1
|
Shen H, van der Kleij R, van der Boog PJM, Chavannes NH. Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach. JMIR Form Res 2024; 8:e48605. [PMID: 38869943 PMCID: PMC11211709 DOI: 10.2196/48605] [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: 04/30/2023] [Revised: 09/24/2023] [Accepted: 04/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. OBJECTIVE This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. METHODS We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR-Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. RESULTS An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including "knowledge and beliefs" in the domain "individual characteristics," "quality and advantage of eHealth intervention" in the domain "intervention characteristics," "compatibility" in the domain "inner setting," and "cultural context" in the domain "outer setting." To ensure the effectiveness of the Dutch MD-based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention's appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. CONCLUSIONS Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients' self-management skills and improve health status and quality of life. Moreover, our study's research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. TRIAL REGISTRATION ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923.
Collapse
Affiliation(s)
- Hongxia Shen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
2
|
Carey NP, Curtis F, Eisenbeisz ML, Akbari S, Sambharia M, Jalal DI, Wilkinson TJ. Does home blood pressure monitoring improve blood pressure-related outcomes in people living with chronic kidney disease? A systematic review. J Clin Hypertens (Greenwich) 2024; 26:314-329. [PMID: 38523586 PMCID: PMC11007799 DOI: 10.1111/jch.14795] [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: 10/24/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024]
Abstract
High blood pressure is an important risk factor for cardiovascular disease and disease progression in chronic kidney disease (CKD). Evidence on the effects of home blood pressure monitoring (HBPM) is limited. This review aimed to determine the effect of HBPM on systolic (SBP) and diastolic blood pressure (DBP) in patients with CKD. We searched medical literature databases for eligible studies presenting pre- and post-data for interventions utilizing HBPM. Study quality was assessed using the NHLBI tools for quality assessment. Heterogeneity prohibited a meta-analysis so estimates of effects were calculated along a sign test to examine the probability of observing the given pattern of positive effect direction. Eighteen studies were included (n = 1187 participants, mean age 56.7 [± 7.7] years). In 15 studies, HBPM was conducted within the context of additional high-level tailored support. Overall, the quality of n = 7/18 studies was rated as "good"; n = 6/18 were "fair," and n = 5/18 were rated as "poor." Interventions utilizing HBPM had a significant effect on SBP, with 14/16 studies favoring the intervention (88% [95% CI: 62%-98%], P = .002). Favorable effects were also seen on DBP (73% [95% CI: 45%-92%], P = .059). HBPM had a favorable effect on blood pressure goal attainment (86% [95% CI: 42%-100%], P = .062). HBPM in patients with CKD as part of a multicomponent intervention may lead to clinically significant reductions in blood pressure; however, research is needed to support the validity of this claim due to the high heterogeneity across the studies included.
Collapse
Affiliation(s)
- Nathan P. Carey
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration East MidlandsLeicesterUK
| | - Ffion Curtis
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - McKenna L. Eisenbeisz
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Sadaf Akbari
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Meenakshi Sambharia
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Diana I. Jalal
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Thomas J. Wilkinson
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration East MidlandsLeicesterUK
- NIHR Leicester Biomedical Research CentreLeicesterUK
| |
Collapse
|
3
|
Shen H, van der Kleij R, van der Boog PJM, Wang W, Song X, Li Z, Brakema E, Lou X, Chavannes N. Digital tools/eHealth to support CKD self-management: A qualitative study of perceptions, attitudes and needs of patients and health care professionals in China. Int J Med Inform 2022; 165:104811. [PMID: 35753175 DOI: 10.1016/j.ijmedinf.2022.104811] [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: 07/28/2021] [Revised: 05/05/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND A growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries. OBJECTIVE To inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific. METHODS We conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. RESULTS Three themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to 'inform, monitor and track' as potentially relevant interventions to support CKD self-management, not those to support 'interaction' and 'data utilization'. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs' workflows. CONCLUSIONS The identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs' workflows.
