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1.  Patient experiences with self-monitoring renal function after renal transplantation: results from a single-center prospective pilot study 
After a kidney transplantation, patients have to visit the hospital often to monitor for early signs of graft rejection. Self-monitoring of creatinine in addition to blood pressure at home could alleviate the burden of frequent outpatient visits, but only if patients are willing to self-monitor and if they adhere to the self-monitoring measurement regimen. A prospective pilot study was conducted to assess patients’ experiences and satisfaction.
Materials and methods
For 3 months after transplantation, 30 patients registered self-measured creatinine and blood pressure values in an online record to which their physician had access to. Patients completed a questionnaire at baseline and follow-up to assess satisfaction, attitude, self-efficacy regarding self-monitoring, worries, and physician support. Adherence was studied by comparing the number of registered with the number of requested measurements.
Patients were highly motivated to self-monitor kidney function, and reported high levels of general satisfaction. Level of satisfaction was positively related to perceived support from physicians (P<0.01), level of self-efficacy (P<0.01), and amount of trust in the accuracy of the creatinine meter (P<0.01). The use of both the creatinine and blood pressure meter was considered pleasant and useful, despite the level of trust in the accuracy of the creatinine device being relatively low. Trust in the accuracy of the creatinine device appeared to be related to level of variation in subsequent measurement results, with more variation being related to lower levels of trust. Protocol adherence was generally very high, although the range of adherence levels was large and increased over time.
Patients’ high levels of satisfaction suggest that at-home monitoring of creatinine and blood pressure after transplantation offers a promising strategy. Important prerequisites for safe implementation in transplant care seem to be support from physicians and patients’ confidence in both their own self-monitoring skills and the accuracy of the devices used.
PMCID: PMC4676625  PMID: 26673985
adherence; blood pressure; creatinine; kidney transplantation; satisfaction; self-monitoring
2.  Response and participation of underserved populations after a three-step invitation strategy for a cardiometabolic health check 
BMC Public Health  2015;15:854.
Ethnic minority and native Dutch groups with a low socioeconomic status (SES) are underrepresented in cardiometabolic health checks, despite being at higher risk. We investigated response and participation rates using three consecutive inexpensive-to-costly culturally adapted invitation steps for a health risk assessment (HRA) and further testing of high-risk individuals during prevention consultations (PC).
A total of 1690 non-Western immigrants and native Dutch with a low SES (35–70 years) from six GP practices were eligible for participation. We used a ‘funnelled’ invitation design comprising three increasingly cost-intensive steps: (1) all patients received a postal invitation; (2) postal non-responders were approached by telephone; (3) final non-responders were approached face-to-face by their GP. The effect of ethnicity, ethnic mix of GP practice, and patient characteristics (gender, age, SES) on response and participation were assessed by means of logistic regression analyses.
Overall response was 70 % (n = 1152), of whom 62 % (n = 712) participated in the HRA. This was primarily accomplished through the postal and telephone invitations. Participants from GP practices in the most deprived neighbourhoods had the lowest response and HRA participation rates. Of the HRA participants, 29 % (n = 207) were considered high-risk, of whom 59 % (n = 123) participated in the PC. PC participation was lowest among native Dutch with a low SES.
Underserved populations can be reached by a low-cost culturally adapted postal approach with a reminder and follow-up telephone calls. The added value of the more expensive face-to-face invitation was negligible. PC participation rates were acceptable. Efforts should be particularly targeted at practices in the most deprived areas.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-015-2139-x) contains supplementary material, which is available to authorized users.
PMCID: PMC4558779  PMID: 26335782
3.  Decision making around living and deceased donor kidney transplantation: a qualitative study exploring the importance of expected relationship changes 
BMC Nephrology  2012;13:103.
Limited data exist on the impact of living kidney donation on the donor-recipient relationship. Purpose of this study was to explore motivations to donate or accept a (living donor) kidney, whether expected relationship changes influence decision making and whether relationship changes are actually experienced.
We conducted 6 focus groups in 47 of 114 invited individuals (41%), asking retrospectively about motivations and decision making around transplantation. We used qualitative and quantitative methods to analyze the focus group transcripts.
Most deceased donor kidney recipients had a potential living donor available which they refused or did not want. They mostly waited for a deceased donor because of concern for the donor’s health (75%). They more often expected negative relationship changes than living donor kidney recipients (75% vs. 27%, p = 0.01) who also expected positive changes. Living donor kidney recipients mostly accepted the kidney to improve their own quality of life (47%). Donors mostly donated a kidney because transplantation would make the recipient less dependent (25%). After transplantation both positive and negative relationship changes are experienced.
Expected relationship changes and concerns about the donor’s health lead some kidney patients to wait for a deceased donor, despite having a potential living donor available. Further research is needed to assess whether this concerns a selected group.
PMCID: PMC3493312  PMID: 22958636
Decision making; Donor-recipient relationship; Expectations; Kidney transplantation

Results 1-3 (3)