Improving Fluid Intake Behavior Among Patients with Kidney Stones: Understanding Patients' Experiences and Acceptability of Digital Health Technology.

OBJECTIVE To understand kidney stone patients' experiences with increasing fluid intake, common barriers to adherence, and technology-mediated intervention techniques that may improve adherence in this population. Increasing fluid intake to produce at least 2.5 L of urine daily is a well-established preventive strategy to reduce the risk of kidney stones. Unfortunately, adherence with this well-known and inexpensive recommendation is commonly below 50%. MATERIALS AND METHODS Patients with a history of kidney stones were recruited to participate in semistructured focus groups about their experiences with increasing fluid intake. Inductive content analysis was used to extract themes from focus group transcripts. RESULTS Themes from discussions with 19 patients described current fluid intake strategies, barriers to increasing fluid intake, and desirable features in a digital tool for promoting fluid intake. Common barriers to increasing fluid intake included work habits, travel, leisure activities, forgetting to drink, limited access to water, and not feeling thirsty. Patients had tried to increase fluid intake using strategies such as carrying a water bottle, identifying contextual cues for drinking, self-monitoring fluid intake, and seeking social support. Patients expressed interest in wearing sensors to improve fluid intake if the sensor was aesthetically pleasing, had guaranteed benefit and was able to connect to existing devices. The most acceptable location to wear a sensor was as a wristband or bracelet. CONCLUSION The use of automated and semiautomated tracking technology in combination with evidence-based behavior change techniques should be explored in efforts to improve adherence to fluid intake recommendations. (C) 2019 Elsevier Inc.