{"paper_id":"307bbeef-8e90-4be8-b3e7-030083c276e4","body_text":"Self-Care Practices Among Patients with Chronic Kidney Disease: Implications for Nursing Care in Vietnam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Self-Care Practices Among Patients with Chronic Kidney Disease: Implications for Nursing Care in Vietnam Le Thi Thao Hien, Nguyen Van Canh, Truong Hoai Nam, Tran Thị Chau, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8149857/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim This study aimed to explore and analyze the self-care behaviors among patients diagnosed with chronic kidney disease at Kien Giang General Hospital. The focus was on understanding how patients managed their condition through self-care practices and the various factors that influenced these behaviors. Methods A qualitative research design was utilized to gain in-depth insights into the experiences of chronic kidney disease patients. Data were collected through a combination of structured questionnaires and in-depth interviews with 20 participants aged between 18 to 60 years. The study achieved data saturation, meaning that the last eight participants provided responses that were largely redundant with those of earlier participants, indicating that sufficient information had been gathered to represent the population. Clinical trial number: not applicable Results The key findings of the study indicated that essential self-care behaviors, including nutrition, physical activity, and medication adherence, played a critical role in the effective management of chronic kidney disease. Participants exhibited varying levels of awareness regarding their disease, which directly impacted their self-care practices. Furthermore, the study revealed that family support and available community resources significantly influenced these self-care behaviors. However, various challenges, such as health-related issues and financial constraints, were identified as significant barriers that hindered patients’ abilities to manage their condition effectively. Conclusions This research provided new insights into the crucial role of educational initiatives and community engagement in empowering patients with chronic kidney disease. By enhancing patients' understanding of their condition and available resources, their overall quality of life could be significantly improved. The study concluded with recommendations for healthcare providers, emphasizing the urgent need for integrated support systems that addressed the identified challenges and enhanced health outcomes for patients suffering from chronic kidney disease. These findings provide critical insights for nurses supporting chronic kidney disease patients, highlighting the need for comprehensive patient education, family-inclusive care approaches, and nursing advocacy to address systemic barriers to effective self-management. Chronic kidney disease self-care behaviors nursing care patient education self-care support awareness Figures Figure 1 1 Introduction Nurses play a pivotal role in chronic kidney disease management, serving as primary educators, care coordinators, and patient advocates within healthcare teams. In chronic kidney disease care, nursing responsibilities encompass comprehensive patient and family education, assessment of self-care capacity, identification of barriers to treatment adherence, and coordination with multidisciplinary teams and community resources. Understanding patients' lived experiences with self-care practices and the challenges they encounter provides essential insights for developing targeted nursing interventions that effectively support chronic kidney disease management in resource-limited settings. This is particularly important in Vietnam, where healthcare infrastructure constraints require innovative, nurse-led approaches to chronic disease management.Chronic kidney disease has emerged as one of the most significant challenges to global public health. According to the World Health Organization (WHO), the prevalence of chronic kidney disease is rapidly rising, especially in developing countries. In 2017, global prevalence was reported at 9.1%, translating to approximately 697.5 million cases, with higher age-standardized rates observed in women and girls (9.5%) compared to men and boys (7.3%). Nearly one-third of chronic kidney disease cases originated from China (132.3 million) and India (115.1 million). Additionally, ten countries reported over 10 million cases, while 79 countries had more than 1 million cases. Although the overall prevalence of chronic kidney disease increased by 29.3% from 1990 to 2017, age-standardized rates showed minimal change, largely due to the aging global population [ 1 ]. The condition of chronic kidney disease not only substantially affects individual health but also imposes a burden on healthcare systems, as the costs associated with treatment and care for patients continue to escalate [ 2 ]. the incidence of dialysis and kidney transplantation globally has also risen from 1990 to 2017, with increases of 43.1% and 34.4% for dialysis, and 10.7% and 12.8% for transplantation, reflecting the growing availability of these therapies. In Vietnam, the situation has become increasingly urgent, with a significant rise in the number of chronic kidney disease patients. statistics from the ministry of health indicate that chronic kidney disease has become one of the leading causes of mortality and disability [ 3 , 4 ]. Individuals aged 18 to 60 are particularly affected, yet there are considerable shortcomings in self-care practices. Many patients lack awareness of their health status, do not fully understand treatment methods and preventive measures, leading to non-adherence to necessary care protocols. This not only diminishes their quality of life but also places significant pressure on the healthcare system, as hospitals face growing numbers of patients in severe conditions. Many studies confirmed that understanding the disease and practicing self-care can reduce the risk of kidney function deterioration. However, in Vietnam, research on self-care behaviors and the factors influencing these behaviors remains insufficient. Many patients not only lack knowledge but also lack support from family and community in implementing necessary health care measures, resulting in suboptimal treatment outcomes. Given these current issues, the research team undertook the study titled \"Investigating Self-Care Behaviors in Patients with Chronic Kidney Disease\" to enhance awareness of self-care practices within the community and to seek practical solutions to improve the quality of healthcare for chronic kidney disease patients. The primary objective of this study is to conduct an in-depth exploration of the self-care behaviors of chronic kidney disease patients in Vietnam. The research will focus on five specific objectives: To clearly describe the self-care behaviors of patients, including dietary habits, physical activity, and treatment adherence. To assess the level of patients' understanding regarding their condition, treatment methods, and preventive measures. To analyze the relationship between self-care behaviors and the quality of life of patients, highlighting the importance of self-care. To identify the barriers that patients encounter in implementing appropriate self-care behaviors, thereby seeking reasonable solutions. To provide recommendations aimed at improving self-care behaviors and enhancing the quality of life for patients with chronic kidney disease. 2 Study Population and Methodology 2.1 Study Population This study focused on individuals diagnosed with chronic kidney disease across stages 1 to 5. The participants were aged between 18 and 60. They were also required to provide informed consent to participate in the research. Inclusion criteria: Patients diagnosed with chronic kidney disease, aged between 18 and 60, receiving care at hospitals nephrology clinics. Exclusion criteria: Individuals with psychiatric disorders, those in acute stages of kidney disease or experiencing severe complications, individuals unable to communicate or comprehend the research protocol, and those with a history of substance abuse or other significant health issues were excluded. 2.2 Research Context Data collection for the study was conducted from June 3 to July 3, 2025, at Kien Giang General Hospital. This timeframe was strategically established to ensure comprehensive data collection and analysis. 2.3 Research Design The study employed a qualitative research design. 2.4 Sampling Strategy The sample size for this investigation consisted of 20 patients diagnosed with chronic kidney disease. A convenience sampling method was utilized to select participants who expressed willingness to engage in the study and met the predetermined inclusion criteria. 2.5 Data Collection Methods and Instruments Data were collected through the administration of questionnaires and in-depth interviews. The questionnaires were meticulously designed to elicit information regarding self-care behaviors, knowledge of chronic kidney disease, quality of life, and barriers to effective care. In-depth interviews aimed to encourage participants to articulate their personal experiences and insights, thereby enriching the qualitative data. 2.6 Research Procedure The research procedure unfolded in a series of systematic steps. Initially, patients were selected based on the established inclusion criteria. Subsequently, participants were briefed about the study’s objectives and methodologies. Following this, data collection commenced, necessitating informed consent prior to the conduct of interviews. Ultimately, all collected information was securely archived. 