An Integrated, Evidence-Guided Framework for CKD Self-Management: Behavioral Mechanisms, Implementation Strategies, and Real-World Application.
Article
Diaz-Martinez, Janet, Leon-Morris, Staci, Delgado-Enciso, Iván et al. (2026). An Integrated, Evidence-Guided Framework for CKD Self-Management: Behavioral Mechanisms, Implementation Strategies, and Real-World Application.
. 1-34. 10.1159/000552085
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.
Methods
We conducted a structured narrative review with framework development. A systematic database search (PubMed, Embase, CINAHL, Scopus) identified English-language studies published January 2010-March 2025 addressing CKD self-management behaviors, behavioral mechanisms/theory, and/or delivery approaches and evaluation measures. Quantitative, qualitative, and mixed-methods studies were included, along with systematic reviews/meta-analyses to characterize evidence patterns. Supplementary sources (clinical guidelines, foundational theory frameworks, and measurement instruments) were used to define constructs and evaluation measures and were not treated as intervention-effect evidence. Findings were extracted into a structured evidence matrix and synthesized using a combined deductive-inductive approach to develop a practice-oriented framework.
Results
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) medication adherence; (2) dietary and fluid management; (3) clinical and home monitoring; (4) lifestyle modification; (5) patient activation; (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) link targets to behavioral mechanisms and specify components; (3) co-design and adapt content to patient priorities and context; (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 system alignment.
Conclusion
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.
