A dual efficacy-implementation trial of a novel mobile application for childhood nephrotic syndrome management: the UrApp for childhood nephrotic syndrome management pilot study protocol (UrApp pilot study)

• Type of Material: Article
• Authors: Chia-shi Wang, Emory University; Ngoc-Cam Escoffery, Emory University; Rachel Patzer, Emory University; Courtney McCracken, Emory University; Diana Ross, Emory University; Michelle N. Rheault, University of Minnesota; Amira Al-Uzri, Oregon Health and Science University; Larry Greenbaum, Emory University
• Language: English
• Date: 2020-04-09
• Publisher: BMC Publishing
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12882-020-01778-w
• Title of Journal or Parent Work: BMC Nephrology
• Volume: 21
• Issue: 1
• Start Page: 125
• End Page: 125
• Grant/Funding Information: This study is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K23DK118189.
• Keywords: Mobile application; Child; Adherence; Urology & Nephrology; Life Sciences & Biomedicine; Science & Technology; Engagement; Nephrotic syndrome; Self-management
• Research Categories: Psychology, Behavioral; Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Health Sciences, Human Development

Abstract

Background: Idiopathic nephrotic syndrome has a relapsing-remitting course in the majority of pediatric patients, demanding vigilant monitoring and self-management. A novel, expert-designed, user-informed mobile application (app), UrApp, was created to support management tasks, including home urine protein monitoring. Methods: The UrApp Pilot Study (ClinicalTrials.gov, NCT04075656) is a randomized trial comparing UrApp-supported nephrotic syndrome management with standard-of-care with parallel process evaluation of the intervention delivery. Sixty caregivers of children with newly diagnosed, steroid-sensitive nephrotic syndrome will be randomized 1:1 to UrApp-supported care or standard-of-care. Follow-up will be 1 year, with primary outcomes of adherence to urine monitoring and medications assessed at 6 and 12 months. Secondary outcomes at 6 and 12 months include self-efficacy, quality-of-life, hospitalizations and delayed relapse diagnoses. A mixed-methods approach will evaluate UrApp engagement, use retention, features used, user perceptions, and contextual barriers and facilitators of UrApp use. User behavior will be assessed for relationships to the primary and secondary outcomes. A Stakeholder Committee of volunteer trial participants, clinicians, and engineers will examine the trial results and design a pragmatic UrApp-enhanced nephrotic syndrome intervention with potential for wide implementation. The final UrApp intervention will be tested in a user-centered hybrid effectiveness-implementation trial designed with stakeholder input. Discussion: The UrApp Pilot Study examines the efficacy of a novel app designed specifically for nephrotic syndrome. The protocol involves dual efficacy and process evaluation aims to increase efficiency and incorporates the stakeholders’ perspective in formative assessment to inform intervention redesign and the design of a future user-centered trial. Trial registration: ClinicalTrials.gov, NCT04075656. Registered on September 2, 2019, https://clinicaltrials.gov/ct2/show/NCT04075656