An Integrated, Evidence-Guided Framework for Chronic Kidney Disease Self-Management: Behavioral Mechanisms, Implementation Strategies, and Real-World Application.

BACKGROUND

Chronic kidney disease (CKD) affects over 850 million people worldwide and contributes substantially to cardiovascular complications, reduced quality of life, and high healthcare utilization. Self-management support can improve patient activation, self-management behaviors, and quality of life, yet application in routine CKD care remains inconsistent. Many existing programs lack explicit specification of behavioral mechanisms and implementation-relevant delivery approaches, limiting reproducibility and real-world scale-up.

SUMMARY: We conducted a structured narrative review with framework development. A structured database search (PubMed, Embase, CINAHL, Scopus) identified English-language quantitative, qualitative, mixed-methods, and review studies published from January 2010 to March 2025 addressing CKD self-management behaviors, behavioral mechanisms, delivery approaches, and evaluation measures. Findings were extracted into a structured evidence matrix and synthesized using a combined deductive-inductive approach to develop a practice-oriented framework. We synthesized 144 included records into an integrated framework linking domain-specific barriers, strategies/delivery supports, and evaluation measures. Seven priority CKD self-management domains were identified: (1) patient activation; (2) medication adherence; (3) dietary and fluid management; (4) clinical and home monitoring; (5) lifestyle modification; (6) emotional, psychological, and symptom burden; and (7) preparation for kidney failure treatment pathways (dialysis, transplant, or conservative kidney management). Cross-domain strategy clusters were mapped to behavioral mechanisms (e.g., self-efficacy strengthened through mastery experiences, observational learning, motivational communication, and management of emotional/physiological feedback). Implementation guidance was organized into a six-step, adaptable process: (1) identify and prioritize behaviors; (2) select and apply relevant behavioral theories; (3) conduct participatory co-design and contextual adaptation; (4) implement multimodal delivery (clinic, digital, and community reinforcement) with structured follow-up; (5) evaluate and refine using behavioral, clinical, patient-reported, utilization, and implementation outcomes; and (6) plan for scalability, sustainability, and policy integration.

KEY MESSAGES: This structured narrative synthesis integrates behavioral mechanisms with implementation-relevant strategies to provide a practice-oriented framework for designing, implementing, and evaluating CKD self-management support across clinical and community settings.