Supporting Self-Management of Healthy Behaviors in Chronic Kidney Disease and Hypertension

Abstract

Key Points Support programs for self-management are underutilized among people with CKD.Implementing a smartphone support tool for self-monitoring physical activity and BP was feasible among people with CKD and hypertension.Despite low digital health literacy, Supporting Self-Management of Healthy Behaviors was observed to be readily usable because of high levels of adherence and usability scores. Background Support programs for self-management are underutilized among people with CKD. We examined the feasibility of a smartphone-based intervention to support physical activity and BP monitoring, Supporting Self-Management of Healthy Behaviors (SMART-HABITS), for individuals with CKD and hypertension. Methods SMART-HABITS was piloted in a 12-week randomized cross-over trial among people with CKD and hypertension. Participants were asked to monitor BP ≥3-times/wk and step counts ≥5-times/wk. Participants were randomized to BP communication approach–self-report through text message for 6 weeks versus automatic reporting with a smartphone application (app) paired to a Bluetooth enabled BP machine for the alternate 6 weeks. The approach to monitoring and reporting steps was the same during both phases. Primary outcomes were adoption (retention and use of SMART-HABITS dashboard), adherence (% of transmitted BP and step counts), and acceptability as assessed with surveys and interviews. Secondary outcomes were reach, maintenance, CKD knowledge, digital health literacy, self-management, self-efficacy, quality of life, step counts, and BP values. Interviews were conducted at study end. Results Of the 47 randomized participants, 44 (94%) completed the text phase and 43 (92%) completed the app phase. The median age was 63 years, 49% were female, and 45% were Black. Retention was 91%. BP adherence was 87% in the text phase and 74% in the app phase, and step count adherence was 97%. Acceptability scores were high, and interviews largely conveyed acceptance. CKD knowledge increased but remaining survey scores did not change. Mean step counts increased from the prestudy period similarly in both phases. BP did not change over time. Conclusions Implementing a smartphone support tool for self-management was feasible among people with CKD and hypertension. The approach can supplement clinic-based care and potentially lead to less cardiovascular disease and CKD progression. Clinical Trial registry name and registration number: NCT04858295.