2.7 Data Collection and Processing Methods Data analysis was conducted through manual framework analysis. The framework analysis was applied following a six-step process as described in the literature: transcription, familiarization, coding, applying the analytical framework, charting the data, and interpreting the data. All interview recordings were anonymized by assigning a protocol number and a sequence number to each interviewee [recording 1]. The authors undertook a preliminary reading of the transcripts to become familiar with the data. The transcripts were coded to capture the underlying concepts of the health behavior model and to create a framework matrix. The charting process involved deductively coding and summarizing the data, with each column representing a construct of the HBM and each row representing participants. Similar data codes were grouped into sub-themes and discussed. Finally, a detailed report was drafted to provide an overview of the exploratory findings of the study. The principles of SRQR for reporting qualitative research were closely followed in this study. 2.8 Ethics Statement This study was approved by the Institutional Review Board of Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam (Registration Number: 22/GCN-NTT, approval date: June 9th, 2025). All participants provided written informed consent prior to data collection. The study was conducted in accordance with the Declaration of Helsinki and all applicable ethical guidelines for research involving human participants. 3 Results 3.1 Self-Care Practices for Effective Kidney Health Management The study found that participants engaged in self-care practices to manage their kidney health, primarily focusing on nutrition, exercise, and medication adherence. Many restricted sodium and potassium intake, emphasizing a balanced diet. Most participants walked for 15 to 30 minutes daily and incorporated household chores into their routines. Managing a chronic illness can be difficult for renal patients due to strict dietary guidelines, requiring significant lifestyle changes. This includes monitoring fluid and food intake, especially high-potassium and high-sodium items [ 5 ]. The pressure to comply can lead to feelings of helplessness if symptoms persist [ 6 ]. Accessible support from healthcare professionals is crucial for guidance and encouragement. Many dialysis patients report insufficient support, leading them to seek their own methods for managing diets and treatment compliance [ 7 ]. This lack of engagement hinders effective self-care, consistent with research on medication adherence [ 8 ]. Nurses should provide ongoing education and emotional support to renal patients to enhance their understanding of dietary guidelines and medication adherence. Collaborating with patients in creating individualized care plans can help bridge gaps in support and improve self-care practices. 3.2 Dietary Habits and Exercise Practices Many participants reported dietary restrictions, particularly regarding sodium and potassium intake. They emphasized limiting salty foods and avoiding high-potassium items like bananas and durians. Meals typically included a variety of vegetables, with an emphasis on lighter portions, such as one bowl at a time, and three smaller meals throughout the day. Some opted for three to four small meals daily, often with well-cooked vegetables to lower potassium levels. Most engaged in light physical activities, exercising for about 45 minutes daily. However, many participants noted challenges in maintaining these dietary practices, stating that managing their eating habits became more difficult after their diagnosis. Additionally, a study highlighted a significant prevalence of physical inactivity among renal patients, linking it to disease complications, time constraints, inadequate staffing, and poor hospital management [ 9 ]. Additionally, a study concluded that patients expressed a strong need for more information and encouragement regarding physical activities and exercises, both during therapy sessions and in their daily lives [ 5 ]. This study underscores the necessity for nurses to adopt a proactive role in educating renal patients about appropriate dietary practices and the importance of structured physical activity. By providing personalized resources and ongoing motivational support, healthcare professionals can empower patients to effectively navigate dietary restrictions and cultivate sustainable exercise routines. Such an approach is likely to enhance patient adherence, improve overall health outcomes, and promote a greater sense of autonomy in managing their chronic conditions. 3.3 Awareness of Chronic Kidney Disease A significant number of participants exhibited a strong awareness of their health condition, particularly recognizing that they were at stage 5 of chronic kidney disease. They described symptoms such as fatigue, unstable blood pressure, loss of appetite, and mild abdominal pain. Many acknowledged the disease's effects on their physical and psychological well-being, noting difficulties with eating and overall quality of life. Some individuals were unaware of their condition until it reached an advanced stage, indicating a gap in knowledge about chronic kidney disease prior to diagnosis. Additionally, many understood the chronic and irreversible nature of their illness, often attributing it to underlying issues like hypertension and diabetes. They recognized the necessity of treatments such as dialysis and grasped the seriousness of their situation after discussions with healthcare providers. While many displayed a thorough understanding of their condition, others had limited awareness before diagnosis [ 10 , 11 ]. Thus, nurses must prioritize patient education to bridge the knowledge gap regarding chronic kidney disease. By organizing open discussions and providing educational resources, nurses can enhance patients' understanding of their condition, its progression, and the importance of early intervention. 3.4 Education Provided by Healthcare Professionals Many participants reported that their doctors provided consultations on medication adherence, regular dialysis treatments, dietary modifications, and medication management. Some noted that healthcare providers involved family members in the educational process, ensuring comprehensive understanding of dietary restrictions and treatment options. Discussions about more invasive treatments, such as kidney transplantation and peritoneal dialysis, were also mentioned. Participants appreciated the thorough information, which helped them better understand their condition and treatment strategies. Their efforts to follow the advice given indicate that this educational support positively impacted their self-care routines, highlighting the importance of provider involvement in patient education [ 12 ]. The variability in education quality underscores the need for standardized nursing education protocols that ensure all chronic kidney disease patients receive comprehensive, practical guidance regardless of which provider they encounterNurses should actively engage in the educational process by reinforcing information provided by doctors and ensuring that patients and their families comprehend their treatment plans. Nurses should always be ready to assist when patients have difficulty understanding; with consistent guidance, nurses can enhance patients’ understanding and adherence to medication regimens and dietary modifications, ultimately improving health outcomes 3.5 Impact of Chronic Kidney Disease on Quality of Life Many individuals reported significant impacts on their physical health, leading to mobility challenges and difficulties in daily activities. A common theme was the inability to work, which contributed to feelings of sadness and frustration. Participants experienced fatigue and mental distress, with a decline in psychological well-being. Social interactions were negatively affected, leading to isolation and low self-esteem. Despite some participants noting a stabilization of their mental state over time, the overall sentiment was that their quality of life had been severely compromised. This finding indicates that nurses should routinely assess the psychological and social well-being of patients with chronic kidney disease to identify those struggling with mental health issues in order to provide timely support 3.6 Self-Care Behaviors and Their Impact on Happiness and Life Satisfaction Many individuals expressed that taking care of their health positively influenced their mood and overall well-being. Participants noted that when they felt healthy, they experienced greater joy and enthusiasm for life, enabling them to engage more easily with others. Conversely, several individuals indicated that periods of fatigue or illness led to feelings of sadness and discouragement. The contrast between feeling well and unwell was frequently mentioned, with a recurring sentiment that good health correlates with positivity and social engagement, while poor health often results in feelings of helplessness and frustration. Nurses should encourage and support self-care behaviors among patients with chronic kidney disease by consistently promoting healthy lifestyle choices and addressing barriers to self-care, nurses can help patients cultivate a more positive outlook and improve their overall quality of life. 3.7 Challenges Faced in Self-Care Practices A significant number of individuals reported difficulties primarily related to their health status, including instability, fatigue, insomnia, and loss of appetite. These factors hindered their ability to maintain regular self-care routines. Financial constraints emerged as a prominent issue, with many participants indicating that high treatment costs significantly impacted their ability to care for themselves. Participants also mentioned specific challenges in adhering to medical guidelines, such as remembering to take medications on time and managing fluid intake. Some individuals expressed that the stress of maintaining dietary restrictions added to their overall psychological burden. Patients with chronic kidney disease faced challenges in adhering to self-care routines due to financial constraints and complex health management. These barriers reduced access to necessary healthcare services and complicated self-management. To enhance adherence and well-being, integrated support systems were deemed essential [ 13 – 15 ]. These barriers require nursing assessment and advocacy, with nurses serving as essential links between patients and available support resources. 