A brief questionnaire on metacognition: psychometric properties

Effect of Fitness-To-Drive and Metacognition on Road Traffic Injury Among Older Taxi Drivers: Hierarchical Modeling

Age-related cognitive and somatic motor skills changes have been linked to impaired driving abilities. Taxi drivers play an important role in providing public transportation services and security. This study aimed to examine the level of fitness-to-drive (FTD) and identify the predictors of self-reported traffic injury among the older taxi drivers. Taxi drivers 60 years and older in Bangkok and the metropolitan area were enrolled. Hierarchical regression models were carried out to examine the effects of demographics, FTD, and metacognition towards self-reported road traffic injury. Totally, 46.1% of the respondents were classified as at-risk drivers. Drivers with alcohol consumption and low risk perception toward road safety were more likely to experience road traffic injury. Regular assessment of physical and psychometric capacity among older taxi drivers could provide another empirical basis to improve public safety transport.

Metacognitive Scales: Assessing Metacognitive Knowledge in Older Adults Using Everyday Life Scenarios

The multidimensional effect of aging on cognition and its interference with daily functioning is well reported by many studies. Therefore, the ability to detect age-related cognitive changes is of great importance for older adults to help compensate for cognitive decline. For that, metacognition and its course of change across the lifespan of a person have attracted considerable scientific interest. The aim of the present study is to present three new self-report questionnaires, developed to measure older adults’ metacognitive knowledge for everyday memory (MKEM), metacognitive knowledge for everyday attention (MKEA), and metacognitive knowledge for everyday executive functions (MKEEFs). The questionnaires were tested for structural validity and reliability. A sample size of 171 community-dwelling adults of advancing age (97 females and 74 males) voluntarily participated in this study and their ages ranged from 50 to 82 years (mean = 59.32, SD = 7.39). Exploratory factor analysis using principal component analysis with varimax rotation was applied to examine structural validity. The results revealed a one-factor structure for the MKEM with high internal consistency (α = 0.88), a two-factor structure for the MKEA, that reflected “divided and shifted attention” (α = 0.74) and “concentration” (α = 0.75), and a two-factor structure for the MKEEFs that reflected “planning” (α = 0.70) and “inhibition” (α = 0.65). The variables created for each factor respectively showed significant positive correlations between each other.

Poor Sleep in Community-Dwelling Polysubstance Users: Association With Khat Dependence, Metacognition, and Socio-Demographic Factors

Purpose

Poor sleep and cognitive deficits are often associated with increased drug use. However, no study has addressed the relationship between poor sleep, substance dependence, and metacognitive deficit in polysubstance users.

Methods

This was a cross-sectional study with a simple random sampling involving community-dwelling polysubstance users (n = 326, age = 18-43 years) in Mizan, Ethiopia. Participants completed a brief sleep questionnaire, severity of dependence on khat (SDS-Khat), a brief meta-cognition questionnaire, and a socio-demographic survey.

Results

Majority (56.4%) of the polysubstance users had sleep disturbance. Chronic health conditions [adjusted odds ratio (AOR) = 2.52, 95% confidence interval (CI) 1.31-4.85], chronic conditions in the family (AOR = 2.69, 95% CI 1.40-5.20), illiterate-primary level of educational status (AOR = 2.40, 95% CI 1.30-4.04), higher SDS-Khat score (AOR = 1.39, 95% CI 1.13-1.72), and lower meta-cognition score (AOR = 0.90, 95% CI 0.84-0.97) predicted poor sleep in the polysubstance users. Moreover, low metacognition score and high SDS score also predicted additional sleep disturbances like chronic sleep insufficiency, lethargy and restlessness after nighttime sleep, socio-occupational dysfunctions, and daytime disturbances in polysubstance users.

Conclusion

Poor sleep, severe khat dependence, and metacognitive deficits are common in community polysubstance users. Moreover, poor sleep is associated with higher khat dependence, lower metacognitive ability, lower educational status, and the presence of chronic conditions in polysubstance users or their families.

