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Lambert K, Tulissio N, Cosier D. Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics. J Hum Nutr Diet 2024. [PMID: 39323106 DOI: 10.1111/jhn.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/16/2024] [Accepted: 09/03/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Inadequate health literacy in people with chronic kidney disease is associated with poorer disease management and greater complications. Adherence to the renal diet is known to be suboptimal and patient feedback about the renal diet suggests that patients leave nephrology clinics feeling confused. The present study aimed to evaluate the impact of a health literacy sensitive model of care (MOC) in outpatient nephrology dietetic clinics. METHODS This quasi-experimental non-randomised pre-post study recruited adults attending three renal dietitian clinics. The revised MOC consisted of a renal diet question prompt sheet, teachback, and plain language materials and instructions. Outcomes assessed included clinical, dietary, patient-reported satisfaction and quality of life. Differences between and within groups were analysed using paired t-tests, independent sample t-tests (or non-parametric equivalent), chi-squared and McNemar's tests. Linear mixed models evaluated change in total diet quality score, fruit, vegetable, protein and dairy intake with time as a fixed effect and a random subject specific effect. RESULTS Fail to attend rates at the initial appointments were lower in the revised MOC (21.5% vs. 9.1%). The revised MOC was associated with significantly improved fruit (p = 0.03) and vegetable (p = 0.003) intake and an improved proportion with adequate diet quality (p = 0.03). These impacts were of moderate effect size (d = 0.5, 95% confidence interval = 0.0-1.0). The revised MOC was also associated with greater satisfaction at baseline (p = 0.04) and higher acceptability scores for all questions at the review appointments. Quality of life improved clinically but not significantly in the revised MOC (p = 0.92). CONCLUSIONS This low-cost health literacy sensitive intervention is a promising strategy to improve fruit and vegetable intake in adults attending renal dietitian clinics. Further research to determine fidelity of teachback use and cost utility analysis would be beneficial. Larger scale trials powered to detect changes in quality of life would also be informative.
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Affiliation(s)
- Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Nicola Tulissio
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Denelle Cosier
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
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Eaton C, Vallejo N, McDonald X, Wu J, Rodríguez R, Muthusamy N, Mathioudakis N, Riekert KA. User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review. J Med Internet Res 2024; 26:e50508. [PMID: 39316431 DOI: 10.2196/50508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/27/2024] [Accepted: 07/29/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies. OBJECTIVE This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point? METHODS Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically. RESULTS A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157/292, 53.8%), involved people with diabetes (51/292, 17.5%), targeted medication adherence (98/292, 33.6%), and comprised apps (220/292, 75.3%). The principal findings were as follows: (1) >60 unique terms were used to define user engagement; "use" (102/292, 34.9%) and "engagement" (94/292, 32.2%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160/292, 54.8%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99/195, 50.8%) reported >1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76/99, 77%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60/103, 58.3%); and (4) user engagement was a research end point in only 19.2% (56/292) of the studies. CONCLUSIONS The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022289693.
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Affiliation(s)
- Cyd Eaton
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Natalie Vallejo
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Jasmine Wu
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Rosa Rodríguez
- Johns Hopkins School of Medicine, Baltimore, MD, United States
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Wang J, Mahe J, Huo Y, Huang W, Liu X, Zhao Y, Huang J, Shi F, Li Z, Jiang D, Li Y, Perceval G, Zhao L, Zhang L. Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis. J Med Internet Res 2024; 26:e58735. [PMID: 39190910 PMCID: PMC11387916 DOI: 10.2196/58735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/09/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. OBJECTIVE This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. METHODS We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. RESULTS Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. CONCLUSIONS High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions. TRIAL REGISTRATION PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.