3.8 Environmental and Familial Factors Affecting Self-Care According to numerous respondents, their families helped them manage their health by offering substantial material and emotional support. This supportive environment was often highlighted as a positive influence on their self-care routines. Conversely, while family support was strong, some participants noted a lack of assistance from local resources or community support systems. Although family members were actively involved in providing help, the absence of additional support from local healthcare services or insurance arrangements was a recurring concern. A few participants mentioned that logistical challenges, such as transportation to medical facilities, could complicate their care. Nurses should assess the familial and environmental support systems of patients with chronic kidney disease to identify gaps in assistance and facilitate connections to community resources or support services to enhance the effectiveness of patients' self-care strategies 3.9 Support Needed to Improve Self-Care Behaviors Participants stressed the importance of support from local government and community resources, including access to healthcare services, insurance coverage, and medical equipment. They called for comprehensive support systems that integrate medical advice with community resources, emphasizing coordinated efforts between healthcare providers, local authorities, and organizations to ensure patients receive necessary support. Nurses should actively advocate for enhanced community support systems that provide comprehensive access to healthcare services, such as connecting with local health stations in each area, insurance options, and necessary medical equipment for patients with chronic kidney disease. 3.10 Raising Awareness About Self-Care in the Community Many survey participants suggested enhancing awareness of kidney health through workshops and seminars focused on education, early detection, and treatment methods. They emphasized promoting healthy eating habits, reducing fried foods and sugary drinks, and encouraging regular health check-ups. Participants also highlighted the need for awareness campaigns via newspapers and radio to inform the public about kidney disease and routine screenings. Additionally, they proposed organizing free health screenings and consultations to help individuals understand kidney disease risks and the benefits of preventive care. Nurses should actively engage in outreach activities, including health screenings and informational workshops, as these initiatives can empower the community by providing essential knowledge and resources that promote overall kidney health 4 Thematic Framework for Self-Care Practices in Chronic Kidney Disease Figure 1 for understanding self-care in chronic kidney disease highlights key factors influencing patient health management, focusing on three main elements: nutrition, physical activity, and medication adherence. Nutrition is vital for chronic kidney disease management, with patients often implementing dietary restrictions to limit salt and potassium, emphasizing a balanced intake of vegetables and light meals. As shown in Fig. 1 , physical activity, such as walking or household chores, is also essential, as consistent light exercise boosts both physical and emotional well-being. Medication adherence is crucial; patients recognize the importance of following prescribed regimens and often devise strategies for timely intake. Their awareness of chronic kidney disease, including understanding symptoms and underlying causes like hypertension and diabetes, significantly influences their self-care behaviors. Education from healthcare professionals shapes these practices, with consultations on medication and dietary needs being highly valued. Involving family members enhances support, but patients face challenges such as fatigue, financial constraints, and limited local resources, which hinder self-management. Community involvement and prompt assistance from medical professionals are crucial for enhancing self-care. Local initiatives and awareness campaigns on kidney health can empower patients and enhance care. This framework underscores the interconnectedness of self-care behaviors, awareness, education, and support systems, guiding healthcare teams in developing effective management plans for patients with chronic kidney disease. 5 Discussion section The findings from this study underscore the critical self-care challenges faced by patients with chronic kidney disease. Nurses play an essential role in mitigating these challenges by providing comprehensive education on dietary restrictions, medication adherence, and the importance of regular monitoring. Furthermore, recognizing that patients often face barriers related to motivation and understanding, the implementation of personalized care plans can be beneficial. That's why, nurses should engage in continuous dialogue with patients, fostering an environment where individuals feel empowered to discuss their challenges and progress. This relational dynamic between nurse and patient is essential in promoting adherence to self-care regimens, ultimately enhancing patient outcomes and quality of life. Other hands, Family involvement is crucial in supporting patients with chronic kidney disease. Nurses must recognize the value of engaging family members in the education and management of their loved one's health. Nurses not only provide knowledge to patients but also provide understanding to patients' families. Coordinating communication among healthcare providers, patients, and family members can enhance the support network necessary for effective disease management. Nurses can facilitate workshops or informational sessions directed at families, equipping them with the tools needed to assist in daily health management and advocacy for the patient’s needs. This collective approach not only strengthens the patient’s support system but also fosters a more holistic view of health care within the familial context. The study highlights various systemic barriers that patients with chronic kidney disease encounter, including limited community resources and challenges in accessing healthcare. Nurses have a pivotal role in advocacy and care coordination to address these issues. By liaising with community organizations, healthcare facilities, and local government, nurses can work to improve accessibility to resources such as transportation, financial assistance, and support groups. Comparing this study's findings with international literature reveals both commonalities and differences in chronic kidney disease self-care practices. Similar to other studies, participants in this research emphasized the importance of education and support in managing their condition. However, disparities emerge concerning the level of family and community support available, which varies significantly across different cultural contexts. For instance, studies from countries with more robust healthcare frameworks report higher rates of patient engagement and access to resources. In contrast, patients in regions with limited support often struggle with adherence to self-care recommendations. This highlights the need for localized strategies that account for the unique challenges faced by chronic kidney disease patients within specific communities. To prepare nurses for the evolving landscape of chronic kidney disease care, educational programs must integrate comprehensive training on self-care assistance, family involvement, and community resource navigation. Specific recommendations include developing curricula that emphasize communication skills tailored for patient and family education, as well as understanding the socio-economic factors influencing health behaviors. Moreover, simulation-based training can enhance nurses' capacity to address complex care scenarios involving chronic kidney disease patients. Continued professional development opportunities should focus on advocating for patients and coordinating care, ensuring that nurses remain equipped to meet the diverse needs of this population. Strengths and Limitations The strengths of this study lie in its comprehensive exploration of self-care practices among chronic kidney disease patients, emphasizing both dietary habits and emotional well-being. However, the research was conducted at a single location, which may limit the generalizability of the findings to other populations. Furthermore, participant responses could have been influenced by the dynamics of the interviewer-interviewee relationship, potentially affecting the depth and authenticity of the data collected. Future studies should aim for a more diverse participant pool across different regions to enhance the applicability of the findings. 