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Abstract Kidney transplantation is the preferred option contributing towards greater survival and a better quality of life for kidney transplant recipients (Kaidar et al., 2014). After kidney transplantation, patients and their caregivers must know and comply with not only the medication for immunosuppression and comorbidities but also with the various therapeutic regimen recommendations (Adhikari et al., 2018). The factors affecting patients’ compliance toward therapeutic regimen includes; patient-related factors (e.g. health beliefs, self-efficacy, and perceived barriers to adherence), social and economic factors (e.g., family functioning, social supports, and medication costs), therapy-related factors (e.g., treatment side effects, duration of treatment, and regimen complexity), condition-related factors (e.g. symptoms, comorbidities, psychiatric conditions), and health care system-related factors (Sabate, 2003). The aim of this study is to: Assess factors affecting patient’s compliance toward therapeutic regimen post kidney transplantation. Summary 111 Research question What are factors affecting patient’s compliance toward therapeutic regimen post kidney transplantation? Research Design A descriptive exploratory design was used in this study. Setting This study conducted at outpatient clinic at Urology and Nephrology center-that affiliated to Mansura University. Sample Purposive sample of 101 patients were recruited in this study according the following criteria: 1. Patients having kidney transplantation treatment since one year or more. 2. Renal transplant recipients aged from 18-60 years of either gender. 3. Patients are welling to participate in this study. Summary 112 Tools: Tool I - Patient’s interview questionnaire. This tool was adopted from (El said, 2017) and included two parts Part I: socio-demographic data of the patient. This part was consisted of seven items to assess socio demographic characteristics of the renal transplant recipients including; age, gender, marital status, education, type of work, residence and monthly income. Part II: patient health history. This part was consisted of ten items to assess patient’s past history (e.g. onset of renal failure, causes of renal failure, type of dialysis, period of dialysis, duration since renal transplantation) and family history of renal failure, and present history (e.g. donor type and relationship between donor and recipient, diseases after transplantation, prescribed medications post renal transplantation and presence of medication side effects). Tool II- Patient’s compliance assessment tool: This tool was adopted from Gheith et al., (2008). It was concerned with assessment level of compliance of the renal transplant recipients to the recommended therapeutic Summary 113 regimen. It was represented as a four points Likert scale ranging from zero to three. zero (never), one (sometimes), two (often), three (always). The total scores of patient’s level of compliance will be recorded between 0 to 270, Score less than 51% will be defined as never or noncompliant; 51% to less than 71% poor compliant; 71% to less than 96% partial compliant; and 96% to 100% good compliant. Tool III: Factors affecting patient compliance assessment tool: This tool was related to assessment factors affecting patient compliance. This part was adopted from a study conducted by WHO (2003). It covered 54 statements with Yes/no. Which include five main dimensions: Social and economic factors (10 items), Health Care System-Related factors (12 items), Condition-Related factors (6 items), Therapy Related factors (8 items) and Patient Related factors (18 items) which included physical factors (5 items) and psychological or behavioral factors (13 items). Each item in each group scored as Yes (1), it meaning that the factor is present and No (0), it meaning that the factor is not present. Summary 114 Methods The study carried out in 101 renal transplant recipients, the actual work of this study started and completed within five months from beginning of Augustus to the end of December (2018). Patients‟ oral consent to participate in the study obtained and every patient was informed that confidentiality was assured. Data were collected by the researcher two days per week, in outpatient clinic in the previous mentioned setting. The researcher was interviewed with the renal transplant recipients to collect the data by using the prepared study tools and each tool take from 10 to 15minutes to be fulfilled. Results - Renal transplant recipient’s age was ranged from18 to up to 60 years, with a mean of age 32.50 ± 9.91. More than two thirds (67.3%) were males and (67.3 %) of them were married. - Less than half (44.6%) of the studied patients were suffering from renal failure from 5 – < 10 years ago. The majority (82.2%) had unknown cause of renal failure, (96.0%) of them were on hemodialysis, (54.6%) of them stayed on dialysis for at least 1 – < 5 years. (54.5%) of them had renal transplantation from1 – <5 Summary 115 years ago. (98.0%) of them had no family history of renal failure. (87.1 %) of them had related kidney donor. - About (63.4%) of studied patients had minor and major side effects related to immunosuppressive medications. - About (81.2 %) of studied patients had a partial compliance toward therapeutic regimen post kidney transplantation. - The study revealed that the factors which affecting patients’ compliance were, therapy-related factors rated the highest dimension followed by condition related factors, patient related factors, social and economic factors and health care system related factors (69.39%, 43.00%, 25.32%, 14.47%, and 11.40%) respectively. - There was a significant relation between total compliance score with social and economic factors, Health care system- related factors and patient related factors .In addition to that, there was a highly significant relation between total compliance score and total factors. Conclusion Based on the findings of the current study, it can be concluded that: the majority of the studied patients had a partial compliance with therapeutic regimen post kidney transplantation and many factors were affecting patients` Summary 116 compliance such as; Therapy-related factors rated the highest dimension followed by condition related factors, patient related factors, social and economic factors and health care system factors respectively. Furthermore, there was a significant relation between total compliance score with social and economic factors, Health care systemrelated factors and patient related factors .In addition to that, there was a highly significant relation between total compliance score and total factors . Recommendations - Educational nursing guidelines should be conducted for kidney transplant recipients’ pre and post transplantation to improve their compliance toward therapeutic regimen. - Intensive assessment of factors affecting patient compliance should be done periodically to identify their needs which help in the plan to improve their compliance. - The study should be replicated on large sample and in different hospitals setting in order to generalize the results. - Further researches in different centers should be done to detect potential risk factors of non-compliance to therapeutic regimen post kidney transplantation |