Front Pharmacol 2020;578887(11):1-13.
• 4. Torres-Gutiérrez M et al. Is non-adherence associated with adverse outcomes in kidney transplant recipients? the role of non-adherence as a risk and predictor factor for graft loss and death. Patient Prefer Adherence 2023;(17):2915-25.
• 5. Torres-Gutiérrez M et al. Prevalence and modifiable factors for holistic non-adherence in renal transplant patients: a cross-sectional study. Patient Prefer Adherence 2023;(17):2201-13.
• 6. Jasiak NM, Park JM. Immunosuppression in solid-organ transplantation: essentials and practical tips. Crit Care Nurs Q 2016;39(3):227-40.
• 7. Zhao H et al. 311.9: Nurse-ınvolved ıntervention strategies for medication compliance in kidney transplant recipients: a systematic review. Transplantation 2022;106(Suppl 9): 203.
• 8. Campos CS et al. Immunosuppressive adherence after kidney transplantation in adult patients treated at an outpatient clinic: a better practice implementation project. JBI Evid Implement 2020;19(3):306-14.
• 9. Shirafkan R et al. Medication adherence in kidney transplant recipients: a cross-sectional study from a nursing clinical practice perspective. Journal of Nursing Reports in Clinical Practice 2024;2(2):65-73.
• 10. Cossart AR et al. Investigating barriers to immunosuppressant medication adherence in renal transplant patients. Nephrology 2019;24(1):102-10.
• 11. Griva K, Neo HLM, Vathsala A. Unintentional and intentional non-adherence to immunosuppressive medications in renal transplant recipients. Int J Clin Pharm 2018;40(5):1234-41.
• 12. Choki D, Tashi T, Kesara N. Application of self-reporting, clinicians’ assessment, and tacrolimus trough levels in evaluating adherence to immunosuppressive therapy in kidney transplant recipients. A cohort study. medRxiv 2023.
• 13. Ostrowski P et al. Immunosuppressant adherence factors differentiating compliant and non-compliant kidney transplant recipients. J Clin Med 2023;12(12):4081.
• 14. Costa LM, Galato D. Identification of factors associated with medication adherence in renal transplant patients: an ıntegrative literature review. BJT 2023;26(01):123.
• 15. Dursun Sİ et al. Yetişkinlerde geleneksel/tamamlayıcı tıp tutumu ile sağlık okuryazarlığı ve sağlık algısı arasındaki ilişki. Halk Sağlığı Hemşireliği Dergisi 2019;1(1):1-10.
• 16. Wang Y et al. Understanding health-related quality of life in kidney transplant recipients: the role of symptom experience and ıllness perceptions. Transpl Int 2023;10837(36):1-11.
• 17. Bendersky VA et al. Factors impacting the medication "adherence landscape" for transplant patients. Clin Transplant 2023;37(6):1-8.
• 18. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Erlbaum; 1988.
• 19. George D, Mallery P. IBM SPSS Statistics 26 step by step: A simple guide and reference. 16th ed. Routledge; 2019.
• 20. Diamond JJ et al. Development of a scale to measure adults' perceptions of health: preliminary findings. Journal of Community Psychology 2007;35(5):557-61.
• 21. Kadıoğlu H, Yıldız A. Sağlık algısı ölçeğinin Türkçe çevriminin geçerlilik ve güvenilirliği. Türkiye Klinikleri J Med Sci 2012;32(1):47-53.
• 22. Özdemir Köken Z, Talas MS, Gökmen D. Development and psychometric testing of the turkish ımmunosuppressive medication adherence scale. Turk J Nephrol 2019;28(2):120-6.
• 23. IBM Corp. IBM SPSS statistics for windows, Version 29.0 [computer software]. Armonk, NY, USA. [ cited 2024 Dec 20]. Available from: https://www.ibm.com/products/spss-statistics.
• 24. Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. Cengage; 2019.
• 25. Grinyó JM. Why is organ transplantation clinically important? Cold Spring Harbor Perspectives in Medicine 2013;3(6):1-10.
• 26. Doğan R et al. Böbrek nakli hastalarında depresyon anksiyete stres seviyeleri ile immünosupresif tedaviye uyum arasındaki ilişki. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi 2022;10(2):539-53.
• 27. Knight SR. Routine adherence monitoring after renal transplantation. Transplant International: Official Journal of the European Society for Organ Transplantation 2019;32(6):600-2.
• 28. Butler JA et al. Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review. Transplantation 2004;77(5):769-76.
• 29. Pinsky BW et al. Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2009;9(11):2597-606.
• 30. Gandolfini I et al. Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation. Clin Kidney J. 2022;15(7):1253-74.
• 31. Joo HJ et al. Medication adherence in patients taking immunosuppressants after kidney transplantation. The Journal of the Korean Society for Transplantation 2010;24(4):289-97.
• 32. Olatise O et al. #6833 are kt recipients taking their immunosuppressant medication? preliminary evidence from a super-specialized transplant centre in sub-saharan africa. Nephrology Dialysis Transplantation 2023;(33):1.
• 33. Özdemir Köken Z et al. Karaciğer transplantasyonu yapılan hastalarda immünsupresif ilaç kullanımına uyum: tek merkez deneyimi. Ahi Evran Medical Journal 2020;4(3):88-95.
• 34. Denhaerynck K et al. Prevalence and risk factors of non-adherence with immunosuppressive medication in kidney transplant patients. American Journal of Transplantation 2007;7(1):108-16.
• 35. Wang Y et al. Illness perceptions and medication nonadherence to immunosuppressants after successful kidney transplantation: a cross-sectional study. Transplant International 2022;10073(35):1-10.
• 36. Massey EK et al. Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation. Transplantation 2015;99(2):375-80.
• 37. Nissen RD, Viftrup DT, Hvidt NC. The process of spiritual care. Frontiers in Psychology 2021;674453(12):1-11.
• 38. Kanchana MN, Sangamesh N. Transcultural nursing: Importance in nursing practice. International Journal of Nursing Education 2016;8(1):135-8.
• 39. Sánchez-Polo MT et al. Overcoming knowledge barriers to health care through continuous learning. Journal of Knowledge Management 2019;23(3):508-26.
• 40. Chan M et al. Effectiveness of eHealth‐based cognitive behavioural therapy on depression: A systematic review and meta‐analysis. Journal of Clinical Nursing 2022;(21-22):3021-31.