Periodic Reporting for period 1 - DIGIPSYCHINCKD (DIGI-PSYCH-IN-CKD: Digital Psychological Inoculation to Promote Self-Efficacy in People Living with Chronic Kidney Disease)
Reporting period: 2020-10-01 to 2021-12-31
Chronic Kidney Disease (CKD) affects 850 million people worldwide, and 12% of the population in Europe. It is an irreversible condition that leads to end stage renal disease that requires dialysis. In Europe, 1 in 100 women and 1 in 75 men will need dialysis therapy at any point in their life. Dialysis therapy costs societies in Europe up to €80,000 per person per year. Moreover, it causes anxiety and distress among patients and their relatives. Effective treatment requires lifestyle intervention in addition to medical treatment to prevent CKD progression. Intensive coaching is highly effective. However, there is a shortage of healthcare professionals.
To address this societal problem Binnovate Digital Health B.V. is developing Renal Tracker, a digitally-delivered, multi-intervention program that trains people with CKD in self-management to help reduce CKD progression and delay dialysis. The program takes a modular approach and offers interventions based on a user’s needs. Renal Tracker is based on scientific models for health behavior, behavior change, and learning as well as international guidelines for the treatment of CKD. As Renal Tracker is a digital therapeutic with blended offline elements it is scalable to service a large number of people with CKD. Furthermore, the content can be adjusted to different languages and cultures. Still, in order to increase motivation and self-efficacy in people living with CKD, Renal Tracker uses motivational interviewing with a health coach, which is labor intensive. We are looking to add digital psychological inoculation - a form of cognitive behavioral therapy - to support or even replace the motivational interviewing and increase the scalability and adaptability of Renal Tracker.
The Innovation Associate will be responsible for motivation and self-efficacy design in Renal Trackerm including
1) Identify personal beliefs and social barriers of people living CKD that prevent adoption of a healthy lifestyle.
2) Identify key threats to adoption of a healthy lifestyle for users of Renal Tracker.
3) Identify possibilities to integrate psychological inoculation in Renal Tracker.
4) Determine modes of delivery of psychological inoculation prompts.
5) Design a framework to iteratively design, test, and evaluate psychological inoculation.
To address this societal problem Binnovate Digital Health B.V. is developing Renal Tracker, a digitally-delivered, multi-intervention program that trains people with CKD in self-management to help reduce CKD progression and delay dialysis. The program takes a modular approach and offers interventions based on a user’s needs. Renal Tracker is based on scientific models for health behavior, behavior change, and learning as well as international guidelines for the treatment of CKD. As Renal Tracker is a digital therapeutic with blended offline elements it is scalable to service a large number of people with CKD. Furthermore, the content can be adjusted to different languages and cultures. Still, in order to increase motivation and self-efficacy in people living with CKD, Renal Tracker uses motivational interviewing with a health coach, which is labor intensive. We are looking to add digital psychological inoculation - a form of cognitive behavioral therapy - to support or even replace the motivational interviewing and increase the scalability and adaptability of Renal Tracker.
The Innovation Associate will be responsible for motivation and self-efficacy design in Renal Trackerm including
1) Identify personal beliefs and social barriers of people living CKD that prevent adoption of a healthy lifestyle.
2) Identify key threats to adoption of a healthy lifestyle for users of Renal Tracker.
3) Identify possibilities to integrate psychological inoculation in Renal Tracker.
4) Determine modes of delivery of psychological inoculation prompts.
5) Design a framework to iteratively design, test, and evaluate psychological inoculation.
Summary of the work
Part 1: Design and implementation of Digital Psychological Inoculation
Objectives
* Develop a minimal set of psychological inoculation challenges and refutations specific to self management of chronic kidney disease.
* Create a digital version of the challenges and refutations for user testing in the digital platform environment.
* Determine the impact of digital psychosocial inoculation on program adherence.
* Determine the impact of digital psychosocial inoculation on self management capabilities of people with chronic kidney disease.
Approach
Dr Einav Levy, the Innovation Associate performed a review of scientific literature to arrive at a minimal set of refutations for pilot testing. Next, a prototype for psychological inoculation in people with chronic kidney disease was created and tested. We captured pseudonymous data on all challenges and refutations for further analysis. A fully digitized version of the psychological inoculation was then incorporated into the Renal Tracker Delay program.
Results
In total, 191 of 228 users who started the program completed the initial set of refutations and challenges. Strength of refutations predicted program retention. Notably, people who picked the second strongest refutation to the challenges were most likely to complete the program (40% to 65%). By comparison, participants who picked weaker refutations were half as likely to retain (20% to 30%). Likewise, participants who picked the strongest refutations were somewhat less likely to complete the program (10% to 50%).
Using the insights gathered from the first stage of the work, we have set out to create a second program, called Decide, to support shared decision making in end stage chronic kidney disease. The program will include:
* Segmentation on decision making style and self efficacy
* Tailored education based on decision making style and self efficacy
* Deeper tailoring of PI, notably reinforce strong refutations by making follow-up refutations less clear and more life-like. This may reduce ‘overconfidence’.
