Volume 28, Issue 3 (7-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(3): 154-162 | Back to browse issues page

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Hemmati Maslak Pak M, Mollazadeh F, Khalkhali H, Abkhiz S. The Impact of Self-Care Education with Teach-Back Method on Self-Esteem in Kidney Transplant Recipients: A Clinical Trial. Avicenna J Nurs Midwifery Care 2020; 28 (3) :154-162
URL: http://nmj.umsha.ac.ir/article-1-2144-en.html
1- Associate Professor, Department of Nursing, Urmia School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
2- MSc in Medical-Surgical Nursing, Department of Nursing, Urmia School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran , farzin.nurse@gmail.com
3- Associate Professor, Department of Epidemiology and Biostatistics, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
4- Assistant Professor, Department of Adult Nephrology, Urmia University of Medical Sciences, Urmia, Iran
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Chronic kidney disease is defined as an irreversible and progressive decrease in kidney function in which the kidneys are no longer able to maintain the balance of the internal environment of the body and maintain the balance of fluid and electrolytes [1]. Chronic kidney disease occurs either gradually and over consecutive years or due to the patient's lack of recovery after acute renal failure [2, 3]. According to the evidence, the best treatment for patients with chronic kidney disease is kidney transplantation, which increases the quality of life, improves life expectancy and reduces the cost of treatment for patients and the government compared to patients undergoing dialysis [1, 4].
Magela et al. (2014) found that patients need ongoing education about their illness to maintain and improve their self-esteem in order to promote self-care behaviors [10]. Low self-esteem is the main cause of differences in people's health so that reducing self-esteem can be detrimental to people's health [11]. According to Kaplan and Sadock (2011), self-esteem is defined as self-confidence, the ability to think and face challenges, self-confidence to succeed and live happily, feeling valued, having the right to express needs and wants, and enjoying the results of one's efforts [12].
Kidney transplant patients need support in terms of knowledge, skills and emotions [14]; Therefore, they need codified educational programs because the ultimate goal of educating transplant patients is their adaptation to the situation and not just the transfer of information to them but their needs assessment, educational program implementation and program evaluation in their education should be considered education [7].
The importance of paying attention to how kidney transplant patients are educated is essential in their treatment and care because the major part of caring for kidney transplant patients is the responsibility of these patients and it is practically impossible to monitor them 24 hours a day. And the need for better and more understanding, and the slightest mistake in caring for these people can have detrimental consequences, and also studies to improve the self-esteem of these patients are few and far more focused on the quantity of their self-care behaviors; In addition, given the above, there is a need to study an effective self-care program based on the needs of kidney transplant recipients to improve their self-esteem. . Therefore, a study was designed and conducted to determine the effect of recurrent self-care education on self-esteem of patients with kidney transplantation.


Materials and Methods

In this clinical trial study, 79 renal transplant patients were selected from the clinic of Imam Khomeini Hospital in Urmia in 2016 and were randomly assigned to intervention and control groups. Then, in the intervention group, educational content about self-care with teach-back method was presented during five 60-minute sessions. Data were collected using demographic questionnaire and Rosenberg self-esteem questionnaire.

Table 1. Recursive self-care training sessions and their content
Sessions Content of sessions
First Assessing the patient's needs in 5 areas of self-care using checklists and determining the quantity and quality of areas required for patient’s education
Second Patient education around self-monitoring through recursive education
Third Educating the patient about self-care behavior in daily life through recursive education
Fourth Patient education about the three areas of early diagnosis and adaptation to disorders after kidney transplantation and the field of stress management and non-categorized cases by the method of recurrent education
Fifth The statement of what has been said in recent sessions by the client with more emphasis on the material in which the patient is weak and has been recorded in the checklists.




Before intervention, the mean score of self-esteem was not significantly different between the control and intervention groups (P=0.559). After the intervention, the intervention group had a significant increase in the mean score of self-esteem compared to the control group (P=0.001).

