Table 1.
Description of the ENTICE-CKD intervention according to the TIDieR checklist (16)
| Item Name/Number | Item Description | |||||
|---|---|---|---|---|---|---|
| Item 1: Brief name | ||||||
| ENTICE-CKD | ||||||
| Item 2: Why | ||||||
| Telehealth intervention may support patients with stage 3–4 CKD to improve their diet quality through access to education, coaching, and regular contact with a health professional. Improving access to dietary education may assist people with stage 3–4 CKD reduce their dietary sodium intake <100 mmol/d and improve their overall diet quality in line with the Australian Dietary Guidelines (17). These dietary changes are complex and different levels of telehealth tailoring and intensity may be needed to support and sustain dietary behavior change. | ||||||
| Item 3: What | ||||||
| ENTICE-CKD program workbook (available on request) | ||||||
| About ENTICE | Introduction page “The focus of the ENTICE program is to help you make gradual changes to your eating and physical activity habits that work for YOU – changes that become lifelong.” | |||||
| Section 1: Setting your goals and keeping track | “Use the following steps every time you set a SMART goal…” | |||||
| Section 2: Eating well for healthy kidneys | “The ENTICE program will help you to gradually make changes to your diet to meet the daily recommended serves of fruit, vegetables and wholegrain breads/cereals.” | |||||
| Section 3: Active living | “Participating in regular physical activity and reducing sitting time is very important for your health and wellbeing.” | |||||
| Section 4: Why is healthy eating important for my kidneys? | Did you know? “<4% of the Australians meet the recommended daily intake for vegetables. Research has shown that increasing your intake of vegetables by as little as ONE serve per day can help you live longer and stronger.” | |||||
| Section 5: Plan for success | “There are a number of things that affect what we eat and our overall energy intake. It is important to be aware of, pay attention to and plan for: How you eat; Where/why you eat?” | |||||
| Section 6: Self-monitoring and setting goals | Smart snacking | |||||
| Reflections | ||||||
| Tracking my food intake | ||||||
| Section 7: Additional healthy eating resources | Useful websites; healthy recipes | |||||
| Useful apps for mobiles or tablets | ||||||
| High/low potassium/phosphate foods (if required) | ||||||
| Healthier verse unhealthy takeaway options | ||||||
| Item 4: What, procedures | ||||||
| Primary care physicians and treating nephrologists retained full responsibility over their patients’ medical care at all times. The ENTICE-CKD intervention was adjunct to the usual care received, which in Australia, typically involves medical care with 3-mo follow-up of patients with stage 4 CKD, and 3–6 mo follow-up for patients with stage 3 CKD. Patients with stage 3–4 CKD do not typically receive dietary consultation with a dietitian, unless there is clinical indication (18). | ||||||
| Before receiving allocated intervention: after a face-to-face baseline assessment with the local site investigator, all participants received the ENTICE-CKD workbook after receiving the randomized intervention, which was designed by dietitians specialized in kidney disease, with extensive academic, clinician, and consumer input. | ||||||
| Phase 1: Intensive coaching using telephone calls and tailored text messages. | ||||||
| Each call was designed to align with each section of the workbook, and structured on the basis of the 5As framework (Assess, Advise, Agree, Assist, Arrange) (49). The overall sequence of calls had the purpose of aligning participants’ diets with a reduced dietary sodium intake to <100 mmol/d and improving their overall diet quality in line with the Australian Dietary Guidelines (17). | ||||||
| Intervention calls | ||||||
| Call 1 | ||||||
| Welcome to ENTICE-CKD | ||||||
| Information about the program | ||||||
| Feedback on baseline outcome measures | ||||||
| Complete section 1: goal setting | ||||||
| Discuss section 6: self-monitoring | ||||||
| Begin section 2: introduction the five food groups | ||||||
| Call 2 | ||||||
| Revisit goals | ||||||
| Recap Australia Guide to Healthy Eating, answer any questions | ||||||
| Continue section 2 (plate model, snacks, salt, label reading, potassium, and phosphate) | ||||||
| Call 3 | ||||||
| Revisit goals | ||||||
| Answer any questions on healthy eating | ||||||
| Complete section 3: active living | ||||||
| Call 4 | ||||||