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Affiliation(s)
- Jian Wang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Jinli Mahe
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Yujia Huo
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Weiyuan Huang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Xinru Liu
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Beijing, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Feng Shi
- East China Aviation Personnel Medical Appraisal Center, Shanghai, China
| | - Zhihui Li
- Tsinghua Vanke School of Public Health, Tsinghua University, Shenzhen, China
| | - Dou Jiang
- School of Economics and Management, Southeast University, Nanjing, China
| | - Yilong Li
- School of Economics and Management, Southeast University, Nanjing, China
| | - Garon Perceval
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Lindu Zhao
- School of Economics and Management, Southeast University, Nanjing, China
| | - Lin Zhang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
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Wen Y, Ruan Y, Yu Y. Mobile health management among end stage renal disease patients: a scoping review. Front Med (Lausanne) 2024; 11:1366362. [PMID: 39055692 PMCID: PMC11269191 DOI: 10.3389/fmed.2024.1366362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
Aims The health management of end-stage renal disease patients is a complicated process, and mobile health management technology provides a new choice for the health management of end-stage renal disease patients. The scope of clinical studies on mobile health management for patients with end-stage renal disease was reviewed, and found that about mobile health management problems existing in the literature were identified to provide ideas for subsequent mobile health management research. Methods The databases Web of Science, PubMed, The Cochrane Library, Embase, CNKI, Wan Fang Data, BMJ, and VIP were systematically searched for studies on Mobile health management among end-stage renal disease in adult and adolescent patients or children undergoing kidney replacement therapy. The search covered the period from the inception of the databases to June 20, 2023. Two independent reviewers conducted the literature screening process. Following eligibility screening, a total of 38 papers were included for data extraction and descriptive analysis. Results A total of 38 studies from 14 countries were finally included. The majority of which were interventional trials. The platforms used in these studies included remote monitoring systems, apps, websites, mobile phones or tablets, and social platforms. These platforms provided patients with a wide range of services, including disease management, behavioral intervention, social support, and follow-up care. Most studies focused on patient clinical indicators, patient experience, quality of life, and healthcare costs. Conclusion Our findings that mobile health management has been widely used in disease management of end-stage renal disease patients, with rich management content and many evaluation indicators. Future studies should strengthen the evaluation of patients' mental health, quality of life, and healthcare costs. Additionally, developing a clinical decision support system would enable mobile health management to play a more effective role in end-stage renal disease patients.
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Affiliation(s)
| | | | - Yang Yu
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
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Zhang Y, Gu D, Luo M, Liu S, Peng H, Jia Y. Relative validity of an intelligent ordering system to estimate dietary intake among university students from a medical school in Shanghai, China. Int J Behav Nutr Phys Act 2024; 21:70. [PMID: 38965619 PMCID: PMC11225410 DOI: 10.1186/s12966-024-01619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 06/14/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Dietary assessment methods have limitations in capturing real-time eating behaviour accurately. Equipped with automated dietary-data-collection capabilities, the "intelligent ordering system" (IOS) has potential applicability in obtaining long-term consecutive, relatively detailed on-campus dietary records among university students with little resource consumption. We investigated (1) the relative validity of IOS-derived nutrient/food intakes compared to those from the 7-day food diary (7DFD); (2) whether including a supplemental food frequency questionnaire (SFFQ) improves IOS accuracy; and (3) sex differences in IOS dietary intake estimation. METHODS Medical students (n = 221; age = 22.2 ± 2.4 years; 38.5% male and 61.5% female) completed the 7DFD and SFFQ. During the consecutive 7-day survey period, students weighed and photographed each meal before and after consumption. Then, students reviewed their 3-month diet and completed the SFFQ, which includes eight underprovided school-canteen food items (e.g., dairy, fruits, nuts). Meanwhile, 9385 IOS dietary data entries were collected. We used Spearman coefficients and linear regression models to estimate the associations among the different dietary intake assessment methods. Individual- and group-level agreement was assessed using the Wilcoxon signed-rank test, cross-classification, and Bland‒Altman analysis. RESULTS IOS mean daily energy, protein, fat, and carbohydrate intake estimations were significantly lower (-15-20%) than those of the 7DFD. The correlation coefficients varied from 0.52 (for added sugar) to 0.88 (for soybeans and nuts), with fruits (0.37) and dairy products (0.29) showing weaker correlations. Sixty-two (milk and dairy products) to 97% (soybeans and nuts) of participants were classified into the same or adjacent dietary intake distribution quartile using both methods. The energy and macronutrient intake differences between the IOS + SFFQ and 7DFD groups decreased substantially. The separate fruit intake measurements from each assessment method did not significantly differ from each other (p > 0.05). IOS and IOS + SFFQ regression models generally yielded higher R2 values for males than for females. CONCLUSION Despite estimation differences, the IOS can be reliable for medical student dietary habit assessment. The SFFQ is useful for measuring consumption of foods that are typically unavailable in school cafeterias, improving the overall dietary evaluation accuracy. The IOS assessment was more accurate for males than for females.
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Affiliation(s)
- Yimeng Zhang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, 130 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Dantong Gu
- Institute of Otolaryngology, Clinical Research Center, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Mengyun Luo
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Shaojie Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, 130 Dongan Road, Shanghai, 200032, People's Republic of China
- Department of Nutrition, the First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Hong Peng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, 130 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Yingnan Jia
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, 130 Dongan Road, Shanghai, 200032, People's Republic of China.
- Health Communication Institute, Fudan University, Shanghai, 200032, China.
