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BACKGROUND Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes and control health care expenditures. Using electronic health (eHealth) to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China in specific, is still limited. OBJECTIVE This study aimed to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch ‘Medical Dashboard (MD)’ eHealth self-management intervention. METHODS We used an Intervention Mapping approach. In phase 1, a systematic review and two qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and HCPs towards CKD self-management and eHealth interventions. After, key factors accumulated from the above-mentioned studies were categorized following five domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, and determinants, theory-based methods and practical strategies. Knowledge obtained from prior results were combined to adapt and complement core components of ‘MD’ self-management intervention for Chinese patients with CKD. Additionally, a CFIR-Expert Recommendations for Implementing Change Matching tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions and implementation strategies were discussed and finalized with the intervention monitoring group. RESULTS An overview of the CFIR domains showed the essential factors influencing the implementation of CKD self-management eHealth interventions in Chinese settings such as ‘knowledge & beliefs’ in the domain ‘individual characteristics’, ‘quality and advantage of eHealth intervention’ in the domain ‘Intervention characteristics’ and ‘compatibility’ in the domain ‘inner setting’, ‘cultural context’ in the domain “outer setting”. To ensure the effectiveness of the Dutch MD-based self-management intervention, we did not change the core self-management intervention components of MD that underline its effectivity, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of local population to enhance the intervention’s appeal, receptivity, and feasibility such as providing video- or voice call options to support interactions with HCPs. Furthermore, the adapted modules were developed in a mobile health application such as Knowledge Center and My Self-monitoring. CONCLUSIONS Our study results in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China, which has the potential to optimize patients’ self-management skills and improve health status and quality of life. Moreover, the research approach used and the results of our study inform future research on the tailoring and translation of evidence-based eHealth self-management interventions in various contexts.

BACKGROUND Chronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Currently, electronic health (eHealth) interventions are increasingly used to optimize patients’ self-management skills. OBJECTIVE This study aimed to systematically review the existing evidence regarding the implementation and effectiveness of eHealth self-management interventions for patients with CKD. METHODS Following a search in 8 databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. Quality was appraised using the Crowe Critical Appraisal Tool; narrative synthesis was performed to analyze the data extracted. RESULTS Of the 3307 articles retrieved, 24 (comprising 23 studies) were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of interventions used and the outcomes measured. A total of 10 effect and 9 process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure (BP), whereas satisfaction was the most frequently reported process outcome indicator. Positive effects were found for proximal outcomes (eg, BP control and medication adherence), and mixed effects were found for more distal outcomes (eg, quality of life). High feasibility, usability, and acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ability of health care professionals to monitor and, if necessary, anticipate on patient measurements online was mostly cited to influence patients’ adherence to interventions. CONCLUSIONS eHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention components used are required. In addition, our review reveals that outcomes closely related to the scope and duration of the intervention implemented are most likely to be impacted. For instance, if a 4-week Web-based training to optimize disease management skills is implemented, the outcome perceived control would more likely be affected than kidney function. Although this seems obvious, most studies evaluate only distal outcomes and thereby fail to capture intervention effects that might contribute to long-term health improvement. We advise future researchers to carefully consider their choice of outcomes based on their sensitivity for change. In this way, we ensure that relevant effects are captured and legitimate conclusions are drawn.