الفهرس 
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Abstract
Kidney transplantion the filed mostly affected by adherence.Transplant recipient need to adhere to immunosuppressive medication and diet regimen for a life-long basis which is vital pre requisite for good organ function
Increased risk of transplant rejection with minimum diversion from the prescribed regimen, shortage of organ donors, long duration of remaining on the transplant waiting list, and the economic costs of dialysis render the need to follow the medical recommendations imperative. Therefore, patients are trained before being discharged from the hospital regarding the new lifestyle, including follow-up visits, prevention of infection, diet, use of immunosuppressive therapy, physical activity, recording self-monitoring, and sun protection items.
Aim of study:
The present study was conducted to fulfill the study aim:
Assess factors affecting adherence of patient after kidney transplantation.
Research question:
This study wasconducted for answering the following question:
What are factor affecting adherence of patient after kidney transplantation?
Subjects and methods:
Research design:
Descriptive expletory design was followed to a chive the aim of this study.
Setting:
This study was conducted in urology and nephrology out- patient clinic in Alexandria university hospital. The clinic consisted of two room one rom have doctor and nurse office and other room for patents examination.
Subject
A purposive sample of 30 patients after kidney transplantation follow in the previous mentioned setting at the time of data collection were recruited in this study.
Tools of data collection
1-Strutured interview questioner tool: (Appendix I)
It was develop by the researcher and written in Arabic language it consisted of 2 part.
Part I:
1-Demographic data assessment tool:
It was used to assess the patient demographic characteristics include (age –occupation, marital status, level of education)
2-Patient habits:
It was used to assess patient habits as smoking and alcohol addiction.
Part II:
Medical data assessment
It was used to assess medical data about patient history which include present illness, past history, family history.
1- Past history include affection of chronic disease, causes of renal failure and renal dialysis before transplant(Duration, Method).
2- Present history include sings of rejection, disease that may affect patient after transplantation only.
3- Family history which include of one of the patient relative hade pervious renal failure and if have kidney transplantation surgery.
II-Patient adherence after kidney transplantation questioner:
It was develop by researcher after reviewing related literature(Braun, 2015) it was used to assess patient adherence to therapeutic regimen it contain (7) items as prescribed diet contain (16) question, drug regimen contain(7) question, physical exercise (13)question, infection control (14)question, follow up (6)question, prevention of skin and breast cancer(8) question and sexual contact contain (8)question.
Scoring system:
Five scale were used to assess the patient adherence as the following:Always----4\ Often-----3\ Some- time ----2
Seldom----1\Never-----0
The total score of knowledge was (72) grade
It was consider that ≥ 75% = 54) adhere to therapeutic regimen. While <75 = 54)non adhere to therapeutic regimen.
III-Factor affecting patient adherence questioner:
It was developed by the researcher based on related literature review (Kenawy et al., 2019)
It divided to five parts:
Part 1:Socio economic factor it consisted of two part first social factor it aimed to assess patient social status as resident area, communication, relation with family member lack of effective support it contain (15) item.
Second economic factor it aim to assess patient economic status as poor economic statues, poverty, ,income of patient it contain(11) item.
Part 2: Patient related factor it aimed to assess patient statues and effect of transplantation on patient live it contain (13) item.
Part 3: Disease related factor it aimed to assess affection of disease and take another diseases it contain (7) item.
Part 4: Therapy related factor it aimed to assess drug regimen forgetfulness of medication dose, side effect of medication it contain (9) item.
Part 5: Health care setting-provider related factor it aimed to assess communication between patient and health care provider and the facility that offered by health care setting.it contain (10) item.The patient was answer by yes or No
III-Patient knowledge assessment interview
It was developed by the research based on related literature (Kidney, 2015).Written on simple Arabic langue, it was used to assess patient knowledge contain(13)Item include Definition, Reason, Treatment, complication, lab investigation, S&S, medication, nutrition, exercise, sexual relation, follow up, smoking habit and infection control.it Contain (63)question to assess patient knowledge regarding kidney transplantations.
Scoring system:
The total score knowledge (63) question
Each correct answer was given one grade and the incorrect answer was given zero, it was considered as follow.
60%was satisfactory level of knowledge when the total grade were >40
60%was unsatisfactory level of knowledge when the total grade <40.
Results:
Represented that 40% of the study patients were aged 20>40 years old with mean of age was 39.5±12.7. Also, 60.0% were male.While 90.0% are married and 53.0% are average education.as well as 83.3% are working, also 36.7% their work need both physical and mental effort. As well as 66.7% live on rural area.
73.3% of the studied patient was not smoker.63.3% of the studied patient suffering from other chronic diseases. 46.7% from them had hypertension, also 30.0% had diabetes and 13.3% have respiratory disease.
60.0% of the studied patient had symptoms of rejection post transplantation and 43.3% had fever66.7% are not adhering to the nutritional system.50.0%adher to treatment.Also 76.7% are not adhering to doing appropriate motor activity.While 70.0% not adhering to prevention of infection.While, 66.7% adhere to follow up program.Moreover 83.3% not adhere tothe precautions necessary to prevent skin cancer and breast. While 80.0% not adhere tothe guidelines for marital relations. Regarding to total adherence there was 70.0% not adhereto therapeutic regimen post kidney transplantations and 30.0% adhere.
80.0% 0f studied patient have adherence affection regarding to social factor, while 20.0% not have.Also 66.7% have adherence affection regarding to economic factors while 33.3% not have, 70.0% have adherence affection regarding to patient related factor and 50.0% have adherence affection regarding to Disease related factor. Also 80.0% have adherence affection regarding to Therapy related factor.86.7% have adherence regardingHealth care provider related factors.
73.3% had unsatisfactory level of knowledgethere were highly statistically significant relation between total knowledge and total adherencethere were highly statistically significant relation between total knowledge and all factors affecting adherencethere were highly statistically significant relation between total adherence and all factor affecting adherence.
There was significant between gender and total adherence. There was significant relation between work and total adherence.
There was a statically significant relation between total knowledge and gender, educational level.
Conclusion:
Based on the findings of the current study, it can be concluded that:
Mean of age was 39.5±12.7 and, two third were male. Less than three quarter of the studied patient was not smoker. Regarding to total adherence there was less than three quarter not adhere to therapeutic regimen post kidney transplantations
Majority of patient in the study have affection regarding to factor affecting adherence as social and economic factor. Also more than two third have adherence affection regarding to economic factors, less than three quarter have adherence affection regarding to patient related factor and half have adherence affection regarding to Disease related factor. Also majority have adherence affection regarding to Therapy related factor. Majority have adherence regarding Health care provider related factors. Less than three quarter had unsatisfactory level of knowledge.
While, there were highly statistically significant relation between total knowledge and total adherence as well as there were highly statistically significant relation between total knowledge and all factors affecting adherence, also there were highly statistically significant relation between total adherence and all factor affecting adherence. There was significant between gender and total adherence. While alsoThere was a statically significant relation between total knowledge and gender, educational level.