6 Conclusions The findings of this study underscore the significant impact of both external and internal factors on the self-management behaviors of individuals with chronic kidney disease. Awareness and education provided by healthcare professionals play a vital role in helping patients understand their condition and adhere to treatment regimens. However, challenges such as financial constraints and limited community support can hinder effective self-care. To improve health outcomes, it is essential for healthcare teams and policymakers to consider these factors and develop comprehensive support systems that empower patients to manage their health effectively. Raising awareness about self-care within the community, along with providing adequate resources and support, is crucial for enhancing the quality of life for those living with chronic kidney disease. These findings generate several critical implications for nursing practice in chronic kidney disease care. Nurses must prioritize comprehensive patient and family education using culturally appropriate, practical approaches. Systematic assessment of self-care barriers—including financial constraints, health literacy, and family support—should be integrated into routine nursing care. Nurses are uniquely positioned to serve as care coordinators, connecting patients with community resources and advocating for systemic improvements in chronic kidney disease care delivery. Declarations Ethics Statement This study was approved by the Institutional Review Board of Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam (Registration Number: 22/GCN-NTT, approval date: June 9th, 2025). All participants provided written informed consent prior to data collection. The study was conducted in accordance with the Declaration of Helsinki and all applicable ethical guidelines for research involving human participants. Consent for publication Not applicable. This manuscript does not contain any individual person's data in any form that would require consent for publication. All participant data is presented in aggregated form or as anonymized quotes. Conflict of Interest Statement The authors declare that they have no competing interests. Authors' information L.T.T.H. is a Doctor of Nursing at Nguyen Tat Thanh University, specializing in chronic disease nursing and research methodologies. N.V.C. and T.H.N. are doctoral candidates in nursing who are clinical nurses with extensive experience in nephrology care at major hospitals in Vietnam. T.T.C. and L.T.Q.P. are also Doctors of Nursing at Nguyen Tat Thanh University and serve as faculty members focused on nursing education and research. L.N.D.H. is a Doctor of Nursing at Nguyen Tat Thanh University with expertise in qualitative research. Funding Statement This research was funded by Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam, under grant number 2025.01.179/HD-KHCN. The funding body had no role in the design of the study, data collection, analysis, interpretation of data, or in writing the manuscript. Author Contribution L.T.T.H.: Principal author; study design, methodology, data analysis, manuscript drafting.N.V.C., T.H.N., L.T.Q.P.: Data collection; conducting interviews and administering questionnaires.T.T.C., L.N.D.H.: Data analysis support; results interpretation; manuscript writing and revision.All authors have read and approved the final manuscript. Acknowledgments We express our sincere gratitude to all individuals and institutions that contributed to this research. Special thanks to the patients for sharing their insights and experiences, and to Kien Giang General Hospital for facilitating data collection. We also thank Nguyen Tat Thanh University for funding and encouraging this study. Data Availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Interview transcripts are available in de-identified form to protect participant confidentiality. References Liu Y, He Q, Li Q, Tian M, Li X, Yao X, Deng C. Global incidence and death estimates of chronic kidney disease due to hypertension from 1990 to 2019: An ecological analysis of the global burden of diseases 2019 study. BMC Nephrol. 2023;24(1):352. https://doi.org/10.1186/s12882-023-03391-z . Chadban S, Arıcı M, Power A, Wu M-S, Mennini FS, Álvarez A, J. J., Retat L. 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Psychosocial barriers and facilitators for adherence to a healthy lifestyle among patients with chronic kidney disease: a focus group study. BMC Nephrol. 2022;23:205. https://doi.org/10.1186/s12882-022-02837-0 . Khorfan R, Hu Y-Y, Agarwal G, Eng J, Riall T, Choi J, Cheung EO. The Role of Personal Accomplishment in General Surgery Resident Wellbeing. Ann Surg. 2021;274(1):12–7. https://doi.org/10.1097/SLA.0000000000004768 . Yasin F, Khraim F, Santos M, Forgrave D, Hamad A. Factors influencing self-care management in adult hemodialysis patients: An integrative review. Qatar Med J. 2024;2024(1):12. https://doi.org/10.5339/qmj.2024.12 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8149857\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":564410237,\"identity\":\"15e00ac3-6cf0-46bf-88a3-4d6291e26f77\",\"order_by\":0,\"name\":\"Le Thi Thao 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01:19:21\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":68308,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003eThematic Framework for Self-Care Practices in Chronic Kidney Disease (The framework was developed through framework analysis of qualitative interview data from 20 Chronic Kidney Disease patients at Kien Giang General Hospital, Vietnam, 2025)\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8149857/v1/2ac0f7d47e3f149e39f0525d.png\"},{\"id\":105896053,\"identity\":\"c3468d41-3ed9-49be-a4d5-8e4fd961e18f\",\"added_by\":\"auto\",\"created_at\":\"2026-04-01 08:43:20\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":884093,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8149857/v1/40b7e6ea-c7af-477a-9e76-29f3d0e53595.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Self-Care Practices Among Patients with Chronic Kidney Disease: Implications for Nursing Care in Vietnam\",\"fulltext\":[{\"header\":\"1 Introduction\",\"content\":\"\\u003cp\\u003eNurses play a pivotal role in chronic kidney disease management, serving as primary educators, care coordinators, and patient advocates within healthcare teams. In chronic kidney disease care, nursing responsibilities encompass comprehensive patient and family education, assessment of self-care capacity, identification of barriers to treatment adherence, and coordination with multidisciplinary teams and community resources. Understanding patients' lived experiences with self-care practices and the challenges they encounter provides essential insights for developing targeted nursing interventions that effectively support chronic kidney disease management in resource-limited settings. This is particularly important in Vietnam, where healthcare infrastructure constraints require innovative, nurse-led approaches to chronic disease management.Chronic kidney disease has emerged as one of the most significant challenges to global public health. According to the World Health Organization (WHO), the prevalence of chronic kidney disease is rapidly rising, especially in developing countries. In 2017, global prevalence was reported at 9.1%, translating to approximately 697.5\\u0026nbsp;million cases, with higher age-standardized rates observed in women and girls (9.5%) compared to men and boys (7.3%). Nearly one-third of chronic kidney disease cases originated from China (132.3\\u0026nbsp;million) and India (115.1\\u0026nbsp;million). Additionally, ten countries reported over 10\\u0026nbsp;million cases, while 79 countries had more than 1\\u0026nbsp;million cases. Although the overall prevalence of chronic kidney disease increased by 29.3% from 1990 to 2017, age-standardized rates showed minimal change, largely due to the aging global population [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe condition of chronic kidney disease not only substantially affects individual health but also imposes a burden on healthcare systems, as the costs associated with treatment and care for patients continue to escalate [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. the incidence of dialysis and kidney transplantation globally has also risen from 1990 to 2017, with increases of 43.1% and 34.4% for dialysis, and 10.7% and 12.8% for transplantation, reflecting the growing availability of these therapies.\\u003c/p\\u003e \\u003cp\\u003eIn Vietnam, the situation has become increasingly urgent, with a significant rise in the number of chronic kidney disease patients. statistics from the ministry of health indicate that chronic kidney disease has become one of the leading causes of mortality and disability [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Individuals aged 18 to 60 are particularly affected, yet there are considerable shortcomings in self-care practices. Many patients lack awareness of their health status, do not fully understand treatment methods and preventive measures, leading to non-adherence to necessary care protocols. This not only diminishes their quality of life but also places significant pressure on the healthcare system, as hospitals face growing numbers of patients in severe conditions.