Table 2. Comparison of qualitative demographic characteristics between control and intervention groups
Variable N (%) Chi-square test and linear by linear test
Control group Intervention group
Male (67.6)25 (66.7)28 P=0.932
Female (32.4)12 (33.3)14
Marital status
Single (13.5)5 (26.2)11 P=0.305
Married (86.5)32 (73.8)31
Illiterate (21.6)8 (7.1)3 P=0.305
School (54.1)20 (47.6)20
Diploma (10.8)4 (31)13
University (13.5)5 (14.3)6
Employed (16.2)6 (23.8)10 P=0.230
Housewife (29.7)11 (26.2)11
Retired (10.8)4 (26.2)11
Unemployed (37.8)14 (19)8
Other (5.4)2 (4.8)2
City (67.6)25 (85.7)36 P=0.055
Village (32.4)12 (14.3)6
Kidney donor
Dead body (8.1)3 (9.5)4 P=0.146
A living relative (0)0 (9.5)4
Unrelated (91.9)34 (81)34
Source of training
Doctor (32.4)12 (26.2)11 P=0.262
Nurse (43.2)16 (31)13
Internet (8.1)3 (2.4)1
Book (0)0 (7.1)3
Other patients (5.4)2 (11.9)5
Class (0)0 (2.4)1
Failure to receive training (10.8)4 (19)8
Earnings less than expenses (59.5)22 (59.5)25 P=0.820
Income equals expenditure (24.3)9 (28.6)12
Earnings more than expenses (16.2)6 (11.9)5
Cause of kidney failure High blood pressure (35.1)13 (59.5)25 P=0.094
Infectious diseases (13.5)5 (14.3)6
Obstructive diseases (2.7)1 (7.1)3
Other diseases (37.8)14 (14.3)6
Table 3. Comparison of quantitative demographic characteristics between control and intervention groups
Control group Intervention group Independent and Mann-Whitney tests
M±SD Average ratings M±SD Average ratings
Age 11.70±41.27 - 12.38±38 - P=0.233
number of children 1.95±2.18 44.11 1.40±1.50 36.38 P=0.126
Link duration 2.61±5.91 35.96 3.53±7.16 43.56 P=0.137
BMI 3.82±26.49 - 4.01±25.41 - P=0.230
Creatinine 0.31±1.35 - 0.36±1.33 - P=0.752
Control group Intervention group Independent and Mann-Whitney tests
M±SD Average ratings M±SD Average ratings
Age 11.70±41.27 - 12.38±38 - P=0.233
Number of children 1.95±2.18 44.11 1.40±1.50 36.38 P=0.126
Link duration 2.61±5.91 35.96 3.53±7.16 43.56 P=0.137
BMI 3.82±26.49 - 4.01±25.41 - P=0.230
Creatinine 0.31±1.35 - 0.36±1.33 - P=0.752
Table 4. Comparison of mean self-esteem score, before and after recursive training between control and intervention groups
Independent t-test M±SD Self-esteem
Intervention Control
t=-0.587 df=77 P=0.559 4.28±31.33 3.98±30.78 Before intervention
t=-3.495 df=77 P=0.001 4.90±34.54 4.99±30.64 After the intervention



The results of this study showed that recurrent self-care education is effective on self-esteem of patients with kidney transplantation. In this study, it was found that before the intervention, there was no significant difference in self-esteem between the intervention and control groups. This finding was consistent with the findings of the study of Shams et al. (2015) [26]. Also in the present study it was found that after the intervention, there is a statistically significant difference between the two groups of intervention and control; therefore, retrospective self-care training has been effective on self-esteem of patients with kidney transplantation. Which contradicted the study of Shams et al. (2015); in their study, the mean self-esteem scores increased in the intervention groups, but this increase was not statistically significant compared to the control group [26].
The study of Hemmati et al. (2012) was also in contradiction with the present study; That is, after the intervention, the difference in mean self-esteem between the intervention and control groups was not statistically significant [28].
But this study was in line with other studies showing a significant difference after the intervention [31,32].
Lack of adequate physical space to educate patients, lack of support from patients' families, remoteness from kidney transplant clinic, possibility of using other educational resources during study, fear and suspicion in patients due to issues related to kidney transplant donor, and Cultural differences were also among the limitations of this study.



In this study, self-care education with teach-back method was effective in improving the self-esteem of kidney transplant patients. And it is suggested to use the teach-back method in education of patients with kidney transplantation.



This study is extracted from the master's thesis and is a clinical trial approved in the Clinical Trial Registration Center with code IRCT2016122817059N10 and ethics code IR.umsu.rec.1395.236 from the ethics committee of Urmia University of Medical Sciences and Grant number 2465 from the Vice Chancellor for Research of Urmia University of Medical Sciences. Urmia University of Medical Sciences sponsored this research.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Systematic Review | Subject: Nursing
Received: 2020/02/5 | Accepted: 2020/03/25 | Published: 2020/05/30

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