الفهرس 
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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.
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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.
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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.
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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
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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`
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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