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.
