A Behaviorally Informed Patient-Facing Intervention to Promote Albuminuria Testing in Hypertension: A Mixed-Methods Evaluation of KnowCKD

Background: Albuminuria testing to diagnose chronic kidney disease (CKD) and guide blood pressure management is recommended for adults with hypertension but remains underused in part due to suboptimal patient understanding of its importance. Patient facing behavioral interventions have the potential to bridge this gap. We developed and evaluated KnowCKD, a behaviorally informed intervention designed to increase patient awareness of CKD and knowledge and promote albuminuria testing among adults with hypertension. Methods: KnowCKD consisted of an educational infographic and brief, behaviorally informed messages delivered to patients' smartphones during the 5 days leading up to and including a scheduled primary care visit at one academic medical center. Among 57 adults with hypertension without diabetes or recent albuminuria testing, we assessed changes in CKD awareness and knowledge and patient-reported engagement via survey pre- and post- exposure to KnowCKD. Electronic Health Record (EHR)- confirmed albuminuria or proteinuria testing was compared with 182 contemporaneous primary care controls using unmatched and propensity score-matched analysis. A postintervention focus group evaluated participant experiences. Results: After exposure to KnowCKD, recognition that adults with hypertension should undergo urine testing increased from 58% to 95%, knowledge that albuminuria indicates protein in the urine increased from 47% to 95%, and awareness that testing facilitates early CKD detection increased from 55% to 100% (P <0.001 for all). After the primary care visit, 77% of patients reported asking their clinician about urine testing and 65% reported that testing was ordered. EHR-confirmed albuminuria or proteinuria testing occurred in 36.8% of KnowCKD participants versus 11.0% of controls (risk ratio, 3.35 [95% CI, 1.96-5.73]; absolute risk difference, 25.9 percentage points [95% CI, 12.5- 39.2]). The propensity score-matched risk ratio was 2.93 (95% CI, 1.59-5.42). Participants described KnowCKD as timely, understandable, and actionable and emphasized trusted health-system communication for broader implementation. Conclusions: KnowCKD was associated with increased patient awareness of CKD and knowledge, patient engagement, and higher EHR-confirmed albuminuria or proteinuria testing among adults with hypertension. A rigorous evaluation of KnowCKD implementation within routine health-system workflows is warranted as a next step.