We will determine the impact of psychological inoculation on decision making style and self efficacy in the Decide program.
Part 2: Impact on self-efficacy and decision making in kideny failure modality preferences
Background
The aim of the present study was to show a proof-of-concept for digital psychological inoculation to promote user's self efficacy and help them identify and communicate treatment preference should they reach kidney failure.
Methods
This is an experimental case-series with before and after measurements of the self efficacy and decision making style. Participants enrolled in a 4 week online course. Data was collected through online surveys.
Results
In total, 5 people with CKD stage 4 and 11 people with CKD stage 5 participated in the program, . Their average self efficacy score was 3.96 out of 5 at baseline and remained similar at 3.65 after the program. The majority of participants were rational decision makers. At the end of the program 9 participants reported a preference, being kidney transplantation (n=3), conservative management (n=2), home dialysis (n=1), and in-center dialysis (n=1).
Conclusions
A substantial number of participant reported a clear treatment preference. Notably, only one out of 10 opted for in-centre dialysis despite it being the most commonly offered treatment. A caveat to these findings is that our participants were self referred and actively searching the internet for information.
Part 1: Design and implementation of Digital Psychological Inoculation
Objectives
* Develop a minimal set of psychological inoculation challenges and refutations specific to self management of chronic kidney disease.
* Create a digital version of the challenges and refutations for user testing in the digital platform environment.
* Determine the impact of digital psychosocial inoculation on program adherence.
* Determine the impact of digital psychosocial inoculation on self management capabilities of people with chronic kidney disease.
Approach
Dr Einav Levy, the Innovation Associate performed a review of scientific literature to arrive at a minimal set of refutations for pilot testing. Next, a prototype for psychological inoculation in people with chronic kidney disease was created and tested. We captured pseudonymous data on all challenges and refutations for further analysis. A fully digitized version of the psychological inoculation was then incorporated into the Renal Tracker Delay program.
Results
In total, 191 of 228 users who started the program completed the initial set of refutations and challenges. Strength of refutations predicted program retention. Notably, people who picked the second strongest refutation to the challenges were most likely to complete the program (40% to 65%). By comparison, participants who picked weaker refutations were half as likely to retain (20% to 30%). Likewise, participants who picked the strongest refutations were somewhat less likely to complete the program (10% to 50%).
Using the insights gathered from the first stage of the work, we have set out to create a second program, called Decide, to support shared decision making in end stage chronic kidney disease. The program will include:
* Segmentation on decision making style and self efficacy
* Tailored education based on decision making style and self efficacy
* Deeper tailoring of PI, notably reinforce strong refutations by making follow-up refutations less clear and more life-like. This may reduce ‘overconfidence’.
We will determine the impact of psychological inoculation on decision making style and self efficacy in the Decide program.
Part 2: Impact on self-efficacy and decision making in kideny failure modality preferences
Background
The aim of the present study was to show a proof-of-concept for digital psychological inoculation to promote user's self efficacy and help them identify and communicate treatment preference should they reach kidney failure.
Methods
This is an experimental case-series with before and after measurements of the self efficacy and decision making style. Participants enrolled in a 4 week online course. Data was collected through online surveys.
Results
In total, 5 people with CKD stage 4 and 11 people with CKD stage 5 participated in the program, . Their average self efficacy score was 3.96 out of 5 at baseline and remained similar at 3.65 after the program. The majority of participants were rational decision makers. At the end of the program 9 participants reported a preference, being kidney transplantation (n=3), conservative management (n=2), home dialysis (n=1), and in-center dialysis (n=1).
Conclusions
A substantial number of participant reported a clear treatment preference. Notably, only one out of 10 opted for in-centre dialysis despite it being the most commonly offered treatment. A caveat to these findings is that our participants were self referred and actively searching the internet for information.
The present work has gone beyond the state of the art by delivering digital asynchonous psychological inoculation. This means that this form of cognitive behavioral therapy can be performed at scale to help people cope with life events, psychological distress and support their self-efficacy in shared (medical) decision making. Research shows that the higher the self efficacy, the more satisfied people are with their health decisions, and the higher their quality of life. Moreover, automated data capture allows for continuous refinement of the psychological inoculation to better tailer the subject's needs.
One of the challenges that we faced was the fact that the intervention appeared to have resulted in drop-out among users who opted for weak refutations. In order to overcome this, additional steps are required such as uplift modeling to further segment users into groups who may benefit from digital psychological inoculation and those who may benefit from other interventions, such as motivational interviewing prior to psychological inoculation.
Digital psychological inoculation is a promissing technique that does not only apply to the field of kidney disease, it may also be used in mental illness or even in mass media health campaign, for example of social media platforms.
One of the challenges that we faced was the fact that the intervention appeared to have resulted in drop-out among users who opted for weak refutations. In order to overcome this, additional steps are required such as uplift modeling to further segment users into groups who may benefit from digital psychological inoculation and those who may benefit from other interventions, such as motivational interviewing prior to psychological inoculation.
Digital psychological inoculation is a promissing technique that does not only apply to the field of kidney disease, it may also be used in mental illness or even in mass media health campaign, for example of social media platforms.