| Revisit goals | ||||||
| Revisit any questions about active living/healthy eating | ||||||
| Complete section 4: why is healthy eating important for my kidneys | ||||||
| Complete section 5: planning for success; how, why, and where you eat and managing slips | ||||||
| Call 5 | ||||||
| Revisit goals | ||||||
| Answer any dietary or active living questions | ||||||
| Discuss section 7: additional information/ resources | ||||||
| Call 6 | ||||||
| Revisit goals | ||||||
| Revisit any questions participant may have | ||||||
| Discuss where to from here | ||||||
| Adjust text message frequency if desired | ||||||
| Text message component | ||||||
| Text message type | SCT construct | Example text | Intervention | Control | ||
| Phase 1 | Phase 2 | Phase 1 | Phase 2 | |||
| Education | Outcome expectations | Dietary fiber intake reduces ur cholesterol levels and controls ur blood sugar. Include wholegrain breads and cereals, fruits and veg regularly | 2–6 | 1–4 | NA | 6–8 |
| Self-monitor | Self-regulation | Hi [name], are u keeping track of ur fruit/vegetable intake every day? Remember ur goal to have 5 serves this week | 0–2 | 1–4 | NA | NA |
| Goal check | Self-regulation | Hi [name], did u reach ur goal to eat 5 fruits/vegetables 4 times this week? Text me back yes or no to let me know | 2 | 2–4 | NA | NA |
| Education (Safety protocol) | Low potassium diet | Choose high fiber, low potassium breakfast cereals. Good choices are Multigrain Weetbix, Rolled Oats, Guardian, Oatbritz, Special K | 0–2a | 0–2a | NA | 0–2a |
| Phase 2: Extended contact using tailored text messages only. At the end of phase 1 (3-mo study midpoint), participants completed their final coaching call and discussed their preferences for the timing and frequency of the phase 2 text messages. At 18 wk, participants received another tailoring call (no dietary coaching) to make individualized adjustments to their text message timing and frequency for the remaining 6 wk of the intervention. | ||||||
| Item 5: Provider | ||||||
| Two accredited practicing dietitians (RD equivalent) with additional training in behavior change, motivational interviewing, and kidney nutrition. Each participant in the intervention was assigned to one dietitian for the duration of the intervention. | ||||||
| Item 6: How | ||||||
| Phase 1 (mo 0–3) | Intervention: One-to-one coaching provided through six phone calls every 2 wk, and tailored text messages at a frequency requested by the participant (TIDieR item 4: text message component). | |||||
| Phase 2 (mo 3–6) | Intervention: Tailored text messages at a frequency requested by the participant (TIDieR item 4: text message component). | |||||
| Item 7: Where | ||||||
| Participants were in locations of their choosing as the intervention was delivered by telephone/mobile. | ||||||
| Item 8: When and how much | ||||||
| Phone calls: Intervention group participants received phone calls every 2 wk for 3 mo. | ||||||
| Text messages: Intervention participants received text messages every 2 wk for 6 mo. Control group participants received text messages for 3 mo (in phase 2 only) (TIDieR item 4: text message component). | ||||||
| Item 9: Tailoring | ||||||
| Telephone calls: Coaches could tailor the dietary guidelines to participants’ individual comorbidities and goals. Coaches documented any tailoring to the intervention in call logs. | ||||||
| Text messages: Tailored text messages were tailored to participants’ names, set goals and barriers to achieving each goal (examples can be seen under TIDieR item 4: text message component). | ||||||
| Safety tailoring: where required, coaches tailored the food group suggestions to be electrolyte controlled, only when clinically indicated or directly requested by participants. | ||||||
| Item 10: Modifications | ||||||
| Some participants who replied to the goal check text messages in a way the system could not recognize (i.e., not a yes/no response) were giving a tailored goal check reply message instead of the automatic system generated reply. No other modifications were made to the intervention during the course of the study. | ||||||
a
Educational permutations were only available for coaches to use if a participant experienced hyperkalaemia or hyperphosphataemia.
ENTICE-CKD, Evaluation of Individualized Telehealth Intensive Coaching to Promote Healthy Eating and Lifestyle in CKD study; TIDieR, template for intervention description and replication; SCT, social cognitive theory; NA, not applicable; RD, registered dietitian.