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Dawson J, Lambert K, Campbell KL, Kelly JT. Incorporating digital platforms into nutritional care in chronic kidney disease. Semin Dial 2024; 37:350-359. [PMID: 34235785 DOI: 10.1111/sdi.12998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Digital health is increasingly recognized for its value to enhance patient care and clinical care processes. People with chronic kidney disease often find dietary self-management challenging. There is promising evidence that digital health interventions can support people with chronic kidney disease to self-manage their diet, by providing more frequent access to nutritional information and dietitians and by facilitating regular monitoring and feedback. There is some emerging evidence of the impact of digital interventions in chronic kidney disease; however, more research is needed to provide meaningful interpretation of how digital interventions can enhance current practice. Importantly, a number of factors need to be considered when designing, developing, implementing, and evaluating the impact of digital interventions. Consideration of the nutrition service and patients' needs, motivation and digital literacy, type of digital intervention, and the ability to embed the digital intervention into current care processes are critical. This paper overviews the current literature on digital health and self-management, factors to consider when embedding digital interventions and platforms into nutrition care and practical considerations for designing and implementing digital health interventions to enhance the nutritional care of people with chronic kidney disease.
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Affiliation(s)
- Jessica Dawson
- Nutrition and Dietetics Department, St George Hospital, Sydney, New South Wales, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
- Centre of Applied Health Economics, School of Medicine, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Jaimon T Kelly
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
- Centre of Applied Health Economics, School of Medicine, Griffith University, Nathan Campus, Nathan, Queensland, Australia
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Ouirdani M, Boutib A, Azizi A, Chergaoui S, Saad EM, Hilali A, Marfak A, Youlyouz-Marfak I. Impact of Nutrition Education on Various Health-Related Components of Hemodialysis Patients: A Systematic Review. Healthcare (Basel) 2024; 12:1197. [PMID: 38921311 PMCID: PMC11203892 DOI: 10.3390/healthcare12121197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
This study aimed to identify the impact of nutrition education on various health-related components of hemodialysis patients. A systematic review was conducted according to the PRISMA guidelines. Relevant literature published between 2013 and 2023 was identified across two databases (PubMed and Science Direct). The protocol was registered in PROSPERO (CRD42023460681). Two independent reviewers retrieved the data, and 41 studies were selected. Nine components related to the impact of nutrition education in hemodialysis patients were identified. Each component was clarified by mentioning each study and its results. This study enabled us to characterize the various components of the impact of nutritional education in hemodialysis patients, namely biological markers, quality of life, cost of care, adherence to dietary recommendations, knowledge, malnutrition inflammation, dietary intake, weight change, and behavior change. This systematic review enables healthcare providers to assess the impact of nutritional education on hemodialysis patients. Also, it gives professionals an exact idea of the impact of nutrition education on hemodialysis patients, with knowledge of new methods using behavior change theories and innovative technological tools.
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Affiliation(s)
- Marouane Ouirdani
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Amal Boutib
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Asmaa Azizi
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Samia Chergaoui
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - El Madani Saad
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Abderraouf Hilali
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
| | - Abdelghafour Marfak
- National School of Public Health, Ministry of Health and Social Protection, Rabat 6329, Morocco;
- Pole of Health, Euro-Mediterranean University of Fez (UEMF), Fez 51, Morocco
| | - Ibtissam Youlyouz-Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco; (A.B.); (A.A.); (S.C.); (E.M.S.); (A.H.); (I.Y.-M.)
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Trần TB, Ambrens M, Nguyễn J, Coleman E, Gilanyi Y, Letton M, Pandit A, Lock L, Thom JM, Sen S, Lambert K, Arnold R. Preferences of people with chronic kidney disease regarding digital health interventions that promote healthy lifestyle: qualitative systematic review with meta-ethnography. BMJ Open 2024; 14:e082345. [PMID: 38802278 PMCID: PMC11131123 DOI: 10.1136/bmjopen-2023-082345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES Diet and physical activity are crucial for people with chronic kidney disease (CKD) to maintain good health. Digital health interventions can increase access to lifestyle services. However, consumers' perspectives are unclear, which may reduce the capacity to develop interventions that align with specific needs and preferences. Therefore, this review aims to synthesise the preferences of people with CKD regarding digital health interventions that promote healthy lifestyle. DESIGN Qualitative systematic review with meta-ethnography. DATA SOURCES Databases Scopus, CENTRAL, MEDLINE, CINAHL and SPORTDiscus were searched between 2000 and 2023. ELIGIBILITY CRITERIA Primary research papers that used qualitative exploration methods to explore the preferences of adults with CKD (≥18 years) regarding digital health interventions that promoted diet, physical activity or a combination of these health behaviours. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened title, abstract and full text. Discrepancies were resolved by a third reviewer. Consumers' quotes were extracted verbatim and synthesised into higher-order themes and subthemes. RESULTS Database search yielded 5761 records. One record was identified following communication with a primary author. 15 papers were included. These papers comprised 197 consumers (mean age 51.0±7.2), including 83 people with CKD 1-5; 61 kidney transplant recipients; 53 people on dialysis. Sex was reported in 182 people, including 53% male. Five themes were generated regarding consumers' preferences for digital lifestyle interventions. These included simple instruction and engaging design; individualised interventions; virtual communities of care; education and action plans; and timely reminders and automated behavioural monitoring. CONCLUSION Digital health interventions were considered an important mechanism to access lifestyle services. Consumers' preferences are important to ensure future interventions are tailored to specific needs and goals. Future research may consider applying the conceptual framework of consumers' preferences in this review to develop and evaluate the effect of a digital lifestyle intervention on health outcomes. PROSPERO REGISTRATION NUMBER CRD42023411511.