Using transcranial direct current stimulation (tDCS) on the dorsolateral prefrontal cortex to promote long-term foreign language vocabulary learning

Transcranial direct current stimulation (tDCS) on the dorsolateral prefrontal cortex (DLPFC) was used to improve foreign-langue learning while using mental imagery. Participants underwent two sessions of 1 mA, 1.5 mA, or sham stimulation prior to learning Swahili-English word pairs two consecutive days. During learning, participants were encouraged to create a mental image of the associated English word. Twenty-four hours after learning and one week later, participants received a cued recall test. A linear dose-response effect of stimulation was found across both tests that occurred long after the immediate effects of stimulation. Follow-up comparisons revealed that only the 1.5 mA condition differed from the sham group. Exploratory moderating effects revealed interactions with sleep quality and handedness. Those with poorer sleep and who were left-handed showed greater recall after 1.5 mA of stimulation than those with better sleep and right-handers. A follow-up behavioral study probing strategy usage indicated that mental imagery strategy use did not strongly impact learning but point to other possible mechanisms including the importance of attending to multimodal perceptual details and memory consolidation. This preliminary evidence supports the role of the DLPFC or connected regions in foreign language vocabulary learning and verbal memory encoding.

Triggering of postpartum depression and insomnia with cognitive impairment in Argentinian women during the pandemic COVID-19 social isolation in relation to reproductive and health factors

Objective

The 2019 coronavirus disease pandemic (COVID-19) required strict confinement measures that differentially impacted the individual's daily life. Thus, this work aimed to study postpartum women's mental health in Argentina during mandatory social isolation.

Design

A cross-sectional survey was conducted from May to July 2020, which included five validated questionnaires to assess postpartum depression (Postpartum Depression Screening Scale‐Short Form), insomnia (Insomnia Severity Index), memory complaints (Memory Complaint Scale), metacognition (Brief Metamemory and Metaconcentration Scale), and breastfeeding self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form). Sociodemographic variables, social isolation characteristics, and breastfeeding practices were also collected. This study was conducted in accordance with the Declaration of Helsinki. Statistical analysis included zero-order correlations, multiple logistic regressions, and a set of structural equation models (SEM) to test direct and indirect effects. Goodness-of-fit indices were calculated for SEM.

Setting

Postpartum women were recruited from public hospitals, private health clinics, and online community recruitment in the Cordoba province (Argentina).

Participants

305 postpartum women from Argentina.

Measurements and findings

37% of women reported postpartum depression, 46% insomnia, 42% memory impairment, 60% low metaconcentration, 50% low metamemory, and 23% low breastfeeding efficacy. Also, significant associations were found demonstrating that social isolation promoted postpartum depression and insomnia were reciprocally related, which compromised female cognition and efficacy. This situation was aggravated in women during late postpartum, with previous children, and by low social support (e.g., family, health professionals), with non-exclusive breastfeeding being increased.

Key conclusions

This is the first study addressing postpartum women's mental status during social isolation in Argentina, which was a promoting factor for postpartum depression and insomnia that were reciprocally related. This situation was also aggravated by reproductive factors, such as late postpartum, multiparity, breastfeeding frequency, and non-exclusive breastfeeding. Additionally, breastfeeding self-efficacy depended on mental health status, and euthymia therefore favoured the practice of exclusive breastfeeding.

Impact of a brief behavioral treatment for insomnia (BBTi) on metacognition in older adults

INTRODUCTION

Brief (≤4 sessions) behavioral treatment for insomnia (BBTi) improves insomnia symptoms in older adults. Findings for BBTi-related improvements in objective cognition are mixed, with our recent trial reporting no effects. Metacognition (appraisal of one's own performance) has not been examined. This study examined the effects of BBTi on metacognition in older adults with insomnia.

