Developing a tailored eHealth self-management intervention for patients with chronic kidney disease in China: an intervention mapping approach (Preprint)

Abstract

Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes and control health care expenditures. Using electronic health (eHealth) to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China in specific, is still limited.

This study aimed to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch ‘Medical Dashboard (MD)’ eHealth self-management intervention.

We used an Intervention Mapping approach. In phase 1, a systematic review and two qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and HCPs towards CKD self-management and eHealth interventions. After, key factors accumulated from the above-mentioned studies were categorized following five domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, and determinants, theory-based methods and practical strategies. Knowledge obtained from prior results were combined to adapt and complement core components of ‘MD’ self-management intervention for Chinese patients with CKD. Additionally, a CFIR-Expert Recommendations for Implementing Change Matching tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions and implementation strategies were discussed and finalized with the intervention monitoring group.

An overview of the CFIR domains showed the essential factors influencing the implementation of CKD self-management eHealth interventions in Chinese settings such as ‘knowledge & beliefs’ in the domain ‘individual characteristics’, ‘quality and advantage of eHealth intervention’ in the domain ‘Intervention characteristics’ and ‘compatibility’ in the domain ‘inner setting’, ‘cultural context’ in the domain “outer setting”. To ensure the effectiveness of the Dutch MD-based self-management intervention, we did not change the core self-management intervention components of MD that underline its effectivity, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of local population to enhance the intervention’s appeal, receptivity, and feasibility such as providing video- or voice call options to support interactions with HCPs. Furthermore, the adapted modules were developed in a mobile health application such as Knowledge Center and My Self-monitoring.

Our study results in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China, which has the potential to optimize patients’ self-management skills and improve health status and quality of life. Moreover, the research approach used and the results of our study inform future research on the tailoring and translation of evidence-based eHealth self-management interventions in various contexts.