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Perceived Barriers and Support Strategies for Reducing Sodium Intake in Patients with Chronic Kidney Disease: a Qualitative Study

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Abstract

Background

Reducing sodium intake can prevent cardiovascular complications and further decline of kidney function in patients with chronic kidney disease. However, the vast majority of patients fail to reach an adequate sodium intake, and little is known about why they do not succeed.

Purpose

This study aims to identify perceived barriers and support strategies for reducing sodium intake among both patients with chronic kidney disease and health-care professionals.

Method

A purposive sample of 25 patients and 23 health-care professionals from 4 Dutch medical centers attended 8 focus groups. Transcripts were analyzed thematically and afterwards organized according to the phases of behavior change of self-regulation theory.

Results

Multiple themes emerged across different phases of behavior change, including the patients’ lack of practical knowledge and intrinsic motivation, the maladaptive illness perceptions and refusal skills, the lack of social support and feedback regarding disease progression and sodium intake, and the availability of low-sodium foods.

Conclusions

The results indicate the need for the implementation of support strategies that target specific needs of patients across the whole process of changing and maintaining a low-sodium diet. Special attention should be paid to supporting patients to set sodium-related goals, strengthening intrinsic motivation, providing comprehensive and practical information (e.g., about hidden salt in products), increasing social support, stimulating the self-monitoring of sodium intake and disease progression, and building a supportive patient–professional relationship that encompasses shared decision making and coaching. Moreover, global programs should be implemented to reduce sodium levels in processed foods, introduce sodium-related product labels, and increase consumer awareness.

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Acknowledgments

We would like to thank the participating patients and health-care professionals for their time and contribution. Y.M., L.t.B, and S.v.D. were responsible for the data collection. All authors participated in the design and the revision of the manuscript and gave final approval.

The present study was supported by a grant from The Netherlands Organisation for Health Research and Development-Medical Sciences (ZonMw 300020016) and the Dutch Kidney Foundation (SB93). They had no role in the study design (collecting, analysis or interpretation of data), writing of the paper, and the decision to submit this paper.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. We confirm all personal identifiers have been removed or disguised so the persons described are not identifiable and cannot be identified through the details of the story.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Psychology, Leiden University Medical Center, p/a Wassenaarseweg 52, 2300 RB, Leiden, The Netherlands

    Yvette Meuleman

  2. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

    Lucia ten Brinke, Tiny Hoekstra & Friedo W. Dekker

  3. Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands

    Arjan J. Kwakernaak & Gerjan Navis

  4. Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands

    Liffert Vogt & Gert A. van Montfrans

  5. Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

    Joris I. Rotmans, Paul J. M. van der Boog & Sandra van Dijk

  6. Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands

    Willem Jan W. Bos

  7. Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, The Netherlands

    Sandra van Dijk

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  1. Yvette Meuleman
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  2. Lucia ten Brinke
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  9. Gert A. van Montfrans
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Correspondence to Yvette Meuleman.

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Meuleman, Y., ten Brinke, L., Kwakernaak, A.J. et al. Perceived Barriers and Support Strategies for Reducing Sodium Intake in Patients with Chronic Kidney Disease: a Qualitative Study. Int.J. Behav. Med. 22, 530–539 (2015). https://doi.org/10.1007/s12529-014-9447-x

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