E-health Guidance in identifying and Overcoming psychological barriers for Adopting a healthy Life style among patients with chronic kidney disease

For patients with chronic kidney disease (CKD), the adoption and maintenance of
self-care and a healthy life style is crucial, as it can postpone disease
progress and prevent cardiovascular complications. Unfortunately, most patients
with CKD experience problems in changing life style habits. Barriers and
facilitators to adopt and maintain a healthy life style are often psychological
factors, which form risk and resilience factors that influence quality of life
and determine how patients cope with CKD and the extent to which they are able
to change their life style habits. Therefore, it is essential to identify those
barriers and facilitators and treat psychological distress. As patients vary
regarding psychological distress levels and related difficulties in changing
life style habits, a personalized approach is needed that identifies patients*
personal risk profiles for (non)adaptation to CKD and the life style changes it
requires. The current project proposes an open randomized controlled trial with
(1) the development of a web-based screening tool and an accompanying patient
profile chart to identify psychological distress and barriers and facilitators
for behavior change among patients with CKD, and (2) a randomized multicenter
study to evaluate the effectiveness of an e-care path to treat psychological
distress, overcome psychological barriers, and promote psychological
facilitators for behavior change among patients with CKD. The findings will be
translated into practical recommendations about implementing a new e-care path.

The overall objective is to assess efficacy of an e-care path with screening
and treating psychological distress, to overcome psychological barriers and
promote psychological facilitators for life style behavior change among
patients with CKD. A secondary objective is to detect barriers and facilitating
factors among patients and health care professionals for successful nation-wide
implementation of the e-care path, resulting in a proposal for implementation
strategies.

The present study is an open randomized controlled trial, in which 120 CKD
patients are randomly assigned to either the control condition or intervention
condition. After the intervention two follow-up measurements (at 3 and 6 months
after the start of the intervention groups) will take place.

All patients will fill out a web-based screening questionnaire. Patients who
fulfill the criteria of heightened psychological distress and related life
style problems will be randomized to either the control or the intervention
condition. Patients in the control group will receive a feedback form about the
results of the screening, and further receive regular care. Patients in the
intervention condition receive tailored online cognitive behavioral therapy
aimed to treat psychological distress, overcome psychological barriers, and
promote psychological facilitators for behavior change among patients with CKD,
with feedback from a psychologist, in a period of maximally 3 months.

There are no risks attached to the study and the participating CKD patients are
at least 18 years old and mentally competent. The only burden for participants
is a time investment. The total involvement in the study for each individual
participant will be 6 months*approximately 1-1.25 hour per measurement moment
(self-report and clinical measurements) for controls and several additional
hours per week during the 3-month intervention period for participants
receiving the intervention, tailored to their personal needs and wishes. All
participants will receive insight into a range of domains of their
psychological functioning. Based on former studies in different populations,
the effects on health and quality of life of participants in the intervention
condition*the condition with the greatest required time investment*are expected
to be high, in proportion to the time investment burden.