Dietary Phosphate Educational Materials for Pediatric Chronic Kidney Disease: Are Confused Messages Reducing Their Impact?

Louise McAlister; Vanessa Shaw; Rukshana Shroff

doi:10.1053/j.jrn.2024.02.004

Dietary Phosphate Educational Materials for Pediatric Chronic Kidney Disease: Are Confused Messages Reducing Their Impact?

J Ren Nutr. 2024 Mar 13:S1051-2276(24)00035-9. doi: 10.1053/j.jrn.2024.02.004. Online ahead of print.

Authors

Louise McAlister¹, Vanessa Shaw², Rukshana Shroff³

Affiliations

¹ Dietetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. Electronic address: Louise.mcalister@gosh.nhs.uk.
² UCL Great Ormond Street Institute of Child Health, University College London, UK.
³ UCL Great Ormond Street Institute of Child Health, University College London, UK; Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.

PMID: 38485067
DOI: 10.1053/j.jrn.2024.02.004

Abstract

Objective: This study aimed to review the quality and content of phosphate educational materials used in pediatric chronic kidney disease.

Methods: The quality of text-based (TB) pediatric phosphate educational materials was assessed using validated instruments for health literacy demands (Suitability Assessment of Materials, Patient Education Material Assessment Tool [PEMAT-P]) readability (Flesch Reading Ease, and Flesch-Kincaid Grade Level). Codes were inductively derived to analyse format, appearance, target audience, resource type, and content, aiming for intercoder reliability > 80%. The content was compared to Pediatric Renal Nutrition Taskforce (PRNT) recommendations.

Results: Sixty-five phosphate educational materials were obtained; 37 were pediatric-focused, including 28 TB. Thirty-two percent of TB materials were directed at caregivers, 25% at children, and 43% were unspecified. Most (75%) included a production date, with 75% produced >2 years ago. The median Flesch Reading Easetest score was 68.2 (interquartile range [IQR] 61.1-75.3) and Flesch-Kincaid Grade Level was 5.6 (IQR 4.5-7.7). Using Suitability Assessment of Materials, 54% rated "superior" (≥70), 38% rated "adequate" (40-69), and 8% rated "not suitable" (≤39). Low-scoring materials lacked a summary (12%), cover graphics (35%), or included irrelevant illustrations (50%). Patient Education Material Assessment Tool-P scores were 70% (IQR 50-82) for understandability and 50% (IQR 33-67) for actionability. An intercoder reliability of 87% was achieved. Over half of limited foods are in agreement with PRNT (including 89% suggesting avoiding phosphate additives). Recommendations conflicting with PRNT included reducing legumes and whole grains. Over a third contained inaccuracies, and over two-thirds included no practical advice.

Conclusions: TB pediatric phosphate educational materials are pitched at an appropriate level for caregivers, but this may be too high for children under 10 years. The inclusion of relevant illustrations may improve this. Three-quarters of materials scored low for actionability. The advice does not always align with the PRNT, which (together with the inaccuracies reported) could result in conflicting messages to patients and their families.

Keywords: CKD; diet; hyperphosphatemia; patient education material; phosphate.