The trigger-information-response model: Exploring health literacy during the first six months following a kidney transplantation

Autoři: Kari Gire Dahl aff001;  Eivind Engebretsen aff001;  Marit Helen Andersen aff001;  Kristin Hjorthaug Urstad aff003;  Astrid Klopstad Wahl aff001
Působiště autorů: Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway aff001;  Department of Transplant Medicine in the Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Oslo, Norway aff002;  Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article


The main objective of this study was to explore how kidney transplant recipients find, understand, and use health information, and make decisions about their health—also known as health literacy. Kidney transplant recipients must take an active part in their health following the transplantation, since a new organ requires new medication and focus on lifestyle to prevent side-effects and signs of organ rejection. Consequently, it is of major clinical relevance to explore how kidney transplant recipients understand and relate to health literacy. Ten kidney transplant recipients were interviewed at three weeks and again at six months post-transplantation. Design and analysis were inspired by constructivist grounded theory. The results of the study are presented through a model consisting of three phases: the trigger phase, the information phase, and the response phase. The participants were influenced by context and personal factors as they moved between three phases, as information seekers, recipients, and sharers. This study illustrates health literacy as an active process. It gives new insight into what motivates kidney recipients to find, share, and receive information, and how a hierarchy of resources is built and used.

Klíčová slova:

Behavioral and social aspects of health – Health care providers – Health education and awareness – Kidneys – Nephrology – Nurses – Patients – Renal transplantation


1. Nutbeam D. Health promotion glossary1. Health promotion international. 1998;13(4):349–64.

2. Friis K, Lasgaard M, Osborne RH, Maindal HT. Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29 473 Danish citizens. BMJ open. 2016;6(1):e009627. doi: 10.1136/bmjopen-2015-009627 26769783

3. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Annals of internal medicine. 2011;155(2):97–107. doi: 10.7326/0003-4819-155-2-201107190-00005 21768583

4. Caruso R, Magon A, Baroni I, Dellafiore F, Arrigoni C, Pittella F, et al. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol. 2018:1–12. doi: 10.1007/s00592-017-1071-1 29129000

5. Karuthu S, Blumberg EA. Common infections in kidney transplant recipients. Clin J Am Soc Nephrol. 2012;7(12):2058–70. doi: 10.2215/CJN.04410512 22977217

6. Ojo AO. Cardiovascular complications after renal transplantation and their prevention. Transplantation. 2006;82(5):603–11. doi: 10.1097/ 16969281

7. Mudigonda T, Levender MM, O’neill JL, West CE, Pearce DJ, Feldman SR. Incidence, Risk Factors, and Preventative Management of Skin Cancers in Organ Transplant Recipients: A Review of Single-and Multicenter Retrospective Studies from 2006 to 2010. Dermatol Surg. 2013;39(3pt1):345–64.

8. Danovitch GM. Handbook of Kidney Transplantation 6. ed. Philadelphia: Wolters Kluwer; 2017.

9. Dageforde LA, Cavanaugh KL. Health literacy: emerging evidence and applications in kidney disease care. Adv Chronic Kidney Dis. 2013;20(4):311–9. doi: 10.1053/j.ackd.2013.04.005 23809283

10. Dageforde LA, Petersen AW, Feurer ID, Cavanaugh KL, Harms KA, Ehrenfeld JM, et al. Health literacy of living kidney donors and kidney transplant recipients. Transplantation. 2014;98(1):88. doi: 10.1097/TP.0000000000000027 24573114

11. Dageforde LA, Box A, Feurer ID, Cavanaugh KL. Understanding patient barriers to kidney transplant evaluation. Transplantation. 2015;99(7):1463. doi: 10.1097/TP.0000000000000543 25606794

12. Demian MN, Shapiro RJ, Thornton WL. An observational study of health literacy and medication adherence in adult kidney transplant recipients. NDT Plus. 2016;9(6):858–65.

13. Escobedo W, Weismuller P. Assessing health literacy in renal failure and kidney transplant patients. Prog Transplant. 2013;23(1):47–54. doi: 10.7182/pit2013473 23448820

14. Gordon EJ, Wolf MS. Health literacy skills of kidney transplant recipients. Prog Transplant. 2009;19(1):25–34. 19341060

15. Taylor DM, Fraser S, Dudley C, Oniscu GC, Tomson C, Ravanan R, et al. Health literacy and patient outcomes in chronic kidney disease: a systematic review. Nephrology Dialysis Transplantation. 2017.

