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

TL;DR

Community health workers helped Latino dialysis patients manage their health by building trust, addressing social barriers, and providing culturally tailored education.

Contribution

The study reveals how community health workers enhance patient engagement and self-management in dialysis care through personalized and culturally responsive support.

Findings

CHWs fostered trust through empathy and reliability, improving patient confidence in self-management.

CHWs addressed social and logistical barriers, enhancing access to care and adherence to dialysis.

Tailored education and support led to improved health outcomes and emotional well-being.

Abstract

How did community health workers (CHWs) in the Navigate-Kidney trial support patients receiving dialysis in managing their health and navigating the health care system?

In this qualitative study of 24 Latino individuals, patients described that CHWs fostered trust through empathy and reliability, addressed social and logistical barriers to care, provided culturally and linguistically tailored health education, and enhanced confidence in self-management, medication adherence, and dialysis attendance.

These findings suggest that CHWs played a vital role in improving patient engagement, emotional well-being, and self-efficacy, suggesting their integration into dialysis care teams may enhance holistic, patient-centered care.

This qualitative study examines the perspectives of Latino individuals with dialysis-dependent kidney failure who received the Navigate-Kidney intervention.

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.

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

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.

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

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).

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.

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