Use of Internet and Mobile Technology to Self-Manage CKD

To enable individuals with chronic kidney disease (CKD) to successfully self-manage their condition, renal clinicians and other care providers employ varying educational and behavioral strategies to support those efforts. Self-management requires patients to be able to monitor their disease, manage symptoms, interpret results of home-monitoring therapies, and adhere to complex treatment regimens and dietary and fluid restrictions. Some patients also opt to perform in-home dialysis.

Increasingly, technology such as smart phones, tablets, laptops, and other devices are being used to deliver educational support programs and information to patients. In many chronic disease populations, the use of internet and mobile technologies (mHealth) is considered an effective tool for patient support. There are some mHealth platforms for patients with CKD; however, there are few data on if and how patients with CKD utilize technology to manage their disease.

Ann Bonner, PhD, and colleagues in Australia, conducted a cross-sectional study at five renal services (two regional and three metropolitan) in Queensland, Australia to examine whether and how patients were accessing and using mobile phones and the internet to gather renal information. The researchers sought to help identify the most effective education platforms for patients with CKD. Study results were reported online in BMC Nephrology [doi:10.1186/s12882-018-0830-8].

Data were collected using a 38-item survey that assessed factors associated with use of the internet and mobile technology, barriers to access, types of data accessed, and why and how information is accessed. Participants were >18 years of age attending a CKD outpatient clinic (regardless of CKD stage) or dialysis unit with end-stage kidney disease. Inclusion criteria were the ability to read and write English or have a family member wo could assist with completion of the survey. Exclusion criteria were cognitive impairment, limited ability with the English language, and prior kidney transplantation. The data collection period was June 2015 to March 2016.

Of the 720 surveys collected across all sites, 12 were excluded due to incompleteness. The final analysis included the remaining 708 surveys. Respondents were 55.2% male, and 51.6% were >61 years of age. The largest proportion (29.3%) was ≥71 years of age, and 83.1% were not Aboriginal or Torres Strait Islander (non-ATSI); 11.8% self-identified as ATSI.

Five hundred eighty-eight owned a mobile phone; 64.3% reported it was a smart phone; 29 were unsure if their phone was a smart phone. More than half (77.6%, n=456) could use the phone for complex activities, and 36.6% (n=215) said they could use mobile phone apps. Ownership of mobile phones was significantly more common in respondents ≤60 years of age (P<.01), those who were employed (P<.01), and those with higher education levels (P<.01). There were no differences in smart phone ownership by ethnicity or whether on dialysis.

When asked about the use of complex apps as a measure of greater mHealth literacy, there was a similar relationship between app use and age, education, and employment. Younger respondents were four times as likely to use complex apps (odds ratio [OR], 4.25; 95% confidence interval [CI], 2.67-6.76; P<.001). The OR for those who were employed was 1.83 (95% CI, 1.1502.89; P=.01), and 2.35 (95% CI, 1.54-3.58; P<.001) for respondents with higher levels of education.

Sixty-nine point four percent of respondents reported use of the internet; of those, 89.4% (n=379) used it at home; 51.9% (n=252) for more than 60 minutes per day; 32.3% (n=113) on a laptop; and 30.6% (n=107) on a desktop computer. Checking e-mail was the most frequently cited internet activity (80.9%, n=395), followed by searching/browsing (n=366;74.5%), accessing social networks (n=245; 50.2%), accessing health information (n=221; 45.3%), and reading/watching the news (n=217, 44.5%). There were 217 respondents who reported they did not use the internet; of those, 54.4% (n=118) said they did not know how to use the internet.

Nearly half of the participants (n=332; 49%) said they had used the internet to search for specific information on CKD. Those participants were younger (P<.01), less likely to be indigenous (P=.03), and more likely to be employed (P<.01) and to have obtained higher educational qualifications (P<.01).

When asked what mHealth technologies they would be willing to use to engage with their healthcare team, telephone calls were the most common modality indicated (n=400; 56.5%), followed by the internet (n=354; 50%), email (n=342; 48.3%), and SMS messages (n=326; 46%).

The researchers summarized their findings by saying, “In the CKD cohort, younger patients are more likely than older patients to use mHealth intensively and interactively although all patients’ technology literacy ought to be thoroughly assessed by renal teams before implementing in practice. Further research testing mHealth interventions to improve self-management in a range of patient cohorts is warranted.”

Takeaway Points

  1. Researchers in Australia conducted a cross-sectional study to assess whether and how patients with chronic kidney disease utilize internet and mobile phone technologies to aid in self-management of their disease.
  2. The study included a 38-item self-report survey that was distributed to patients with CKD attending outpatient clinics or dialysis units in Queensland, Australia.
  3. Of the 708 surveys included in the analyses, 89.2% of respondents said they had access to a computer and 83.5% reported they had a mobile phone. Compared with older patients, those ≤60 years of age were more likely to use the internet and mobile technologies.