Feasibility and Acceptability of a Co-Designed Self-Management Programme for People Living With Kidney Failure.

The study had no control group, so any change cannot be attributed to the programme alone. Only 30 participants were analysed, all from one clinic, so the results may not apply to other settings or more diverse patients. All participants spoke English and were mostly metropolitan, highly educated and health literate, limiting use for culturally and linguistically diverse patients or people with low health literacy. Follow-up was 12 weeks, which is too short to judge sustained self-management or preparedness for dialysis. Acceptability was measured with self-reported questions, and the 0-10 scale used for value, burden and recommendation was not formally validated. The study was not powered to detect changes in patient activation, and no minimal clinically important difference has been validated for this measure in kidney failure before dialysis. Motivational interviewing training for nurse practitioners was not certified and fidelity was not scored, so it is unclear how consistently the intervention was delivered. The programme combined motivational interviewing, goal setting, education modules and peer support, so the contribution of any single component cannot be separated. The reported low-burden percentage differs between the text (97%) and the table (93%), so acceptability figures should be read with care.

The authors declared no conflicts of interest, and the article does not report a funding source.

Do not read the high feasibility and acceptability as evidence that the programme improves activation or that any single component caused engagement. The mean activation score did not improve, the components were delivered together, and there was no control group.