{ "abstract": "Background: When chronic kidney disease progresses to end-stage kidney disease, many patients receive in-center hemodialysis. Although lifesaving, hemodialysis is associated with intradialytic hypotension. Peer mentoring and patient activation support in hemodialysis have not been well studied.\n\nObjective: This Dialysafe study combined patient education and peer mentoring to promote health behaviors supporting prevention of intradialytic hypotension. We aimed to describe recruitment, engagement, completion, and attrition; assess participants’ health goals and self-reported behavior changes; and evaluate satisfaction and recommendations for improvement.\n\nMethods: At 10 Dialysafe hemodialysis centers assigned to patient activation, all eligible English-speaking patients were invited. The intervention comprised 5 educational modules and 5 videoconference peer-mentoring sessions. Mixed methods analyses integrated electronic health record and platform data, postintervention surveys, and clinic operations committee notes. An engagement score (range 0-50) summarized intervention use. Descriptive statistics, t tests, chi-square tests, logistic regression, and zero-inflated Poisson regression were used to assess recruitment, completion (all 5 mentoring sessions), and engagement. Qualitative data were inductively coded and integrated through joint displays.\n\nResults: Of the 639 eligible patients, 155 (24.3%) were recruited. Recruited patients were younger than nonrecruited patients (mean 57.6, SD 13.8, vs 64.3, SD 14.7 y; P<.001); each additional year was associated with 4% lower odds of recruitment (odds ratio [OR] 0.96, 95% CI 0.94-0.98; P<.001). Recruitment was more likely among college graduates (OR 1.70, 95% CI 1.02-2.83; P=.04) and patients with sleep disorders (OR 2.27, 95% CI 1.06-4.87; P=.03). Attrition was concentrated before mentoring sessions began. Of recruited patients, 72 of 155 (46.5%) met with a peer mentor and 58 of 155 (37.4%) completed all 5 sessions. Completers were 1.9 years younger (56.4, SD 13.8, vs 58.3, SD 13.9 y) and had Charlson Comorbidity Index scores 0.4 points higher (3.4, SD 2.0, vs 3.0, SD 2.3) than noncompleters. The average engagement score was 18.4 of 50 (SD 20.1). Engagement was higher among men (incidence rate ratio [IRR] 1.33, 95% CI 1.22-1.45; P<.001), Black patients (IRR 1.27, 95% CI 1.16-1.39; P<.001), and patients with dialysis vintage <1 year (IRR 1.22, 95% CI 1.05-1.42; P=.01). Higher Charlson Comorbidity Index scores predicted engagement (IRR 1.04, 95% CI 1.01-1.07; P=.002) and completion (OR 1.37, 95% CI 1.05-1.79; P=.02). Of 79 patients who set goals, 64 (81%) selected communication with the care team; 22 of 54 (40.7%) survey respondents identified this as their main behavior change. Both mentees and mentors identified peer-mentoring sessions as the most valuable component. Among mentee respondents, 55 of 55 (100%) respondents rated the program good or excellent, and 53 of 54 (98.1%) respondents would recommend it.\n\nConclusions: Participants constituted a self-selecting group. Patient-clinician communication was a priority, and participants valued peer mentoring. Digital patient activation intervention strategies to increase reach are needed.