\\u003c/p\\u003e \\u003cp\\u003eMany studies confirmed that understanding the disease and practicing self-care can reduce the risk of kidney function deterioration. However, in Vietnam, research on self-care behaviors and the factors influencing these behaviors remains insufficient. Many patients not only lack knowledge but also lack support from family and community in implementing necessary health care measures, resulting in suboptimal treatment outcomes.\\u003c/p\\u003e \\u003cp\\u003eGiven these current issues, the research team undertook the study titled \\\"Investigating Self-Care Behaviors in Patients with Chronic Kidney Disease\\\" to enhance awareness of self-care practices within the community and to seek practical solutions to improve the quality of healthcare for chronic kidney disease patients.\\u003c/p\\u003e \\u003cp\\u003eThe primary objective of this study is to conduct an in-depth exploration of the self-care behaviors of chronic kidney disease patients in Vietnam. The research will focus on five specific objectives:\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTo clearly describe the self-care behaviors of patients, including dietary habits, physical activity, and treatment adherence.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTo assess the level of patients' understanding regarding their condition, treatment methods, and preventive measures.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTo analyze the relationship between self-care behaviors and the quality of life of patients, highlighting the importance of self-care.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTo identify the barriers that patients encounter in implementing appropriate self-care behaviors, thereby seeking reasonable solutions.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eTo provide recommendations aimed at improving self-care behaviors and enhancing the quality of life for patients with chronic kidney disease.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \"},{\"header\":\"2 Study Population and Methodology\",\"content\":\"\\u003ch2\\u003e2.1 Study Population\\u003c/h2\\u003e\\u003cp\\u003eThis study focused on individuals diagnosed with chronic kidney disease across stages 1 to 5. The participants were aged between 18 and 60. They were also required to provide informed consent to participate in the research.\\u003c/p\\u003e\\u003cp\\u003eInclusion criteria: Patients diagnosed with chronic kidney disease, aged between 18 and 60, receiving care at hospitals nephrology clinics.\\u003c/p\\u003e\\u003cp\\u003eExclusion criteria: Individuals with psychiatric disorders, those in acute stages of kidney disease or experiencing severe complications, individuals unable to communicate or comprehend the research protocol, and those with a history of substance abuse or other significant health issues were excluded.\\u003c/p\\u003e\\u003ch2\\u003e2.2 Research Context\\u003c/h2\\u003e\\u003cp\\u003eData collection for the study was conducted from June 3 to July 3, 2025, at Kien Giang General Hospital. This timeframe was strategically established to ensure comprehensive data collection and analysis.\\u003c/p\\u003e\\u003ch2\\u003e2.3 Research Design\\u003c/h2\\u003e\\u003cp\\u003eThe study employed a qualitative research design.\\u003c/p\\u003e\\u003ch2\\u003e2.4 Sampling Strategy\\u003c/h2\\u003e\\u003cp\\u003eThe sample size for this investigation consisted of 20 patients diagnosed with chronic kidney disease. A convenience sampling method was utilized to select participants who expressed willingness to engage in the study and met the predetermined inclusion criteria.\\u003c/p\\u003e\\u003ch2\\u003e2.5 Data Collection Methods and Instruments\\u003c/h2\\u003e\\u003cp\\u003eData were collected through the administration of questionnaires and in-depth interviews. The questionnaires were meticulously designed to elicit information regarding self-care behaviors, knowledge of chronic kidney disease, quality of life, and barriers to effective care. In-depth interviews aimed to encourage participants to articulate their personal experiences and insights, thereby enriching the qualitative data.\\u003c/p\\u003e\\u003ch2\\u003e2.6 Research Procedure\\u003c/h2\\u003e\\u003cp\\u003eThe research procedure unfolded in a series of systematic steps. Initially, patients were selected based on the established inclusion criteria. Subsequently, participants were briefed about the study’s objectives and methodologies. Following this, data collection commenced, necessitating informed consent prior to the conduct of interviews. Ultimately, all collected information was securely archived.\\u003c/p\\u003e\\u003ch2\\u003e2.7 Data Collection and Processing Methods\\u003c/h2\\u003e\\u003cp\\u003eData analysis was conducted through manual framework analysis. The framework analysis was applied following a six-step process as described in the literature: transcription, familiarization, coding, applying the analytical framework, charting the data, and interpreting the data.\\u003c/p\\u003e\\u003cp\\u003eAll interview recordings were anonymized by assigning a protocol number and a sequence number to each interviewee [recording 1].\\u003c/p\\u003e\\u003cp\\u003eThe authors undertook a preliminary reading of the transcripts to become familiar with the data.\\u003c/p\\u003e\\u003cp\\u003eThe transcripts were coded to capture the underlying concepts of the health behavior model and to create a framework matrix.\\u003c/p\\u003e\\u003cp\\u003eThe charting process involved deductively coding and summarizing the data, with each column representing a construct of the HBM and each row representing participants. Similar data codes were grouped into sub-themes and discussed.\\u003c/p\\u003e\\u003cp\\u003eFinally, a detailed report was drafted to provide an overview of the exploratory findings of the study.\\u003c/p\\u003e\\u003cp\\u003eThe principles of SRQR for reporting qualitative research were closely followed in this study.\\u003c/p\\u003e\\u003ch2\\u003e2.8 Ethics Statement\\u003c/h2\\u003e\\u003cp\\u003e This study was approved by the Institutional Review Board of Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam (Registration Number: 22/GCN-NTT, approval date: June 9th, 2025). All participants provided written informed consent prior to data collection. The study was conducted in accordance with the Declaration of Helsinki and all applicable ethical guidelines for research involving human participants.\\u003c/p\\u003e\"},{\"header\":\"3 Results\",\"content\":\"\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.1 Self-Care Practices for Effective Kidney Health Management\\u003c/h2\\u003e \\u003cp\\u003e The study found that participants engaged in self-care practices to manage their kidney health, primarily focusing on nutrition, exercise, and medication adherence. Many restricted sodium and potassium intake, emphasizing a balanced diet. Most participants walked for 15 to 30 minutes daily and incorporated household chores into their routines.\\u003c/p\\u003e \\u003cp\\u003e Managing a chronic illness can be difficult for renal patients due to strict dietary guidelines, requiring significant lifestyle changes. This includes monitoring fluid and food intake, especially high-potassium and high-sodium items [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The pressure to comply can lead to feelings of helplessness if symptoms persist [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAccessible support from healthcare professionals is crucial for guidance and encouragement. Many dialysis patients report insufficient support, leading them to seek their own methods for managing diets and treatment compliance [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. This lack of engagement hinders effective self-care, consistent with research on medication adherence [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003e Nurses should provide ongoing education and emotional support to renal patients to enhance their understanding of dietary guidelines and medication adherence. Collaborating with patients in creating individualized care plans can help bridge gaps in support and improve self-care practices.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.2 Dietary Habits and Exercise Practices\\u003c/h2\\u003e \\u003cp\\u003eMany participants reported dietary restrictions, particularly regarding sodium and potassium intake. They emphasized limiting salty foods and avoiding high-potassium items like bananas and durians. Meals typically included a variety of vegetables, with an emphasis on lighter portions, such as one bowl at a time, and three smaller meals throughout the day. Some opted for three to four small meals daily, often with well-cooked vegetables to lower potassium levels. Most engaged in light physical activities, exercising for about 45 minutes daily. However, many participants noted challenges in maintaining these dietary practices, stating that managing their eating habits became more difficult after their diagnosis. Additionally, a study highlighted a significant prevalence of physical inactivity among renal patients, linking it to disease complications, time constraints, inadequate staffing, and poor hospital management [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAdditionally, a study concluded that patients expressed a strong need for more information and encouragement regarding physical activities and exercises, both during therapy sessions and in their daily lives [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study underscores the necessity for nurses to adopt a proactive role in educating renal patients about appropriate dietary practices and the importance of structured physical activity. By providing personalized resources and ongoing motivational support, healthcare professionals can empower patients to effectively navigate dietary restrictions and cultivate sustainable exercise routines. Such an approach is likely to enhance patient adherence, improve overall health outcomes, and promote a greater sense of autonomy in managing their chronic conditions.