Collapse
Affiliation(s)
- Hongxia Shen
- School of Nursing, Guangzhou Medical University, Guangzhou, China; Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Wenjiao Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Evelyn Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Xiaoping Lou
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
4
|
Dirikgil E, Roos R, Groeneveld GH, Heringhaus C, Silven AV, Petrus AHJ, Villalobos-Quesada M, Tsonaka R, van der Boog PJM, Rabelink TJ, Bos WJW, Chavannes NH, Atsma DE, Teng YKO. Home monitoring reduced short stay admissions in suspected COVID-19 patients: COVID-box project. Eur Respir J 2021; 58:13993003.00636-2021. [PMID: 33795321 PMCID: PMC8015644 DOI: 10.1183/13993003.00636-2021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/21/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Ebru Dirikgil
- Dept of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rick Roos
- Dept of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Geert H Groeneveld
- Dept of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian Heringhaus
- Dept of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna V Silven
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelieke H J Petrus
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Villalobos-Quesada
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Roula Tsonaka
- Dept of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ton J Rabelink
- Dept of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Dept of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Dept of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Niels H Chavannes
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Douwe E Atsma
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands.,Dept of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y K Onno Teng
- Dept of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
5
|
van Duijl TT, Soonawala D, de Fijter JW, Ruhaak LR, Cobbaert CM. Rational selection of a biomarker panel targeting unmet clinical needs in kidney injury. Clin Proteomics 2021; 18:10. [PMID: 33618665 PMCID: PMC7898424 DOI: 10.1186/s12014-021-09315-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/30/2021] [Indexed: 12/01/2022] Open
Abstract
The pipeline of biomarker translation from bench to bedside is challenging and limited biomarkers have been adopted to routine clinical care. Ideally, biomarker research and development should be driven by unmet clinical needs in health care. To guide researchers, clinical chemists and clinicians in their biomarker research, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has developed a structured questionnaire in which the clinical gaps in current clinical pathways are identified and desirable performance specifications are predefined. In kidney injury, the high prevalence of the syndrome acute kidney injury (AKI) in the hospital setting has a significant impact on morbidity, patient survival and health care costs, but the use of biomarkers indicating early kidney injury in daily patient care remains limited. Routinely, medical labs measure serum creatinine, which is a functional biomarker, insensitive for detecting early kidney damage and cannot distinguish between renal and prerenal AKI. The perceived unmet clinical needs in kidney injury were identified through the EFLM questionnaire. Nephrologists within our tertiary care hospital emphasized that biomarkers are needed for (1) early diagnosis of in-hospital AKI after a medical insult and in critically ill patients, (2) risk stratification for kidney injury prior to a scheduled (elective) intervention, (3) kidney injury monitoring in patients scheduled to receive nephrotoxic medication and after kidney transplantation and (4) differentiation between prerenal AKI and structural kidney damage. The biomarker search and selection strategy resulted in a rational selection of an eleven-protein urinary panel for kidney injury that target these clinical needs. To assess the clinical utility of the proposed biomarker panel in kidney injury, a multiplexed LC-MS test is now in development for the intended translational research.
Collapse
Affiliation(s)
- T T van Duijl
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Postzone E2-P, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - D Soonawala
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - J W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - L R Ruhaak
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Postzone E2-P, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Postzone E2-P, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
6
|
Shen H, van der Kleij R, van der Boog PJM, Song X, Wang W, Zhang T, Li Z, Lou X, Chavannes N. Development and evaluation of an eHealth self-management intervention for patients with chronic kidney disease in China: protocol for a mixed-method hybrid type 2 trial. BMC Nephrol 2020; 21:495. [PMID: 33213398 PMCID: PMC7678219 DOI: 10.1186/s12882-020-02160-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a significant public health concern. In patients with CKD, interventions that support disease self-management have shown to improve health status and quality of life. At the moment, the use of electronic health (eHealth) technology in self-management interventions is becoming more and more popular. Evidence suggests that eHealth-based self-management interventions can improve health-related outcomes of patients with CKD. However, knowledge of the implementation and effectiveness of such interventions in general, and in China in specific, is still limited. This study protocol aims to develop and tailor the evidence-based Dutch ‘Medical Dashboard’ eHealth self-management intervention for patients suffering from CKD in China and evaluate its implementation process and effectiveness. Methods To develop and tailor a Medical Dashboard intervention for the Chinese context, we will use an Intervention Mapping (IM) approach. A literature review and mixed-method study will first be conducted to examine the needs, beliefs, perceptions of patients with CKD and care providers towards disease (self-management) and eHealth (self-management) interventions (IM step 1). Based on the results of step 1, we will specify outcomes, performance objectives, and determinants, select theory-based methods and practical strategies. Knowledge obtained from prior results and insights from stakeholders will be combined to tailor the core interventions components of the ‘Medical Dashboard’ self-management intervention to the Chinese context (IM step 2–5). Then, an intervention and implementation plan will be developed. Finally, a 9-month hybrid type 2 trial design will be employed to investigate the effectiveness of the intervention using a cluster randomized controlled trial with two parallel arms, and the implementation integrity (fidelity) and determinants of implementation (IM step 6). Discussion Our study will result in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China, which has the potential to optimize patients’ self-management skills and improve health status and quality of life. Moreover, it will inform future research on the tailoring and translation of evidence-based eHealth self-management interventions in various contexts. Trial registration Clinicaltrials.gov NCT04212923; Registered December 30, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02160-6.
