Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial

Abstract

Background Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. Objective This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. Methods This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. Results The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group × time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group × time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group × time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). Conclusions The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. Trial Registration ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. International Registered Report Identifier (IRRID) RR2-10.2196/30191

Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review

“…This theme included medication compliance, program or treatment adherence, follow-up visits, medical knowledge, and decrease in emergency department visits. There were 12% (11/92) of instances of 2 themes: changed behavior, which included sexual behavior, self-care, drinking, smoking, physical activity, weight loss, and salt intake [ 29 , 32 , 34 , 50 , 53 , 55 , 56 , 58 - 60 ] and increased quality of life (QoL), which included sleep, vitality, interpersonal problems, attitude, or as measured by the EuroQoL visual analog scale [ 31 , 36 , 37 , 39 - 41 , 45 , 54 , 56 , 57 , 59 , 60 ]. There were 7% (6/92) of instances of increased self-efficacy [ 28 , 35 , 36 , 41 , 47 ].…”

“…Patients appreciated the telemedicine modality for medical education because it allowed them to absorb or learn at their own pace. This was observed in 21% (7/33) of studies [ 28 , 30 , 38 , 39 , 44 , 52 , 53 ]. In 6% (2/33) of studies, one on alcohol consumption and one on HIV management, avoidance of stigma was mentioned [ 29 , 32 ].…”

“…All these 33 studies reported the positive effectiveness of telemedicine as a modality across all 6 domains of quality. These studies showed positive outcomes in physical [ 30 , 33 , 39 - 42 , 44 , 47 , 49 , 51 - 55 , 57 , 58 ] and mental health [ 31 , 32 , 37 , 39 , 43 , 45 , 47 , 54 , 57 ], medical engagement [ 28 , 30 , 32 , 35 , 36 , 40 , 43 , 46 , 48 , 60 ], changed behavior [ 29 , 32 , 34 , 50 , 53 , 55 , 56 , 58 - 60 ], increased QoL [ 31 , 36 , 37 , 39 - 41 , 45 , 54 , 56 , 57 , 59 , 60 ], increased self-efficacy [ 28 , 35 , 36 , 41 , 47 ], increased social support [ 28 , 32 ], and reduced costs [ 34 ].…”

“…The pandemic has taught health care that telemedicine increases patients’ perception of the availability of care and most patients prefer this modality [ 68 ]. It is convenient, saves time and mileage [ 28 - 31 , 33 , 34 , 36 - 60 ], enables education at one’s own pace [ 28 , 30 , 38 , 39 , 44 , 52 , 53 ], avoids stigma [ 29 , 32 ], and provides personal navigation through the health care system. These results serve as strong facilitators for the adoption of telemedicine because they show strong quality results in favor of patient commensurate with other published literature [ 6 ].…”

Addressing Cognitive Function and Psychological Well-Being in Chronic Kidney Disease: A Systematic Review on the Use of Technology-Based Interventions

“…There were no specific criteria met by all 13 studies. Nine of the 13 studies analyzed used true randomization for the assignment of participants to treatment groups [ 28 , 30 , 45 , 54 , 55 , 56 , 57 , 58 , 59 ], whereas the remaining 4 did not meet this criterion [ 22 , 24 , 31 , 32 ].…”