Participant Experiences in a Kidney Failure Care Intervention in the Navigate-Kidney Study.

Katherine Rizzolo, Julie Ressalam, Kayla Robledo, Elizabeth Juarez-Colunga, Neil R Powe, Jennifer E Flythe, Russell E Glasgow, Spero M Manson, Romana Hasnain-Wynia, Michel Chonchol, Seth Furgeson, Allison Jaure, Chiadi E Ndumele, Claudia Camacho, Daniel Cukor, Ladan Golestaneh, Delphine S Tuot, Lauren McBeth, Lilia Cervantes

Journal: JAMA network open 2025;8(11):e2548506

PMID: 41203231

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Abstract

IMPORTANCE

Latino individuals with dialysis-dependent kidney failure experience social challenges that render self-management of kidney disease difficult. In the Navigate-Kidney trial, a community health worker (CHW) intervention for Latinos receiving dialysis, intervention recipients experienced a decrease in interdialytic weight gain, a surrogate end point for patient self-management. Understanding how the Navigate-Kidney trial was experienced by participants is important when considering scalability and sustainment of the intervention.

OBJECTIVE

To examine participant perspectives on their experience in the Navigate-Kidney intervention.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study used semistructured interviews with participants receiving the Navigate-Kidney intervention. Participants received care at dialysis centers in Denver, Colorado, between November 2020 and August 2022 and were randomized to receive the Navigate-Kidney intervention. Interview transcripts were deidentified and analyzed using deductive thematic analysis. Data were examined from September 2024 to July 2025.

MAIN OUTCOMES AND MEASURES

The main outcomes were the themes and subthemes from the interviews.

RESULTS

Twenty-four Latino individuals (11 females [46%]; 13 males [54%]; mean [SD] age of 56 [11] years) participated. The identified themes and subthemes were (1) build trust through understanding health experience (cultivating a personalized connection, promoting optimism and resilience, demonstrating consistency and reliability); (2) address multilevel social and structural challenges to facilitate health system navigation (addressing health insurance barriers, improving food security, relieving the stress of administrative and financial tasks, bridging registered dietitian guidance, enabling attendance of and adherence to dialysis sessions and appointments, coordinating nonnephrology clinical care); (3) provide patient-centered education (improving language concordant communication, promoting health and numeracy literacy, providing culturally responsive dietary restriction); and (4) enhance self-management (exploring opportunities for transplant and peritoneal dialysis, facilitating quality of dialysis care and symptom management, encouraging medication adherence, increasing confidence in diet and fluid intake self-management, achieving clinical parameter targets, activating patients).

CONCLUSIONS AND RELEVANCE

In this qualitative study of participants in the Navigate-Kidney trial, participants' experience with CHWs built trusting relationships through empathy and consistent support, helped them navigate complex health and social systems, provided culturally and linguistically tailored education, and empowered them to manage their care. Understanding participant perspectives about those activities that promoted health and well-being is critical for future patient-centered adaptations of Navigate-Kidney and similar interventions.

Address: Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology, Boston, Massachusetts.; Evans Center for Implementation and Improvement Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston Massachusetts.; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.; Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, California.; Department of Medicine, University of California, San Francisco.; Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill.; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill.; Department of Family Medicine and ACCORDS Dissemination and Implementation Science Program, University of Colorado Anschutz Medical Campus, Aurora.; Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.; Department of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora.; Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.; Division of Cardiology, Department of Medicine, John Hopkins University School of Medicine, Baltimore, Maryland.; Departments of Medicine and Psychiatry, NYU Grossman School of Medicine, New York, New York.; Department of Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut.; Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco.

DOI: 10.1001/jamanetworkopen.2025.48506

MeSH Terms: Humans, Female, Male, Middle Aged, Qualitative Research, Hispanic or Latino, Colorado, Renal Dialysis, Adult, Patient Navigation, Aged, Kidney Failure, Chronic, Community Health Workers, Self-Management, Renal Insufficiency, White