Collapse
Affiliation(s)
- Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands. .,Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wenjiao Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Tongtong Zhang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiaoping Lou
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
7
|
Nielsen C, Agerskov H, Bistrup C, Clemensen J. Evaluation of a telehealth solution developed to improve follow-up after kidney Transplantation. J Clin Nurs 2020; 29:1053-1063. [PMID: 31889357 DOI: 10.1111/jocn.15178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/04/2019] [Accepted: 12/20/2019] [Indexed: 12/25/2022]
Abstract
AIM To explore patients' and healthcare professionals' experiences of using a telehealth solution developed to improve follow-up after kidney transplantation. BACKGROUND Transplantation is the treatment of choice whenever feasible for patients with end-stage kidney disease. However, it implies lifelong adherence of self-monitoring, medicine and other restrictions to ensure successful outcomes. Based on user involvement, a telehealth solution was developed to support patients and healthcare professionals post-transplantation. DESIGN An explorative qualitative study with a phenomenological-hermeneutic approach. METHODS The developed app and workflow for follow-up were tested by patients and healthcare professionals and evaluated with interviews. In total, 16 patients and 20 healthcare professionals participated. Individual interviews were conducted with the patients, four nurses participated in two sets of interviews, and 16 doctors participated in a focus group. Data were analysed with inspiration from Ricoeur's theory of interpretation, on three levels: Naïve reading, structural analysis and critical interpretation and discussion. The COREQ checklist was applied in reporting the study. RESULTS Three themes emerged: Challenging conditions for training sessions, telehealth improves patient reflection and collaboration, and telehealth gives patients a voice in consultations. In a challenging time, post-transplantation patients found the app easy to use; it facilitated support and reflection on how to manage. It also supported both patients and healthcare professionals at follow-up consultations in terms of enhanced preparation, improved dialogue and enabling consultations by phone. CONCLUSION The study showed that patients and healthcare professionals found the app and workflow valuable and easy to use. The Patient Data feature in the app has potential as a communication tool. However, adjustments and further investigations are needed to develop the solution. RELEVANCE TO CLINICAL PRACTICE The potential of telehealth brings new opportunities to provide treatment and care to newly transplanted patients. Telehealth can support both patients and health professionals by improving dialogue and collaboration.
Collapse
Affiliation(s)
- Charlotte Nielsen
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jane Clemensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,HCA Research, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
8
|
Abstract
Abstract
Chronic disease poses a major burden to patients and health care systems. This review considers how patient self-testing can contribute to the management of chronic disease. Self-testing can only confer benefit if it occurs in the context of an empowered patient who has the skills and training to translate test results into meaningful actions. The benefits may include improved clinical outcomes, greater patient convenience and improved psychological well-being; separately and together these may contribute to reduced costs of care. As self-testing may be expensive and burdensome to patients, it is important that its use in chronic disease is supported by a robust evidence base confirming its utility and efficacy. The design of studies to assess the impact of self-testing poses challenges for the researcher and the quality of evidence presented is often variable. Randomised controlled trials (RCTs) provide more robust evidence than observational studies; the intervention under study is not just self-testing but includes the educational support to allow patients to use results effectively. This review discusses the evidence base relating to patient self-testing in diabetes, anticoagulant monitoring and in renal transplant patients and in particular highlights the impact of new technology developments such as flash glucose monitoring in diabetes.
