Bootcongres

Introduction Health literacy (HL) and self-management (SM) play an important role in the outcomes after kidney transplantation. Older, lower educated, unemployed, and non-European patients have been shown to score significantly lower on HL at discharge after transplantation. The lower patients score on HL the less they can cope with SM in the period immediately after kidney transplantation. In this study we investigated changes in HL levels and SM skills over time and patient characteristics associated with this change. 

Methods We invited patients to participate in a prospective cohort study. T0 was at discharge from the hospital after transplantation and T1 was 6 months later. At each time-point we measured SM using an adapted Partners in Health scale (PIH, range 1-8) and HL using the Dutch Newest Vital Sign (NVSD, range 0-6). Change scores were calculated. Univariate tests (paired t-test, independent t-test, and chi-squared) were used. 

Results Of the 165 approached patients, 154 participated. Six patients dropped out due to graft failure or death. In the whole sample HL was significantly higher at T1 (p=0.02), from a mean of 3.1 to 3.5. There was no statistically significant association between change in HL and sociodemographic characteristics. We found a significant higher score for the whole sample at T1 on SM subscale ‘After care and Knowledge’ (p=0.001) and a significant lower score on subscale ‘Healthy Lifestyle’ (p=0.003). There was a significantly greater increase in ‘After care and Knowledge’ among patients with a lower education compared to those with a higher education (p<.05), and among dialysis patients compared to patients transplanted pre-emptively (p < .01). Women also showed a significant decrease in coping with ‘Emotional and Social consequences’ while men remained the same (p<.01). 

Conclusion HL was initially low but improved over time. After care and knowledge components of SM skills improved in the 6 months after transplantation, however self-management of lifestyle deteriorated. Lower educated and patients who underwent dialysis prior to transplantation had initially lower SM skills but improved over time. Women reported struggling more with the emotional and social consequences after transplantation. There is thus a need for ongoing attention for lifestyle factors in the clinic as these may influence transplant outcomes.