A Mobile App for Triangulating Strategies in Phosphate Education Targeting Patients with Chronic Kidney Disease in Malaysia: Development, Validation, and Patient Acceptance

Abstract

Hyperphosphatemia afflicts end-stage chronic kidney disease (CKD) patients, contributing to comorbidities and mortality. Management strategies are dialysis, phosphate binder, and limiting dietary phosphate intake, but treatment barriers are poor patient compliance and low health literacy arising from low self-efficacy and lack of educational resources. This study describes developing and validating a phosphate mobile application (PMA). The PMA development based on the seven-stage Precaution Adoption Process Model prioritized titrating dietary phosphate intake with phosphate binder dose supported by educational videography. Experts (n = 13) first evaluated the PMA for knowledge-based accuracy, mobile heuristics, and clinical value. Adult HD patients validated the improved PMA using the seven-point mHealth App Usability Questionnaire (MAUQ). Patient feedback (n = 139) indicated agreement for ease of use (69.2%), interface and satisfaction (69.0%), and usefulness (70.1%), while 72.7% said they would recommend this PMA. The expectation confirmation for 25 PMA features ranged from 92.1% (lifestyle) up to 100.0% (language option); and the utilization rate of each feature varied from 21.6% (goal setting and feature-based log) to 91.4% (information on dietary phosphate and phosphate binder). The Conclusions: MyKidneyDiet-Phosphate Tracker PMA was acceptable to adult Malaysian HD patients as part of clinical phosphate management in low-resource settings.

Effectiveness of a Nutritional Mobile Application for Management of Hyperphosphatemia in Patients on Hemodialysis: A Multicenter Open-Label Randomized Clinical Trial

“…Lastly, the age profile of the recruited patients favored the 45 to 54 years old range whereas the majority of adult HD patients in Malaysia are in the 55 to 64 years old range (Wong 2018). However, we note that younger patients are more receptive to smartphones and mobile app use, as shown in an earlier survey [ 18 ].…”

“…Our study’s intervention with the mobile app indicated a positive impact, in contrast to the other studies. This is mainly attributed to the intervention tools (the mobile app and educational pamphlets) being validated by multi-disciplinary experts and undergoing testing for acceptance by HD patients [ 18 ]. Secondly, the study was conducted at multiple centers for 3 months with systematic randomization, and analyzed using modified intention-to-treat protocols, whilst the other studies were executed as pilot trials.…”

“…PMA Group (PG) —PG patients received access to the PMA, ©2019 MyKidneyDiet-Phosphate Tracker. The development process and features of this PMA have been previously described [ 18 ]. In brief, the PMA carries six animated education videos covering topics on hyperphosphatemia, dialysis, phosphate binders, dietary phosphorus, lifestyles, and the responsibilities of a dialysis patient.…”

“…A mobile app focusing on phosphate management, specifically the phosphate mobile app (PMA), can be an innovative approach to narrowing the gaps in phosphate education delivery to CKD patients. We had earlier conceptualized and developed a PMA-triangulating meal dietary phosphorus content assessment with binder dose prescription, which was validated by experts before been tested for acceptance by HD patients [ 18 ]. The mobile app received high acceptability from HD patients.…”

Development of a digital tool for home‐based monitoring of skin disease for older adults

“…MHealth app usability questionnaire scores for our digital tool are comparable to other mobile healthcare apps, indicating good usability and satisfaction by older adults, and patient retention was high. 6 , 7 Clinicians were confident in making triage recommendations, but only moderately confident in diagnosing and making clinical decisions based on the photos. In order to increase physician confidence, clinically relevant information about the patient and lesion should be provided alongside the photo of the lesion.…”