The role of self-regulation in managing chronic kidney disease

Self-regulation, which involves planning, initiating, monitoring, and evaluating behaviour to achieve goals, is essential for optimising health outcomes among patients on dialysis. However, many patients struggle with this, and the factors influencing effective self-regulation remain unclear. This thesis aimed to identify factors contributing to successful self-management of chronic kidney disease across three empirical chapters. Chapter 2 revealed that 46 randomised control interventions using techniques like goal setting and monitoring produced moderate to large effects on behavioural and physiological outcomes. Few studies assessed psychological targets, but significant effects were observed for knowledge and quality of life. Moderation showed that interventions including social support enhanced self-efficacy. Chapters 3 and 4 qualitatively examined patients' experiences and attitudes towards self-regulation, identifying differences between high and low adherence groups. Both groups used similar self-regulatory strategies, but their frequency and effectiveness varied. Patients with low adherence employed a broader range of strategies (e.g., more habitual behaviours, drink substitutions, and thirst management strategies, along with increased self-monitoring of behavioural outcomes) compared to those with high adherence. They also encountered more challenges, frequently reporting negative impacts from competing life demands and feeling less supported. Chapter 5 demonstrated a strong positive relationship between regulatory support and fluid management, with family support being particularly influential. Further, self-efficacy and commitment emerged as crucial mechanisms in this relationship. The quality of support and patients' geographical location significantly influenced outcomes. Overall, the findings highlight the significant impact of psychosocial and environmental factors on disease management. This work has several theoretical and methodological implications for understanding self-regulation and offers a nuanced perspective on processes supporting effective self-management.