Collapse
Affiliation(s)
- Maurice J. O’Kane
- Clinical Chemistry Laboratory, Altnaglevin Hospital , Western Health and Social Care Trust , Londonderry , Northern Ireland , UK
| |
Collapse
|
9
|
Shen H, van der Kleij RMJJ, van der Boog PJM, Chang X, Chavannes NH. Electronic Health Self-Management Interventions for Patients With Chronic Kidney Disease: Systematic Review of Quantitative and Qualitative Evidence. J Med Internet Res 2019; 21:e12384. [PMID: 31687937 PMCID: PMC6864489 DOI: 10.2196/12384] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/28/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Currently, electronic health (eHealth) interventions are increasingly used to optimize patients' self-management skills. OBJECTIVE This study aimed to systematically review the existing evidence regarding the implementation and effectiveness of eHealth self-management interventions for patients with CKD. METHODS Following a search in 8 databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. Quality was appraised using the Crowe Critical Appraisal Tool; narrative synthesis was performed to analyze the data extracted. RESULTS Of the 3307 articles retrieved, 24 (comprising 23 studies) were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of interventions used and the outcomes measured. A total of 10 effect and 9 process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure (BP), whereas satisfaction was the most frequently reported process outcome indicator. Positive effects were found for proximal outcomes (eg, BP control and medication adherence), and mixed effects were found for more distal outcomes (eg, quality of life). High feasibility, usability, and acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ability of health care professionals to monitor and, if necessary, anticipate on patient measurements online was mostly cited to influence patients' adherence to interventions. CONCLUSIONS eHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention components used are required. In addition, our review reveals that outcomes closely related to the scope and duration of the intervention implemented are most likely to be impacted. For instance, if a 4-week Web-based training to optimize disease management skills is implemented, the outcome perceived control would more likely be affected than kidney function. Although this seems obvious, most studies evaluate only distal outcomes and thereby fail to capture intervention effects that might contribute to long-term health improvement. We advise future researchers to carefully consider their choice of outcomes based on their sensitivity for change. In this way, we ensure that relevant effects are captured and legitimate conclusions are drawn.
Collapse
Affiliation(s)
- Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Xinwei Chang
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
10
|
Nielsen C, Agerskov H, Bistrup C, Clemensen J. User involvement in the development of a telehealth solution to improve the kidney transplantation process: A participatory design study. Health Informatics J 2019; 26:1237-1252. [PMID: 31566460 DOI: 10.1177/1460458219876188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease, and leads to everyday self-management of this chronic condition. This article aims to provide documentation for a participatory design study of a telehealth solution to improve the kidney transplantation process, and to identify the impact from the different participants in the participatory design study. Through a participatory design approach, a smartphone application (app) was developed for the entire kidney transplantation process together with a workflow for post-transplantation follow-up. A core element in participatory design is user involvement. By way of workshops and laboratory tests, the telehealth solution was developed in close cooperation with patients, their families, healthcare professionals, kidney association representatives, and Information Technology designers. The participatory design approach means that the telehealth solution was designed to be functional in a clinical setting, address patients' needs, and support their self-management.
