Patient Perspectives on Ways to Improve Participation and Engagement with Kidney Nutrition Education

Background: Lifestyle intervention programs can unify guidance to promote health for multimorbid conditions such as cardio-kidney-metabolic syndrome. Medical nutrition therapy is a covered benefit for patients with chronic kidney disease (CKD); however, only 10% of patients with CKD receive this benefit and awareness of nutrition resources is low. We aimed to learn facilitators and barriers to recruitment, retention, and preferences for a nutrition-focused lifestyle intervention. Methods: We interviewed 15 patients from our kidney clinic who previously enrolled in our CKD plant-based cooking classes and/or whole food voucher program redeemable at local farmer’s markets. A semi-structured interview guide aimed to elicit program characteristics which promote and dissuade recruitment and retention. Interviews were audio recorded and transcribed verbatim. The primary coder (LL) developed the codebook, both inductively based on interview content and deductively based on Capability-Opportunity-Motivation Behavior model and Behavior Change Wheel. Two coders (LL, LA) are in process of coding all interviews. Preliminary results are below. Results: Of 15 total interviewees, mean age was 62 years and 11 were women. Two preliminary themes from 10 of 15 coded transcripts were: 1) Interviewees desired more nutrition education, but a common barrier to use of available resources or programs was lack of awareness. Auto-enrollment into the whole food voucher program facilitated recruitment. Suggestions to improve awareness of upcoming courses included advertisements via newsletters, email or a website. 2) Aspects that would promote participation and retention in nutrition education were mode of delivery, structure of classes, and coverage of interesting topics. Most preferred an educational series with a mix of learning settings, such as groups to increase opportunity to learn and socialize with people with CKD, and individual sessions to enable personalized counseling. Preferred topics included meal-planning and eating with multi-morbid conditions and dietary limitations. Conclusion: Uncertainty of available resources reduces use of CKD nutrition resources. Automated advertisements or enrollment may improve inclusion and recruitment. Written education is appreciated, but peer groups and expert longitudinal coaching may increase use of interventions. Funding: Private Foundation Support