METHODS

Older adults with insomnia [N = 62, Mage = 69.45 (SD = 7.71)] were randomized to 4-weeks of BBTi (n = 32; psychoeducation, sleep hygiene, stimulus control, sleep restriction, relaxation, review/maintenance) or self-monitoring control (SMC; n = 30; social conversations). Throughout the study (2 week baseline, 4 week treatment, 2 week post-treament, 2 week 3-month followup), participants completed daily paper/pencil cognitive tasks (measuring verbal memory, attention, processing speed and reasoning) and provided daily metacognition ratings of their performance in four areas: quality, satisfaction, compared to same age peers, compared to own ability. Two-week averages of metacognitive ratings were calculated for baseline, treatment-first half, treatment-second half, post-treatment, and 3-month follow-up. Multilevel Modeling examined treatment effects (BBTi/SMC) over time on metacognition, controlling for age and sex.

RESULTS

A significant group by time interaction (p = 0.05) revealed consistent improvements over time in better metacognitive ratings relative to same age peers for BBTi. Specifically, baseline ratings [mean (M) = 51.21, standard error (SE) = 3.15] improved at first half of treatment (M = 56.65, SE = 3.15, p < 0.001), maintained improvement at second-half of treatment (p = 0.18), showed additional improvement at post-treatment (M = 60.79, SE = 3.15, p = 0.02), and maintained improvement at follow-up (M = 62.30, SE = 3.15; p = 0.02). SMC prompted inconsistent and smaller improvements between baseline (M = 53.24, SE = 3.29) and first-half of treatment (M = 56.62, SE = 3.28; p = 0.004), with additional improvement at second-half of treatment (M = 59.39, SE = 3.28; p = 0.02) that was maintained at post-treatment (p = 0.73) and returned to levels observed at first-half of treatment (M = 57.78, SE = 3.21; p = 0.55). Significant main effects of time (all ps < 0.001) for other metacognition variables (Quality, Satisfaction, Compared to own ability) indicated general improvements over time for both groups.

DISCUSSION

Metacognition generally improved over time regardless of treatment. BBTi selectively improved ratings of performance relative to same age peers. Repeated objective testing alone may improve metacognition in older adults with insomnia. Better understanding of metacognition and how to improve it has important implications for older adults as metacognitive complaints have been associated with mild cognitive impairment.

Older adults show a higher heartbeat-evoked potential than young adults and a negative association with everyday metacognition

The ability to monitor internal bodily and cognitive processes is essential for everyday functioning and independence in older adults, because it allows for adjustments when lapses in performance are imminent. In the present study, age-related morphological changes to the heartbeat evoked potential (HEP), an electrophysiological cortical representation of cardiac signals, and its association with self-reported everyday cognition were examined. A community sample of older adults showed an increased HEP amplitude, which could reflect a stronger representation of early stages of cardiac interoception, and a more anterior scalp distribution of the HEP, suggesting a more widespread configuration of the underlying neural generators, compared to a group of young adults. Furthermore, in older adults, HEP amplitude was negatively correlated with self-estimated everyday cognitive functioning. Older adults with pronounced cortical representations of peripheral signals may thus be more likely to take note of lapses in their own bodily and cognitive function, leading to lower estimates of their cognitive abilities. These results provide novel insights into age-related changes in interoceptive processing and their association with metacognitive judgments, with potentially far-reaching implications for cognitive aging and age-related cognitive decline.

Insomnia severity index: a psychometric investigation among Saudi nurses

BACKGROUND

Insomnia is the most prevalent sleep disorder, but it is widely untreated and under-diagnosed in Saudi Arabia. Moreover, no tool to screen insomnia has been validated in the Saudi population in general or nurses in particular. This study, therefore, assessed the psychometric validity of the Insomnia Severity Index (ISI) in Saudi nurses.

METHODS

A cross-sectional study with purposive sampling was performed with nurses (n = 134, age = 21-48 years) from Al Majmaah, Saudi Arabia. Both conventional and online survey methods using the ISI, a brief measure of metacognition, and a socio-demographics questionnaire were employed.

