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An Integrated, Evidence-Guided Framework for Chronic Kidney Disease Self-Management: Behavioral Mechanisms,

Janet Diaz-Martinez1,2, Staci Leon-Morris3, Iván Delgado-Enciso4,5,6

  • 1Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA, jdimarti@fiu.edu.

Kidney & Blood Pressure Research
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PubMed
Summary

This study presents a framework to improve chronic kidney disease (CKD) self-management support by integrating behavioral science with practical implementation strategies. It guides the design, delivery, and evaluation of effective CKD care across settings.

Keywords:
Chronic kidney diseaseCommunity health workersHealth literacyImplementation sciencePatient activationSelf-efficacySelf-management supportSocial cognitive theory

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Area of Science:

  • Nephrology
  • Behavioral Science
  • Health Services Research

Background:

  • Chronic kidney disease (CKD) impacts over 850 million globally, causing significant morbidity and healthcare costs.
  • Effective self-management support is crucial for improving patient outcomes in CKD but is inconsistently applied.
  • Existing CKD self-management programs often lack detailed behavioral mechanisms and implementation strategies, hindering scalability.

Purpose of the Study:

  • To develop a practice-oriented framework for designing, implementing, and evaluating CKD self-management support.
  • To integrate behavioral mechanisms with implementation-relevant delivery approaches for CKD care.
  • To address inconsistencies in routine CKD self-management support by providing a structured approach.

Main Methods:

  • A structured narrative review of studies published January 2010-March 2025 was conducted.
  • Systematic database searches (PubMed, Embase, CINAHL, Scopus) identified relevant quantitative, qualitative, and mixed-methods research.
  • Findings were synthesized using a deductive-inductive approach to develop an integrated framework.

Main Results:

  • An integrated framework was developed, linking CKD self-management domains (medication, diet, monitoring, lifestyle, activation, emotional burden, treatment pathways) with behavioral mechanisms and evaluation measures.
  • Seven priority CKD self-management domains were identified.
  • A six-step implementation process was outlined, guiding behavior prioritization, mechanism linkage, co-design, multimodal delivery, evaluation, and scalability planning.

Conclusions:

  • A novel framework synthesizes behavioral science and implementation strategies for CKD self-management support.
  • This framework facilitates the design, implementation, and evaluation of effective CKD self-management interventions.
  • The approach is applicable across clinical and community settings to enhance patient care and outcomes.