Fostering Self-Empowerment in CKD Patients Through Food Choice Mapping

Fostering Self-Empowerment in Kidney Disease Patients Through Food Choice Mapping: A Pilot Study

This project aims to develop mapping of food choices available for chronic kidney disease (CKD) patients when dining out in Singapore. Following the mapping, a mobile application will be developed based on renal dining out food map mobile application (RENDOFOMAP) and trialed on patients with CKD. The specific aims of the project include:

1. Mapping out food choices suitable for patients with CKD when dining out in Singapore which will eventually be translated into a mobile application incorporating simple AI functionality.
2. To evaluate the impact of using RENDOFOMAP on self-empowerment, quality of life, nutritional status, and serum biochemistry in patients with CKD.
3. To evaluate the acceptability and user experience of RENDOFOMAP

Participants with CKD will use the newly developed mobile application to find out if there is improvement in self-empowerment, quality of life, nutritional status, and serum biochemistry.

Diet is integral in CKD management; however, it is not sustainable for patients in the long term if there is solely emphasis on food restrictions without providing knowledge on modifying food choices to allow enjoyment. Thus, a strategic nutritional education approach needs to be adopted to maximise cost-effectiveness.

Patients' self-empowerment is gaining recognition as a means to optimise hospital resource utilisation, reduce healthcare costs, and decrease patients' dependency on medical services. This is particularly relevant for patients with chronic kidney disease (CKD), who are required to adhere to a disease management regimen that often conflicts with their pre-diagnosis lives and priorities.

In recent years, mobile applications have emerged as a popular platform for delivering nutrition education programs. Research indicates that mobile applications designed to engage patients and promote self-management of CKD show promise in improving adherence to dietary restrictions related to sodium, potassium, phosphorus, protein, calories, and fluid intake. Some of these applications offer a range of features but will still need to be reviewed by dietitians during face-to-face consultations. This in-depth approach, while beneficial, may not fully optimise time efficiency for dietitians.

Thus, there is an impetus to create an improved mobile application for CKD nutritional management to allow patients to individualise food choices, on top of charting food intake in the form of food diary. Patients can be trained to use the application during dietetics session which can eventually help reduce time spent for each session thereby improving dietitians' workload.

The proposed application will also incorporate some preliminary Artificial Intelligence (AI) to offer personalised food choices for patients. This feature is expected to further enhance the user-friendliness and convenience of the application, thereby promoting its usage and empowerment among CKD patients.

Inclusion Criteria:

• Are fluent in English. This is necessary to ensure clear communication and understanding of study procedures and materials.
• Adequate proficiency in using smartphone i.e. downloading app, taking photo, completing e-forms within the mobile applications. This is essential for participants to effectively use the mobile application being tested.
• Diagnosed with CKD Stage 3B-5. This targets the specific patient population that the study aims to benefit.

Exclusion Criteria:

• Only fluent in languages other than English. This could hinder effective communication and understanding of the study.
• Diagnosis of cognitive deficit or neurological disorder. These conditions could impair the ability to follow study procedures or provide reliable data.
• Uncontrolled diabetes (HbA1c>8.5%). This condition could introduce additional health risks and confound study results.
• Recent hypoglycemic episodes. This could pose a safety risk during the study.
• Newly initiated on dialysis or planning for dialysis within the next 6 months. These patients may have rapidly changing health conditions that could affect study outcomes.
• Decompensated liver cirrhosis. This condition could complicate the interpretation of study results.
• Pregnant and lactating. These conditions could introduce additional variables that affect study outcomes.
• Inability to provide consent. This ensures that all participants can legally and ethically participate in the study