Promoting medication adherence and self-management among kidney transplant recipients (mars-trial): Development and first experiences

Introduction: After kidney transplantation nonadherence has been demonstrated to be substantial in all age groups, undermining optimal health outcomes. In this study developed and pilot tested an adherence promoting intervention. The aim of the pilot study was to assess feasibility and acceptability of intervention implementation. Method: Evidence-based theories and methods were translated into an intervention for the population of nonadherent adolescent and adult kidney transplant recipients (ages > 12 yrs). A random selection of patients for whom there was an indication of medication nonadherence were approached for participation in the pilot study. All received the intervention and were interviewed after completion on their experiences and feedback. Results: The intervention is outreaching (home-based) and uses principles of (multi) systemic therapy. During the intervention sessions with the psychologist, determinants of nonadherence are assessed with the patient in collaboration with the social network. Specific behavior change techniques are offered based on the determinants, making tailoring possible. Duration and frequency of the intervention are determined by the achievement of goals. Six nonadherent patients participated in the pilot (50% response rate). Reasons for declining were too busy or no interest. Median age was 24yr (range 20-51yrs) and 5 were male. A median of 13,5 (range 7-18) sessions were carried out. Patients appreciated the home-based approach of the intervention and the methods used. They were motivated intrinsic to achieve and maintain their goals. Patients set goals aimed at achieving medication adherence, intimacy/relations, lose weight/more exercise, and work/income. Family members were positive about the intervention because of more understanding about patient perspective and their own role in the problems and solutions addressed. Conclusion: This unique intervention is outreaching, tailored to the needs and situation of each individual and its social network. The pilot demonstrated feasibility and acceptability among patients and their family members. A single-center randomized controlled trial is currently being conducted to test the effectiveness of the intervention.