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BACKGROUND Fatigue is an important symptom for many patients, including kidney patients. Cognitive Bias Modification (CBM) training is a promising technique to counter fatigue symptoms. OBJECTIVE The current study aimed to evaluate a CBM training among kidney patients and health care professionals. Using an iterative design process, evaluating expectations and experiences with the training, acceptability and applicability in the clinical setting were assessed. METHODS This study is a longitudinal, qualitative, and multiple stakeholder-perspective usability study interviewing end-users and health care professionals during the prototyping phase and after end of training. Semi-structured interviews were conducted with 29 patients and 16 health care professionals. The interviews were transcribed and analysed thematically. RESULTS Generally, participants were positive about the training and its applicability. The biggest negatives were doubts about effectiveness and annoyance about the repetitive character of CBM. Barriers for applicability were patients’ varying computer skills, the subjectivity of fatigue, and integration with regular treatment, (e.g., role of health care professionals). Possible solutions were assigning representatives among nurses, offering the training on an app, and providing assistance via a helpdesk. The iterative design process, including the repeated waves of testing user expectations and experiences, yielded complementary data. CONCLUSIONS The current study provided one of the first user evaluations of a CBM training, both among patients and care providers. Acceptability and applicability appear positive although barriers were identified. The proposed solutions need further testing, preferably following the same frameworks, as the iteration in the current study contributed positively to the quality of the training.

Background Fatigue is an important symptom for many patients, including patients with kidney disease. Cognitive biases, such as attentional bias and self-identity bias, are thought to influence fatigue. Cognitive bias modification (CBM) training is a promising technique to counter fatigue. Objective We aimed to evaluate a CBM training among patients with kidney disease and health care professionals (HCPs) and assess acceptability and applicability in the clinical setting using an iterative design process to evaluate expectations and experiences with the training. Methods This was a longitudinal, qualitative, and multiple stakeholder–perspective usability study in which we interviewed end users and HCPs during the prototyping phase and after the end of training. We conducted semistructured interviews with 29 patients and 16 HCPs. The interviews were transcribed and analyzed thematically. Next to a general evaluation of the training, the acceptability of the training was evaluated using the Theoretical Framework of Acceptability, and applicability was assessed by evaluating obstacles and solutions for implementation in the kidney care setting. Results Generally, participants were positive about the training and its applicability. The biggest negatives were doubts about effectiveness and annoyance about the repetitive character of CBM. Acceptability was judged with a mixed evaluation, with a negative evaluation of perceived effectiveness; mixed results for burden, intervention coherence, and self-efficacy; and positive results for affective attitude, ethicality, and opportunity costs. Barriers for applicability were patients’ varying computer skills, subjectivity of fatigue, and integration with regular treatment (eg, the role of HCPs). Possible solutions included assigning representatives among nurses, offering training on an app, and providing assistance via a help desk. The iterative design process, including repeated waves of testing user expectations and experiences, yielded complementary data. Conclusions To the best of our knowledge, this study is the first to introduce a CBM training targeting fatigue. Furthermore, this study provides one of the first user evaluations of a CBM training, both among patients with kidney disease and their care providers. Overall, the training was evaluated positively, although acceptability showed mixed results. Applicability was positive although barriers were identified. The proposed solutions require further testing, preferably following the same frameworks, as the iteration in this study contributed positively to the quality of the training. Therefore, future research should follow the same frameworks and consider stakeholders and end users in eHealth intervention design.

Summary This study compares the effects of metformin, sulfonylurea derivative (SU) and no treatment in HNF4A-MODY on glycemic control. In two patients with HNF4A-MODY, we changed the existing metformin treatment to SU derivative. The effect on the glycemic control was registered with a Freestyle Libre Flash glucose monitoring device. Each treatment period had a duration of 2 consecutive weeks, and in between, an intermediate period without medication. Data from the first 2 days after changing medications were excluded. We calculated time in range (TIR), and differences in the mean glucose level were tested with a one-way ANOVA test. The 24-h average glucose levels were significantly lower with either metformin (7.7 mmol/L; P < 0.001 and 6.3 mmol/L; P < 0.001) or gliclazide (7.6 mmol/L; P < 0.001 and 5.8 mmol/L; P < 0.001) compared to no treatment (9.4 and 8.9 mmol/L). The TIR with metformin or gliclazide was higher than without treatment (patient 1: 87 and 83 vs 61% and patient 2: 83 and 93 vs 67%). Treatment with either metformin or gliclazide effectively decreases blood glucose, rendering both drugs appropriate for treating HNF4A-MODY. Learning points HNF4A-MODY has a mild phenotype. Blood glucose was responsive to long-term metformin treatment in HNF4A-MODY. Metformin and gliclazide seem appropriate treatments for HNF4A-MODY.