Collapse
Affiliation(s)
- Charlotte Nielsen
- Odense University Hospital, Denmark; University of Southern Denmark, Denmark
| | - Hanne Agerskov
- Odense University Hospital, Denmark; University of Southern Denmark, Denmark
| | - Claus Bistrup
- Odense University Hospital, Denmark; University of Southern Denmark, Denmark
| | - Jane Clemensen
- Odense University Hospital, Denmark; University of Southern Denmark, Denmark
| |
Collapse
|
11
|
Guided or factual computer support for kidney patients with different experience levels and medical health situations: preferences and usage. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
12
|
Mollazadeh F, Hemmati Maslakpak M. The Effect of Teach-Back Training on Self Management in Kidney Transplant Recipients: A Clinical Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2018; 6:146-155. [PMID: 29607343 PMCID: PMC5845118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Kidney transplant recipients need self-management during their lifetime, and training these patients is essential for the realization of self-management. Teach-back training (TBT) was used to receive, understand, and retain information. This study aimed to determine the effect of TBT on self-management in kidney transplant recipients. METHODS In this clinical trial study, 84 kidney transplant recipients who referred to the clinic of Imam Khomeini Hospital in Urmia (a city in northwest of Iran), from January to March 2017, were selected through convenience sampling and randomly assigned to intervention and control groups. In the intervention group, educational content was presented for each patient with TBT in 5 sessions of 60 minutes. Data were collected before and after the intervention by a special Self-Management Questionnaire for Kidney Transplant Recipients in five areas as follows: self-monitoring, self-care behavior in daily living, early detecting and coping with abnormalities after kidney transplantation, stress management and the category of non-categorized area. This is a valid and reliable questionnaire (α=0.76). Collected data were analyzed by independent t-test and Mann-Whitney test. Statistical analysis was performed using SPSS 20 and P≤0.05 was considered as significant. RESULTS Independent t-test showed that the mean of self-management score between the control and intervention groups was not statistically significant before the intervention (P=0.90). The mean score of self-management increased after implementation of TBT in the intervention group compared to the control group, and the difference was statistically significant (P=0.001). CONCLUSION The implementation of TBT method is effective in promoting self-management of kidney transplant recipients. Therefore, it is recommended that this method should be used to train the patients to better understand the components of self-management. Trial Registration Number: IRCT2016122817059N10.
Collapse
Affiliation(s)
- Farzin Mollazadeh
- Department of Medical Surgical, School of Nursing, Urmia University of Medical Sciences, Urmia, Iran;
| | - Masumeh Hemmati Maslakpak
- Department of Medical Surgical, Maternal and Childhood Obesity Research Center, School of Nursing, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
13
|
van Lint C, Wang W, van Dijk S, Brinkman WP, Rövekamp TJ, Neerincx MA, Rabelink TJ, van der Boog PJ. Self-Monitoring Kidney Function Post Transplantation: Reliability of Patient-Reported Data. J Med Internet Res 2017; 19:e316. [PMID: 28951385 PMCID: PMC5640424 DOI: 10.2196/jmir.7542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background The high frequency of outpatient visits after kidney transplantation is burdensome to both the recovering patient and health care capacity. Self-monitoring kidney function offers a promising strategy to reduce the number of these outpatient visits. Objective The objective of this study was to investigate whether it is safe to rely on patients’ self-measurements of creatinine and blood pressure, using data from a self-management randomized controlled trial. Methods For self-monitoring creatinine, each participant received a StatSensor Xpress-i Creatinine Meter and related test material. For self-monitoring blood pressure, each participant received a Microlife WatchBP Home, an oscillometric device for blood pressure self-measurement on the upper arm. Both devices had a memory function and the option to download stored values to a computer. During the first year post transplantation, 54 patients registered their self-measured creatinine values in a Web-based Self-Management Support System (SMSS) which provided automatic feedback on the registered values (eg, seek contact with hospital). Values registered in the SMSS were compared with those logged automatically in the creatinine device to study reliability of registered data. Adherence to measurement frequency was determined by comparing the number of requested with the number of performed measurements. To study adherence to provided feedback, SMSS-logged feedback and information from the electronic hospital files were analyzed. Results Level of adherence was highest during months 2-4 post transplantation with over 90% (42/47) of patients performing at least 75% of the requested measurements. Overall, 87.00% (3448/3963) of all registered creatinine values were entered correctly, although values were often registered several days later. If (the number of) measured and registered values deviated, the mean of registered creatinine values was significantly lower than what was measured, suggesting active selection of lower creatinine values. Adherence to SMSS feedback ranged from 53% (14/24) to 85% (33/39), depending on the specific feedback. Conclusions Patients’ tendency to postpone registration and to select lower creatinine values for registration and the suboptimal adherence to the feedback provided by the SMSS might challenge safety. This should be well considered when designing self-monitoring care systems, for example by ensuring that self-measured data are transferred automatically to an SMSS.