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Affiliation(s)
- Thái Bình Trần
- School of Medical, Indigenous and Health Sciences, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Meghan Ambrens
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Jennifer Nguyễn
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Eve Coleman
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Yannick Gilanyi
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Meg Letton
- School of Medical, Indigenous and Health Sciences, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Anurag Pandit
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Logan Lock
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Jeanette M Thom
- School of Health Sciences, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shaundeep Sen
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Ria Arnold
- School of Medical, Indigenous and Health Sciences, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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Curtis F, Burton JO, Butt A, Dhaliwal HK, Graham-Brown MM, Lightfoot CJ, Rawat R, Smith AC, Wilkinson TJ, March DS. Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review. PLoS One 2024; 19:e0297107. [PMID: 38266006 PMCID: PMC10807786 DOI: 10.1371/journal.pone.0297107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
A method of overcoming barriers associated with implementing lifestyle interventions in CKD may be through the use of eHealth technologies. The aim of this review was to provide an up-to-date overview of the literature on this topic. Four bibliographical databases, two trial registers, and one database for conference proceedings were searched from inception to August 2023. Studies were eligible if they reported a lifestyle intervention using eHealth technologies. A narrative synthesis of the findings from the included studies structured around the type of eHealth intervention was presented. Where a sufficient number of studies overlapped in terms of the type of intervention and outcome measure these were brought together in a direction of effect plot. There were 54 included articles, of which 23 were randomised controlled trials (RCTs). The main component of the intervention for the included studies was mobile applications (n = 23), with the majority being in the dialysis population (n = 22). The majority of eHealth interventions were reported to be feasible and acceptable to participants. However, there was limited evidence that they were efficacious in improving clinical outcomes with the exception of blood pressure, intradialytic weight gain, potassium, and sodium. Although eHealth interventions appear acceptable and feasible to participants, there is insufficient evidence to make recommendations for specific interventions to be implemented into clinical care. Properly powered RCTs which not only demonstrate efficacy, but also address barriers to implementation are needed to enhance widespread adoption.
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Affiliation(s)
- Ffion Curtis
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - James O. Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ayesha Butt
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | | | - Matthew M.P. Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Courtney J. Lightfoot
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Rishika Rawat
- Leicester Medical School, University of Leicester, Leicester, United Kingdom
| | - Alice C. Smith
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Thomas J. Wilkinson
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Daniel S. March
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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10
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Beer J, Lambert K, Lim W, Keane C, Boudville N. Can Telehealth Improve Access to Dietary Management in Patients Receiving Dialysis? Insights from Consumers. Nutrients 2023; 16:105. [PMID: 38201934 PMCID: PMC10780464 DOI: 10.3390/nu16010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Timely, effective, and individualised dietary interventions are essential for patients undergoing dialysis. However, delivery of dietary advice is challenging due to limited access to renal dietitians, as well as logistic and scheduling difficulties for patients receiving dialysis. The objectives of this study were to explore consumer perspectives regarding dietary advice utilising telehealth technology. Twenty-two participants (seventeen patients receiving dialysis, five caregivers) were purposively recruited from a local dialysis centre and participated in one of three focus groups. Each focus group was recorded, transcribed, and analysed using inductive thematic analysis. One overarching theme: "a desire to learn" was apparent. The four themes that facilitated this process are herein described: Meaningful communication-a need for improved and individualised communication about diet using positively framed messages with consistency among clinicians. Conducive information-a preference for tailored, current, and clear dietary information (plain language was preferred, with practical advice on making dietary changes). Appropriate timing-health advice at the right time (consumers felt overwhelmed, not supported enough with timely advice, and experienced difficulty attending appointments in addition to dialysis treatments). Contemporary modalities-delivering information using different technologies (consumers preferred a combination of delivery methods for dietetic advice including text/SMS/App messages as an adjunct to face-to-face care). The results showed that consumers believe that telehealth options are an acceptable adjunct to receive dietary advice in a timely manner, and feedback from patients and caregivers has informed the design of a clinical trial to incorporate the use of telehealth to improve the management of serum phosphate.
