JMIR Publications

ABSTRACT

Background:

Chronic kidney disease poses a major challenge to public health. In patients with chronic kidney disease, sound self-management has been shown to improve both proximal and distal outcomes. Currently, eHealth interventions are increasingly used to optimize patients’ self-management skills.

Objective:

To systematically review the existing evidence regarding eHealth self-management interventions for patients with chronic kidney disease.

Methods:

Following a search in eight databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. The quality of each study was appraised using the Crowe Critical Appraisal Tool. Narrative synthesis was performed to analyse the data extracted.

Results:

Of the 3307 articles retrieved, 24 studies were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of intervention (strategies) used and the outcomes measured. Nine effect and eight process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure, whereas satisfaction was the most frequently reported process indicator. Positive effects were found for proximal outcomes (e.g., blood pressure control, medication adherence), and mixed effects were found for more distal outcomes (e.g., quality of life, costs). High feasibility, usability, acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ‘feedback by care providers’ was mostly cited to influence patients’ adherence to interventions.

Conclusions:

There was an indication that eHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention (strategies) used are required. Future studies need to carefully consider their choice of outcomes, based on their sensitivity to change with eHealth interventions.