Abstract
Background: Kidney transplant recipients (KTRs) frequently develop excessive fear regarding disease recurrence and progression, which substantially affects their health. The Common-Sense Model of Self-Regulation (CSM) offers a useful framework to explain how these recipients perceive, process, and respond to such health threats.
Objective: To develop and validate a model of fear of progression (FoP) in kidney transplant recipients, analyzing its influencing factors; and to identify contextual factors associated with this fear as well as recipients’ lived experiences.
Design: A convergent mixed-methods design was employed in this study.
Settings: Kidney transplant follow-up centers at three tertiary hospitals in Beijing, Hunan, and Shandong provinces, China.
Participants: A total of 253 KTRs completed the questionnaire surveys, 10 of whom participated in semi-structured interviews.
Methods: A convenience sampling method was used to recruit KTRs from the follow-up centers between August 2024 and February 2025. Questionnaire surveys were conducted to assess FoP, symptom experience, illness perception, coping styles, and social support. Data were analyzed with SPSS 22.0 for univariate and correlation analyses, and AMOS 24.0 was employed to develop and validate the structural equation model. Recipients scoring ≥34 on the FoP scale were selected for semi-structured interviews. Interview data underwent content analysis, and the Pillar Integration Process (PIP) was applied to integrate quantitative and qualitative findings.
Results: The median score for FoP among KTRs was 31.0 (IQR: 23.0, 37.0). A total of 96 recipients (37.94%) exhibited psychological distress related to FoP. The structural equation modeling results indicated that illness perception, symptom severity, perceived social support, negative coping, and renal function collectively explained 63.0% of the variance in FoP. Analysis of the semi-structured interviews yielded four principal themes: triggers of fear, coping styles, social support, and consequences of FoP. The quantitative and qualitative findings demonstrated strong complementarity, consistency, and expansiveness.
Conclusions: Most KTRs experience some degree of FoP, which is influenced by illness perception, coping styles, social support, symptom severity, and renal function. The CSM demonstrates applicability in understanding FoP in this population.
Notes
References:
Brilland, B., et al., Kidney Transplantation Improves Survival in Lupus Nephritis With End-Stage Kidney Disease. Kidney Int Rep, 2025. 10(4): p. 1163-1174.
Liu, S., et al., The Mediating Role of Self-Perceived Burden Between Social Support and Fear of Progression in Renal Transplant Recipients: A Multicenter Cross-Sectional Study. Psychol Res Behav Manag, 2023. 16: p. 3623-3633.
Ocalewski, J., et al., Fear of Cancer Progression and Health Behaviors in Patients with Colorectal Cancer. Am J Health Behav, 2021. 45(1): p. 138-151.
Wang, M., et al., Analysis of fear of disease progression and influencing factors in patients after kidney transplantation. Electronic Journal of Practical Clinical Nursing Science, 2024. 9(21): p. 1-5.
Liu, S., et al., The Mediating Role of Self-Perceived Burden Between Social Support and Fear of Progression in Renal Transplant Recipients: A Multicenter Cross-Sectional Study. Psychol Res Behav Manag, 2023. 16: p. 3623-3633.
Wang, Y., et al., Understanding Health-Related Quality of Life in Kidney Transplant Recipients: The Role of Symptom Experience and Illness Perceptions. Transpl Int, 2023. 36: p. 10837.
Zhang, Y., et al., The Heterogeneity of Symptom Burden and Fear of Progression Among Kidney Transplant Recipients: A Latent Class Analysis. Psychol Res Behav Manag, 2024. 17: p. 1205-1219.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Stress and Coping, Theory, Kidney Transplantation, Kidney Transplant Patients, Disease Progression, Anxiety, Fear, Psychological Manifestations of General Diseases, Self-Management (Psychology), Self-Control, China
Recommended Citation
Liu, Hongxia, "Fear of Progression and Associated Factors in Kidney Transplant Recipients: A Mixed-Methods Study" (2026). International Nursing Research Congress (INRC). 338.
https://www.sigmarepository.org/inrc/2026/presentations_2026/338
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-30
Fear of Progression and Associated Factors in Kidney Transplant Recipients: A Mixed-Methods Study
Toronto, Ontario, Canada
Background: Kidney transplant recipients (KTRs) frequently develop excessive fear regarding disease recurrence and progression, which substantially affects their health. The Common-Sense Model of Self-Regulation (CSM) offers a useful framework to explain how these recipients perceive, process, and respond to such health threats.
Objective: To develop and validate a model of fear of progression (FoP) in kidney transplant recipients, analyzing its influencing factors; and to identify contextual factors associated with this fear as well as recipients’ lived experiences.
Design: A convergent mixed-methods design was employed in this study.
Settings: Kidney transplant follow-up centers at three tertiary hospitals in Beijing, Hunan, and Shandong provinces, China.
Participants: A total of 253 KTRs completed the questionnaire surveys, 10 of whom participated in semi-structured interviews.
Methods: A convenience sampling method was used to recruit KTRs from the follow-up centers between August 2024 and February 2025. Questionnaire surveys were conducted to assess FoP, symptom experience, illness perception, coping styles, and social support. Data were analyzed with SPSS 22.0 for univariate and correlation analyses, and AMOS 24.0 was employed to develop and validate the structural equation model. Recipients scoring ≥34 on the FoP scale were selected for semi-structured interviews. Interview data underwent content analysis, and the Pillar Integration Process (PIP) was applied to integrate quantitative and qualitative findings.
Results: The median score for FoP among KTRs was 31.0 (IQR: 23.0, 37.0). A total of 96 recipients (37.94%) exhibited psychological distress related to FoP. The structural equation modeling results indicated that illness perception, symptom severity, perceived social support, negative coping, and renal function collectively explained 63.0% of the variance in FoP. Analysis of the semi-structured interviews yielded four principal themes: triggers of fear, coping styles, social support, and consequences of FoP. The quantitative and qualitative findings demonstrated strong complementarity, consistency, and expansiveness.
Conclusions: Most KTRs experience some degree of FoP, which is influenced by illness perception, coping styles, social support, symptom severity, and renal function. The CSM demonstrates applicability in understanding FoP in this population.
Description
After this educational activity, participants should:
1. Understand the status of FoP among KTRs, the relationships between illness perception, social support, coping styles, symptom experience, and FoP;
2. Identify contextual factors contributing to FoP;
3. Understand how recipients interpret these factors in daily life and how they engage in psychological and behavioral adaptation in specific contexts.