WCN25-1183 implementing CKD patient education in a low-resource setting: a mixed methods feasibility study in Western Kenya

Abstract

Introduction: Chronic Kidney Disease (CKD) is a huge public health concern in sub-Saharan Africa. As a chronic condition, it often requires strong patient engagement in self-management to slow disease progression and manage complications. CKD-specific knowledge gained from education programs mediates self-care behaviors and can lead to improved outcomes. Currently, there are no formal education efforts in place locally. To fill this gap, a CKD educational program was piloted and factors affecting implementation ease explored. Methods: A mixed methods study was conducted from October 2022 to May 2023. This pilot study used a convenience sample of 80 adult predialysis CKD patients for the quantitative arm. The qualitative arm included 10 patients from the quantitative cohort, stratified by gender and age, and 4 purposively sampled healthcare providers, stratified by cadre. For the first objective, CKD-specific knowledge was assessed before the intervention and 1 hour after a 45-minute, doctor-led group education session, which covered the causes, diagnosis, stages, and treatment of CKD, using the pre-validated Kidney Knowledge Survey (KIKs) tool. Changes in CKD knowledge were analyzed using descriptive statistics and a paired t-test in Stata version 16. Qualitative data was gathered from 14 in-depth interviews and analyzed using thematic analysis. Results: The median participant age was 49.5 years (IQR: 28–63). About 75% had at least a secondary education, and most had advanced CKD, with 66.3% in stage 3B or beyond. The pre-test mean Kidney Knowledge survey (KIKs) score was 52.1% ( 16.7). After the intervention, the average score increased significantly (t¼16.73, p<0.001) from 52.1% ( 16.8%) to 80.7% ( 8.6%), showing a 28.6% improvement. The intervention was well received by patients and healthcare providers, who noted benefits such as improved knowledge of medication and nutrition, renewed hope, better understanding of treatment plans, and a sense of empowerment for peersupport. However, patients found it challenging to understand the CKD stages, and providers noted an increased workload. Concerns were also raised about poor staffing, inadequate infrastructure, and insufficient provider skills for program implementation. Conclusions: The educational intervention significantly improved CKDspecific knowledge and was well-accepted by both patients and providers. However, challenges in staffing, infrastructure readiness, and provider skills could hinder the effective implementation of the program. The CKD intervention shows promise in enhancing patient engagement at the MTRH renal clinic and should be considered for adoption. To make the group CKD educational intervention feasible at MTRH and other low-resource settings, especially where financial constraints and low patient literacy are factors, it is necessary to revise the educational materials to improve understanding of CKD stages, address staffing issues, and empower providers with the skills needed for patient education. I have no potential conflict of interest to disclose. I did not use generative AI and AI-assisted technologies in the writing process.