Abstract
BACKGROUND: Arteriovenous fistula (AVF) is the preferred access modality for patients requiring long-term hemodialysis. To promote AVF maturation, clinicians often recommend patients to practice upper extremity exercise after the creation of fistulas. However, little is known about how patients perceive these exercises or the challenges they encounter in performing it. METHODS: Semi-structured one-to-one interviews with patients were conducted. Purposive sampling was used to ensure the sample was heterogenous. Patients were recruited until thematic saturation was reached. The data was analyzed using thematic analysis in an inductive approach. Open coding was used, without restricting the focus. RESULTS: Four main themes and their corresponding sub-themes were identified from the analysis of 13 interviews: equipment availability and suitability, adaptive exercise routines, perceived benefits, and concrete patient education content. Incorporating exercises into daily routines emerged as a key enabler, helping patients maintain consistency and adherence. The theme of perceived benefits emphasized patients' belief in physiological improvement, their motivation to achieve catheter-free access, and their desire to avoid invasive procedures encouraged exercise compliance. However, the unavailability or unsuitable equipment, such as dumbbells or softballs, were noted to be a major obstacle. Furthermore, insufficient guidance from healthcare professionals and limited access to educational materials were also identified as challenges to adherence. CONCLUSIONS: Patients expressed the importance of clear guidance from healthcare providers, consistent motivation, access to appropriate equipment, and the integration of exercises into their daily routines to enhance adherence. Future educational programs on upper limb exercises for AVF maturation should be tailored to align with patients' daily routines and individual needs. TRIAL REGISTRATION: Not applicable as no health care intervention was involved.