A single-center, prospective, randomized, parallel-controlled clinical trial conducted in Zhuhai, China, has demonstrated that health coaching significantly improves health information literacy (HIL) in patients with chronic kidney disease (CKD) stages 3-4. The study, which enrolled 130 participants, highlights the potential of health coaching to enhance self-management skills and improve health outcomes in this patient population.
The trial, registered with the China Clinical Trial Registry (ChiCTR2100053103), randomized participants to either a 12-month health coaching intervention group or a control group receiving routine care. The intervention comprised courses tailored to the patients' health literacy, mini-lectures, WeChat sharing salons, exercise check-ins, and personalized dietary prescriptions. The primary outcome was the improvement in patients' ability to obtain, understand, and apply health information and services, as well as improvement in self-management ability.
Study Design and Methods
The study enrolled patients aged 18 years or older diagnosed with stage 3-4 CKD according to the K/DOQI guidelines. Exclusion criteria included severe impairment of vital organs, mental or cognitive disorders, and inability to sign informed consent. Participants in the intervention group received health coaching in addition to routine care. The health coaching program included weekly articles, mini-lectures (5-10 minutes each), personalized dietary prescriptions every 4-6 weeks using a CKD diet prescription tool developed by Fresenius Kabi AG, and encouragement for daily exercise check-ins via the "Tencent exercise time" app.
Randomization was performed using IBM SPSS Statistics ver. 21, with block group randomization stratified by age, literacy, and work status. Allocation concealment was ensured through automated assignment using the Research Electronic Data Capture (REDCap) randomization module. While blinding of participants and physicians was not possible, staff members responsible for outcome measurements were kept unaware of the intervention details.
Key Findings
The primary outcomes focused on the ability of patients with CKD stage 3–4 to correctly obtain, understand, and apply health information and services, as well as improvement in patients’ self-management ability. The CKD Health Information Literacy Questionnaire, which contains 6 dimensions and 24 items, was used to assess these outcomes. The overall Cronbach’s A coefficient was 0.922, indicating good structural validity.
Secondary outcomes included improvements in hemoglobin, platelet, albumin, and other renal function-related indices. These were collected before and after 12 months of follow-up.
Implications for CKD Management
The study's findings suggest that health coaching can be a valuable tool for improving health information literacy and self-management skills in patients with CKD. By providing tailored education, support, and encouragement, health coaches can empower patients to make informed decisions about their health and adhere to recommended treatments and lifestyle modifications. The personalized dietary prescriptions, developed using the Fresenius Kabi AG tool, further enhance the intervention's effectiveness by addressing individual nutritional needs and risk factors.
Limitations
The study acknowledges a higher-than-expected loss to follow-up rate (12%) due to the COVID-19 pandemic, which may have impacted the results. Additionally, the single-center design limits the generalizability of the findings to other populations and healthcare settings. Future research should explore the effectiveness of health coaching in diverse populations and investigate the long-term impact of the intervention on clinical outcomes and healthcare costs.
