Just-In-Time Adaptive Intervention To Promote Fluid Consumption In Patients With Kidney Stones

Objective: Kidney stones are painful and costly. Prevention guidelines emphasize a simple behavior change: increasing fluid intake and urine output. Unfortunately, adherence to those prevention guidelines is limited, and patients report forgetting or not being thirsty enough. This study evaluated the acceptability of using semiautomated tracking of fluid consumption to trigger just-in-time reminders to drink and increase the experienced automaticity of fluid intake. Method: In a single-group trial, participants with a history of kidney stones (n = 31) used the sip(IT) digital tools (H2OPal connected water bottle, H2OPal mobile app for self-tracking, Fitbit smartwatch app for gesture detection) for 3 months. Results: The semiautomated monitoring system detected 46,654 drinking events. From baseline to 1-month follow-up, the experienced automaticity of fluid intake increased significantly (d = 0.50) and remained elevated at 3-month follow-up (d = 0.64). A major barrier to adherence (lack of thirst) decreased from baseline to follow-ups. Retention rates and participant feedback indicated that this digital tool was acceptable to patients. Conclusion: Semiautomated tracking of fluid consumption can be used to trigger just-in-time reminders. Based on this demonstration, the sipIT tools are ready for testing in a rigorous Phase II trial to evaluate efficacy for increasing fluid consumption and urine output as recommended for preventing the recurrence of kidney stones.