Technology in Education of Patients with CKD in Singapore

Background: With high penetration of technology and a shrinking workforce in Singapore, healthcare is turning increasingly to the former to improve patients’ knowledge and self-management skills. However, for it to be effective, patients need to have adequate health literacy skills. In this study, we aim to evaluate current technology use, electronic health literacy and receptiveness of education via electronics means among our CKD patients. Methods: This is a cross-sectional survey of 200 CKD patients attending renal clinics at Sengkang General Hospital, Singapore between Feb-Jun 2022. The survey consisted of questions on technology use, the validated eHealth Literacy Scale (eHEALS), and patient preference of modality for CKD education. Results: We sampled 100 men and 100 women, median age was 56.5y (IQR 44.5-68). 51% of patients was CKD stages 1-3. 22.5% were on dialysis at the time of the study. 38.5% were not aware of their diagnosis of CKD. 37.5% had >10years of formal education. 53% were employed, 61.3% of whom were professionals. The median eHEALS score was 29 (IQR 24-32). 194 (97%) participants had mobile phones, with 158 (79%) using the internet on them. The top modality preferred for CKD education was for in person education by a renal coordinator (66.5%). Overall, 94 (47%) participants were receptive to education by electronic means (website or mobile application), though only 19.5% chose it as their top choice. Older participants were less likely to be receptive to education by electronic means (OR=0.95, CI 0.91-0.98, p=0.003), while those with a higher eHealth literacy were more likely (OR=1.14, CI 1.05-1.23, p=0.001). Education level and internet use on phone were not associated. Conclusion: Access to technology was high among our Singapore CKD patients but electronic health literacy scores lower than CKD counterparts in the US. Receptiveness to education by electronic means was associated with younger age and higher eHEALS scores. Face-to face education was still much preferred. Funding: Government Support – Non-U.S. Regression analysis for receptiveness of education via electronic means - Univariate analysis Multivariate analysis OR 95% CI p-value OR 95% CI p-value Age 0.95 0.93-0.97 <0.001 0.95 0.95-0.98 0.002 Education 2.15 1.43-3.27 <0.001 1.31 0.70-2.46 0.394 eHEALS score 1.17 1.10-1.25 <0.001 1.14 1.05-1.23 0.001 Internet use on phone 5.80 2.43-13.87 <0.001 1.05 0.30-3.72 0.935