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Patients’ Experiences and Perspectives of Telehealth Coaching with a Dietitian to Improve Diet Quality in Chronic Kidney Disease: A Qualitative Interview Study

Published:April 09, 2019DOI:https://doi.org/10.1016/j.jand.2019.01.023

      Abstract

      Background

      Dietary behavior change interventions for the self-management of chronic kidney disease (CKD) have the potential to slow disease progression and reduce metabolic complications. Telehealth-delivered dietary interventions may assist in the self-management of CKD, although their acceptability by patients is unknown.

      Objective

      This study aims to describe the acceptability and experiences of a telehealth coaching intervention that utilized telephone calls and tailored text messages to improve diet quality in patients with stage 3 to 4 CKD.

      Design

      Semistructured interview study of adults with CKD.

      Participants/setting

      Adults with stage 3 to 4 CKD (n=21) aged 28 to 78 (mean 62) years, who completed a 12-week telehealth-delivered dietary intervention in Queensland, Australia, were interviewed from March to July 2017.

      Data analysis

      Interviews were transcribed verbatim and analyzed thematically.

      Results

      Five themes were identified: valuing relationships (receiving tangible and perceptible support, building trust and rapport remotely, motivated by accountability, readily responding to a personalized approach, reassured by health professional expertise); appreciating convenience (integrating easily into lifestyle, talking comfortably in a familiar environment, minimizing travel and wait time burden); empowered with actionable knowledge (comprehending diet-disease mechanisms, practical problem solving for sustainable dietary behavior); increasing diet consciousness (learning from recurrent feedback, prompted by reiteration of messages); making sense of complexity (contextualizing and prioritizing comorbidities, gaining confidence to make dietary decisions, setting and achieving realistic goals).

      Conclusions

      Among adults with stage 3 to 4 CKD, individualized telehealth coaching for improving diet quality was convenient for patients, and they felt supported and empowered to navigate recommendations and prioritize dietary behavior changes. Telehealth-delivered dietary interventions appear to be well accepted by patients as a way of providing regular, tailored contact with a health professional to support dietary management in CKD.