Collapse
Affiliation(s)
- Céline van Lint
- Leiden University Medical Center, Department of Nephrology, Leiden, Netherlands
| | - Wenxin Wang
- Interactive Intelligence Group, Delft University of Technology, Delft, Netherlands
| | - Sandra van Dijk
- Department of Health, Medical and Neuropsychology and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Willem-Paul Brinkman
- Interactive Intelligence Group, Delft University of Technology, Delft, Netherlands
| | - Ton Jm Rövekamp
- Dutch Organization for Applied Scientific Research (TNO), the Hague, Netherlands
| | - Mark A Neerincx
- Interactive Intelligence Group, Delft University of Technology, Delft, Netherlands.,Dutch Organization for Applied Scientific Research (TNO), the Hague, Netherlands
| | - Ton J Rabelink
- Leiden University Medical Center, Department of Nephrology, Leiden, Netherlands
| | | |
Collapse
|
14
|
De Pasquale C, Veroux M, Fornaro M, Sinagra N, Basile G, Gozzo C, Santini R, Costa A, Pistorio ML. Psychological perspective of medication adherence in transplantation. World J Transplant 2016; 6:736-742. [PMID: 28058225 PMCID: PMC5175233 DOI: 10.5500/wjt.v6.i4.736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/25/2016] [Accepted: 10/27/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To identify the risk factors and the post-transplant psychological symptoms that affect adherence to therapy in a population of kidney transplant recipients.
METHODS The study examined the psychological variables likely responsible for the non-adherent behavior using a psychological-psychiatric assessment, evaluation of the perception of patients’ health status, and an interview regarding the anti-rejection drug therapy assumption. The study included 74 kidney transplant recipients.
RESULTS Individuals with a higher level of education and more years since transplantation showed better mental balance. Regarding gender, women appeared to be less adherent to therapy. Further, the years since transplantation adversely affected the proper pharmacological assumption. Adherence to therapy did not significantly change with the mental health index.
CONCLUSION The biopsychosocial illness model provides a conceptual frame of reference in which biological, psychological, and social aspects take on the same importance in the adherence to treatment protocols. For effective management, it is necessary to understand the patients’ personal experiences, their assumptions about the disease, health status perception, and mood, and to identify any “barriers” that could cause them to become noncompliant.
Collapse
|
15
|
Grijpma JW, Tielen M, van Staa AL, Maasdam L, van Gelder T, Berger SP, Busschbach JJ, Betjes MGH, Weimar W, Massey EK. Kidney transplant patients' attitudes towards self-management support: A Q-methodological study. PATIENT EDUCATION AND COUNSELING 2016; 99:836-843. [PMID: 26682972 DOI: 10.1016/j.pec.2015.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/11/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Kidney transplant recipients face many self-management challenges. We aimed to identify profiles of attitudes towards self-management support (SMS) shortly after kidney transplantation. METHODS Profiles were generated using Q-methodology: In face-to-face interviews participants rank-ordered opinion statements on aspects of SMS according to agreement. Socio-demographic and medical characteristics were assessed using a questionnaire. By-person factor analysis was used to analyze the rankings and qualitative data was used to support choice of profiles. The resulting factors represent clusters of patients with similar attitudes towards SMS. RESULTS Forty-three patients (mean age=56; 77% male) participated. Four profiles were identified: (A) transplant-focused and obedient; (B) holistic and collaborative; (C) life-focused and self-determined; and (D) was bipolar. The positive pole (D+) minimalizing and disengaged and the negative pole (D-) coping-focused and needy represent opposing viewpoints within the same profile. Socio-demographic and medical characteristics were not related to profile membership. DISCUSSION Each profile represents a specific attitude on post-transplant life, responsibility for health and decision-making, SMS needs, and preferences for SMS. PRACTICAL IMPLICATIONS Patients vary in their attitude, needs and preferences for SMS indicating the necessity of providing personalized support after kidney transplantation. Health professionals should explore patients' SMS needs and adapt support accordingly.
Collapse
Affiliation(s)
- J W Grijpma
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - M Tielen
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - A L van Staa
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands; Erasmus University Rotterdam, Institute of Health Policy & Management (iBMG), Rotterdam, The Netherlands.
| | - L Maasdam
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - T van Gelder
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - S P Berger
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - J J Busschbach
- Erasmus MC, Department of Psychiatry, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - M G H Betjes
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - W Weimar
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - E K Massey
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| |
Collapse
|