Digital health interventions in chronic kidney disease: levelling the playing field?

Abstract

Digital health interventions (DHIs) have long been thought of as a convenient way to deliver aspects of healthcare and broaden access to services. For patients with chronic kidney disease, DHIs designed to improve health literacy, self-efficacy and health-related behaviours like physical activity, diet and adherence have been developed and are being tested, but their translation into clinical practice will challenging. Whilst DHIs potentially have broad reach, it is increasingly clear that patients from lower socioeconomic and educational backgrounds, minority ethnic groups, elderly patients and those who face digital poverty are the least likely to access and benefit from DHIs, when they are precisely the patients who stand to gain the most. This article discusses the potential for DHIs to level the playing field for patients with chronic kidney disease as well as the steps researchers, clinicians and developers should consider to ensure DHIs are developed, in collaboration with patients, to be inclusive and effective as well as strategies that should be considered during development to support translation into practice.

Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review

“…Future work should aim to test the efficacy of these interventions on relevant outcomes in appropriately designed and powered RCTs. The co-development and design of these interventions should occur alongside participants and key-stakeholders [ 15 ]. Moreover, these trials should include implementation work or pragmatic and adaptive designs that take into account feasibility, as the widespread uptake of eHealth interventions is currently limited [ 15 ].…”

“…The co-development and design of these interventions should occur alongside participants and key-stakeholders [ 15 ]. Moreover, these trials should include implementation work or pragmatic and adaptive designs that take into account feasibility, as the widespread uptake of eHealth interventions is currently limited [ 15 ]. That said, there were two included protocol publications [ 35 , 36 ] for appropriately powered RCTs investigating the effect and engagement of web-based self-management platforms, they were co-designed with relevant stakeholders so that they can be embedded as part of usual clinical care should they prove efficacious.…”

“…However, participants did report high levels of satisfaction due to the eHealth interventions being informative, of low burden, and easy to use [ 13 ]. There is a growing interest in the use eHealth and digital technologies for the delivery of healthcare in CKD, particularly following the rise of digital healthcare utilisation during COVID-19, and thus an up-to-date scope of the evidence in this population is required [ 14 , 15 ].…”

Digital health interventions to promote healthy lifestyle in hemodialysis patients: an interventional pilot study

“…Digital health interventions (DHIs) notably manage chronic conditions to improve health literacy, self-efficacy and health-related behaviors such as physical activity, diet control and adherence 14 . A health management platform was used widely in telehealth interventions 15 .…”

Preferences of people with chronic kidney disease regarding digital health interventions that promote healthy lifestyle: qualitative systematic review with meta-ethnography

“…Digital health interventions (DHIs) may provide a useful mechanism to promote healthy lifestyles for people with CKD. 29 DHI is defined as the use of health informatics to assist the delivery of healthcare (ie, provide education and instruction, record and display data, guide users’ behaviours, provider reminders and facilitate provider–consumer communication). 30 31 In this review, DHI may include mobile health technology (eg, application software and short messaging services 30 ), telehealth technology (eg, videoconferencing and audio call 32 ), wearable technology (eg, step count monitor 30 ), computerised systems (eg, websites 33 ) or multicomponent interventions that use more than one type of technology.…”