RESULTS

No ceiling or floor effects were found in the ISI total score (8.84 ± 5.07) or the factor scores, but the floor effect was found in the item scores. A two-factor model showed the best fit (Pclose .97, comparative fit index [CFI] 1.00, root mean square error of approximation [RMSEA] 0.00, non-significant χ²test, χ²/df 0.904). This model showed favorable configural, metric, scalar, and partial strict invariance across gender groups (CFI > .95, RMSEA < .05, χ²/df < 3, non-significant Δχ², ΔCFI ≤ .01). The internal consistency was adequate (Cronbach's alpha = 0.75, 0.78 for the two factors of the ISI). The lack of correlations between the ISI scores and the scores of the brief measure of the metacognition favored its divergent validity.

CONCLUSION

The ISI showed adequate psychometric validity for screening insomnia among Saudi nurses.

Discrepancy between objective and subjective cognition in major depressive disorder

Objective and subjective cognitive measures are altered in major depressive disorder (MDD), but there is a poor correlation between them. This study aims to explore such discrepancy and the characteristics explaining this phenomenon. 229 patients with MDD subdivided into remitted (n = 57), partially remitted (n = 90) and acute (n = 82) underwent a clinical interview, completed self-report questionnaires and a neuropsychological assessment. The association between objective and subjective cognition was evaluated in the areas of attention and memory. Also, dependent measures of concordance and self-appraisal were calculated for each patient. Potential predictors of these outcomes were evaluated through regression analysis. Depressive symptoms correlated negatively with objective but especially with subjective cognition. Patients in an acute episode showed a significant correlation between objective and subjective attention/memory measures, but also the greatest underestimation of their cognitive performance. In those with fewer depressive symptoms, objective and subjective cognition showed poor correspondence between them. In the regression analyses with the full MDD sample, higher scores on depressive symptoms, intelligence quotient and executive functions predicted lower self-appraisal. Objective and subjective cognition show poor concordance in MDD patients, especially in those with residual mood symptoms. Higher executive functions also explain this discrepancy. Assessments of both subjective cognitive complaints and objective performance seem necessary as they may be measuring different aspects of cognitive functioning.

The Mizan meta-memory and meta-concentration scale for students (MMSS): a test of its psychometric validity in a sample of university students

BACKGROUND

Predisposing factors for metacognitive dysfunctions are common in university students. However, there is currently no valid questionnaire instrument designed to assess metacognitive aspects including meta-memory and meta-concentration in students. To address this need, the present study investigated the psychometric validity of a brief questionnaire, the Mizan meta-memory and meta-concentration scale for students (MMSS) in university students.

MATERIALS AND METHODS

A cross-sectional study with simple random sampling was conducted among students (n = 383, age = 18-35, body mass index = 21.2 ± 3.4 kg/m2) of Mizan-Tepi University, Ethiopia. MMSS, a socio-demographics questionnaire, and the Epworth sleepiness scale (ESS) were employed.

RESULTS

No ceiling/floor effect was seen for the MMSS global and its sub-scale scores. Confirmatory factor analysis showed that a 2-Factor model had excellent fit. Both, the comparative Fit Index (CFI) and goodness of fit index were above 0.95, while both the standardized root mean square residual and root mean square error of approximation (RMSEA) were less than 0.05, while χ2/df was less than 3 and PClose was 0.31. The 2-Factor MMSS model had adequate configural, metric, scalar, and strict invariances across gender groups as determined by a CFI > .95, RMSEA<.05, χ2/df < 3, non-significant Δχ2 and/or ΔCFI≤.01. Good internal consistency (Cronbach's alpha = 0.84, 0.80 and McDonald's Omega =0.84, 0.82) was found for both subscales of the MMSS. No correlations between the MMSS scores and ESS score favored its divergent validity.

CONCLUSION

The MMSS was found to have favorable psychometric validity for assessing meta-memory and meta-concentration among university students.

