Moving Research to Practice: A Qualitative Study Exploring Patient Perspectives of the Implementation and Sustainability of a Digital Health Intervention for Chronic Kidney Disease.

Abstract

My Kidneys & Me (MK&M) is a digital health intervention (DHI) codeveloped to provide specialist health and lifestyle education aimed at enhancing self-management among individuals with chronic kidney disease. The MK&M DHI was shown to improve self-management behaviors in a multicenter randomized controlled trial (SMILE-K), but strategies to support effective integration into routine clinical practice are not known. This study aimed to explore patient perspectives about real-world implementation and sustainability of the MK&M DHI. For this substudy, participants from the SMILE-K trial were invited to take part in a semistructured qualitative interview to explore their perspectives on the implementation and sustainability of the MK&M DHI in routine clinical practice. Barriers and facilitators that could potentially influence the uptake and usage of the program in real-world settings, outside of a clinical trial, were also explored. Topics included accessibility, usability, integration into routine care, and types of support required to sustain engagement over time. Data were analyzed using reflexive thematic analysis. A total of 42 interviews were conducted with 35 individuals (mean age 62.5, SD 9.9, range 38-84 years; 23/35, 66% male; 33/35, 94% White British; estimated glomerular filtration rate: mean 33.5, SD 12.4 mL/min/1.73 m2). Five themes were identified, encompassing a range of critical factors that should be addressed to ensure the successful implementation of MK&M into routine kidney care and its alignment with real-world clinical needs. These include ensuring that information is timely, relevant, and tailored to individual needs. Participants highlighted the importance of promotion through multimodal strategies and approaches, leveraging diverse communication channels to maximize reach and engagement. Equitable access was identified as a priority, with potential barriers, such as digital literacy and digital poverty, requiring attention. Building trust, through reassurance and endorsement from trusted health care professionals, was seen as essential to strengthen confidence in MK&M. Finally, participants stressed the need for continued engagement and sustainability, ensuring that MK&M is successfully integrated into care pathways and supported over time to maintain its impact. The study findings highlight that timely, well-targeted communication using diverse strategies will be critical for the successful uptake of MK&M among people living with chronic kidney disease. The identification of perceived factors that will influence implementation of the program provides actionable insights to guide the development of tailored implementation strategies to ensure that MK&M is relevant, acceptable, and feasible in real-world practice. These findings provide a foundation for designing approaches that are not only patient-centered and inclusive but also adaptable to diverse clinical contexts. By addressing these factors proactively, implementation efforts can promote equitable access, foster sustained engagement, and support the long-term integration of DHIs, such as MK&M, into routine kidney care.