Background
Chronic kidney disease (CKD) is a global public health problem and has become a common chronic non-communicable disease threatening human well-being. There is no effective cure for CKD, and once it progresses to end-stage renal disease, only renal replacement therapy can be performed, which brings a heavy medical burden to families and the country. Dietetic-nutritional management is closely related to delaying the progression of CKD and improving health outcomes and is essential in the treatment of CKD. However, dietary compliance of patients is currently a major challenge in clinical work. With the
integration of mobile Internet and healthcare, mobile health, represented by smartphones, has become an important tool for healthcare services. Previous studies have shown that information tools can motivate users to make positive eating behavior changes and improve their confidence in achieving their dietary goals. In recent years, diet management tools for
CKD patients have gradually increased in China, but most patients still face difficulties in self-managing their diet at home.
Aims
Given that the advantages of WeChat Mini Program in China and the cost limitation of the study, the purpose of this study is to follow the concept of human-centred design to design an open accessible WeChat Mini Program for home diet
management, and with CKD patients and caregivers as the target users, to ultimately improve the patient's experience of diet management and improve their dietary compliance to obtain the optimal benefits of medical nutrition therapy. To understand the usability and design flaws of this Mini Program through the prototype development and evaluation, to further improve the design and provide a reference for future development.
Methods
This study was divided into three stages. The first stage was the requirements analysis of diet management Mini Program: stakeholders, i.e., CKD patients and caregivers, renal dietitians, nephrologists, and specialist nurses, were interviewed through a qualitative study to explore their functional needs and suggestions for the Mini Program. The second stage was the design and expert evaluation of the Mini Program for CKD patients: based on literature review and stakeholders' requirements analysis and drawing on the features of the existing applications on the market, the first draft of the written design of this Mini Program was completed and then the written design and technical feasibility of the Mini Program were
evaluated by multidisciplinary experts, including renal dietitians, nephrologists and specialist nurses, as well as WeChat Mini Program development technicians, to further revise and finalize the written design of this Mini Program. The third stage was prototype development and evaluation of the Mini Program: using Mocking Bot to develop the prototype and then was a mixed study, 15 testers were recruited to evaluate the prototype by convenience sampling. mHealth App Usability Questionnaire (MAUQ) (patient version) was used to collect quantitative usability scores, and qualitative interviews were conducted to explore their experience and suggestions for improvement of the Mini Program.
Results
1. Requirements analysis of diet management Mini Program: 22 stakeholders were interviewed, including 9 CKD patients, 4 caregivers, and 9 clinical professionals. Three themes are extracted, which are attitudes towards the Mini Program (overall, highly expected the Mini Program for diet management), functional requirements of the Mini Program (including provide comprehensive diet management information, diet decision support, professional diet self-management skills, and emotional support channels), and performance requirements of the Mini Program (easy to use and learn, with simple interface). There are 12 specific functional requirements, which is expected to provide reliable dietary knowledge, food nutrient query, individualized dietary advice, dietary nutrition monitoring, customize individual recipes, recommend disease-specific foods, diet record and analysis, nutrition consultation, promote family participation, communication among patients, user feedback, and intelligent reminder. 2. Design and expert evaluation of the Mini Program: After two rounds of evaluation and feedback from multidisciplinary experts, the final version of the written design of the Mini Program was formed, including 4 modules, namely, Home Page, Interactive Community, Health Record, Personal Centre; and 19 functions, including Site
Search, Diet Management, Popular Science Articles, and News (Home Page), Circle of Patients, My Doctors, Doctor's Lectures, My Family (Interactive Community), BP Record, BG Record, Wt. Record, Exercise Record (Health Record), and Basic Information Setting, Health Report, My equipment, My favourites, My Posts, Product Introduction, Feedback and
Help (Personal Centre). 3. Prototype development and evaluation of the Mini Program: the prototype developed in this study was high-fidelity and interactive. Quantitative result: the mean value of the overall scoring of MAUQ was 1.39, with a standard deviation of 0.29, indicating that patients and caregivers recognize the Mini Program as usable. Qualitative
result: clinical professionals, CKD patients, and caregivers who participated in the testing have a high acceptance of the Mini Program. Clinical professionals consider the Mini Program to be comprehensive, helpful for patients' diet management, and to reduce the burden of clinical diet education; patients and caregivers consider the Mini Program to be a comprehensive, easy-to-use, and practical tool that facilitates access to professional knowledge, improves their confidence in diet management and social support, and they have a positive attitude towards using it and express their great expectations. The main shortcomings of the Mini Program are the need to adjust the colour scheme and optimize the layout of the user interface and to highlight the main functions of diet management, and to realize the function of voice use if the development technology is feasible.
Conclusion
The Mini Program designed in this study meet the needs and demands of home diet management for CKD patients and may positively affect their diet self-management. In the future, we consider further collaboration with information technology companies and clinical usability assessment and effectiveness evaluation would be necessary, to determine the clinical effect and economic cost-effectiveness of interventions for CKD patients based on such a WeChat Mini Program, and to promote the close integration of mHealth and clinical practice
