A longitudinal qualitative study to explore and optimize self-management in mild to end stage chronic kidney disease patients with limited health literacy: Perspectives of patients and health care professionals

Boonstra, Marco D.; Reijneveld, Sijmen A.; Westerhuis, Ralf; Tullius, Janne M.; Vervoort, Johanna P. M.; Navis, Gerjan; Winter, Andrea F. de

doi:10.1016/j.pec.2021.05.016

Cited by 16 publications

(16 citation statements)

References 59 publications

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“…Motivating activation and subsequent self‐management in a multifactorial disease setting, requires the delivery and comprehension of complex information. Building health professional capacity in effective communication in the context of CKD therefore requires targeted and ongoing professional development (Boonstra et al, 2021; Havas et al, 2016). Increased support for professional development was recognised in the current study as crucial to ensure the delivery of accurate and consistent health information that encourages self‐management.…”

Section: Discussionmentioning

confidence: 99%

Optimising health care for people living with chronic kidney disease: Health‐professional perspectives

Fildes

Stefoska‐Needham

Atkinson

et al. 2022

Journal of Renal Care

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Background: People with chronic kidney disease are often multimorbid and have complex psychosocial needs. For health professionals to deliver holistic, personcentred care to individuals and their carers living with this multifaceted disease, they are required to communicate complex information and problem solve in a multifactorial health and disease context.Objectives: To explore the perspectives and experiences of tertiary care multidisciplinary team members and primary care providers of health care to people with chronic kidney disease; identify opportunities to innovate and improve the coordinated delivery of health services.Design: The qualitative study design used purposive sampling to recruit 39 health professionals, working in the primary and tertiary sector in a regional Australian health district. Participants included general practitioners, renal and general practice nurses, dietitians, nephrologists and social workers.Approach: The data were collected through semistructured interviews and analysed using a relativist ontological position and directed content analysis approach. Analysis of interviews was undertaken by three independent researchers and key themes were derived via consensus. Findings and Conclusions:A common goal to deliver person-centred individualised care was evident among health care professionals. However a deficit in shared understanding of the disease within and between disciplines was identified. The complex nature of chronic kidney disease requires up-skilling of health professionals to ensure patient education is targeted to individual health contexts and motivates self-management. Improved communication and comprehension might best be achieved across disciplines with an integrated approach to delivery of primary health care to individuals living with early-stage kidney disease.

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Section: Discussionmentioning

confidence: 99%

Optimising health care for people living with chronic kidney disease: Health‐professional perspectives

Fildes

Stefoska‐Needham

Atkinson

et al. 2022

Journal of Renal Care

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“…Although the steps to develop the patient and HCP intervention were conducted simultaneously to align their components, we will first describe the procedure for developing the patient intervention and then that for developing the HCP intervention. Step 1: Problem analysis For both interventions, step 1, the problem analysis, came from the identified barriers for self-management and the proposed solutions in a previous longitudinal, qualitative study, as described in the introduction (see Supplemental Table S1) [16]. This provided the starting point for our intervention development.…”

Section: Study Proceduresmentioning

confidence: 99%

“…Step 2: Logic model of change Firstly, we formulated preliminary objectives and determinants for the HCP intervention, based on the previous longitudinal, qualitative study [16]. One researcher (M.D.B.)…”

Section: Procedures For the Hcp Interventionmentioning

confidence: 99%

“…Patients with severe or end-stage CKD consider information to be overwhelming, and self-management of lifestyle and medication to be complex. Finally, patients report problems in maintaining better self-management in the long term [16]. The long-term effect of existing HL interventions, targeting self-management behaviors of CKD patients with LHL, often with digital strategies, is unknown [17].…”

Section: Introductionmentioning

confidence: 99%

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Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals

Boonstra

Reijneveld

Navis

et al. 2021

IJERPH

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Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.

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“…Additionally, some experts believe that too much information can cause confusion for the patient and interfere with medication adherence. It is also thought that communication barriers between healthcare providers and patients with low health literacy may influence self-management promotion for prevention and disease management [ 19 ]. Self-management experiences and patient attitudes and perceptions toward mHealth apps are very limited in Asian populations.…”

Section: Introductionmentioning

confidence: 99%

Measuring Mobile Phone Application Usability for Anticoagulation from the Perspective of Patients, Caregivers, and Healthcare Professionals

Wang

Chiou

et al. 2022

IJERPH

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Oral anticoagulants (OAC) are recommended for preventing stroke and systemic embolism in atrial fibrillation. Proper use is imperative for maximizing anticoagulation therapy’s effectiveness and safety. In preparation for the implementation of a smartphone-based SmartMed app (application) aiming to promote patient self-management, medication adherence, and data collection for patients on anticoagulation therapy, its usability assessment can ensure the value of OAC app development and adoption. We evaluated the SmartMed app’s usability using the System Usability Scale (SUS) and the app-specific domain of the Mobile App Rating Scale (MARS) for its perceived impact on taking OAC regularly. We recruited 25 OAC users and their home caregivers and 59 healthcare professionals, including pharmacists, nurses, and cardiac surgeons from one medical center and one regional hospital in Taiwan. All participants (n = 84) thought the SmartMed app was useful, with mean SUS and MARS scores of 81.49 (±14.42) and 4.65 (±0.49), respectively. Usability evaluation revealed that fewer experiences with smartphone apps and different healthcare professionals (pharmacists versus nurses or cardiac surgeons) were associated with lower SUS scores and perceived impact. Throughout the evaluation process, the SmartMed app’s design was considered helpful from multiple stakeholders’ perspectives. Further ongoing mobile technology supports are necessary to establish the SmartMed app’s effectiveness.

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A longitudinal qualitative study to explore and optimize self-management in mild to end stage chronic kidney disease patients with limited health literacy: Perspectives of patients and health care professionals

Cited by 16 publications

References 59 publications

Optimising health care for people living with chronic kidney disease: Health‐professional perspectives

Optimising health care for people living with chronic kidney disease: Health‐professional perspectives

Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals

Measuring Mobile Phone Application Usability for Anticoagulation from the Perspective of Patients, Caregivers, and Healthcare Professionals

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