Peer support interventions in patients with kidney failure: A systematic review.

BACKGROUND: Peer support has been associated with improved health-related outcomes (e.g., psychological well-being and treatment adherence) among patients with serious, chronic conditions, including kidney disease. Yet, there is little existing research evaluating the effects of peer support programs on health outcomes among patients with kidney failure being treated with kidney replacement therapy. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a systematic review using five databases to assess the effects of peer support programs on health-related outcomes (e.g., physical symptoms, depression) among patients with kidney failure undergoing kidney replacement therapy. RESULTS: Peer support in kidney failure was assessed across 12 studies (eight randomized controlled trials, one quasi-experimental controlled trial, and three single-arm trials) with 2893 patients. Three studies highlighted the links between peer support and improved patient engagement with care, while one found peer support did not significantly impact engagement. Three studies showed associations between peer support and improvements in psychological well-being. Four studies underscored the effects of peer support on self-efficacy and one on treatment adherence. CONCLUSIONS: Despite preliminary evidence of the positive associations between peer support and health-related outcomes among patients with kidney failure, peer support programs for this patient population remain poorly understood and underutilized. Further rigorous prospective and randomized studies are needed to evaluate how peer support can be optimized and incorporated into clinical care for this vulnerable patient population.

A novel health behaviour intervention to promote adherence in kidney failure.

BACKGROUND: Health behaviour adherence is associated with improved survival in kidney failure (KF); however, most patients with KF do not adhere to one or more health behaviours. Existing health behaviour interventions have significant limitations and do not focus on psychological factors that are associated with adherence and health. OBJECTIVES: To examine the feasibility, acceptability, and preliminary efficacy of a 12-week, phone-delivered, positive psychology-motivational interviewing (MI) intervention to promote psychological well-being and adherence in KF. DESIGN: Single-arm, proof-of-concept trial (N = 10). PARTICIPANTS: Participants were adults with KF undergoing haemodialysis and reporting suboptimal adherence to physical activity, diet, and/or medications. Participants attended weekly phone sessions with a study trainer, completed weekly positive psychology exercises (focused on gratitude, strengths, and meaning), and worked towards physical activity, diet, and/or medication goals. MEASUREMENTS: Feasibility was measured by the percentage of sessions completed, while acceptability was assessed through participant ratings of positive psychology and MI session ease and utility (0-10 Likert scales). We explored the intervention's impact on psychological outcomes and health behaviour adherence using validated scales and accelerometers. RESULTS: Participants completed 78% of sessions and rated the program's components as easy to complete (positive psychology: 8.7 ± 1.5; MI: 8.3 ± 2.0) and subjectively helpful (positive psychology: 8.8 ± 1.2; MI: 8.8 ± 1.6). The intervention led to promising but nonsignificant improvements in psychological and adherence measures. CONCLUSIONS: This 12-week, phone-delivered program was feasible, well-accepted, and associated with nonsignificant improvements health behaviour adherence, highlighting the need for a larger efficacy trial.

A tax on sugar sweetened beverages in Colombia: Estimating the impact on overweight and obesity prevalence across socio economic levels.

Colombia has a high prevalence of overweight (56%) and obesity (19%) among adults and is experiencing a growing trend in the prevalence of associated chronic conditions. Evidence suggests that sugar sweetened beverages (SSB) are associated to overweight/obesity, and that taxes on these beverages could reduce their associated health consequences. This paper assesses the potential effect of different levels of a SSB tax in Colombia on overweight and obesity prevalence. Using peer-reviewed local data on own-price elasticity of SSB, we applied a comparative risk assessment strategy to simulate the effect of the SSB tax on a nationally representative nutritional survey with 7140 adults in 2010 (ENSIN, 2010). Our results varied depending on the tax scenario, pass-through assumption and household socio economic strata (SES). We found that among individuals belonging to lower SES households, the SSB tax would reduce overweight and obesity between 1.5-4.9 and 1.1-2.4 percentage points (p < 0.05), respectively. Among individuals belonging to higher SES households, we found no statistically significant effects on obesity, and a reduction on overweight prevalence between 2.9 and 3.9 percentage points (p < 0.05). In the most conservative scenario (40% pass-through), a tax rate of at least 75 cents of Colombian peso (0.75 COP) per milliliter (24% of the average price) is needed to have statistically significant effects on both overweight and obesity prevalence among lower SES households. The results of this study suggest that a SSB tax could reduce the overweight and obesity prevalence in Colombia, especially among lower SES households. This study shows that SSB taxes have a particularly beneficial effect in the most vulnerable population. Additional social and individual benefits, or individual costs arising from the tax are not assessed in this research, implying that even larger health gains could be observed.