Mindset Survey: A Deep Dive into Patients' Perspective of CKD

Background: South Texas has higher rates of diabetes (DM), obesity, and CKD. Lifestyle modifications including dietary changes and physical activity play a significant role in preventing progression of CKD. Patients’ understanding of the diagnosis and implication of it on their health are essential to increase adherence to these changes. We conduct a qualitative survey to assess patient understanding of CKD and identify facilitators and barriers for adoption of healthy changes to help design future interventions. Methods: Patients with diagnosis of CKD (excluding stage V) were identified from an academic center internal medicine resident clinic. A semi-structured in-person interview was conducted in the first 15 interested patients, when saturation was achieved. The responses were recorded and analyzed for themes. Medical charts were reviewed to collect demographic, clinical and laboratory parameters. Results: The mean age was 61±10.9 year, 53% were females, 80% were Hispanic, 47% were disabled or retired, 47% had high school & 33% had college education, and 73% had either Medicare/low-income plan. Seventy-three percent of patients had DM, 93% hypertension (HTN), with 57% of HTN having complications such as stroke and heart failure. Themes identified in interviews were: 1) lack of knowing underlying cause of their CKD, yet perceiving it as manageable; 2) believe taking prescribed medications alone would prevent or manage CKD; 3) lack of knowing lifestyle changes can prevent and manage CKD, not just DM and HTN; 4) perception of being “a burden” to their support system as an obstacle to adhere to lifestyle changes/treatment; 5) social support has positive influence by encouragement to adhere to lifestyle changes, but negative if has bad habits; 6) “fear” and “worry” as initial and ongoing emotional response to a CKD diagnosis. Conclusion: Our survey informs the awareness of diagnosis but lack of understanding of the causes of CKD. We identified an important role of support system, both positive and negative, in determining the adoption of lifestyle changes. The approach to CKD should be holistic and individualistic, taking into consideration factors other than social determinants of health.