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.3 Awareness of Chronic Kidney Disease\\u003c/h2\\u003e \\u003cp\\u003eA significant number of participants exhibited a strong awareness of their health condition, particularly recognizing that they were at stage 5 of chronic kidney disease. They described symptoms such as fatigue, unstable blood pressure, loss of appetite, and mild abdominal pain. Many acknowledged the disease's effects on their physical and psychological well-being, noting difficulties with eating and overall quality of life. Some individuals were unaware of their condition until it reached an advanced stage, indicating a gap in knowledge about chronic kidney disease prior to diagnosis. Additionally, many understood the chronic and irreversible nature of their illness, often attributing it to underlying issues like hypertension and diabetes. They recognized the necessity of treatments such as dialysis and grasped the seriousness of their situation after discussions with healthcare providers. While many displayed a thorough understanding of their condition, others had limited awareness before diagnosis [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThus, nurses must prioritize patient education to bridge the knowledge gap regarding chronic kidney disease. By organizing open discussions and providing educational resources, nurses can enhance patients' understanding of their condition, its progression, and the importance of early intervention.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.4 Education Provided by Healthcare Professionals\\u003c/h2\\u003e \\u003cp\\u003eMany participants reported that their doctors provided consultations on medication adherence, regular dialysis treatments, dietary modifications, and medication management. Some noted that healthcare providers involved family members in the educational process, ensuring comprehensive understanding of dietary restrictions and treatment options. Discussions about more invasive treatments, such as kidney transplantation and peritoneal dialysis, were also mentioned. Participants appreciated the thorough information, which helped them better understand their condition and treatment strategies. Their efforts to follow the advice given indicate that this educational support positively impacted their self-care routines, highlighting the importance of provider involvement in patient education [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe variability in education quality underscores the need for standardized nursing education protocols that ensure all chronic kidney disease patients receive comprehensive, practical guidance regardless of which provider they encounterNurses should actively engage in the educational process by reinforcing information provided by doctors and ensuring that patients and their families comprehend their treatment plans. Nurses should always be ready to assist when patients have difficulty understanding; with consistent guidance, nurses can enhance patients\\u0026rsquo; understanding and adherence to medication regimens and dietary modifications, ultimately improving health outcomes\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.5 Impact of Chronic Kidney Disease on Quality of Life\\u003c/h2\\u003e \\u003cp\\u003eMany individuals reported significant impacts on their physical health, leading to mobility challenges and difficulties in daily activities. A common theme was the inability to work, which contributed to feelings of sadness and frustration. Participants experienced fatigue and mental distress, with a decline in psychological well-being. Social interactions were negatively affected, leading to isolation and low self-esteem. Despite some participants noting a stabilization of their mental state over time, the overall sentiment was that their quality of life had been severely compromised.\\u003c/p\\u003e \\u003cp\\u003eThis finding indicates that nurses should routinely assess the psychological and social well-being of patients with chronic kidney disease to identify those struggling with mental health issues in order to provide timely support\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.6 Self-Care Behaviors and Their Impact on Happiness and Life Satisfaction\\u003c/h2\\u003e \\u003cp\\u003eMany individuals expressed that taking care of their health positively influenced their mood and overall well-being. Participants noted that when they felt healthy, they experienced greater joy and enthusiasm for life, enabling them to engage more easily with others. Conversely, several individuals indicated that periods of fatigue or illness led to feelings of sadness and discouragement. The contrast between feeling well and unwell was frequently mentioned, with a recurring sentiment that good health correlates with positivity and social engagement, while poor health often results in feelings of helplessness and frustration.\\u003c/p\\u003e \\u003cp\\u003eNurses should encourage and support self-care behaviors among patients with chronic kidney disease by consistently promoting healthy lifestyle choices and addressing barriers to self-care, nurses can help patients cultivate a more positive outlook and improve their overall quality of life.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.7 Challenges Faced in Self-Care Practices\\u003c/h2\\u003e \\u003cp\\u003eA significant number of individuals reported difficulties primarily related to their health status, including instability, fatigue, insomnia, and loss of appetite. These factors hindered their ability to maintain regular self-care routines. Financial constraints emerged as a prominent issue, with many participants indicating that high treatment costs significantly impacted their ability to care for themselves. Participants also mentioned specific challenges in adhering to medical guidelines, such as remembering to take medications on time and managing fluid intake. Some individuals expressed that the stress of maintaining dietary restrictions added to their overall psychological burden.\\u003c/p\\u003e \\u003cp\\u003ePatients with chronic kidney disease faced challenges in adhering to self-care routines due to financial constraints and complex health management. These barriers reduced access to necessary healthcare services and complicated self-management. To enhance adherence and well-being, integrated support systems were deemed essential [\\u003cspan additionalcitationids=\\\"CR14\\\" citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThese barriers require nursing assessment and advocacy, with nurses serving as essential links between patients and available support resources.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.8 Environmental and Familial Factors Affecting Self-Care\\u003c/h2\\u003e \\u003cp\\u003eAccording to numerous respondents, their families helped them manage their health by offering substantial material and emotional support. This supportive environment was often highlighted as a positive influence on their self-care routines. Conversely, while family support was strong, some participants noted a lack of assistance from local resources or community support systems. Although family members were actively involved in providing help, the absence of additional support from local healthcare services or insurance arrangements was a recurring concern.\\u003c/p\\u003e \\u003cp\\u003eA few participants mentioned that logistical challenges, such as transportation to medical facilities, could complicate their care.\\u003c/p\\u003e \\u003cp\\u003eNurses should assess the familial and environmental support systems of patients with chronic kidney disease to identify gaps in assistance and facilitate connections to community resources or support services to enhance the effectiveness of patients' self-care strategies\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.9 Support Needed to Improve Self-Care Behaviors\\u003c/h2\\u003e \\u003cp\\u003eParticipants stressed the importance of support from local government and community resources, including access to healthcare services, insurance coverage, and medical equipment. They called for comprehensive support systems that integrate medical advice with community resources, emphasizing coordinated efforts between healthcare providers, local authorities, and organizations to ensure patients receive necessary support.\\u003c/p\\u003e \\u003cp\\u003eNurses should actively advocate for enhanced community support systems that provide comprehensive access to healthcare services, such as connecting with local health stations in each area, insurance options, and necessary medical equipment for patients with chronic kidney disease.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec20\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.10 Raising Awareness About Self-Care in the Community\\u003c/h2\\u003e \\u003cp\\u003e Many survey participants suggested enhancing awareness of kidney health through workshops and seminars focused on education, early detection, and treatment methods. They emphasized promoting healthy eating habits, reducing fried foods and sugary drinks, and encouraging regular health check-ups. Participants also highlighted the need for awareness campaigns via newspapers and radio to inform the public about kidney disease and routine screenings. Additionally, they proposed organizing free health screenings and consultations to help individuals understand kidney disease risks and the benefits of preventive care.