Psychometric properties of the severity of the dependence scale for Khat (SDS-Khat) in polysubstance users

BACKGROUND

Current evidence suggests that the addiction on one substance may underpin or affect addiction on another in polysubstance users. However, there is no tool that has been shown to have psychometric validation for assessment of the severity of khat addiction in polysubstance users.

METHODS

Polysubstance users with khat chewing habit (n = 178, age = 25.8 ± 3.6, BMI = 23.3 ± 2.8 kg/m2) were recruited from randomly selected houses for a cross-sectional study in Mizan, Ethiopia. The survey including severity of dependence scale for khat (SDS-khat), a brief metacognition questionnaire, and a semi-structured socio-demographics tool were administered by trained interviewers.

RESULTS

There was no ceiling effect or floor effect in the SDS-Khat scores. Internal consistency was moderate (Cronbach's alpha = 0.58). Internal homogeneity was adequate (Item-total correlations of the SDS-Khat; r ≥ 0.55). Significant negative correlations between the SDS-Khat and the metacognition (r = -.19 to -.34, p < 0.05 or p < 0.01) indicated convergent validity. The findings of exploratory factor analysis were non-unanimous with a suggestion of two models, i.e., a 2-factor and a 1-factor model, while the confirmatory factor analysis favored 1-Factor model.

CONCLUSION

The SDS-Khat has adequate psychometric validity for the assessment of psychological severity of khat addiction in the polysubstance users.

Escala de Avaliação da Metacognição em Idosos: Evidências de Validade e Consistência Interna

RESUMO O objetivo deste estudo foi investigar as evidências de validade e precisão de um instrumento que avalia a metacognição em idosos, denominado Escala Metacognitiva Sênior (EMETA-S). Participaram da amostra 194 idosos de ambos os sexos, que responderam a própria EMETA-S, composta por 74 itens. A análise fatorial exploratória com rotação Varimax revelou a presença de dois fatores, responsáveis por 27,18% da variância da escala. Após a exclusão de itens, a EMETA-S ficou composta por 27 itens, com consistência interna de 0,85. Não foram encontradas diferenças significativas entre a média do desempenho em relação às variáveis: sexo, escolaridade e idade dos participantes. A análise das evidências de validade e precisão indicou adequação dos itens ao conceito proposto e boa consistência interna da escala.

Rationale and design for SHAREHD: a quality improvement collaborative to scale up Shared Haemodialysis Care for patients on centre based haemodialysis

Background

The study objective is to assess the effectiveness and economic impact of a structured programme to support patient involvement in centre-based haemodialysis and to understand what works for whom in what circumstances and why. It implements a program of Shared Haemodialysis Care (SHC) that aims to improve experience and outcomes for those who are treated with centre-based haemodialysis, and give more patients the confidence to dialyse independently both at centres and at home.

Methods/Design

The 24 month mixed methods cohort evaluation of 600 prevalent centre based HD patients is nested within a 30 month quality improvement program that aims to scale up SHC at 12 dialysis centres across England. SHC describes an intervention where patients who receive centre-based haemodialysis are given the opportunity to learn, engage with and undertake tasks associated with their treatment.

Following a 6-month set up period, a phased implementation programme is initiated across 12 dialysis units using a randomised stepped wedge design with 6 centres participating in each of 2 steps, each lasting 6 months. The intervention utilises quality improvement methodologies involving rapid tests of change to determine the most appropriate mechanisms for implementation in the context of a learning collaborative. Running parallel with the stepped wedge intervention is a mixed methods cohort evaluation that employs patient questionnaires and interviews, and will link with routinely collected data at the end of the study period. The primary outcome measure is the number of patients performing at least 5 dialysis-related tasks collected using 3 monthly questionnaires. Secondary outcomes measures include: the number of people choosing to perform home haemodialysis or dialyse independently in-centre by the end of the study period; end-user recommendation; home dialysis establishment delay; staff impact and confidence; hospitalisation; infection and health economics.

