Open Access Highly Accessed Research article

Pre-dialysis patients' perceived autonomy, self-esteem and labor participation: associations with illness perceptions and treatment perceptions. A cross-sectional study

Daphne L Jansen1*, Diana C Grootendorst2, Mieke Rijken1, Monique Heijmans1, Ad A Kaptein3, Elisabeth W Boeschoten4, Friedo W Dekker2 and the PREPARE-2 Study Group

Author Affiliations

1 NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568 3500 BN Utrecht The Netherlands

2 Department of Clinical Epidemiology, Leiden University Medical Center, P.O. Box 9600 2300 RC Leiden The Netherlands

3 Unit of Psychology, Leiden University Medical Center, P.O. Box 9600 2300 RC Leiden The Netherlands

4 Hans Mak Institute, Koningin Wilhelminalaan 29-B 1411 EL Naarden The Netherlands

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BMC Nephrology 2010, 11:35  doi:10.1186/1471-2369-11-35

Published: 8 December 2010



Compared to healthy people, patients with chronic kidney disease (CKD) participate less in paid jobs and social activities. The aim of the study was to examine a) the perceived autonomy, self-esteem and labor participation of patients in the pre-dialysis phase, b) pre-dialysis patients' illness perceptions and treatment perceptions, and c) the association of these perceptions with autonomy, self-esteem and labor participation.


Patients (N = 109) completed questionnaires at home. Data were analysed using bivariate and multivariate analyses.


The results showed that the average autonomy levels were not very high, but the average level of self-esteem was rather high, and that drop out of the labor market already occurs during the pre-dialysis phase. Positive illness and treatment beliefs were associated with higher autonomy and self-esteem levels, but not with employment. Multiple regression analyses revealed that illness and treatment perceptions explained a substantial amount of variance in autonomy (17%) and self-esteem (26%). The perception of less treatment disruption was an important predictor.


Patient education on possibilities to combine CKD and its treatment with activities, including paid work, might stimulate positive (realistic) beliefs and prevent or challenge negative beliefs. Interventions focusing on these aspects may assist patients to adjust to CKD, and ultimately prevent unnecessary drop out of the labor market.