A nurse-led digital intervention linked to modest gains in sodium knowledge among patients with chronic kidney disease (CKD), but this benefit did not translate into measurable behavioral change, according to a study by Yu Shi, MD, and colleagues. The findings, published in JMIR Nursing, suggest that future research should identify interventions that narrow the gap between acquiring health knowledge and self-managing chronic disease.
High sodium consumption accelerates CKD progression, but adherence to clinical guidelines is poor, with less than 30% of patients meeting target intake recommendations. Although studies demonstrate that digital therapeutics have value for chronic disease management, most research relies on idealized clinical trial designs but overlooks real-world barriers to implementation.
To address the adherence gap, researchers conducted a study of a nurse-led digital program to identify factors underlying discrepancies between increases in health knowledge and behavioral response to sodium management recommendations. They focused on barriers that can impair engagement, implementation, and patient experience.
The investigation was a mixed-methods implementation study that recruited patients between June and August 2022 and randomly assigned them to an intervention or control group. Participants in the intervention group received enhanced digital experiences, including teaching, quizzes, behavioral practice, and individual reporting, while those in the control group received minimal digital intervention.
Researchers measured 24-hour urinary sodium excretion—the gold standard for determining sodium intake—as the primary outcome, and assessed knowledge acquisition, blood pressure, and quality of life as secondary outcomes. The team also conducted in-depth qualitative interviews with a sample of participants and followed them for 3 months.
Of the 99 enrolled participants, 46 were in the enhanced digital intervention group, and 53 were in the minimal digital control group. Those in the intervention group experienced a significant improvement in sodium-related knowledge. However, reliable conclusions about the intervention’s efficacy were not possible because the completion rate of 24-hour urine collection was only 24.2% (n=24). Moreover, the interviews revealed initial enthusiasm and active engagement, followed by disengagement due to family barriers and digital fatigue.
While the findings suggest that digital interventions can foster improved health knowledge, this alone does not determine long-term behavioral change. High-burden evaluation tools, such as 24-hour urine testing, pose an adherence challenge to ongoing monitoring. In addition, cooking habits, family dynamics, and taste preferences affect sodium restriction.
Investigators concluded that the disconnect between idealized trial protocols and patients’ daily realities highlights the need for more feasible ways to measure outcomes and more effective methods to promote behavioral change.