Discussion

The results from this study will provide evidence of impact of SHC, barriers to patient and centre level adoption and inform development of future interventions to support its implementation.

Trial registration

ISRCTN Number: 93999549, (retrospectively registered 1^st May 2017); NIHR Research Portfolio: 31566

The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice

Introduction

Kidney disease is associated with significant cognitive dysfunction. Subjective reports of cognitive ability have not been studied extensively in chronic kidney disease. We investigated the association between objective and subjective cognitive functions in predialysis patients and their association with self-care dialysis modality choice.

Methods

Cross-sectional data from the Barriers to Successful Implementation of Care in Home Haemodialysis study were used for the study of cognition in 220 predialysis patients. The data were used to ascertain the demographics, clinical, laboratory, and neuropsychometric variables. The latter includes Trail Making Tests (TMT) parts A and B, Modified Mini Mental State Examination, and metacognition questionnaire for subjective assessment of one's cognitive ability. The outcome variable was fully assisted and self-care dialysis modality choice.

Results

Within the study cohort, 90 patients chose fully assisted hemodialysis and 114 patients chose self-care dialysis. The median Modified Mini Mental State Examination, TMT part A, and TMT part B scores were greater for the assisted versus the self-care group. Metamemory was not significantly different between groups, but the metaconcentration score was significantly worse in the group choosing assisted dialysis. Higher (i.e., better) metaconcentration scores were significantly associated with the self-care modality choice in the univariate and hierarchical regression analyses. Adjusted and unadjusted analyses showed a significant association between perceived concentration and TMT part B scores (P < 0.01). With every 1.6-minute increase in TMT part B score, there was a 1-unit reduction in metaconcentration score, and the latter was associated with 20% lower odds of choosing self-care dialysis over a fully assisted dialysis modality.

Discussion

Patients' self-perception of cognitive ability is a significant predictor of self-care dialysis modality choice. Subjective report of "metaconcentration" is also strongly associated with poorer outcome on the TMT part B.

Aerobic and Cognitive Exercise (ACE) Pilot Study for Older Adults: Executive Function Improves with Cognitive Challenge While Exergaming

Dementia cases are increasing worldwide; thus, investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life. Extensive research confirms the benefits of physical exercise for brain health, yet only a fraction of older adults exercise regularly. Interactive mental and physical exercise, as in aerobic exergaming, not only motivates, but has also been found to yield cognitive benefit above and beyond traditional exercise. This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning. Sixty-four community based older adults (mean age=82) were randomly assigned to pedal a stationary bike, while interactively engaging on-screen with: (1) a low cognitive demand task (bike tour), or (2) a high cognitive demand task (video game). Executive function (indices from Trails, Stroop and Digit Span) was assessed before and after a single-bout and 3-month exercise intervention. Significant group × time interactions were found after a single-bout (Color Trails) and after 3 months of exergaming (Stroop; among 20 adherents). Those in the high cognitive demand group performed better than those in the low cognitive dose condition. Everyday function improved across both exercise conditions. Pilot data indicate that for older adults, cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge.

Self-cannulation for haemodialysis: patient attributes, clinical correlates and self-cannulation predilection models

BACKGROUND AND OBJECTIVES

With emerging evidence in support of home haemodialysis (HHD), patient factors which determine uptake of the modality need to be better understood. Self-cannulation (SC) is a major step towards enabling self-care 'in-centre' and at home and remains the foremost barrier to its uptake. Human factors governing this aspect of HD practice are poorly understood. The aim of this study is to better understand self-cannulation preferences and factors which define them in end stage renal disease (ESRD).

DESIGN

In this multicentre study, 508 of 535 patients from predialysis (Group A: n = 222), in-centre (Group B: n = 213), and home HD (Group C: n = 100) responded to a questionnaire with 3 self-cannulation questions. Simultaneously, data on clinical, cognitive and psychosocial variables were ascertained. The primary outcome measure was 'perceived ability to self-cannulate AV access'. Predictive models were developed using logistic regression analysis.

