Effects of E-Coach-Based Chronic Disease Management on Self-Management, Quality of Life, and Mental Health in Maintenance Hemodialysis Patients

The study investigated the effects of E-Coach on self-management behavior, quality of life (QoL), and mental health of patients with maintenance hemodialysis (MHD). The study included 96 patients receiving regular MHD, and they were randomly assigned to receive either usual care (a UC group) or usual care plus E-Coach intervention (an E-Coach group). The E-Coach was implemented through a WeChat-based mini-application that provided health education, dietary and exercise guidance, medication reminders, and regular online counseling through text-based materials, videos, and interactive quizzes. After adjustment for baseline score, the self-management behavior score after 6 months remained significantly higher in the E-Coach group than in the UC group (analysis of covariance (ANCOVA): F(1, 93) = 6.3, p = 0.014, partial η2 = 0.06), with a mean difference of +11.6 (95%CI: 9.7 to 13.6; p < 0.001 by Bonferroni correction). The mean self-management behavior score increased from 57.1 to 78.3 points in the E-Coach group, representing a change of +21.2 points, compared with a change of +7.9 points (from 58.6 to 66.5 points) in the UC group. The between-group difference in change was +13.3 (95%CI: 9.9 to 16.5). As for the Kidney Disease Quality of Life-Short Form, the magnitude of score increase from baseline to 6 months was higher in the E-Coach group than the UC group, suggesting an improvement in patients' QoL. Regarding the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS), the E-Coach group had a greater magnitude of score reduction from baseline to 6 months compared to the UC group, indicating a reduction in depressive and anxiety symptoms. The E-Coach group exhibited lower levels of potassium and phosphorus after 6 months than the UC group. The study demonstrates the superior effectiveness of E-Coach in enhancing self-management behavior, improving QoL, and alleviating depressive and anxiety symptoms in patients receiving MHD.