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Self-Monitoring and Self-Efficacy in Patients with Chronic Kidney Disease During Low-Sodium Diet Self-Management Interventions: Secondary Analysis of the ESMO and SUBLIME Trials

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Abstract

Background

Patients with chronic kidney disease are often requested to engage in self-monitoring sodium (i.e. salt) intake, but it is currently unknown how self-monitoring would empower them. This study aims to assess: (1) how frequent self-monitoring tools are being used during low-sodium diet self-management interventions; (2) whether self-efficacy (i.e. trust in own capability to manage the chronic disease) is associated with self-monitoring frequency; and (3) whether higher self-monitoring frequency is associated with an improvement in self-efficacy over time.

Method

Data from two multicenter randomized controlled trials (ESMO [n = 151] and SUBLIME [n = 99]) among adult Dutch patients with chronic kidney disease (eGFR ≥ 20–25 mL/min/1.73 m2) were used. In both studies, routine care was compared to a 3-month low-sodium diet self-management intervention with several self-monitoring tools (online food diary, home blood pressure monitor, and urinary sodium measurement device [only ESMO]). Data was collected on usage frequency of self-monitoring tools. Frequencies during the interventions were compared between low and high baseline self-efficacy groups using the Mann-Whitney U test and T-test and associated with changes in self-efficacy during the interventions using Spearman correlation coefficients.

Results

Large variations in self-monitoring frequency were observed. In both interventions, usage of self-monitoring tools was highest during the first month with sharp drops thereafter. The online food diary was the most frequently used tool. In the ESMO intervention, low baseline self-efficacy was associated with a higher usage frequency of self-monitoring tools. This finding was not confirmed in the SUBLIME intervention. No significant associations were found between usage frequency of self-monitoring tools and changes in self-efficacy over time.

Conclusion

Patients with low self-efficacy might benefit most from frequent usage of self-monitoring tools when sufficient guidance and support is provided.

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Acknowledgements

We would like to thank all the patients participating in the ESMO study and SUBLIME study. We are also grateful for the support by the staff of the participating centers, the research nurses, students, and data managers at Nefrovisie. The SUBLIME E-health modules were developed by Bonstato, in collaboration with Sandra van Dijk and Yvette Meuleman.

The ESMO Study Group

consists of Sandra van Dijk, Yvette Meuleman, Friedo W Dekker, Tiny Hoekstra, Gerjan Navis, Liffert Vogt, Paul JM van der Boog, Willem Jan W Bos, Gert A van Montfrans, Elisabeth W Boeschoten, Marion Verduijn, Lucia ten Brinke, Anke Spijker, Arjan J Kwakernaak, Jelmer K Humalda, Tonnie van Hirtum, Robin Bokelaar, Marie-Louise Loos, Anke Bakker-Edink, Charlotte Poot, Yvette Ciere, Sophie Zwaard, Glenn Veldscholte, Lara Heuveling, Marjolein Storm, and Karen Prantl.

The SUBLIME Study Group

consists of Gerjan Navis, Paul JM van der Boog, Sandra van Dijk, Jelmer K Humalda, Gerald Klaassen, Yvette Meuleman, Willem Jan W Bos, Olivier A Blanson Henkemans, Martin H de Borst, Goos D Laverman, Wilma Otten, Hannie Piels, Karin M Vermeulen, and Hanne de Vries.

Funding

The ESMO study was supported by grants from The Netherlands Organization for Health Research and Development - Medical Sciences (ZonMw: 300020016) and the Dutch Kidney Foundation (SB93). The SUBLIME study was funded by a grant from ZonMw (project number 837001005 of the ‘Doelmatigheidsonderzoek 2013–2015’ program) and the Dutch Kidney Foundation (PV48). They had no role in the study design (collecting, analysis, or interpretation of data), writing of the paper, and the decision to submit this paper.

Author information

Authors and Affiliations

  1. Department of Nephrology, Amsterdam University Medical Centers, VU University Amsterdam, Amsterdam, The Netherlands

    Tiny Hoekstra, Manouk Dam & Brigit van Jaarsveld

  2. Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands

    Tiny Hoekstra, Manouk Dam, Liffert Vogt & Brigit van Jaarsveld

  3. Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands

    Gerald Klaassen & Gerjan Navis

  4. Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

    Willem Jan W. Bos & Paul J. M. van der Boog

  5. Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands

    Willem Jan W. Bos

  6. Nephrology Section, Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Liffert Vogt

  7. Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands

    Sandra van Dijk

  8. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

    Yvette Meuleman

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  1. Tiny Hoekstra
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Consortia

on behalf of ESMO

  • Sandra van Dijk
  • , Yvette Meuleman
  • , Friedo W Dekker
  • , Tiny Hoekstra
  • , Gerjan Navis
  • , Liffert Vogt
  • , Paul J M van der Boog
  • , Willem Jan W Bos
  • , Gert A van Montfrans
  • , Elisabeth W Boeschoten
  • , Marion Verduijn
  • , Lucia ten Brinke
  • , Anke Spijker
  • , Arjan J Kwakernaak
  • , Jelmer K Humalda
  • , Tonnie van Hirtum
  • , Robin Bokelaar
  • , Marie-Louise Loos
  • , Anke Bakker-Edink
  • , Charlotte Poot
  • , Yvette Ciere
  • , Sophie Zwaard
  • , Glenn Veldscholte
  • , Lara Heuveling
  • , Marjolein Storm
  •  & Karen Prantl

and SUBLIME study group

  • Gerjan Navis
  • , Paul J M van der Boog
  • , Sandra van Dijk
  • , Jelmer K Humalda
  • , Gerald Klaassen
  • , Yvette Meuleman
  • , Willem Jan W Bos
  • , Olivier A Blanson Henkemans
  • , Martin H de Borst
  • , Goos D Laverman
  • , Wilma Otten
  • , Hannie Piels
  • , Karin M Vermeulen
  •  & Hanne de Vries

Corresponding author

Correspondence to Tiny Hoekstra.

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All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the ESMO study and the SUBLIME study.

Statement Regarding the Reference of Animals

This study does not contain any studies with animals performed by any of the authors.

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The authors declare no competing interests.

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Hoekstra, T., Dam, M., Klaassen, G. et al. Self-Monitoring and Self-Efficacy in Patients with Chronic Kidney Disease During Low-Sodium Diet Self-Management Interventions: Secondary Analysis of the ESMO and SUBLIME Trials. Int.J. Behav. Med. (2023). https://doi.org/10.1007/s12529-023-10240-8

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