Patients with kidney failure express interest, show proficiency in mobile health
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A majority of patients with kidney failure were deemed ready for increased utilization of mobile health based on reported availability of necessary devices, as well as proficiency and interest in the technology.
The survey results were published in The Clinical Journal of the American Society of Nephrology.
"Mobile health can be utilized to bring along a number of interventions that can help people on dialysis manage their health and improve independence,” Wael F. Hussein, MD, of Satellite Healthcare, said in a related press release. “Findings of our study are encouraging to health care providers and technology developers to invest in innovations and solutions that utilize mobile health.”
For the study, Hussein and colleagues surveyed 949 patients receiving either in-center hemodialysis or home dialysis in California, Texas or Tennessee.
Results showed 81% of respondents owned smartphones or other internet-capable devices, and 72% used the internet.
Regarding mobile health proficiency, 70% of the study population reported having intermediate or advanced ability. Older patients, as well as those with Hispanic/Latinx ethnicity or who had less than a college education, had lower proficiency. Employment was associated with higher proficiency.
“We assessed various elements of internet or device users that we converted to three levels of proficiency: basic use (phone calls and text messages only), intermediate use (video calls, email, photos, videos, online media, social media, internet articles/news, alarms, reminders, maps, directions or calendar), and advanced use (internet shopping, personal health information, planning and tracking, booking travel or entertainment, banking or online payments),” Hussein and colleagues wrote. “Each participant was assigned to the highest level of activity he or she reported performing.”
Researchers evaluated motivation by determining whether patients currently engaged in mobile health activities or if they had interest in future use.
In total, 60% of respondents expressed an interest in using mobile health to “learn or engage with their health care,” with the main reasons for utilization of mobile health being appointments (56%), communication with health care personnel (56%) and laboratory results (55%).
Researchers noted that the primary concerns with mobile health involved privacy and security (18%).
In a related editorial, Karandeep Singh, MD, MMSc, of University of Michigan Medical School, suggested that working toward an uptick in mobile health utilization is an appropriate solution to improving patient outcomes, as 81% of Americans now own a smartphone.
“People burdened with the responsibility of managing an illness, such as patients receiving long-term dialysis, face many such moments where obtaining a rapid answer to a question could change the trajectory of their care or prevent hospitalization,” he wrote. “How to engage these patients more effectively can perhaps be summed up with the following advice: The best engagement medium is the one that’s with patients.”
Singh contended that these survey results, which indicate the readiness of patients to use mobile health, place the responsibility “on the professional nephrology community to deliver.”
Lana Schmidt, a member of the board of directors for the American Association of Kidney Patients who has had kidney disease for 18 years, expressed agreement that smartphones are a viable tool for managing the condition.
“Kidney failure is a battle, and patients need every tool available to help them fight and manage this life-threatening disease,” Schmidt wrote in an accompany patient voice. “Patients with kidney disease are so overdue for advanced technology support that having the use of a smartphone at their fingertips to help monitor their health would make a remarkable difference.”
She contended that with the executive order on Advancing American Kidney Health, the United States is now in a position to improve care through technology.
“It will mark the start of an era where we will see the development of more medical devices and technology in the fight against kidney disease,” she wrote.
Healio Nephrology previously reported on a study that demonstrated similar results with regard to patients with chronic kidney disease finding mobile health technologies to be potentially “intrusive” (although a majority of this cohort still expressed interest in use). However, researchers determined mobile health literacy (ie, proficiency) to be lower than reported in this study. The story can be found here.
Perspective
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Hussein and colleagues concluded that the majority of survey participants receiving in-center hemodialysis or home dialysis were, in fact, ready for mobile health technologies. However, the conclusions are not generalizable.
Among the 949 participants in this study, 81% were from California. This is a state that the National Center for Education Statistics ranks seventh in the country for household access to internet and fourth in the country for access to a smartphone or a computer. Furthermore, 57% of the survey participants had some college education or higher. This is in stark contrast to other studies such as the DMMS Wave 2 study, which showed only 33.3% of dialysis patients with a college education, and the Comprehensive Dialysis Study, in which 44.6% had some college education. In addition, the authors were not able to ascertain rural vs. urban status. Still, even among this highly educated group of dialysis patients with high access to the internet and computers/smart devices, 30% of individuals had a low mobile health proficiency.
The COVID-19 pandemic has moved health care even further in its reliance of technology, with reports of anywhere from 2,000% to 4,000% increases in video and/or audio visits. This massive rise in mobile health has exposed disparities as it relates to technology-enabled delivery of care. It has shown that we must focus on ways to improve mobile health proficiency, which is likely overestimated in this study population.
This study focuses on whether patients are ready for mobile health, but just as important is the question of whether health care systems are ready to implement and scale mobile health. There are currently millions of apps available, but only 0.01% of apps are ever successful. How do we go about collating and choosing which app we advise our patients to use when they are constantly changing and failing?
Challenges aside, technology has and will continue to transform every aspect of our lives. We must ensure that our technology choices and their implementation are meaningful, equitable and scalable. Addressing the causes of low mobile health proficiency is a good start.
References:
Kutner NG, et al. Clin J Am Soc Nephrol. 2009;doi:10.2215/CJN.05721108.
National Center of Education Statistics. Table 702.60. Number and percentage of households with computer and internet access, by state: 2016. Available at: https://nces.ed.gov/programs/digest/d17/tables/dt17_702.60.asp. Accessed Dec. 28, 2020.
US Renal Data System: USRDS 2003 Annual Data Report, Bethesda, NIH, National Institute of Diabetes and Digestive and Kidney Diseases, 2003.
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