\n\nTrial Registration: ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545\n\nInternational Registered Report Identifier (IRRID): RR2-10.2196/46187", "abstract_shown": true, "affiliations": [ "School of Information University of Michigan Ann Arbor, MI United States", "Department of Internal Medicine, Division of Nephrology School of Medicine University of Michigan Ann Arbor, MI United States", "Kidney Epidemiology and Cost Center University of Michigan Ann Arbor, MI United States", "National Kidney Foundation New York, NY United States", "Fresenius Medical Care (United States) Waltham, MA United States", "Center for Clinical Management Research Veterans Affairs Ann Arbor Ann Arbor, MI United States", "Department of Internal Medicine, Division of General Medicine School of Medicine University of Michigan Ann Arbor, MI United States", "Institute for Clinical and Translational Science University of California, Irvine Irvine, CA United States", "School of Information and Computer Sciences University of California, Irvine Irvine, CA United States", "Department of Learning Health Sciences School of Medicine University of Michigan Ann Arbor, MI United States", "Department of Health Behavior and Health Equity School of Public Health University of Michigan Ann Arbor, MI United States" ], "article_type": "research article", "arxiv": null, "author_total": 16, "authors": [ { "affs": [ 0 ], "name": "Megan Wickens", "orcid": "0000-0002-7184-1689" }, { "affs": [ 1, 2 ], "name": "Jennifer Bragg-Gresham", "orcid": "0000-0002-9069-9489" }, { "affs": [ 1, 2 ], "name": "Rajiv Saran", "orcid": "0000-0001-7317-8756" }, { "affs": [ 2 ], "name": "Meera Tandan", "orcid": "0000-0002-7742-7980" }, { "affs": [ 3 ], "name": "Marissa Argentina", "orcid": "0000-0003-1974-626X" }, { "affs": [ 4 ], "name": "Dinesh Chatoth", "orcid": "0000-0002-6406-093X" }, { "affs": [ 3 ], "name": "Kelli Collins Damron", "orcid": "0000-0002-1745-3714" }, { "affs": [ 1, 2 ], "name": "Michael Heung", "orcid": "0000-0002-0533-3192" }, { "affs": [ 5, 6 ], "name": "Sarah Krein", "orcid": "0000-0003-2111-8131" }, { "affs": [ 7 ], "name": "Vu Le", "orcid": "0009-0003-7164-1454" }, { "affs": [ 2 ], "name": "Ana Laura Licon", "orcid": "0009-0001-9160-2044" }, { "affs": [ 0 ], "name": "Kara Eggebrecht", "orcid": "0009-0004-0756-5060" }, { "affs": [ 4 ], "name": "Barbara Murphy", "orcid": "0009-0004-2047-8754" }, { "affs": [ 4 ], "name": "Alicia Zerkle", "orcid": "0009-0000-5452-6997" }, { "affs": [ 8 ], "name": "Kai Zheng", "orcid": "0000-0003-4121-4948" }, { "affs": [ 0, 9, 10 ], "name": "Tiffany C Veinot", "orcid": "0000-0003-1200-9515" } ], "bibtex": "https://research.draconitic.com/paper/2cg53tffq83ap.bib", "cited_by": 0, "doi": "10.2196/93049", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13722927/", "id": "2cg53tffq83ap", "issns": [ "1439-4456", "1438-8871" ], "landing_url": "https://doi.org/10.2196/93049", "language": "en", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Original Paper" ], [ "openalex", "2727|Dialysis and Renal Disease Management" ] ], "openalex": "W7171416260", "pdf_url": null, "pmcid": "PMC13722927", "pmid": "42887003", "published": "2026-10-16", "publisher": "JMIR Publications Inc.", "ris": "https://research.draconitic.com/paper/2cg53tffq83ap.ris", "sources": [ { "first_seen": "2026-11-04T12:21:38Z", "native_id": "PMC13722927", "source": "pmc", "url": "https://doi.org/10.2196/93049" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2727|Dialysis and Renal Disease Management", "subfield": "general" } ], "title": "Recruitment, Engagement, Experiences, and Self-Reported Changes in a Digital Patient Activation Intervention to Improve Hemodialysis Session Stability: Mixed Methods Study", "title_text": "Recruitment, Engagement, Experiences, and Self-Reported Changes in a Digital Patient Activation Intervention to Improve Hemodialysis Session Stability: Mixed Methods Study", "type": "peer-reviewed", "updated_at": "2026-11-04T12:21:38Z", "url": "https://research.draconitic.com/paper/2cg53tffq83ap", "venue": "Journal of Medical Internet Research", "versions": [] }