Improving Dietary Choices Using a Digital Health Intervention in People with CKD

Background: We co-developed a digital health intervention (DHI) ‘My Kidneys & Me’ (MK&M) to support people with non-dialysis CKD to better self-manage health and lifestyle. MK&M includes theory-based educational and action (behaviour change) sessions about a healthy balanced diet, plus trackers for dietary goals. Here we report findings on dietary behaviours from a multicentre randomised control trial of MK&M. Methods: 420 participants aged ≥18 years with CKD stages 3-4 were recruited from 26 hospitals and randomised 2:1 to intervention (MK&M) (n=280) or control (n=140) groups. The UK Diabetes Diet Questionnaire (UKDDQ) was collected at baseline and 20-weeks via an online survey. The UKDDQ asks respondents how often they consumed certain foods and drinks over the last month. Items are scored on the frequency of consumption and classified into “healthy”, “less healthy” and “unhealthy” choices. Access to and usage data of MK&M were collected. Linear regression models, adjusted for baseline values, were conducted. Results: Of the 280 participants assigned to the intervention group, 225 (80%) used MK&M at least once. Over 20-weeks, the diet educational session was accessed by 107 (48%) participants and viewed 10.5 (±5.4) times for 11.0 (±15.0) minutes; the diet action session was accessed by 77 (35%) participants and viewed 12.1 (±5.7) times for 7.5 (±6.7) minutes. The healthy eating tracker was used by 32 (14%) participants. 30 (13%) participants set healthy eating goals (mean:1.6±1.2). At baseline, 44% MK&M (n=122) and 40% control (n=55) participants had a UKDDQ score in the healthy range (≥4) (mean:3.3±0.4). At 20-weeks, the proportion with a UKDDQ in the healthy range increased by 45% in MK&M group (44-64%, P<0.001) and 28% in control (40-51%, P<0.001). Significant between-group differences were observed for changes in the number of healthy (±0.8, P=0.024) and less healthy dietary choices (±0.5, P=0.027), with MK&M group increasing the number of healthy food choices (+0.7, P=0.005) and decreasing the number of less healthy food choices (-0.6, P=0.009). Conclusion: The use of MK&M DHI improved dietary food choices. People with CKD are interested in and actively engaged with DHIs to support healthy dietary habits. MK&M can be used to support people with CKD to improve their dietary behaviours.