Abstract
Hyperphosphatemia afflicts end-stage chronic kidney disease (CKD) patients, contributing to comorbidities and mortality. Management strategies are dialysis, phosphate binder, and limiting dietary phosphate intake, but treatment barriers are poor patient compliance and low health literacy arising from low self-efficacy and lack of educational resources. This study describes developing and validating a phosphate mobile application (PMA). The PMA development based on the seven-stage Precaution Adoption Process Model prioritized titrating dietary phosphate intake with phosphate binder dose supported by educational videography. Experts (n = 13) first evaluated the PMA for knowledge-based accuracy, mobile heuristics, and clinical value. Adult HD patients validated the improved PMA using the seven-point mHealth App Usability Questionnaire (MAUQ). Patient feedback (n = 139) indicated agreement for ease of use (69.2%), interface and satisfaction (69.0%), and usefulness (70.1%), while 72.7% said they would recommend this PMA. The expectation confirmation for 25 PMA features ranged from 92.1% (lifestyle) up to 100.0% (language option); and the utilization rate of each feature varied from 21.6% (goal setting and feature-based log) to 91.4% (information on dietary phosphate and phosphate binder). The Conclusions: MyKidneyDiet-Phosphate Tracker PMA was acceptable to adult Malaysian HD patients as part of clinical phosphate management in low-resource settings.
Highlights
Hyperphosphatemia is prevalent in the end-stage kidney disease population [1]
The theoretical principle underpinning this phosphate mobile application (PMA) development was based on the seven-stage Precaution Adoption Process Model, which applies the stages of change in health behaviors to phosphate management in HD patients [39]
Tracker PMA, PMA, which experts validated to improve the before we proceeded to the final evaluaexperts validated to improve the PMA before we proceeded to the final evaltion step forfor acceptance by by adult is a is novel mobile app app developed uation step acceptance adult patients
Summary
Hyperphosphatemia is prevalent in the end-stage kidney disease population [1]. InMalaysia, approximately 43% of hemodialysis (HD) patients have an above-recommended serum phosphate level >1.8 mmol/L [2]. Consuming phosphate binders with protein-rich meals is critical to managing serum phosphate levels along with prudent dietary phosphorus restriction [7]. These strategies have been shown to be limited in promoting desirable patient behaviors to achieve optimal serum phosphorus control [11]. Issues relate to barriers such as the lack of resources and expertise for patient education [12], poor patient knowledge on phosphate management [13], and phosphate binder medication compliance [11]. It appears that HD patients have the lowest knowledge about dietary phosphorus compared to other nutrients [14,15]. The complexity of phosphate origin compounds is a determinant of phosphate bioavailability, which is variously affected by organic animal (40–60%) and plant (10–30%) foods with phytates and inorganic (up to 100%) sources [16]
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