RESULTS

36.6% of predialysis patients (A) and 29.1% of the 'in-centre' haemodialysis patients (B) felt able to consider SC for HD. Technical-skills related apprehension was highest in Group B (14.4%) patients. Response to routine venepuncture and the types of SC concerns were significant predictors of perceived ability to self-cannulate. There was no significant difference in concern for pain across the groups. In multivariable regression analysis, age, education level, 3 MS score, hypoalbuminemia in Groups B & C and additionally, attitude to routine phlebotomy and the nature of specific concern for self-cannulation in Groups A, B and C, are significant predictors of SC preference. The unadjusted c-statistics of models 1 (derived from Group A and validated on A) and 2 (derived from B+C and validated on B), are 0.76(95% CI 0.69, 0.83) and 0.80 (95% CI 0.74, 0.87) respectively.

CONCLUSIONS

There is high prevalence of perceived ability to self-cannulate. Modifiable SC concerns exist in ESRD. The use of predictive models to objectively define and target education and training strategies could potentially impact on HD self-management and future uptake of home HD.

Barriers to successful implementation of care in home haemodialysis (BASIC-HHD):1. Study design, methods and rationale

Background

Ten years on from the National Institute of Health and Clinical Excellence’ technology appraisal guideline on haemodialysis in 2002; the clinical community is yet to rise to the challenge of providing home haemodialysis (HHD) to 10-15% of the dialysis cohort. The renal registry report, suggests underutilization of a treatment type that has had a lot of research interest and several publications worldwide on its apparent benefit for both physical and mental health of patients. An understanding of the drivers to introducing and sustaining the modality, from organizational, economic, clinical and patient perspectives is fundamental to realizing the full benefits of the therapy with the potential to provide evidence base for effective care models. Through the BASIC-HHD study, we seek to understand the clinical, patient and carer related psychosocial, economic and organisational determinants of successful uptake and maintenance of home haemodialysis and thereby, engage all major stakeholders in the process.

Design and methods

We have adopted an integrated mixed methodology (convergent, parallel design) for this study. The study arms include a. patient; b. organization; c. carer and d. economic evaluation. The three patient study cohorts (n = 500) include pre-dialysis patients (200), hospital haemodialysis (200) and home haemodialysis patients (100) from geographically distinct NHS sites, across the country and with variable prevalence of home haemodialysis. The pre-dialysis patients will also be prospectively followed up for a period of 12 months from study entry to understand their journey to renal replacement therapy and subsequently, before and after studies will be carried out for a select few who do commence dialysis in the study period. The process will entail quantitative methods and ethnographic interviews of all groups in the study. Data collection will involve clinical and biomarkers, psychosocial quantitative assessments and neuropsychometric tests in patients. Organizational attitudes and dialysis unit practices will be studied together with perceptions of healthcare providers on provision of home HD. Economic evaluation of home and hospital haemodialysis practices will also be undertaken and we will apply scenario ("what … if") analysis using system dynamics modeling to investigate the impact of different policy choices and financial models on dialysis technology adoption, care pathways and costs. Less attention is often given to the patient’s carers who provide informal support, often of a complex nature to patients afflicted by chronic ailments such as end stage kidney disease. Engaging the carers is fundamental to realizing the full benefits of a complex, home-based intervention and a qualitative study of the carers will be undertaken to elicit their fears, concerns and perception of home HD before and after patient’s commencement of the treatment. The data sets will be analysed independently and the findings will be mixed at the stage of interpretation to form a coherent message that will be informing practice in the future.

Discussion

The BASIC-HHD study is designed to assemble pivotal information on dialysis modality choice and uptake, investigating users, care-givers and care delivery processes and study their variation in a multi-layered analytical approach within a single health care system. The study results would define modality specific service and patient pathway redesign.

Study Registration

This study has been reviewed and approved by the Greater Manchester West Health Research Authority National Research Ethics Service (NRES) The study is on the NIHR (CLRN) portfolio.