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.

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.