Positive Mental Health and Self-Efficacy in Management of Chronic Kidney Disease: a Mixed-Methods Study in a Rural, Minority Population

Background: Chronic kidney disease (CKD) is a progressive, irreversible condition that affects 15% of the US population, causing poor health outcomes and enormous social and economic burden. Rural and minority populations bear significant disparity in CKD outcome. Self-management of CKD and comorbid conditions is important in slowing the progression of CKD and preventing end stage renal disease.

Methods: This study uses a mixed-methods study design to investigate the association between positive mental health and self-efficacy and to qualitatively explore the dimensions of positive mental health that influence self-efficacy. A cross-sectional study involving 257 individuals was conducted from May to July 2016. Quantitative data collection involved administration of a questionnaire and clinical assessment of kidney function. Participants were asked about their medical history and attitudes on the chronic disease management (self-efficacy for chronic disease management, coping, social support, and perceived stress), and mental health and illness (positive mental health, depression, anxiety, and PTSD). Ordered logistic regression was used to assess the relationship between positive mental health and self-efficacy, controlling for depression, the interaction between positive mental health and depression, and other covariates. Qualitative data collection involved conducting six focus group discussions involving 35 individuals who experience significant life impact due to kidney disease to explore facilitators and barriers of CKD self-management.

Results: Individuals with flourishing positive mental health were significantly more likely to have high self-efficacy compared to individuals with languishing positive mental health (p < 0.001, Figure 10). Overall, in the fully adjusted model, the proportional odds ratio of improved self-efficacy was 2.89 (95% CI 1.29-6.47), all else held constant. For individuals with CKD, the proportional odds ratio of improved self-efficacy was 7.67 (95% CI 2.42-24.29), all else held constant. For individuals without CKD, positive mental health was not a significant predictor of self-efficacy (p-value > 0.05). Qualitative data showed support for the broaden and build theory as a possible mechanism linking positive mental health and CKD self-management. Positive emotions derived from positive mental health allowed individuals to acquire personal and social resources such as resilience, optimism, and social support that encourage self-management of CKD.

Conclusion: These findings suggest that positive mental health should be incorporated into existing CKD self-management programs to fully address the psychosocial needs of patients and effectively encourage sustainable behavioral changes for CKD self-management. Future efforts should focus on identifying positive mental health interventions that builds on the strong familial relationships, and spiritual and religious organizations in the community to improve positive mental health in this population.