Adaptation of the RenalSmart^® web-based application for the dietary management of patients with diabetic nephropathy

Abstract

Objectives: The aim of this study was to develop and test a web-based application for the dietary management of patients with diabetic nephropathy. Design: Observational descriptive study. Settings and subjects: RenalSmart^® is a web-based application used to assist dietitians in clinical practice, from tertiary to primary care, to manage patients with chronic renal failure. The application was adapted and enhanced to include functions for the nutritional assessment of a patient with diabetic nephropathy, the formulation of a dietary prescription and the development of a meal plan and sample menu. It includes a graphical display of anthropometric and biochemical measurements. Quality assurance testing was undertaken throughout the development process by the project team in a pilot study involving generalist dietitians and dietitians who specialise in diabetic and renal nutrition. Nonrandom purposive sampling, including snowball sampling, was used to recruit them. Outcome measures: The application was finally tested for accuracy and acceptability by registered dietitians in South Africa. Results: Thirty-seven dietitians completed the final testing of the application. The mean age of the respondents was 33 years. Thirty-five per cent resided in the Western Cape. The overall acceptability of the application was rated as good to excellent by 81% of respondents. There was a significant difference between dietitians who usually consulted renal patients, compared to those who did not, in their rating of the accuracy of the data-saving function (p-value = 0.02) and the fluid requirements (p-value = 0.03). In this regard, the former group of dietitians was dissatisfied with these functions. Conclusion: The web-based application developed in this study was rated as accurate and acceptable by the majority of respondents. Identified problem areas were addressed in the final version.