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Affiliation(s)
- Joanne Beer
- Nutrition and Dietetics Department, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Wai Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (W.L.); (N.B.)
| | | | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (W.L.); (N.B.)
- Medical School, University of Western Australia, Crawley, WA 6009, Australia
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11
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Kelly JT, Jegatheesan DK, Dawson J, Barnett A, Khor BH, Chang AR, Carrero JJ, Campbell KL. Are Digital Health Technologies and Models of Nutrition Care the Future of Chronic Kidney Disease Management? J Ren Nutr 2023; 33:S80-S87. [PMID: 36965753 DOI: 10.1053/j.jrn.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/11/2022] [Accepted: 02/27/2023] [Indexed: 03/27/2023] Open
Abstract
People living with chronic kidney disease (CKD) require long-term support at varying levels of individualization, intensity, and frequency. Mobile and digital models of nutrition care can facilitate long-term behavior change, address nutrition issues proactively, reduce travel burden, and reach people without access to health care more easily. However, while traditional health delivery continues to be digitally disrupted, there are many barriers to address before mobile and digitally supported models of nutrition care can become business as usual in nephrology and nutrition care practice. This paper overviews the current evidence base concerning the past and present mobile and digital health programs to improve nutrition in CKD and highlights the novel future trends in this field. The way nutrition and dietetic care can be feasible, safe, and potentially effective when delivered using various digital and virtual technologies, including consultations, assessments, establishment of diagnoses, formulation of plans, and monitoring/reviewing clinical progress is discussed. Of the available evidence to date, these modalities appear to improve dietary sodium intake and diet quality, self-efficacy, interdialytic weight gain, and body weight. Many barriers exist to sustaining the continued and widespread adoption of digital and mobile health-supported nutrition care in CKD. These include patient-, clinician-, and health system-specific and are discussed in detail. Mobile and digital-supported models of nutrition care present an exciting opportunity to assist kidney dietitians deliver patient-centred nutrition care in CKD.
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Affiliation(s)
- Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Dev K Jegatheesan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Jessica Dawson
- Nutrition and Dietetics Department, St George Hospital, Sydney, New South Wales, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Amandine Barnett
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Alex R Chang
- Center for Kidney Health Research, Geisinger Health, Danville, PA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Katrina L Campbell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Australia
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12
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Greene B, Bernardo L, Thompson M, Loughead J, Ashare R. Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial. JMIR Form Res 2023; 7:e47121. [PMID: 37477975 PMCID: PMC10403799 DOI: 10.2196/47121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Nearly 1 in 3 clinical trials end prematurely due to underenrollment. Strategies to enhance recruitment are often implemented without scientific rigor to evaluate efficacy. Evidence-based, cost-effective behavioral economic strategies designed to influence decision-making may be useful to promote clinical trial enrollment. OBJECTIVE This study evaluated 2 behavioral economic strategies to improve enrollment and retention rates across 4 clinical trials: information provision (IP) and contingency management (CM; ie, lottery). IP targets descriptive and injunctive norms about participating in research and CM provides participants incentives to reinforce a target behavior. METHODS A sample of 212 participants was enrolled across 4 clinical trials focused on tobacco use: 2 focused on HIV and 2 focused on neuroimaging. The CM condition included a lottery: for each study visit completed, participants received 5 "draws" from a bowl containing 500 "chips" valued at US $0, US $1, US $5, or US $100. In the IP condition, text messages that targeted injunctive norms about research (eg, "Many find it a rewarding way to advance science and be part of a community") were sent through the Way to Health platform before all study visits. Participants were randomized to 1 of 4 conditions: IP, CM, IP+CM, or standard recruitment (SR). We performed logistic regression, controlling for sex and study, with condition as a between-subject predictor. Outcomes were the percentage of participants who attended a final eligibility visit (primary), met intent-to-treat (ITT) criteria (secondary), and completed the study (secondary). Recruitment was evaluated by the percentage of participants who attended a final eligibility visit, enrollment by ITT status, and retention by the percentage of participants who completed the study. RESULTS Rates of attending the eligibility visit and meeting ITT status were 58.9% (33/56) and 33.9% (19/56) for IP+CM; 45.5% (25/55) and 18.2% (10/55) for IP only; 41.5% (22/53) and 18.9% (10/53) for CM only; and 37.5% (18/48) and 12.5% (6/48) for SR, respectively. In the logistic regression, females were more likely to meet ITT status than males (odds ratio [OR] 2.7, 95% CI 1.2-5.7; P=.01). The IP+CM group was twice as likely to attend the final eligibility visit than the SR group (OR 2.4, 95% CI 1.1-5.2; P=.04). The IP+CM group was also significantly more likely to reach ITT status than the SR condition (OR 3.9, 95% CI 1.3-11.1; P=.01). Those who received any active intervention (IP, CM, or IP+CM) had a higher study completion rate (33/53, 63.5%) compared to those who received SR (5/12, 41.7%), but this difference was not significant (P=.26). CONCLUSIONS Combining IP and CM strategies may motivate participants to participate in research and improve recruitment and retention rates. Evidence from this study provides preliminary support for the utility of behavioral economics strategies to improve enrollment and reduce attrition in clinical trials.
