Development and usability testing of a patient safety educational tool in chronic kidney disease (Preprint)

Abstract

Background Chronic kidney disease (CKD) is a health condition that threatens patient safety; however, few interventions provide patient-centered education about kidney-specific safety hazards. Objective We sought to develop and test the usability of a mobile tablet–based educational tool designed to promote patient awareness of relevant safety topics in CKD. Methods We used plain language principles to develop content for the educational tool, targeting four patient-actionable safety objectives that are relevant for individuals with CKD. These four objectives included avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs); hypoglycemia awareness (among individuals with diabetes); temporary cessation of certain medications during acute volume depletion to prevent acute kidney injury (ie, “sick day protocol”); and contrast dye risk awareness. Our teaching strategies optimized human-computer interaction and content retention using audio, animation, and clinical vignettes to reinforce themes. For example, using a vignette of a patient with CKD with pain and pictures of common NSAIDs, participants were asked “Which of the following pain medicines are safe for Mr. Smith to take for his belly pain?” Assessment methods consisted of preknowledge and postknowledge surveys, with provision of correct responses and explanations. Usability testing of the tablet-based tool was performed among 12 patients with any stage of CKD, and program tasks were rated upon completion as no error, noncritical error (self-corrected), or critical error (needing assistance). Results The 12 participants in this usability study were predominantly 65 years of age or older (n=7, 58%) and female (n=7, 58%); all participants owned a mobile device and used it daily. Among the 725 total tasks that the participants completed, there were 31 noncritical errors (4.3%) and 15 critical errors (2.1%); 1 participant accounted for 30 of the total errors. Of the 12 participants, 10 (83%) easily completed 90% or more of their tasks. Most participants rated the use of the tablet as very easy (n=7, 58%), the activity length as “just right” (rather than too long or too short) (n=10, 83%), and the use of clinical vignettes as helpful (n=10, 83%); all participants stated that they would recommend this activity to others. The median rating of the activity was 8 on a scale of 1 to 10 (where 10 is best). We incorporated all participant recommendations into the final version of the educational tool. Conclusions A tablet-based patient safety educational tool is acceptable and usable by individuals with CKD. Future studies leveraging iterations of this educational tool will explore its impact on health outcomes in this high-risk population.

Sick Day Medication Guidance for People With Diabetes, Kidney Disease, or Cardiovascular Disease: A Systematic Scoping Review

“…8 , 18 , 22 , 23 , 25 , 31 , 33 , 34 , 35 , 36 , 37 , 42 , 44 , 46 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 Additionally, 9 documents were publicly available on webpages, 29 , 45 , 48 , 58 , 59 , 60 , 61 , 62 , 63 4 documents referred to wallet-sized cards with instructions for use by patients, 21 , 27 , 28 , 64 and 3 referred to telephonic support. Two studies reported on an interactive tool for delivering sick day medication guidance 65 , 66 ; 1 was a website algorithm specific to insulin adjustment for children with diabetes mellitus, and the content of the other was neither described nor publicly accessible. There was 1 document that described the use of sick day medication guidance using prescription notes and dispensing labels.…”

Use of Scratch as ICT Educational Tool in Health

“…Our study is expected to assist interactive training of health professionals and students to provide better quality of care [6,8], and train patients to better understand aspects of their health or still comply to their treatment [5,6,7]. There are studies that prepare presentation of health issues targeting students [9].…”

“…Several studies on health training exploiting Information and Communication Technology (ICT) tools rely either on training patients to comply with prevention and treatment [5,6,7], or on training health professionals to improve quality of care [6,8]. Mobile tablet-based educational tools [7] or online interactive educational tools [5,6,8] have been used for the training of health providers. These studies have concluded that the use of ICT tools enriches learners' knowledge and promotes the correct response to health-related events [6,8].…”

Evaluation of Usability and Learning Motivation of e-Learning Courses for People With Chronic Kidney Disease

“…13,14 Bowman et al 13 have developed a tablet-based educational tool that supports disease-specific patient safety awareness, and Diamantidis et al 14 have developed a website that provides information about common patient safety issues related to kidney disease. Both studies 13,14 reported that the online material they developed had "critical errors (tasks that participants could not complete independently)." 13 We developed an e-learning course, "Kidney Care e-Learning Course: Protecting Your Kidneys!," 15 for people with CKD who have not received renal replacement therapy.…”

“…Usability is defined as the “extent to which a system, product or service can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use.” 12 Online teaching materials have been developed to educate people with CKD who have not received renal replacement therapy, and there are several studies that have observed their use and evaluated usability 13,14 . Bowman et al 13 have developed a tablet-based educational tool that supports disease-specific patient safety awareness, and Diamantidis et al 14 have developed a website that provides information about common patient safety issues related to kidney disease. Both studies 13,14 reported that the online material they developed had “critical errors (tasks that participants could not complete independently).” 13 …”