Factors influencing the development and implementation of a prehabilitation program for kidney transplant candidates: A mixed-methods contextual analysis

Kidney transplantation is the preferred treatment for kidney failure. However, kidney transplant candidates often experience a decline in health while awaiting transplantation due to disease progression, comorbidities, and negatives effects of dialysis. Prehabilitation aims to optimize physical and psychological functioning prior to surgery, potentially improving overall health and outcomes. Despite its potential benefits, there are currently no official guidelines or standardized prehabilitation programs for kidney transplant candidates. To explore factors that influence the development and implementation of a prehabilitation program for kidney transplant candidates. A mixed methods context analysis was conducted, guided by the Context and Implementation of Complex Interventions framework. Data collection included a survey, interviews, and focus groups. The survey was sent to kidney transplant candidates. It assessed current lifestyle-related practice patterns, health status including physical functioning, nutritional status, and psychological well-being, as well as needs, preferences, and perceived barriers and facilitators regarding prehabilitation. Qualitative data were collected from kidney transplant candidates and recipients, their significant others, and healthcare providers, addressing the same topics in greater depth. Quantitative data were analyzed using descriptive statistics and comparative analysis. Qualitative data were analyzed thematically. Eighty-seven kidney transplant candidates completed the survey. Additionally, 22 interviews and five focus groups were conducted. Findings were that clinical consultations primarily focused on medical aspects, with less emphasis on lifestyle factors such as physical activity. Nearly all participants reported issues related to physical functioning, nutritional status, or psychological well-being, with 44% experiencing problems across all three domains. All groups expressed a strong need for prehabilitation, emphasizing that programs should be tailored to individual needs and preferences, implemented in a home-based setting, and guided by a professional. Key facilitators for engagement included peer support and professional guidance, ease of access and convenience, and high levels of intrinsic and extrinsic motivation. Identified barriers included geographical and logistical challenges, fatigue, perceived lack of need, and time constraints. This study highlights the need for home-based, tailored, and professionally guided prehabilitation programs for kidney transplant candidates. Key facilitators and barriers to participation were identified, emphasizing the need to address logistical, physical and psychological challenges to enhance engagement in this vulnerable population. The use of a mixed-methods approach, guided by the Context and Implementation of Complex Interventions framework, provided valuable insights into factors influencing the development and implementation of prehabilitation programs. Future research should explore the feasibility and effectiveness of prehabilitation in this vunerable patient group.