16. Kazley AS, Jordan J, Simpson KN, Chavin K, Rodrigue J, Baliga P. Development and testing of a disease-specific health literacy measure in kidney transplant patients. Prog Transplant. 2014;24(3):263–70. doi: 10.7182/pit2014958 25193727

17. Grubbs V, Gregorich SE, Perez-Stable EJ, Hsu C-y. Health literacy and access to kidney transplantation. Clin J Am Soc Nephrol. 2009;4(1):195–200.

18. Taylor DM, Bradley JA, Bradley C, Draper H, Johnson R, Metcalfe W, et al. Limited health literacy in advanced kidney disease. Kidney International. 2016;90(3):685–95. doi: 10.1016/j.kint.2016.05.033 27521115

19. Fraser SD, Roderick PJ, Casey M, Taal MW, Yuen HM, Nutbeam D. Prevalence and associations of limited health literacy in chronic kidney disease: a systematic review. Nephrology Dialysis Transplantation. 2013;28(1):129–37.

20. Patzer RE, Serper M, Reese PP, Przytula K, Koval R, Ladner DP, et al. Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients. Clinical Transplantation. 2016;30(10):1294–305. doi: 10.1111/ctr.12821 27447351

21. Urstad KH, Øyen O, Andersen MH, Moum T, Wahl AK. The effect of an educational intervention for renal recipients: a randomized controlled trial. Clinical transplantation. 2012;26(3):E246–E53. doi: 10.1111/j.1399-0012.2012.01666.x 22686948

22. Charmaz K. Constructing grounded theory: Sage; 2014.

23. Charmaz K. Special invited paper: Continuities, contradictions, and critical inquiry in Grounded Theory. International Journal of Qualitative Methods. 2017;16(1):1609406917719350.

24. Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC public health. 2013;13(1):1.

25. Haavind Hm. Liten og stor: mødres omsorg og barns utviklingsmuligheter. [Oslo]: Universitetsforl.; 1987. 358, [1] s.; 21 cm p.

26. Jordan JE, Buchbinder R, Osborne RH. Conceptualising health literacy from the patient perspective. Patient education and counseling. 2010;79(1):36–42. doi: 10.1016/j.pec.2009.10.001 19896320

27. Mai J-E. Looking for information: A survey of research on information seeking, needs, and behavior: Emerald Group Publishing; 2016.

28. Leung AYM, Bo A, Hsiao H-Y, Wang SS, Chi I. Health literacy issues in the care of Chinese American immigrants with diabetes: a qualitative study. BMJ open. 2014;4(11):e005294. doi: 10.1136/bmjopen-2014-005294 25406155

29. Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora NK, Rimer BK, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Archives of internal medicine. 2005;165(22):2618–24. doi: 10.1001/archinte.165.22.2618 16344419

30. Marrie RA, Salter AR, Tyry T, Fox RJ, Cutter GR. Preferred sources of health information in persons with multiple sclerosis: degree of trust and information sought. J Med Internet Res. 2013;15(4).

31. Case DO, Andrews JE, Johnson JD, Allard SL. Avoiding versus seeking: the relationship of information seeking to avoidance, blunting, coping, dissonance, and related concepts. J Med Libr Assoc. 2005;93(3):353. 16059425

32. Maslow AH. The need to know and the fear of knowing. The Journal of General Psychology. 1963;68(1):111–25.

33. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international. 2000;15(3):259–67.

34. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. American journal of health behavior. 2007;31(Supplement 1):S19–S26.

35. Engebretsen E, Vøllestad NK, Wahl AK, Robinson HS, Heggen K. Unpacking the process of interpretation in evidence-based decision making. Journal of evaluation in clinical practice. 2015;21(3):529–31. doi: 10.1111/jep.12362 25851201

36. Squiers L, Peinado S, Berkman N, Boudewyns V, McCormack L. The health literacy skills framework. Journal of health communication. 2012;17(sup3):30–54.

37. Baker DW. The meaning and the measure of health literacy. J Gen Intern Med. 2006;21(8):878–83. doi: 10.1111/j.1525-1497.2006.00540.x 16881951

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2019 Číslo 10
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