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Affiliation(s)
- Brittney Greene
- State University of New York at Buffalo, Buffalo, NY, United States
| | - Leah Bernardo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Morgan Thompson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - James Loughead
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Ashare
- State University of New York at Buffalo, Buffalo, NY, United States
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13
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Barnett A, Wright C, Stone C, Ho NY, Adhyaru P, Kostjasyn S, Hickman IJ, Campbell KL, Mayr HL, Kelly JT. Effectiveness of dietary interventions delivered by digital health to adults with chronic conditions: Systematic review and meta-analysis. J Hum Nutr Diet 2022; 36:632-656. [PMID: 36504462 DOI: 10.1111/jhn.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Digital health interventions may facilitate management of chronic conditions; however, no reviews have systematically assessed the effectiveness of dietary interventions delivered by digital health platforms for improving dietary intake and clinical outcomes for adults with diet-related chronic conditions. METHODS Databases CINAHL, CENTRAL, Embase and MEDLINE were searched from inception to April 2021 to identify controlled trials for dietary education delivered by digital health (mobile or electronic health) to adults with diet-related chronic conditions. Random effects analysis was performed for diet quality, food groups, nutrients and clinical outcomes. Screening, data extraction and quality checking were completed in duplicate. RESULTS Thirty-nine studies were included involving 7333 participants. Significant changes were found for Mediterranean diet adherence score (standardised mean difference [SMD] = 0.79; 95% confidence interval [CI] = 0.18 to 1.40), overall fruit and vegetable intake (mean difference [MD]: 0.63 serves/day; 95% CI = 0.27-0.98), fruit intake alone (MD = 0.58 serves/day; 95% CI = 0.39 to 0.77) and sodium intake (SMD = -0.22; 95% CI = -0.44 to -0.01). Improvements were also found for waist circumference [MD = -2.24 centimetres; 95% CI = -4.14 to -0.33], body weight (MD = -1.94 kg; 95% CI = -2.63 to -1.24) and haemoglobin A1c (MD = -0.17%; 95% CI = -0.29 to -0.04). Validity of digital assessment tools to measure dietary intake were not reported. The quality of evidence was considered to have low to moderate certainty. CONCLUSIONS Modest improvements in diet and clinical outcomes may result from intervention via digital health for those with diet-related chronic conditions. However, additional robust trials with better reporting of digital dietary assessment tools are needed to support implementation within clinical practice.
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Affiliation(s)
- Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Charlene Wright
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Christine Stone
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nok Yin Ho
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Pooja Adhyaru
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Sarah Kostjasyn
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Ingrid J Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Katrina L Campbell
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Hannah L Mayr
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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14
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Chen L, Zhang Y, Li C, Li Q, He L. Construction of haemodialysis nursing-sensitive quality indicators based on Donabedian theory: A Delphi method study. Nurs Open 2022; 10:807-816. [PMID: 36040112 PMCID: PMC9834505 DOI: 10.1002/nop2.1349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/17/2022] [Accepted: 08/22/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS To establish a sensitive, scientific and practical evaluation system for haemodialysis nursing and to provide a reference for the evaluation of haemodialysis nursing quality. DESIGN Through a literature review and Delphi method. METHOD According to the literature review, a preliminary nursing-sensitive quality indicators for haemodialysis were established, and an expert survey questionnaire was designed. Finally, the evaluation system for the nursing-sensitive quality indicators was determined using the Delphi method. RESULTS Thirteen nursing-sensitive quality indicators for haemodialysis were finally constructed, including two structural indicators, three process indicators and eight outcome indicators. The effective recovery rate of the two rounds of expert survey questionnaires was 100%, the coefficient of judgement basis is 0.956, the coefficient of familiarity is 0.833, the coefficient of authority is 0.895, and the Kendall's harmony coefficients of the two rounds of expert consultation were 0.158 ~ 0.307 and 0.170 ~ 0.315, respectively, with statistical significance (p < .05). CLINICAL RELEVANCE In this study, the nursing-sensitive quality indicators for haemodialysis were developed by the Delphi method and included structural indicators, outcome indicators and process indicators, which made up for some deficiencies noted in previous studies. The authors have provided a more reliable and comprehensive basis for evaluating the quality and safety of haemodialysis nursing in the future.
