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Peer-reviewedCC BY 4.0Journal of Medical Internet Research

Recruitment, Engagement, Experiences, and Self-Reported Changes in a Digital Patient Activation Intervention to Improve Hemodialysis Session Stability: Mixed Methods Study

  • Megan Wickens1
  • Jennifer Bragg-Gresham2,3
  • Rajiv Saran2,3
  • Meera Tandan3
  • Marissa Argentina4
  • Dinesh Chatoth5
  • Kelli Collins Damron4
  • Michael Heung2,3
  • Sarah Krein6,7
  • Vu Le8
  • Ana Laura Licon3
  • Kara Eggebrecht1
4 more authors
  • Barbara Murphy5
  • Alicia Zerkle5
  • Kai Zheng9
  • Tiffany C Veinot1,10,11
11 affiliations
  1. 1School of Information University of Michigan Ann Arbor, MI United States
  2. 2Department of Internal Medicine, Division of Nephrology School of Medicine University of Michigan Ann Arbor, MI United States
  3. 3Kidney Epidemiology and Cost Center University of Michigan Ann Arbor, MI United States
  4. 4National Kidney Foundation New York, NY United States
  5. 5Fresenius Medical Care (United States) Waltham, MA United States
  6. 6Center for Clinical Management Research Veterans Affairs Ann Arbor Ann Arbor, MI United States
  7. 7Department of Internal Medicine, Division of General Medicine School of Medicine University of Michigan Ann Arbor, MI United States
  8. 8Institute for Clinical and Translational Science University of California, Irvine Irvine, CA United States
  9. 9School of Information and Computer Sciences University of California, Irvine Irvine, CA United States
  10. 10Department of Learning Health Sciences School of Medicine University of Michigan Ann Arbor, MI United States
  11. 11Department of Health Behavior and Health Equity School of Public Health University of Michigan Ann Arbor, MI United States
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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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial Registration: ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545

International Registered Report Identifier (IRRID): RR2-10.2196/46187

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Cite

BibTeXRIS
BibTeX
@article{wickens2026recruitment,
  title = {{Recruitment, Engagement, Experiences, and Self-Reported Changes in a Digital Patient Activation Intervention to Improve Hemodialysis Session Stability: Mixed Methods Study}},
  author = {Megan Wickens and Jennifer Bragg-Gresham and Rajiv Saran and Meera Tandan and Marissa Argentina and Dinesh Chatoth and Kelli Collins Damron and Michael Heung and Sarah Krein and Vu Le and Ana Laura Licon and Kara Eggebrecht and Barbara Murphy and Alicia Zerkle and Kai Zheng and Tiffany C Veinot},
  journal = {Journal of Medical Internet Research},
  year = {2026},
  month = oct,
  doi = {10.2196/93049},
  url = {https://doi.org/10.2196/93049},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Recruitment, Engagement, Experiences, and Self-Reported Changes in a Digital Patient Activation Intervention to Improve Hemodialysis Session Stability: Mixed Methods Study
AU  - Megan Wickens
AU  - Jennifer Bragg-Gresham
AU  - Rajiv Saran
AU  - Meera Tandan
AU  - Marissa Argentina
AU  - Dinesh Chatoth
AU  - Kelli Collins Damron
AU  - Michael Heung
AU  - Sarah Krein
AU  - Vu Le
AU  - Ana Laura Licon
AU  - Kara Eggebrecht
AU  - Barbara Murphy
AU  - Alicia Zerkle
AU  - Kai Zheng
AU  - Tiffany C Veinot
PY  - 2026
DA  - 2026/10/16
JO  - Journal of Medical Internet Research
DO  - 10.2196/93049
UR  - https://doi.org/10.2196/93049
AB  - 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.  Objective: 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.  Methods: 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.  Results: 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.  Conclusions: 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.  Trial Registration: ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545  International Registered Report Identifier (IRRID): RR2-10.2196/46187
SN  - 1439-4456
SN  - 1438-8871
ER  -