OBJECTIVES: To detail patient challenges, and how technology support addressed them, in a remote patient activation intervention for hemodialysis patients (n = 93) from trained patient mentors (n = 26). MATERIALS AND METHODS: Using digital divide theory-derived codes, content analysis of: technology support program delivery data, hemodialysis clinic staff interviews, and support staff reflection papers. Descriptive statistics from postintervention mentee/mentor surveys. RESULTS: All mentees and 46.2% of mentors received support. Motivational access was targeted with explanations, rapport, and support availability. Study-provided, data-capable tablets enhanced material access, but internet access barriers persisted. Skills access was addressed by training; password-related challenges initially dominated. For usage access, on-demand technology support was balanced by engagement support: proactive prementoring session calls and login monitoring. DISCUSSION: Interventionists should examine internet coverage in targeted areas, potentially using multiple carriers. A balance between password usability and security is required. Engagement support may be needed. CONCLUSION: Technology support can close patient digital divides.

OBJECTIVE: Hemodialysis patients frequently experience dialysis therapy sessions complicated by intradialytic hypotension (IDH), a major patient safety concern. We investigate user-centered design requirements for a theory-informed, peer mentoring-based, informatics intervention to activate patients toward IDH prevention. METHODS: We conducted observations (156 hours) and interviews (n = 28) with patients in 3 hemodialysis clinics, followed by 9 focus groups (including participatory design activities) with patients (n = 17). Inductive and deductive analyses resulted in themes and design principles linked to constructs from social, cognitive, and self-determination theories. RESULTS: Hemodialysis patients want an informatics intervention for IDH prevention that collapses distance between patients, peers, and family; harnesses patients' strength of character and resolve in all parts of their life; respects and supports patients' individual needs, preferences, and choices; and links "feeling better on dialysis" to becoming more involved in IDH prevention. Related design principles included designing for: depth of interpersonal connections; positivity; individual choice and initiative; and comprehension of connections and possible actions. DISCUSSION: Findings advance the design of informatics interventions by presenting design requirements for outpatient safety and addressing key design opportunities for informatics to support patient involvement; these include incorporation of behavior change theories. Results also demonstrate the meaning of design choices for hemodialysis patients in the context of their experiences; this may have applicability to other populations with serious illnesses. CONCLUSION: The resulting patient-facing informatics intervention will be evaluated in a pragmatic cluster-randomized controlled trial in 28 hemodialysis facilities in 4 US regions.

Journal of the American Medical Informatics Association, ocab033, https://doi.org/10.1093/jamia/ocab033 In the originally publication of this article, co-author Leah Hein was omitted from the authorship list. This should read: “Matthew A Willis, Leah Brand Hein, Zhaoxian Hu, Rajiv Saran, Marissa Argentina, Jennifer Bragg-Gresham, Sarah L Krein, Brenda Gillespie, Kai Zheng, Tiffany C Veinot” instead of “Matthew A Willis, Zhaoxian Hu, Rajiv Saran, Marissa Argentina, Jennifer Bragg-Gresham, Sarah L Krein, Brenda Gillespie, Kai Zheng, Tiffany C Veinot.” The AUTHOR CONTRIBUTIONS statement also lacked details. This should read: “TV supervised the project and study design, TV designed data collection instruments for the observations and individual interviews, and LH designed focus group data collection instruments. TV, LH, and MA collected data, and LH conducted first-cycle data analysis. ZH designed ideas for the application and developed the application. MAW and TV conducted the literature review, analyzed data, developed the theoretical framework, and drafted the manuscript and revisions. RS, MA, JBG, SLK, BG, and KZ provided input into design of the study, substantive review, and final approval.” instead of “TV supervised the project and study design. MAW and TV conducted literature review, drafted the manuscript and revisions, analyzed data, and developed the theoretical framework. ZH designed ideas for the application and developed the application. TV and MA collected data. RS, MA, JBG, SLK, BG, and KZ contributed input into design of the study, substantive review, and final approval.” These errors have now been corrected.

Hemodialysis is life-saving therapy for end-stage renal disease; yet, 20% of hemodialysis sessions are complicated by intradialytic hypotension ("IDH"). There is a need for approaches to preventing IDH that account for their implementation contexts. Using Activity Theory, we outline the design of a digital diagnostic checklist to identify patients at risk of IDH. Checklists were chosen a priori as an outcome due to prior evidence of effectiveness. Drawing on individual interviews with 20 clinicians and three focus groups with 17 patients, we describe four activity systems within hemodialysis care. We then outline a novel design process that includes co-design activities with clinicians, and four rapid-cycle iterations that progressively incorporated activity system elements into checklist design. We contribute a new type of checklist design to HCI: one that supports diagnostic thinking rather than consistent task completion. We further broaden checklist design by including a formal role for patients in checklist completion.