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

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Abstract

Objectives

Diet and physical activity are crucial for people with chronic kidney disease (CKD) to maintain good health. Digital health interventions can increase access to lifestyle services. However, consumers’ perspectives are unclear, which may reduce the capacity to develop interventions that align with specific needs and preferences. Therefore, this review aims to synthesise the preferences of people with CKD regarding digital health interventions that promote healthy lifestyle.

Design

Qualitative systematic review with meta-ethnography.

Data sources

Databases Scopus, CENTRAL, MEDLINE, CINAHL and SPORTDiscus were searched between 2000 and 2023.

Eligibility criteria

Primary research papers that used qualitative exploration methods to explore the preferences of adults with CKD (≥18 years) regarding digital health interventions that promoted diet, physical activity or a combination of these health behaviours.

Data extraction and synthesis

Two independent reviewers screened title, abstract and full text. Discrepancies were resolved by a third reviewer. Consumers’ quotes were extracted verbatim and synthesised into higher-order themes and subthemes.

Results

Database search yielded 5761 records. One record was identified following communication with a primary author. 15 papers were included. These papers comprised 197 consumers (mean age 51.0±7.2), including 83 people with CKD 1–5; 61 kidney transplant recipients; 53 people on dialysis. Sex was reported in 182 people, including 53% male. Five themes were generated regarding consumers’ preferences for digital lifestyle interventions. These included simple instruction and engaging design; individualised interventions; virtual communities of care; education and action plans; and timely reminders and automated behavioural monitoring.

Conclusion

Digital health interventions were considered an important mechanism to access lifestyle services. Consumers’ preferences are important to ensure future interventions are tailored to specific needs and goals. Future research may consider applying the conceptual framework of consumers’ preferences in this review to develop and evaluate the effect of a digital lifestyle intervention on health outcomes.

PROSPERO registration number

CRD42023411511.

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Most cited references 157

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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2009)

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The behaviour change wheel: A new method for characterising and designing behaviour change interventions

Susan Michie, Maartje M. van Stralen, Robert H. West (2012)

Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.

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Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Boris Bikbov, Caroline A. Purcell, Andrew Levey … (2021)

Summary Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Funding Bill & Melinda Gates Foundation.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2024

Publication date (Electronic): 27 May 2024

Volume: 14

Issue: 5

Electronic Location Identifier: e082345

Affiliations

[1 ] departmentSchool of Medical, Indigenous and Health Sciences , Ringgold_90119University of Wollongong Faculty of Science Medicine and Health , Wollongong, New South Wales, Australia

[2 ] departmentDepartment of Renal Medicine , Ringgold_2659Concord Repatriation General Hospital , Concord, New South Wales, Australia

[3 ] departmentFalls, Balance and Injury Research Centre , Ringgold_6803Neuroscience Research Australia , Randwick, New South Wales, Australia

[4 ] departmentSchool of Population Health , Ringgold_98994University of New South Wales Faculty of Medicine , Sydney, New South Wales, Australia

[5 ] departmentSchool of Health Sciences , Ringgold_98994University of New South Wales Faculty of Medicine , Sydney, New South Wales, Australia

[6 ] departmentCentre for Pain IMPACT , Ringgold_6803Neuroscience Research Australia , Randwick, New South Wales, Australia

[7 ] departmentSchool of Health Sciences , Ringgold_522555The University of Sydney Faculty of Medicine and Health , Sydney, New South Wales, Australia

[8 ] departmentSydney Musculoskeletal Health , Ringgold_4334The University of Sydney , Sydney, New South Wales, Australia

[9 ] departmentConcord Clinical School , Ringgold_522555The University of Sydney Faculty of Medicine and Health , Sydney, New South Wales, Australia

[10 ] Ringgold_226154Illawarra Shoalhaven Local Health District , Wollongong, New South Wales, Australia

Author notes

[Correspondence to ] Associate Professor Ria Arnold; rarnold@ 123456uow.edu.au

Author information

Thái Bình Trần http://orcid.org/0000-0002-0437-7118

Meghan Ambrens http://orcid.org/0000-0001-9117-7722

Jeanette M Thom http://orcid.org/0000-0002-6575-3711

Kelly Lambert http://orcid.org/0000-0001-5935-7328

Ria Arnold http://orcid.org/0000-0002-7469-6587

Article

Publisher ID: bmjopen-2023-082345

DOI: 10.1136/bmjopen-2023-082345

PMC ID: 11131123

PubMed ID: 38802278

SO-VID: fdcaa820-57e3-4320-ae2b-ddc6d760d9e1

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 21 November 2023

Date accepted : 25 April 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001777, University of Wollongong;

Award ID: Australian Government Research Training Program Sc

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ScienceOpen disciplines: Medicine

Keywords: qualitative research,systematic review,chronic renal failure,nutrition & dietetics,physical therapy modalities

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ScienceOpen disciplines: Medicine

Keywords: qualitative research, systematic review, chronic renal failure, nutrition & dietetics, physical therapy modalities

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

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Abstract

Objectives

Design

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Data extraction and synthesis

Results

Conclusion

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Karger: Nephrology

Most cited references 157

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

The behaviour change wheel: A new method for characterising and designing behaviour change interventions

Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

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