ABSTRACT
Objective
To identify the key behavioural determinants that influence dietary self-management among adults with CKD, using the Theoretical Domains Framework and Behaviour Change Wheel to guide development of practical dietary interventions for clinical practice and research trials.
Methods
A theory-informed secondary analysis of a published qualitative meta-synthesis that included 92 studies and 2924 adults with CKD from 23 countries. Themes from the meta-synthesis were mapped to Theoretical Domains Framework (v2) and linked to Behaviour Change Wheel intervention functions and behaviour change techniques. Potential behaviour change intervention strategies were then evaluated using the APEASE criteria (Affordability, Practicability, Effectiveness/Cost-effectiveness, Acceptability, Side-effects/Safety, Equity).
Results
Twelve of the 14 Theoretical Domains Framework (v2) domains were identified, indicating that dietary self-management in CKD is influenced by a broad range of cognitive, emotional, social, and environmental factors. Key barriers included inconsistent or conflicting dietary advice (Knowledge; Environmental Context and Resources), limited practical guidance (Skills; Behavioural Regulation), and emotional distress and social disruption associated with dietary change (Emotion; Social Influences). Trust in healthcare professionals and experiential learning also shaped adherence (Beliefs about Capabilities and Consequences). Optimism and Intentions domains were not evident. Mapping to the Behaviour Change Wheel identified Education, Enablement, Environmental Restructuring, Training, Persuasion, Incentivisation, and Modelling as relevant intervention functions. APEASE assessment suggested that Education and Enablement were the most feasible, acceptable, and scalable approaches for clinical implementation, while more complex components requiring additional resources or coordination (e.g., training and system-level changes) were comparatively less practical.
Conclusions
Dietary self-management in CKD is influenced by multiple behavioural determinants beyond knowledge alone. Interventions should therefore integrate education with skills training, confidence building, social support, and environmental adaptation. Embedding these multi-component strategies within clinical nutrition practice and research may enhance self-management and improve patient engagement across the CKD care pathway.
Journal of Human Nutrition and Dietetics, Volume 39, Issue 4, August 2026. Read More