Document Type : Original Article


Nursing Care Research Center, Iran University of Medical Sciences,Tehran, Iran, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran


BACKGROUND: Many kidney transplant recipients lack the knowledge, abilities, and support they
need for self‑care. On the other hand, most kidney transplant centers do not have a well‑planned
and specific training program for them, and educational interventions for kidney transplant recipients
have not been adequately effective. This study aimed to describe strategies for improving patient
education in kidney transplantation.
MATERIALS AND METHODS: Data were collected through semi‑structured individual and group
interviews with 24 patients, family members, and health‑care staff in one of the main kidney transplant
centers in Tehran. Participants were selected purposefully, and qualitative content analysis was
used to analyze the data.
RESULTS: The main finding emerged from the data was the shift from current patient education
program to patient‑ and family‑centered education (PFCE). The strategies to achieve this goal were
categorized into four main categories including “continuous patient and family education” (pre‑ and
posttransplant patient education), “facilitating the process” (using new technologies, teamwork
education, and patient and family accessibility), “strengthening human resources” (empowerment
health‑care team, allocation of human resources, promoting staffs’ motivation, and updating
educational content and materials), and “monitoring and evaluation” (correcting patient education
recording, supervising the patient education, and appropriate educational evaluation).
CONCLUSIONS: Transforming from the current patient education program to PFCE seems to be
essential to increase the effectiveness of patient education in kidney transplant process. To this
end, providing continuous patient and family education, facilitating the processes, strengthening
human resources, and monitoring and evaluation in health‑care organizations conducting the kidney
transplantation is necessary.


