MyKidneyCoach, Patient Activation, and Clinical Outcomes in Diverse Kidney Transplant Recipients: A Randomized Control Pilot Trial

McLean D Pollock; Nicolas Stauffer; Hui-Jie Lee; Shein-Chung Chow; Ito Satoru; Lynnette Moats; Sherri Swan-Nesbit; Yan Li; John K Roberts; Matthew J Ellis; Clarissa J Diamantidis; Sharron L Docherty; Eileen T Chambers

doi:10.1097/TXD.0000000000001462

MyKidneyCoach, Patient Activation, and Clinical Outcomes in Diverse Kidney Transplant Recipients: A Randomized Control Pilot Trial

Transplant Direct. 2023 Mar 15;9(4):e1462. doi: 10.1097/TXD.0000000000001462. eCollection 2023 Apr.

Authors

Affiliations

¹ Department of Psychiatry, Duke University, Durham, NC.
² Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
³ Department of Surgery, Duke University, Durham, NC.
⁴ Department of Pathology, Duke University, Durham, NC.
⁵ Department of Medicine, Duke University, Durham, NC.
⁶ Department of Pediatrics, School of Nursing, Duke University, Durham, NC.
⁷ Department of Pediatrics, Duke University, Durham, NC.

Abstract

Kidney transplant (KT) recipients who are not actively engaged in their care and lack self-management skills have poor transplant outcomes, which are disproportionately observed among Black KT recipients. This pilot study aimed to determine whether the MyKidneyCoach app, an mHealth intervention that provides self-management monitoring and coaching, improved patient activation, engagement, and nutritional behaviors in a diverse KT population.

Methods: This was a randomized, age-stratified, parallel-group, attention-control, pilot study in post-KT patients. Participants were randomized into the attention-control with access to MyKidneyCoach for education and self-management (n = 9) or the intervention with additional tailored nurse coaching (n = 7). Feasibility, acceptability, and clinical outcomes were assessed.

Results: The acceptability of MyKidneyCoach by System Usability Scale was 67.5 (95% confidence interval [CI], 59.1-75.9). Completion rates based on actively using MyKidneyCoach were 81% (95% CI, 57%-93%) and study retention rate of 73%. Patient activation measure significantly increased overall by a mean of 11 points (95% CI, 3.2-18.8). Additionally, Black patients (n = 7) had higher nutrition self-efficacy scores of 80.5 (95% CI, 74.4-86.7) compared with 75.6 (95% CI, 71.1-80.1) in non-Black patients (n = 9) but lower patient activation measure scores of 69.3 (95% CI, 56.3-82.3) compared with 71.8 (95% CI, 62.5-81) in non-Black patients after 3 mo.

Conclusions: MyKidneyCoach was easy to use and readily accepted with low attrition, and improvements were demonstrated in patient-reported outcomes. Both Black and non-Black participants using MyKidneyCoach showed improvement in self-management competencies; thus, this intervention may help reduce healthcare inequities in KT.