Perceived susceptibility to chronic kidney disease among high-risk patients seen in primary care practices

Leigh Boulware, Kathryn Anne Carson, Misty U. Troll, Neil R. Powe, Lisa A Cooper

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Patients' views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized. OBJECTIVE: To assess perceived risk and concern regarding CKD development or progression among high-risk patients seen in primary care, identify predictors of perceptions, and correlate perceptions with adherence to high blood pressure management. DESIGN AND PARTICIPANTS: Cross-sectional study of 195 patients enrolled in a randomized controlled trial on hypertension management in 40 Maryland primary care practices. MEASUREMENTS: We assessed independent predictors (sociodemographics, health literacy, clinical presence of CKD, co-morbid conditions, and health behaviors) of perceived susceptibility (assessed via questionnaire) and adherence (assessed via Hill-Bone blood pressure adherence scale) in multivariable analyses. MAIN RESULTS: In this hypertensive majority African American (63%) population, many participants had uncontrolled blood pressure (44%) or diabetes (42%). Few (20%) felt "very likely" to develop CKD and one third (33%) were "very concerned" about developing CKD. Participants who were female and had low health literacy had lower perceived susceptibility to CKD compared to males and those with higher health literacy. Race and diabetes were also associated with perceived susceptibility. Greater perceived susceptibility was associated with poorer blood pressure management adherence scores. CONCLUSIONS: Many high-risk patients have low perceived susceptibility to CKD. Poor blood pressure therapy adherence scores among those with greatest perceived susceptibility suggest fatalistic attitudes about CKD. If our findings are confirmed in larger studies, interventions targeting patient perceptions of CKD risk and other attitudes associated with these perceptions could impact adherence to therapies and health outcomes.

Original languageEnglish (US)
Pages (from-to)1123-1129
Number of pages7
JournalJournal of General Internal Medicine
Volume24
Issue number10
DOIs
StatePublished - 2009

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Chronic Renal Insufficiency
Primary Health Care
Health Literacy
Blood Pressure
Hypertension
Health Behavior
African Americans
Randomized Controlled Trials
Cross-Sectional Studies
Bone and Bones
Health
Therapeutics
Population

Keywords

  • Adherence
  • Attitudes
  • Chronic kidney disease
  • Perceived susceptibility
  • Primary care

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Perceived susceptibility to chronic kidney disease among high-risk patients seen in primary care practices. / Boulware, Leigh; Carson, Kathryn Anne; Troll, Misty U.; Powe, Neil R.; Cooper, Lisa A.

In: Journal of General Internal Medicine, Vol. 24, No. 10, 2009, p. 1123-1129.

Research output: Contribution to journalArticle

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N2 - BACKGROUND: Patients' views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized. OBJECTIVE: To assess perceived risk and concern regarding CKD development or progression among high-risk patients seen in primary care, identify predictors of perceptions, and correlate perceptions with adherence to high blood pressure management. DESIGN AND PARTICIPANTS: Cross-sectional study of 195 patients enrolled in a randomized controlled trial on hypertension management in 40 Maryland primary care practices. MEASUREMENTS: We assessed independent predictors (sociodemographics, health literacy, clinical presence of CKD, co-morbid conditions, and health behaviors) of perceived susceptibility (assessed via questionnaire) and adherence (assessed via Hill-Bone blood pressure adherence scale) in multivariable analyses. MAIN RESULTS: In this hypertensive majority African American (63%) population, many participants had uncontrolled blood pressure (44%) or diabetes (42%). Few (20%) felt "very likely" to develop CKD and one third (33%) were "very concerned" about developing CKD. Participants who were female and had low health literacy had lower perceived susceptibility to CKD compared to males and those with higher health literacy. Race and diabetes were also associated with perceived susceptibility. Greater perceived susceptibility was associated with poorer blood pressure management adherence scores. CONCLUSIONS: Many high-risk patients have low perceived susceptibility to CKD. Poor blood pressure therapy adherence scores among those with greatest perceived susceptibility suggest fatalistic attitudes about CKD. If our findings are confirmed in larger studies, interventions targeting patient perceptions of CKD risk and other attitudes associated with these perceptions could impact adherence to therapies and health outcomes.

AB - BACKGROUND: Patients' views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized. OBJECTIVE: To assess perceived risk and concern regarding CKD development or progression among high-risk patients seen in primary care, identify predictors of perceptions, and correlate perceptions with adherence to high blood pressure management. DESIGN AND PARTICIPANTS: Cross-sectional study of 195 patients enrolled in a randomized controlled trial on hypertension management in 40 Maryland primary care practices. MEASUREMENTS: We assessed independent predictors (sociodemographics, health literacy, clinical presence of CKD, co-morbid conditions, and health behaviors) of perceived susceptibility (assessed via questionnaire) and adherence (assessed via Hill-Bone blood pressure adherence scale) in multivariable analyses. MAIN RESULTS: In this hypertensive majority African American (63%) population, many participants had uncontrolled blood pressure (44%) or diabetes (42%). Few (20%) felt "very likely" to develop CKD and one third (33%) were "very concerned" about developing CKD. Participants who were female and had low health literacy had lower perceived susceptibility to CKD compared to males and those with higher health literacy. Race and diabetes were also associated with perceived susceptibility. Greater perceived susceptibility was associated with poorer blood pressure management adherence scores. CONCLUSIONS: Many high-risk patients have low perceived susceptibility to CKD. Poor blood pressure therapy adherence scores among those with greatest perceived susceptibility suggest fatalistic attitudes about CKD. If our findings are confirmed in larger studies, interventions targeting patient perceptions of CKD risk and other attitudes associated with these perceptions could impact adherence to therapies and health outcomes.

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