JMIR Publications

ABSTRACT

Background:

Digital therapeutics hold promise for improving self-management in chronic kidney disease (CKD), particularly for sodium restriction. However, the implementation of such interventions in real-world settings and the barriers to sustained engagement remain poorly understood.

Objective:

To conduct a convergent mixed-methods evaluation of a digital sodium restriction program for CKD patients, focusing on implementation processes, patient engagement trajectories, and the alignment between intervention design and lived experience.

Methods:

We conducted a prospective, single-center, convergent mixed-methods study. Quantitative measures included 24-hour urinary sodium excretion, knowledge tests, blood pressure and quality of life. Concurrently, we performed in-depth qualitative interviews with a purposive sample of participants. Quantitative and qualitative data were collected in parallel, analyzed separately, and then integrated to provide a comprehensive understanding of the patient experience.

Results:

Among 99 enrolled patients( (46 in the intervention group, 53 in the control group), the program led to a significant improvement in sodium-related knowledge (P=0.005). However, completion rates for the 24-hour urine collections were critically low (24%), precluding definitive conclusions about the primary behavioral outcome. Qualitative findings revealed a "measurement paradox," where the gold-standard assessment itself posed a major adherence barrier. Integration of data streams uncovered a patient journey characterized by an initial empowerment phase, often followed by a decline in engagement driven by digital fatigue, social pressures, and a misalignment between the intervention's demands and patients' daily lives. This misalignment created a disconnect between acquired knowledge and measurable behavior change.

Conclusions:

This study demonstrates that while knowledge-based gains are achievable, the success of digital dietary interventions is critically dependent on overcoming implementation barriers related to burdensome monitoring and contextual fit. We propose a "stage-matched intervention" framework as a roadmap for designing adaptive, person-centered digital tools that resonate with patients' lived experiences. Future research should prioritize pragmatic, multi-center trials embedded in routine care to validate these findings and bridge the persistent gap between knowledge and action in CKD management.