      Keywords

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      References

        • Bello A.K.
        • Levin A.
        • Tonelli M.
        • et al.
        Assessment of global kidney health care status.
        JAMA. 2017; 317: 1864-1881
        • Eckardt K.U.
        • Coresh J.
        • Devuyst O.
        • et al.
        Evolving importance of kidney disease: From subspecialty to global health burden.
        Lancet. 2013; 382: 158-169
        • Tong A.
        • Sainsbury P.
        • Carter S.M.
        • et al.
        Patients’ priorities for health research: Focus group study of patients with chronic kidney disease.
        Nephrol Dial Transplant. 2008; 23: 3206-3214
        • Palmer S.C.
        • Hanson C.S.
        • Craig J.C.
        • et al.
        Dietary and fluid restrictions in CKD: A thematic synthesis of patient views from qualitative studies.
        Am J Kidney Dis. 2015; 65: 559-573
        • Kelly J.T.
        • Campbell K.L.
        • Hoffmann T.
        • Reidlinger D.P.
        Patient experiences of dietary management in chronic kidney disease: A focus group study.
        J Ren Nutr. 2018; 28: 393-402
        • Hemmelgarn B.R.
        • Pannu N.
        • Ahmed S.B.
        • et al.
        Determining the research priorities for patients with chronic kidney disease not on dialysis.
        Nephrol Dial Transplant. 2017; 32: 847-854
        • Stevenson J.
        • Tong A.
        • Campbell K.L.
        • Craig J.C.
        • Lee V.W.
        Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: An interview study.
        BMJ Open. 2018; 8: e020023
        • Ash S.
        • Campbell K.L.
        • Bogard J.
        • Millichamp A.
        Nutrition prescription to achieve positive outcomes in chronic kidney disease: A systematic review.
        Nutrients. 2014; 6: 416-451
        • Hand R.K.
        • Steiber A.
        • Burrowes J.
        Renal dietitians lack time and resources to follow the NKF KDOQI guidelines for frequency and method of diet assessment: Results of a survey.
        J Ren Nutr. 2013; 23: 445-449
        • Australian Institute of Health and Welfare
        Chronic kidney disease: regional variation in Australia. Cat. no. PHE 172. 2013.
        • Kelly J.T.
        • Reidlinger D.P.
        • Hoffmann T.C.
        • Campbell K.L.
        Telehealth methods to deliver dietary interventions in adults with chronic disease: A systematic review and meta-analysis.
        Am J Clin Nutr. 2016; 104: 1693-1702
        • Desroches S.
        • Lapointe A.
        • Ratte S.
        • Gravel K.
        • Legare F.
        • Turcotte S.
        Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults.
        Cochrane Database Syst Rev. 2013; : CD008722
        • Goode A.D.
        • Reeves M.M.
        • Eakin E.G.
        Telephone-delivered interventions for physical activity and dietary behavior change: An updated systematic review.
        Am J Prev Med. 2012; 42: 81-88
        • Beall R.F.
        • Baskerville N.
        • Golfam M.
        • Saeed S.
        • Little J.
        Modes of delivery in preventive intervention studies: A rapid review.
        Eur J Clin Invest. 2014; 44: 688-696
        • Craig P.
        • Dieppe P.
        • Macintyre S.
        • Michie S.
        • Nazareth I.
        • Petticrew M.
        Developing and evaluating complex interventions: The new Medical Research Council guidance.
        Int J Nurs Stud. 2013; 50: 587-592
        • Sekhon M.
        • Cartwright M.
        • Francis J.J.
        Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework.
        BMC Health Serv Res. 2017; 17: 88
        • Australian New Zealand Clinical Trials Registry
        The Evaluation of iNdividualized Telehealth Intensive Coaching to promote healthy Eating and lifestyle in Chronic Kidney Disease. 2016. Trial ID ACTRN12616001212448.
        • National Health and Medical Research Council
        Australian dietary guidelines. 2013.
        https://www.eatforhealth.gov.au/guidelines
        Date accessed: January 25, 2019
        • Kidney Health Australia
        Chronic kidney disease guidelines.
        http://www.cari.org.au/CKD/ckd_guidelines.html
        Date accessed: January 25, 2019
        • National Kidney Foundation
        KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease.
        Am J Kidney Dis. 2007; 49: S12-S154
        • Department of Health
        Australia’s physical activity and sedentary behaviour guidelines for adults. 2014.
        • The University of Queensland
        Propelo. 2018.
        www.propelo.com.au
        Date accessed: January 25, 2019
        • Bandura A.
        Social Foundations of Thought and Action: A Social Cognitive Theory.
        Prentice-Hall Inc, Englewood Cliffs, NJ1986
        • Michie S.
        • Wood C.E.
        • Johnston M.
        • Abraham C.
        • Francis J.J.
        • Hardeman W.
        Behaviour change techniques: The development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data).
        Health Technol Assess. 2015; 19: 1-188
        • Lo C.
        • Ilic D.
        • Teede H.
        • et al.
        Primary and tertiary health professionals’ views on the health-care of patients with co-morbid diabetes and chronic kidney disease—A qualitative study.
        BMC Nephrol. 2016; 17: 50
        • Cummings K.M.
        • Becker M.H.
        • Kirscht J.P.
        • Levin N.W.
        Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients.
        J Behav Med. 1981; 4: 111-127
        • Bosworth H.B.
        • Olsen M.K.
        • McCant F.
        • et al.
        Hypertension Intervention Nurse Telemedicine Study (HINTS): Testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control.
        Am Heart J. 2007; 153: 918-924
      1. HyperRESEARCH [computer program]. Version 3.7.5. Researchware Inc, Randolph, MA2015
        • Glaser B.
        • Strauss A.
        The Discovery of Grounded Theory: Strategies for Qualitative Research.
        Transaction Publishers, New York, NY2012
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Lincoln Y.
        • Guba E.
        Naturalistic Inquiry.
        Sage Publications, London, UK1985
      2. Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011.
        • Australian Government Department of Home Affairs
        Regional post codes.
        • Miller W.
        • Rollnick S.
        Motivational Interviewing: Helping People Change.
        3rd ed. The Guilford Press, New York, NY2013
        • Fuertes J.N.
        • Toporovsky A.
        • Reyes M.
        • Osborne J.B.
        The physician-patient working alliance: Theory, research, and future possibilities.
        Patient Educ Couns. 2017; 100: 610-615
        • Dinesen B.
        • Nonnecke B.
        • Lindeman D.
        • et al.
        Personalized telehealth in the future: a global research agenda.
        J Med Internet Res. 2016; 18: e53
        • Partridge S.R.
        • Allman-Farinelli M.
        • McGeechan K.
        • et al.
        Process evaluation of TXT2BFiT: A multi-component mHealth randomised controlled trial to prevent weight gain in young adults.
        Int J Behav Nutr Phys Act. 2016; 13: 7

      Biography

      M. M. Warner is accredited practising dietitian, Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia.

      Biography

      J. T. Kelly is accredited practising dietitian, Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia.

      Biography

      A. Tong is an associate professor, Sydney School of Public Health, The University of Sydney, Australia, and from the Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia.

      Biography

      K. L. Campbell is an associate professor, Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia, and an associate professor, Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.