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Affiliation(s)
- Lin Chen
- West China School of NursingSichuan UniversityChengduChina,Hemodialysis CenterDepartment of NephrologyWest China HospitalSichuan UniversityChengduChina
| | - Yingjun Zhang
- West China School of NursingSichuan UniversityChengduChina,Hemodialysis CenterDepartment of NephrologyWest China HospitalSichuan UniversityChengduChina
| | - Chao Li
- West China School of NursingSichuan UniversityChengduChina,Hemodialysis CenterDepartment of NephrologyWest China HospitalSichuan UniversityChengduChina
| | - Qiao Li
- West China School of NursingSichuan UniversityChengduChina,Hemodialysis CenterDepartment of NephrologyWest China HospitalSichuan UniversityChengduChina
| | - Li He
- West China School of NursingSichuan UniversityChengduChina,Hemodialysis CenterDepartment of NephrologyWest China HospitalSichuan UniversityChengduChina
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15
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Bruinius J, Hannan M, Kagalwalla M, Iddrisu MD, Missikpode C, Frydrych A, Wilk M, Gerber B, Sharp LK, Cedillo-Couvert E, Lash JP, Porter AC. Healthy diet text message-based intervention in adults with CKD: a pilot study. J Nephrol 2022; 35:1759-1761. [PMID: 35020186 DOI: 10.1007/s40620-021-01233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jacob Bruinius
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois Chicago, 820 South Wood Street (MC 793), Chicago, IL, 60612, USA
| | - Mary Hannan
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois Chicago, 820 South Wood Street (MC 793), Chicago, IL, 60612, USA
| | | | - Muftawu-Deen Iddrisu
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Celestin Missikpode
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois Chicago, 820 South Wood Street (MC 793), Chicago, IL, 60612, USA
| | - Anne Frydrych
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois Chicago, 820 South Wood Street (MC 793), Chicago, IL, 60612, USA
| | - Meredith Wilk
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois Chicago, 820 South Wood Street (MC 793), Chicago, IL, 60612, USA
| | - Ben Gerber
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois Chicago, 820 South Wood Street (MC 793), Chicago, IL, 60612, USA.,Department of Population and Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lisa K Sharp
- College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | | | - James P Lash
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois Chicago, 820 South Wood Street (MC 793), Chicago, IL, 60612, USA
| | - Anna C Porter
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois Chicago, 820 South Wood Street (MC 793), Chicago, IL, 60612, USA.
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16
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Dawson J, Howell M, Howard K, Campbell KL, Craig JC, Tong A, Lee VW. Cost-effectiveness of a mobile phone text messaging program (KIDNEYTEXT) targeting dietary behaviours in people receiving haemodialysis. J Hum Nutr Diet 2021; 35:765-773. [PMID: 34323334 DOI: 10.1111/jhn.12937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is little information available to inform the cost-effectiveness of eHealth interventions in improving patient health outcomes. A trial-based economic evaluation was undertaken aiming to inform the feasibility of conducting a mobile phone text messaging programme targeting dietary behaviours in people receiving haemodialysis. METHODS A trial-based economic evaluation from a health system perspective of a 6-month pilot randomised controlled trial was undertaken. One hundred and thirty patients receiving haemodialysis from six dialysis units across Sydney, Australia, were enrolled into the KIDNEYTEXT study. Usual care (inperson dietary counselling) was compared with usual care plus three semi-personalised dietary mobile phone text messages per week over a 6-month period. The outcomes of this economic evaluation included: cost of intervention, cost-effectiveness and marginal effects on total costs. RESULTS The cost of developing and maintaining the KIDNEYTEXT intervention was US $110 per participant. Total costs were US $1418 higher in the usual care arm compared to the intervention arm. The incremental benefits for quality-adjusted life adjusted years were 0.01 [95% confidence interval (CI) = -0.03 to 0.06] and dietary adherence (i.e., adherent to three or more dietary guidelines at 6 months) being 0.04 (95% CI = -0.15 to 0.24). The largest component of total costs was related to unplanned admissions to hospital. CONCLUSIONS Mobile phone text messages targeting dietary behaviours may be cost saving, at the same time as maintaining similar or improved dietary behaviours. A larger trial with a longer follow-up time is warranted.
