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Through the Patient’s Lense: A Photovoice Study of Social Support-Related Barriers and Facilitators to Renal Dietary Adherence in Adults with Kidney Failure and Obesity
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Through the Patient’s Lense: A Photovoice Study of Social Support-Related Barriers and Facilitators to Renal Dietary Adherence in Adults with Kidney Failure and Obesity

Bengucan Gunen, Meera N Harhay, Meghan L Butryn, Brandy-Joe Milliron, Renee H Moore, Mridula C Ghotane and Ann Carroll Klassen
Annals of behavioral medicine, v 60(Supplement_1), pp S520-S520
01 Apr 2026
DOI: https://doi.org/10.1093/abm/kaag012#page=S520
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https://doi.org/10.1093/abm/kaag012#page=S520View
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Abstract

Diet Social support
Patients with kidney failure (KF) are encouraged to follow renal dietary guidelines (RDG) to limit fluid, sodium, potassium, phosphorus intake, and consume adequate protein and fiber. Over 30% of KF patients have poor adherence to RDG, increasing risk of hospitalization and mortality. Diet is influenced by sociobehavioral factors, but the relationship between adherence to RDG and social support is unclear. In July-Nov. 2024, we recruited 10 patients from an R01 study (R01DK124388) examining the health trajectories of adults with coexisting KF and obesity (BMI≥30 kg/m²). Patients consented to a participatory Photovoice activity and took guided photos of meals, food preparation methods and eating environments over 2 weeks. We interpreted the images with patients, first in in-depth interviews, then in focus groups with patients of similar ages. We conducted a thematic analysis of images and interview transcripts in NVivo and integrated findings with dietary intake, social support and 1-yr clinical data. Patients varied in age (32 to 72 yrs), BMI at baseline (30.1 to 41.6 kg/m ²), Medical Outcomes Study Social Support Survey scores (17 to 86 out of 100 ), 1 yr weight change (-21.9 to +12.9 kg ). Each patient took 10-15 images and selected two that best captured their diet. Patients in their 30s had an inner circle (household members, immediate relatives) aware of their dietary needs, and an outer circle (colleagues, distant relatives) that provided an escape from their patient persona. They reported a desire to maintain a sense of normalcy, which was reflected in their dietary behaviors (e.g. intentionally maintaining strict RDG adherence most of the week to forgo adherence when eating with friends). Moving near family and preparing meals in advance helped patients leverage instrumental support and avoid convenience behaviors such as eating takeout meals, especially when experiencing post-treatment fatigue. Photos showed portion-packaged foods used to facilitate integrating RDG into social events. Patients aged 65+ had limited social support due to retirement, death of peers, reduced mobility. Images showed food cooked by home health aides and large meals prepared for the week, to fill this gap in social support. Long-term planning and instrumental social support help younger patients with KF and obesity integrate their dietary needs into social settings. Older patients experience social isolation and reduced mobility, impacting their adherence to RDG.

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