\\u003c/p\\u003e \\u003cp\\u003eNurses should actively engage in outreach activities, including health screenings and informational workshops, as these initiatives can empower the community by providing essential knowledge and resources that promote overall kidney health\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"4 Thematic Framework for Self-Care Practices in Chronic Kidney Disease\",\"content\":\"\\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e for understanding self-care in chronic kidney disease highlights key factors influencing patient health management, focusing on three main elements: nutrition, physical activity, and medication adherence. Nutrition is vital for chronic kidney disease management, with patients often implementing dietary restrictions to limit salt and potassium, emphasizing a balanced intake of vegetables and light meals. As shown in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, physical activity, such as walking or household chores, is also essential, as consistent light exercise boosts both physical and emotional well-being.\\u003c/p\\u003e \\u003cp\\u003eMedication adherence is crucial; patients recognize the importance of following prescribed regimens and often devise strategies for timely intake. Their awareness of chronic kidney disease, including understanding symptoms and underlying causes like hypertension and diabetes, significantly influences their self-care behaviors.\\u003c/p\\u003e \\u003cp\\u003eEducation from healthcare professionals shapes these practices, with consultations on medication and dietary needs being highly valued. Involving family members enhances support, but patients face challenges such as fatigue, financial constraints, and limited local resources, which hinder self-management.\\u003c/p\\u003e \\u003cp\\u003eCommunity involvement and prompt assistance from medical professionals are crucial for enhancing self-care. Local initiatives and awareness campaigns on kidney health can empower patients and enhance care. This framework underscores the interconnectedness of self-care behaviors, awareness, education, and support systems, guiding healthcare teams in developing effective management plans for patients with chronic kidney disease.\\u003c/p\\u003e\"},{\"header\":\"5 Discussion section\",\"content\":\"\\u003cp\\u003eThe findings from this study underscore the critical self-care challenges faced by patients with chronic kidney disease. Nurses play an essential role in mitigating these challenges by providing comprehensive education on dietary restrictions, medication adherence, and the importance of regular monitoring.\\u003c/p\\u003e \\u003cp\\u003eFurthermore, recognizing that patients often face barriers related to motivation and understanding, the implementation of personalized care plans can be beneficial. That's why, nurses should engage in continuous dialogue with patients, fostering an environment where individuals feel empowered to discuss their challenges and progress. This relational dynamic between nurse and patient is essential in promoting adherence to self-care regimens, ultimately enhancing patient outcomes and quality of life.\\u003c/p\\u003e \\u003cp\\u003eOther hands, Family involvement is crucial in supporting patients with chronic kidney disease. Nurses must recognize the value of engaging family members in the education and management of their loved one's health. Nurses not only provide knowledge to patients but also provide understanding to patients' families.\\u003c/p\\u003e \\u003cp\\u003eCoordinating communication among healthcare providers, patients, and family members can enhance the support network necessary for effective disease management. Nurses can facilitate workshops or informational sessions directed at families, equipping them with the tools needed to assist in daily health management and advocacy for the patient\\u0026rsquo;s needs. This collective approach not only strengthens the patient\\u0026rsquo;s support system but also fosters a more holistic view of health care within the familial context.\\u003c/p\\u003e \\u003cp\\u003eThe study highlights various systemic barriers that patients with chronic kidney disease encounter, including limited community resources and challenges in accessing healthcare. Nurses have a pivotal role in advocacy and care coordination to address these issues. By liaising with community organizations, healthcare facilities, and local government, nurses can work to improve accessibility to resources such as transportation, financial assistance, and support groups.\\u003c/p\\u003e \\u003cp\\u003eComparing this study's findings with international literature reveals both commonalities and differences in chronic kidney disease self-care practices. Similar to other studies, participants in this research emphasized the importance of education and support in managing their condition. However, disparities emerge concerning the level of family and community support available, which varies significantly across different cultural contexts.\\u003c/p\\u003e \\u003cp\\u003eFor instance, studies from countries with more robust healthcare frameworks report higher rates of patient engagement and access to resources. In contrast, patients in regions with limited support often struggle with adherence to self-care recommendations. This highlights the need for localized strategies that account for the unique challenges faced by chronic kidney disease patients within specific communities.\\u003c/p\\u003e \\u003cp\\u003eTo prepare nurses for the evolving landscape of chronic kidney disease care, educational programs must integrate comprehensive training on self-care assistance, family involvement, and community resource navigation. Specific recommendations include developing curricula that emphasize communication skills tailored for patient and family education, as well as understanding the socio-economic factors influencing health behaviors. Moreover, simulation-based training can enhance nurses' capacity to address complex care scenarios involving chronic kidney disease patients. Continued professional development opportunities should focus on advocating for patients and coordinating care, ensuring that nurses remain equipped to meet the diverse needs of this population.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eStrengths and Limitations\\u003c/b\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe strengths of this study lie in its comprehensive exploration of self-care practices among chronic kidney disease patients, emphasizing both dietary habits and emotional well-being. However, the research was conducted at a single location, which may limit the generalizability of the findings to other populations. Furthermore, participant responses could have been influenced by the dynamics of the interviewer-interviewee relationship, potentially affecting the depth and authenticity of the data collected. Future studies should aim for a more diverse participant pool across different regions to enhance the applicability of the findings.\\u003c/p\\u003e\"},{\"header\":\"6 Conclusions\",\"content\":\"\\u003cp\\u003eThe findings of this study underscore the significant impact of both external and internal factors on the self-management behaviors of individuals with chronic kidney disease. Awareness and education provided by healthcare professionals play a vital role in helping patients understand their condition and adhere to treatment regimens. However, challenges such as financial constraints and limited community support can hinder effective self-care. To improve health outcomes, it is essential for healthcare teams and policymakers to consider these factors and develop comprehensive support systems that empower patients to manage their health effectively. Raising awareness about self-care within the community, along with providing adequate resources and support, is crucial for enhancing the quality of life for those living with chronic kidney disease.\\u003c/p\\u003e \\u003cp\\u003eThese findings generate several critical implications for nursing practice in chronic kidney disease care. Nurses must prioritize comprehensive patient and family education using culturally appropriate, practical approaches. Systematic assessment of self-care barriers\\u0026mdash;including financial constraints, health literacy, and family support\\u0026mdash;should be integrated into routine nursing care. Nurses are uniquely positioned to serve as care coordinators, connecting patients with community resources and advocating for systemic improvements in chronic kidney disease care delivery.\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eEthics Statement\\u003c/h2\\u003e \\u003cp\\u003eThis study was approved by the Institutional Review Board of Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam (Registration Number: 22/GCN-NTT, approval date: June 9th, 2025). All participants provided written informed consent prior to data collection. The study was conducted in accordance with the Declaration of Helsinki and all applicable ethical guidelines for research involving human participants.\\u003c/p\\u003e\\u003ch2\\u003eConsent for publication\\u003c/h2\\u003e\\n\\u003cp\\u003eNot applicable. This manuscript does not contain any individual person\\u0026apos;s data in any form that would require consent for publication. All participant data is presented in aggregated form or as anonymized quotes.