1. Jensen CE, Sørensen P, Petersen KD. In Denmark kidney
transplantation is more cost‑effective than dialysis. Dan Med J
2. McPake D, Burnapp L. Caring for patients after kidney
transplantation. Nurs Stand 2009;23:49‑57.
3. Rosselli D, Rueda JD, Diaz CE. Cost‑effectiveness of kidney
transplantation compared with chronic dialysis in end‑stage renal
disease. Saudi J Kidney Dis Transpl 2015;26:733‑8.
4. Schmid‑Mohler G, Albiez T, Schäfer‑Keller P, Fehr T, Biotti B,
Spirig R. In‑patient education after renal transplantation. Pflege
5. Trivedi P, Rosaasen N, Mansell H. The health‑care provider’s
perspective of education before kidney transplantation. Prog
Transplant 2016;26:322‑7.
6. Kostro JZ, Hellmann A, Kobiela J , S k ó r a I ,
Lichodziejewska‑Niemierko M, Dębska‑Ślizień A, et al. Quality of
life after kidney transplantation: A prospective study. Transplant
Proc 2016;48:50‑4.
7. Low JK, Williams A, Manias E, Crawford K. Interventions
to improve medication adherence in adult kidney transplant
recipients: A systematic review. Nephrol Dial Transplant
8. Gokoel SR, Gombert‑Handoko KB, Zwart TC, van der Boog PJ,
Moes DJ, de Fijter JW. Medication non‑adherence after kidney
transplantation: A critical appraisal and systematic review.
Transplant Rev (Orlando) 2020;34:100511.
9. Snyder JJ, Israni AK, Peng Y, Zhang L, Simon TA, Kasiske BL.
Rates of first infection following kidney transplant in the United
States. Kidney Int 2009;75:317‑26.
10. Burns T, Fernandez R, Stephens M. The experiences of adults who
are on dialysis and waiting for a renal transplant from a deceased
donor: A systematic review. JBI Database System Rev Implement
Rep 2015;13:169‑211.
11. Ghadami A, Memarian R, Mohamadi E, Abdoli S. Patients’
experiences from their received education about the process of
kidney transplant: A qualitative study. Iran J Nurs Midwifery
Res 2012;17:S157‑64.
12. Sharkey C, Gourishankar S. Transplant friends: An interactive
education program for patients awaiting kidney transplantation.
Transplant Proc 2003;35:2405‑6.
13. Ghadami A. Explaining Patients’ Experiences in the Kidney
Transplant Process and Designing a Care Model. Tehran: Tarbiat
Modares Universit; 2011.
14. Urstad KH, Wahl AK, Andersen MH, Øyen O, Fagermoen MS.
Renal recipients’ educational experiences in the early
post‑operative phase: A qualitative study. Scand J Caring Sci
15. Williams A, Low JK, Manias E, Crawford K. The transplant
team’s support of kidney transplant recipients to take their
prescribed medications: A collective responsibility. J Clin Nurs
16. Urstad KH, Wahl AK, Andersen MH, Øyen O, Hagen KB. Limited
evidence for the effectiveness of educational interventions for
renal transplant recipients. Results from a systematic review
of controlled clinical trials. Patient Educ Couns 2013;90:147‑54.
17. Tracy SJ. Qualitative Research Methods: Collecting Evidence,
Crafting Analysis. Wiley: Communicating Impact; 2012.
18. Zhang Y, Wildemuth BM. Qualitative analysis of content.
Applications of Social Research Methods to Questions in
Information and Library Science. Westport: Libraries Unlimited;
2009. p. 308‑19.
19. Schreier M. Qualitative Content Analysis in Practice. London:
Sage Publications; 2012.
20. Drisko JW, Maschi T. Content Analysis (Pocket Guide to Social
Work Research Methods). New York: Oxford University Press;
21. Polit DF, Beck CT. Essentials of Nursing Research: Appraising
Evidence for Nursing Practice. Wilkins: Wolters Kluwer Health/
Lippincott Williams; 2014.
22. Ågård AS, Hofhuis JG, Koopmans M, Gerritsen RT, Spronk PE,
Engelberg RA, et al. Identifying improvement opportunities for
patient‑ and family‑centered care in the ICU: Using qualitative
methods to understand family perspectives. J Crit Care
23. Dhurjati R, Sigurdson K, Profit J. Patient‑ and family‑centered
care as a dimension of quality. Am J Med Qual 2019;34:307‑8.
24. Ji H, Zhao H, An Y. Promoting patient‑ and family‑centered care
services in intensive care unit. Zhonghua Wei Zhong Bing Ji Jiu
Yi Xue 2019;31:397‑9.
25. Johnson B, Abraham M. Partnering With Patients, Residents,
and Families: A Resource for Leaders of Hospitals, Ambulatory
Care Settings, and Long‑term Care Communities. Bethesda, MD:
Institute for Patient‑and Family‑Centered Care; 2012.
26. Rathert C, Wyrwich MD, Boren SA. Patient‑centered care and
outcomes: A systematic review of the literature. Med Care Res
Rev 2013;70:351‑79.
27. Windrum P, García‑Goñi M, Coad H. The impact of
patient‑centered versus didactic education programs in chronic
patients by severity: The case of type 2 diabetes mellitus. Value
Health 2016;19:353‑62.
28. Khanjari S, Tajik Z, Haghani H. The effect of family‑centered
education on the quality of life of adolescents with spinal cord
injuries. J Family Med Prim Care 2019;8:711‑6.
29. Hsu C, Gray MF, Murray L, Abraham M, Nickel W, Sweeney JM,
et al. Actions and processes that patients, family members, and
physicians associate with patient‑ and family‑centered care. BMC
Fam Pract 2019;20:35.
30. Browne T, Amamoo A, Patzer RE, Krisher J, Well H, Gander J,
et al. Everybody needs a cheerleader to get a kidney transplant:
A qualitative study of the patient barriers and facilitators to
kidney transplantation in the Southeastern United States. BMC
Nephrol 2016;17:108.
31. Rosaasen N, Mainra R, Kukha‑Bryson A, Nhin V, Trivedi P,
Shoker A, et al. Development of a patient‑centered video series to
improve education before kidney transplantation. Patient Educ
Couns 2018;101:1624‑9.
32. Rosaasen N, Mainra R, Shoker A, Wilson J, Blackburn D,
Mansell H. Education before kidney transplantation. Prog
Transplant 2017;27:58‑64.
33. Urstad KH, Wahl AK, Engebretsen E, Larsen MH, Vidnes TK,
Stenwig AG, et al. Implementation of a new patient education
programme for renal transplant recipients. J Ren Care
34. Wilson R, Brown DR, Boothe MA, Weng FL. Improving the delivery of patient education about kidney transplant in a
transplant center. Prog Transplant 2012;22:403‑12.
35. Schapira MM, Swartz S, Ganschow PS, Jacobs EA, Neuner JM,
Walker CM, et al. Tailoring educational and behavioral
interventions to level of health literacy: A systematic review.
MDM Policy Pract 2017;2:1‑12.
36. AndersenMH, WahlAK, EngebretsenE, UrstadKH. Implementing
a tailored education programme: Renal transplant recipients’
experiences. J Ren Care 2019;45:111‑9.
37. Tsapepas DS, Salerno D, Jandovitz N, Hammad S, Jordan P,
Mohan S, et al. Using technology to enhance medication regimen
education after solid organ transplantation. Am J Health Syst
Pharm 2018;75:1930‑7.
38. Hunt HF, Rodrigue JR, Dew MA, Schaffer RL, Henderson ML,
BloomR, et al. Strategies for increasing knowledge, communication,
and access to living donor transplantation: An evidence review
to inform patient education. Curr Transplant Rep 2018;5:27‑44.
39. Malkina A, Tuot DS. Role of telehealth in renal replacement
therapy education. Semin Dial 2018;31:129‑34.
40. Farahani MA, Mohammadi E, Ahmadi F, Mohammadi N. Factors
influencing the patient education: A qualitative research. Iranian
Journal of Nursing and Midwifery Research. 2013;18:133‑9.
41. Preussler JM, Mau LW, Majhail NS, Bevans M, Clancy E,
Messner C, et al. Caregiver availability and patient access to
hematopoietic cell transplantation: Social worker perspectives
inform practice. Support Care Cancer 2019;27:4253‑64.
42. Bastable SB. Essentials of Patient Education. Massachusetts: Jones
& Bartlett Learning; 2016.
43. Ramezanli S, Badiyepeymaie Jahromi Z. Iranian nurses’ views
on barriers and facilitators in patient education: A cross‑sectional
study. Glob J Health Sci 2015;7:288‑93.
44. Khorasani P, Rassouli M, Parvizy S, Zagheri‑Tafreshi M,
Nasr‑Esfahani M. Nurse‑led action research project for expanding
nurses’ role in patient education in Iran: Process, structure, and
outcomes. Iran J Nurs Midwifery Res 2015;20:387‑97.
45. Seyedin H, Goharinezhad S, Vatankhah S, Azmal M. Patient
education process in teaching hospitals of Tehran University of
Medical Sciences. Med J Islam Repub Iran 2015;29:220.