Optimization of the Chronic Kidney Disease–Peritoneal Dialysis App to Improve Care for Patients on Peritoneal Dialysis in Northeast Thailand: User-Centered Design Study

Abstract

Background The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part because of Thailand’s Peritoneal Dialysis First policy. PD is a home-based renal replacement therapy in which patients with chronic kidney disease perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in patients on PD and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume, from each dialysis cycle and enter this information into a PD logbook. This information is reviewed bimonthly at PD clinic appointments. The chronic kidney disease-PD (CKD-PD) app with near-field communication (NFC) and optical character recognition (OCR) was developed to automate hydration metric collection. The information was displayed in the app for self-monitoring and uploaded to a database for real-time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce the morbidity and mortality related to overhydration. Objective This study aims to identify usability issues and technology adoption barriers for the CKD-PD app with NFC and OCR and a monitoring system and to use this information to make rapid cycle improvements. Methods A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers, and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC and OCR and a monitoring system. The participants were observed using technology in their homes in 3 phases. The data collected included the Unified Theory of Acceptance and Use of Technology questionnaire, think-aloud observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app. Results The CKD-PD app with NFC and OCR and a monitoring system underwent 3 rapid improvement cycles. Issues were identified regarding the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation, and display. NFC and OCR improved hydration metric capture; however, issues remained with their usability. App stability and user interface issues were corrected, and hydration metrics were successfully uploaded by the end of phase 3. Participants’ scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinical communication features. Conclusions Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC and OCR and a monitoring system. We believe that this methodology can be accomplished with limited training in data collection, statistical analysis, and funding.

Functionality and Usability of mHealth Apps in Patients with Peritoneal Dialysis: A Systematic Review

“…Mobile health (mHealth) applications (apps) have the potential to increase patients’ willingness to adopt PD. These apps can record PD conditions, enhance patients’ self-practice of PD techniques at home, alleviate concerns about unmanageable health conditions, help patients with chronic kidney diseases understand their condition, strengthen disease self-management [ 5 , 6 , 7 ], facilitate two-way communication and data sharing between patients and HCP, assist patients in gaining necessary knowledge and skills, and support patients in problem solving and decision making [ 1 , 8 , 9 , 10 , 11 ], ultimately increasing patients’ sense of security and satisfaction.…”

Effects of a mobile application on improving self‐management of adult patients receiving peritoneal dialysis: A randomized controlled trial

“…However, there continues to be a lack of evidence on the impact of theory-based interventions using mobile applications to enhance self-management in patients receiving PD. Moreover, because such patients require an intervention that allows healthcare professionals to monitor their health with patients' lifelog data accessible through continuous networking, thereby encouraging patients to adequately perform dialysis related to disease management and promoting other positive behavioral changes (O. L. Park & Kim, 2019), it may be useful to develop a mobile application as a health management mediator (Lukkanalikitkul et al, 2022). Bandura's (2004) social cognitive theory (SCT) explains that the dynamic interaction among cognitive, behavioral, and environmental factors induce individual behavioral changes, and the focus of SCT is on the improvement of an individual's health.…”

Authors who contributed most to the fields of hemodialysis and peritoneal dialysis since 2011 using the hT-index: Bibliometric analysis

“…Chronic kidney disease is a major health problem due to its high prevalence, cost of treatment, significant morbidity and mortality, and substantial impact on patients and their families. [ 25 ] Patients with PD, for instance, manage their PD at home manually or by using a PD cycler to deliver dialysate fluid through a catheter placed in the peritoneal cavity, where the fluid remains for a period of time. In each cycle, they enter hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume.…”