Examination Date

5-2026

Degree

Dissertation

Degree Program

Nursing (PhD)

Examination Committee

Mary Dioise Ramos, PhD, RN, CNE, FAAN; Marie Adorno, PhD, APRN, CNS, RNC-MNN, CNE; Alison Davis, PhD, RN, CNE, CHSE, ANEF, FAAN; Todd Tartavoulle, PhD, APRN, CNS-BC; Jamie Wiggins, PhD, MBA, NEA-BC, FACHE, FAAN; Evrim Oral PhD, MS; Diego Aviles, MD

Abstract

Adolescents with end-stage renal disease face challenges in maintaining adherence to dialysis related regimens, particularly fluid intake restrictions, due in part to developmental, cognitive, and psychosocial factors. Health literacy plays a critical role in supporting self-management behaviors in this population, yet there is limited research on interventions adolescents undergoing dialysis. The purpose of this randomized controlled trial was to examine the effectiveness of a mobile application intervention on improving renal health literacy and fluid intake adherence among adolescents aged 13–17 receiving dialysis.

A total of 72 participants were randomly assigned to either an intervention group (n = 36) or a control group (n = 36). Health literacy was measured using the Health Literacy Measure for Adolescents (HELMA), and fluid adherence was assessed using interdialytic weight gain (IDWG). Data was collected at baseline and post-intervention for HELMA, and at Weeks 0 and 12 for interdialytic weight gain. Paired-samples t-tests were used to assess changes in HELMA scores, and repeated measures analyses were used to evaluate changes in IDWG over time.

Results indicated that participants in the intervention group demonstrated a significant improvement in health literacy compared to the control group, with a mean increase of 16.2 points in HELMA scores. The control group showed minimal change. The intervention group showed significant reductions in interdialytic weight gain over the 12-week period, while no meaningful changes were observed in the control group. A moderate negative correlation was found between improvements in health literacy and reductions in IDWG, suggesting that increased health literacy was associated with improved adherence behaviors.

These findings support the effectiveness of mobile application interventions in improving both educational and clinical outcomes among adolescents with chronic kidney disease (CKD). The results also highlight the importance of developmentally appropriate, technology-based approaches to health education in this population. This study contributes to the limited body of research on adolescent-focused health literacy interventions and supports the integration of mobile applications into dialysis care to improve self-management and long-term outcomes.

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