Behavioural strategies to self-manage low-potassium diets in chronic kidney disease

Abstract

Background: Dietary potassium restrictions may be challenging to follow, due in part to the restrictive nature of recommendations on foods people enjoy. Little is known how people incorporate low-potassium diets into their lifestyles.

Objective: To examine the self-directed behavioural strategies people employ to follow low-potassium advice.

Design: Qualitative methodology.

Participants: Thirty-four adults with chronic kidney disease.

Approach: Semistructured interviews were undertaken in an outpatient department. Thematic analysis was undertaken on transcribed interviews.

Findings: Analysis identified three themes: 'Differing opinions of food'; 'Food generates positive emotions'; and 'Doing what works'. Participants described foods providing different levels of enjoyment. Favourite foods in their habitual diet held either a physiological or a psychological value to them. Five subthemes underpinned the 'Doing what works' theme that described the self-management behaviours used by participants to follow low-potassium dietary advice. These were positive reframing; reflection; self-talk; social support; decisional balance; paradoxical instruction; and knowledge shaping. These techniques helped overcome the conflict between favourite food preferences and dietary restrictions. Dietary restrictions proved more challenging where an emotional connection to a favourite food existed. Restrictions on less preferred foods did not present participants with the same self-management challenges.

Conclusions: Promoting behavioural change techniques such as decisional balance, and social support may be a useful strategy to empower people following dietary restrictions. Practitioners should understand whether suggested dietary restrictions include an individual's favourite food; the value attached to it, and explore specific ways to include favourite foods in some way when discussing a low-potassium diet.

Keywords: kidney diseases; nutrition therapy; renal diet.