Adaptation of navigate-kidney: A community health worker intervention for people with kidney disease

INTRODUCTION: Patient self-management is critical for health outcomes for individuals with dialysis-dependent kidney failure. Latino populations with dialysis-dependent kidney failure have identified key barriers to self-management, including lack of tailored and patient-centered education, and social needs and challenges with health system navigation. Community health worker (CHW) interventions have been effective in reducing health disparities and promoting self-management; however, they have not been used for Latino individuals with dialysis-dependent kidney failure. To address these disparities, we describe adaptation of Navigate-Kidney, a CHW intervention for Latino individuals with hemodialysis-dependent kidney failure. 

METHODS: We used a community participatory approach with implementation science (IS) methodologies and retroactive framework application to guide intervention selection, adaptation, and evaluation of a CHW intervention for Latino individuals with hemodialysis-dependent kidney failure. Data sources included cross-sectional surveys, semistructured interviews, and field observations. 

RESULTS: Our needs assessment informed the selection and adaptation of a conservative care management-focused CHW intervention for Latino populations with dialysis. The feasibility of the adapted intervention (Navigate-Kidney) was evaluated in a single-arm clinical trial among 40 Latino individuals with dialysis-dependent kidney failure. Postintervention, participants and clinicians reported a need to prioritize support for social needs and health navigation, patient-centered education, and self-management. A randomized controlled trial (RCT), adapted to address these needs demonstrated significant improvement in interdialytic weight gain (IDWG), a surrogate marker for diet self-management. 

CONCLUSION: We describe the adaptation of the Navigate-Kidney, a CHW intervention for Latinos with dialysis-dependent kidney failure. IS methodologies can improve effectiveness and uptake of interventions, thereby reducing kidney health disparities.