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Affiliation(s)
- Jessica Dawson
- Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Nutrition and Dietetics Department, St George Hospital, Sydney, NSW, Australia
| | - Martin Howell
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Katrina L Campbell
- Menzies Health Institute, Griffith University, Allied Health Services, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Vincent W Lee
- Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
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17
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Dawson J, Tong A, Matus Gonzalez A, Campbell KL, Craig JC, Lee VW. Patients' experiences and perspectives of a mobile phone text messaging intervention to improve dietary behaviours in haemodialysis. Nutr Diet 2021; 78:516-523. [PMID: 33870612 DOI: 10.1111/1747-0080.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
AIM Dietary requirements for people on haemodialysis are complex and often poorly adhered to. Mobile phone text messaging offers a simple strategy to enhance current nutritional care. KIDNEYTEXT was a 6-month pilot randomised controlled trial that evaluated the feasibility and impact of mobile phone text messages to alter participants' dietary behaviours. The aim of this study was to elicit the perspectives of people on haemodialysis regarding acceptability of mobile phone text messages targeting dietary behaviours. METHODS Semi-structured interviews were conducted with participants in the intervention arm of the KIDNEYTEXT study. Participants were purposively sampled and interviews were conducted in-person or over the phone. Transcripts were thematically analysed using principles of grounded theory. RESULTS Interviews were conducted with 25 participants. Four major themes were identified: building awareness (reinforcement of information, simple and comprehensible, guiding choices, accessible information enhancing motivation, gaining skills in management), valuing care (boosting self-esteem, in-person care bolstered by reminders), activating change (adjusting lifestyle, gaining control of electrolytes and fluid, striving to improve overall health), waning attention and motivation (lack of personalisation limiting change, maintaining the status quo, reverting back to old habits). CONCLUSIONS Participants perceived that the KIDNEYTEXT intervention enabled participants to build on their knowledge through the dissemination of simple and actionable content. Participants appreciated frequent reminders of how to improve their diet and felt that this increased contact motivated them to alter some dietary behaviours. Future trials should consider strategies to enhance personalisation to further motivate dietary change.
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Affiliation(s)
- Jessica Dawson
- Faculty of Medicine and Health, Sydney Medical School, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrea Matus Gonzalez
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Menzies Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Vincent W Lee
- Faculty of Medicine and Health, Sydney Medical School, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
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18
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Brown TJ, Williams H, Mafrici B, Jackson HS, Johansson L, Willingham F, McIntosh A, MacLaughlin HL. Dietary interventions with dietitian involvement in adults with chronic kidney disease: A systematic review. J Hum Nutr Diet 2021; 34:747-757. [PMID: 33682964 DOI: 10.1111/jhn.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A comprehensive evidence base is needed to support recommendations for the dietetic management of adults with chronic kidney disease (CKD). The present study aimed to determine the effect of dietary interventions with dietitian involvement on nutritional status, well-being, kidney risk factors and clinical outcomes in adults with CKD. METHODS Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO and EMBASE.com were searched from January 2000 to November 2019. Intentional weight loss and single nutrient studies were excluded. Risk of bias was assessed using the Cochrane risk-of-bias tool. Effectiveness was summarised using the mean difference between groups for each outcome per study. RESULTS Twelve controlled trials (1906 participants) were included. High fruit and vegetable intake, as well as a multidisciplinary hospital and community care programme, slowed the decline in glomerular filtration rate in adults with stage 3-4 CKD. Interventions addressing nutrition-related barriers increased protein and energy intake in haemodialysis patients. A Mediterranean diet and a diet with high n-3 polyunsaturated fatty acids improved the lipid profile in kidney transplant recipients. CONCLUSIONS A limited number of studies suggest benefits as a result of dietary interventions that are delivered by dietitians and focus on diet quality. We did not identify any studies that focussed on our primary outcome of nutritional status or studies that examined the timing or frequency of the nutritional assessment. This review emphasises the need for a wider body of high-quality evidence to support recommendations on what and how dietetic interventions are delivered by dietitians for adults with CKD.
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Affiliation(s)
- Tamara J Brown
- Usher Institute, Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Harriet Williams
- Department of Nutrition and Dietetics, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Bruno Mafrici
- Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helena S Jackson
- Renal and Transplantation Unit (Nutrition & Dietetics), St George's University Hospitals NHS Trust, London, UK
| | - Lina Johansson
- Department of Metabolism, Digestion and Reproduction, Imperial Healthcare NHS Trust, London, UK
| | - Fiona Willingham
- Dietetic department, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Ashleigh McIntosh
- Faculty of Health Sciences and Medicine, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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