Preferences for digital health services among patients with chronic kidney disease: a discrete choice experiment

Digital health technologies offer novel approaches for chronic kidney disease management. However, quantitative evidence on patient preferences for digital health services remains limited. There is a critical need for more evidence on the sustainability and optimization of chronic kidney disease management in China, especially from the demand side. Policymakers require detailed data on the needs of chronic kidney disease patients regarding digital health services.

A discrete choice experiment was conducted to measure the preferences of people with chronic kidney disease. Participants were recruited face-to-face in Sichuan Province, China, and completed an anonymous electronic questionnaire on-site. The mixed logit model evaluated participants' preferences for six attributes, estimating willingness to pay and relative importance, and performing subgroup analysis based on the initial model results.

A total of 322 patients completed the questionnaire (mean age 49.8 years; 55.3% female). Out-of-pocket cost was the most influential attribute (relative importance 50.8%), followed by healthcare provider type (17.2%) and consultation frequency (10.0%). Patients preferred the combination of an attending nephrologist and a clinical nurse specialist (coefficient = 0.716; 95% CI, 0.510-0.921) and a higher consultation frequency (coefficient for five consultations per month = 0.414; 95% CI, 0.208-0.620). Willingness to pay for the combined provider team was 52.99 yuan. Exploratory subgroup analyses suggested possible differences in preferences by sex, age, disease duration, and comorbidity type, but most formal between-group comparisons were not statistically significant and were unadjusted for multiple testing.

Out-of-pocket cost is the primary determinant of digital health service selection among patients with chronic kidney disease. The type of healthcare provider is critical for service appeal. Exploratory subgroup analyses suggested possible preference differences across patient groups, indicating that stratified or preference-sensitive service designs may merit further investigation. Future research should examine whether aligning digital health services with patient preferences is associated with improved engagement or outcomes in real-world settings.