\\u003c/p\\u003e\\n\\u003ch2\\u003eConflict of Interest Statement\\u003c/h2\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthors\\u0026apos; information\\u003c/h2\\u003e\\n\\u003cp\\u003eL.T.T.H. is a Doctor of Nursing at Nguyen Tat Thanh University, specializing in chronic disease nursing and research methodologies. N.V.C. and T.H.N. are doctoral candidates in nursing who are clinical nurses with extensive experience in nephrology care at major hospitals in Vietnam. T.T.C. and L.T.Q.P. are also Doctors of Nursing at Nguyen Tat Thanh University and serve as faculty members focused on nursing education and research. L.N.D.H. is a Doctor of Nursing at Nguyen Tat Thanh University with expertise in qualitative research.\\u003c/p\\u003e\\n\\u003ch2\\u003eFunding Statement\\u003c/h2\\u003e\\n\\u003cp\\u003eThis research was funded by Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam, under grant number 2025.01.179/HD-KHCN. The funding body had no role in the design of the study, data collection, analysis, interpretation of data, or in writing the manuscript.\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\n\\u003cp\\u003eL.T.T.H.: Principal author; study design, methodology, data analysis, manuscript drafting.N.V.C., T.H.N., L.T.Q.P.: Data collection; conducting interviews and administering questionnaires.T.T.C., L.N.D.H.: Data analysis support; results interpretation; manuscript writing and revision.All authors have read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003ch2\\u003eAcknowledgments\\u003c/h2\\u003e\\n\\u003cp\\u003eWe express our sincere gratitude to all individuals and institutions that contributed to this research. Special thanks to the patients for sharing their insights and experiences, and to Kien Giang General Hospital for facilitating data collection. We also thank Nguyen Tat Thanh University for funding and encouraging this study.\\u003c/p\\u003e\\n\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\n\\u003cp\\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Interview transcripts are available in de-identified form to protect participant confidentiality.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eLiu Y, He Q, Li Q, Tian M, Li X, Yao X, Deng C. Global incidence and death estimates of chronic kidney disease due to hypertension from 1990 to 2019: An ecological analysis of the global burden of diseases 2019 study. 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Hanoi Medical University Journal. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.52852/tcncyh.v183i10.2735\\u003c/span\\u003e\\u003cspan address=\\\"10.52852/tcncyh.v183i10.2735\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMesa-Gresa P, Avesani CM, Clyne N, Garc\\u0026iacute;a-Testal A, Kouidi E, Van Craenenbroeck AH, Segura-Ort\\u0026iacute; E. Needs, barriers and facilitators for a healthier lifestyle in haemodialysis patients: The GoodRENal project. 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PLoS ONE. 2022;17(10):e0274454. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1371/journal.pone.0274454\\u003c/span\\u003e\\u003cspan address=\\\"10.1371/journal.pone.0274454\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRivera E, Clark-Cutaia MN, Schrauben SJ, Townsend RR, Lash JP, Hannan M, Hirschman KB. Treatment adherence in chronic kidney disease and support from healthcare providers: A qualitative study. Kidney Med. 2022;4(11):100545. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.xkme.2022.100545\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.xkme.2022.100545\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLiddelow C, Mullan B, Boyes M, McBride H. A qualitative application of temporal self-regulation theory to understand adherence to simple and complex medication regimens. 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J Nephrol. 2024;37(7):1735\\u0026ndash;65. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s40620-024-02049-9\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s40620-024-02049-9\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAvgoustou E, Tzivaki I, Diamantopoulou G, Zachariadou T, Avramidou D, Dalopoulos V, Skourtis A. Obesity-related chronic kidney disease: From diagnosis to treatment. Diagnostics. 2025;15(2):169. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.3390/diagnostics15020169\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/diagnostics15020169\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOkolie J. (2024). Prevalence of chronic kidney disease and awareness levels among young adults in Imo and Anambra States, Nigeria. Public Health.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBhattad PB, Pacifico L. Empowering patients: Promoting patient education and health literacy. Cureus. 2022;14(7):e27336. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.7759/cureus.27336\\u003c/span\\u003e\\u003cspan address=\\\"10.7759/cureus.27336\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCardol CK, Boslooper-Meulenbelt K, van Middendorp H, Meuleman Y, Evers AWM, van Dijk S. Psychosocial barriers and facilitators for adherence to a healthy lifestyle among patients with chronic kidney disease: a focus group study. BMC Nephrol. 2022;23:205. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1186/s12882-022-02837-0\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12882-022-02837-0\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKhorfan R, Hu Y-Y, Agarwal G, Eng J, Riall T, Choi J, Cheung EO. The Role of Personal Accomplishment in General Surgery Resident Wellbeing. Ann Surg. 2021;274(1):12\\u0026ndash;7. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1097/SLA.0000000000004768\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/SLA.0000000000004768\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYasin F, Khraim F, Santos M, Forgrave D, Hamad A. Factors influencing self-care management in adult hemodialysis patients: An integrative review. Qatar Med J. 2024;2024(1):12. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.5339/qmj.2024.12\\u003c/span\\u003e\\u003cspan address=\\\"10.5339/qmj.2024.12\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Chronic kidney disease, self-care behaviors, nursing care, patient education, self-care support, awareness\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8149857/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8149857/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eAim\\u003c/h2\\u003e \\u003cp\\u003eThis study aimed to explore and analyze the self-care behaviors among patients diagnosed with chronic kidney disease at Kien Giang General Hospital. The focus was on understanding how patients managed their condition through self-care practices and the various factors that influenced these behaviors.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA qualitative research design was utilized to gain in-depth insights into the experiences of chronic kidney disease patients. Data were collected through a combination of structured questionnaires and in-depth interviews with 20 participants aged between 18 to 60 years. The study achieved data saturation, meaning that the last eight participants provided responses that were largely redundant with those of earlier participants, indicating that sufficient information had been gathered to represent the population. Clinical trial number: not applicable\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe key findings of the study indicated that essential self-care behaviors, including nutrition, physical activity, and medication adherence, played a critical role in the effective management of chronic kidney disease. Participants exhibited varying levels of awareness regarding their disease, which directly impacted their self-care practices. Furthermore, the study revealed that family support and available community resources significantly influenced these self-care behaviors. However, various challenges, such as health-related issues and financial constraints, were identified as significant barriers that hindered patients\\u0026rsquo; abilities to manage their condition effectively.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eThis research provided new insights into the crucial role of educational initiatives and community engagement in empowering patients with chronic kidney disease. By enhancing patients' understanding of their condition and available resources, their overall quality of life could be significantly improved. The study concluded with recommendations for healthcare providers, emphasizing the urgent need for integrated support systems that addressed the identified challenges and enhanced health outcomes for patients suffering from chronic kidney disease. These findings provide critical insights for nurses supporting chronic kidney disease patients, highlighting the need for comprehensive patient education, family-inclusive care approaches, and nursing advocacy to address systemic barriers to effective self-management.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Self-Care Practices Among Patients with Chronic Kidney Disease: Implications for Nursing Care in Vietnam\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-30 01:19:16\",\"doi\":\"10.21203/rs.3.rs-8149857/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"d57ddd41-fa57-4515-9ee8-32f6a03046b4\",\"owner\":[],\"postedDate\":\"December 30th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-01T08:40:17+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-12-30 01:19:16\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8149857\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8149857\",\"identity\":\"rs-8149857\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}