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Nurse-Led Digital Intervention for Sodium Restriction in Chronic Kidney Disease: Mixed Methods Implementation Study
Yu Shi1, Hongmei Peng1, Youying Zhang1
1Department of Nephrology, Chongqing Key Laboratory of Prevention and Treatment of Kidney Disease, Chongqing Clinical Research Center of Kidney and Urology Diseases, The Second Affiliated Hospital (Xinqiao Hospital), Army Medical University (Third Military Medical University), 83 Xinqiao Zhengjie, Shapingba District, Chongqing, 400037, China, 86 13668007369.
JMIR Nursing
|July 20, 2026
Summary
Digital interventions improved sodium knowledge in chronic kidney disease patients but faced engagement barriers. Reducing monitoring burden and improving real-world fit are key for successful digital health tools.
Area of Science:
- Nephrology
- Digital Health
- Implementation Science
Background:
- Digital interventions show promise for supporting sodium restriction in chronic kidney disease (CKD).
- However, understanding implementation and engagement barriers remains a significant challenge.
- Effective strategies are needed to optimize digital health tools for CKD management.
Purpose of the Study:
- To evaluate a nurse-led digital program designed to support sodium restriction in CKD patients.
- To investigate implementation, patient engagement, and overall patient experience with the digital intervention.
- To identify barriers and facilitators influencing the effectiveness of digital health interventions in CKD.
Main Methods:
- A mixed methods approach was employed, integrating quantitative and qualitative data.
- Quantitative measures included 24-hour urinary sodium excretion, knowledge tests, blood pressure, and quality of life.
- Qualitative data were gathered through in-depth interviews to explore patient experiences and barriers.
Main Results:
- The digital program significantly improved sodium-related knowledge (P=.005) but had a low 24-hour urine collection completion rate (24.2%).
- Qualitative findings revealed a 'measurement paradox,' where the assessment method hindered adherence.
- Patient engagement declined due to digital fatigue, family resistance, and poor integration into daily life, creating a knowledge-behavior gap.
Conclusions:
- Nurse-led digital interventions can enhance sodium knowledge in CKD patients.
- Addressing the 'measurement paradox' and improving real-world applicability are crucial for success.
- A 'stage-matched intervention' framework is proposed to guide adaptive digital tool development for CKD management.
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