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• Reply to “Questioning the superiority of mHealth applications over face-to-face training in treatment adherence among haemodialysis patients”
  Zahra Farsi, Mohsen Torabi Khah and Seyedeh Azam Sajadi
  Published on: 5 July 2023
• Questioning the superiority of mHealth applications over face-to-face training in treatment adherence among haemodialysis patients
  Toshinari Kaku, Masahiro Banno and Takahiro Tsuge
  Published on: 4 July 2023

• Published on: 5 July 2023

  Reply to “Questioning the superiority of mHealth applications over face-to-face training in treatment adherence among haemodialysis patients”

  • Zahra Farsi, Professor in Nursing Research and Community Health Departments, Nursing School, Aja University of Medical Sciences
  • Other Contributors:
    • Mohsen Torabi Khah, Master of Science in Nursing
    • Seyedeh Azam Sajadi, Assistant Professor in Nursing

  Dear authors: Toshinari Kaku, Masahiro Banno and Takahiro Tsuge,
  We are delighted that our article took your attention and we appreciate the time that you spent reviewing our study. We hope the prepared response can solve your concerns.
  First, you mentioned an issue about not implementing face-to-face training properly. As you can see, in the method section, under the participants' headline, we considered not attending the face-to-face training for over three sessions as an exclusion criterion, which means that it was important for us to observe this group closely. No one missed the sessions which means that they were eager to learn and all the participants received the prepared content. Besides, the reason why we designed each session for only about 10 minutes was that the result of previous studies showed long training sessions distract patients’ attention and reduce the outcome. Therefore, we stuck to the mentioned duration to avoid adversely affecting the face-to-face training. Furthermore, in the intervention section, we mentioned that this group was trained by one of the researchers. It means that we directly observed all the participants of this group. There was a chance for the participants of this group to ask their questions by the end of each session while the other group had no access to any source to ask their questions. Moreover, the written training content was handed to the patients of this group to review whenever they wanted.
  Second...

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  Dear authors: Toshinari Kaku, Masahiro Banno and Takahiro Tsuge,
  We are delighted that our article took your attention and we appreciate the time that you spent reviewing our study. We hope the prepared response can solve your concerns.
  First, you mentioned an issue about not implementing face-to-face training properly. As you can see, in the method section, under the participants' headline, we considered not attending the face-to-face training for over three sessions as an exclusion criterion, which means that it was important for us to observe this group closely. No one missed the sessions which means that they were eager to learn and all the participants received the prepared content. Besides, the reason why we designed each session for only about 10 minutes was that the result of previous studies showed long training sessions distract patients’ attention and reduce the outcome. Therefore, we stuck to the mentioned duration to avoid adversely affecting the face-to-face training. Furthermore, in the intervention section, we mentioned that this group was trained by one of the researchers. It means that we directly observed all the participants of this group. There was a chance for the participants of this group to ask their questions by the end of each session while the other group had no access to any source to ask their questions. Moreover, the written training content was handed to the patients of this group to review whenever they wanted.
  Second, you implied that the mHealth group received advanced treatment. The treatment was hemodialysis which was the same in both groups. If you mean the intervention (using the app), it was the goal of this study to compare an up-to-date intervention with one of the most common training methods. As a result, it relates to the nature of the method and we could not do anything with that.
  Third, it was asked about exchanging views between two groups. In the last paragraph of the method section, it is written that “To avoid contamination information among the HD patients in both groups, they were explained the study objectives and asked not to swap information until the study completion”. Besides, to use the app, users had to log in by their phone number and their name. These data were sent immediately to the server of the app and we checked regularly if the participants of the face-to-face group used it, which did not happen during the study.
  We tried to answer your concerns. Please feel free to ask any other related questions.
  Sincerely yours

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  Conflict of Interest:
  None declared.

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• Published on: 4 July 2023

  Questioning the superiority of mHealth applications over face-to-face training in treatment adherence among haemodialysis patients

  • Toshinari Kaku, Cardiologist Minami-Satsuma Municipal Bonotsu Hospital
  • Other Contributors:
    • Masahiro Banno, psychiatrist
    • Takahiro Tsuge, Rehabilitation

  Abstract: Objective: This article critically examines the study "Comparing the effects of mHealth application based on micro-Learning method and face-to-face training on treatment adherence and perception in haemodialysis patients: A randomised clinical trial" by Mohsen Torabi Khah, Zahra Farsi, and Seyedeh Azam Sajadi. Summary of the argument: There are two concerns that the intervention effect may be overestimated and one that the intervention effect may be underestimated. Conclusion: While the study indicates innovative use of mHealth applications in enhancing treatment adherence, it also highlights potential biases that may have resulted in an overestimation and an underestimation of the intervention's effect.
  Full References: Torabi Khah M, Farsi Z, Sajadi SA. Comparing the effects of mHealth application based on micro-learning method and face-to-face training on treatment adherence and perception in haemodialysis patients: A randomised clinical trial. BMJ Open 2023;13:e071982. doi:10.1136/bmjopen-2023-071982
  Authors’ Contributions: The author of this communication article critically analysed the referenced study and authored the article.
  Funding Statement: This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
  Competing Interests Statement: The author declares no competing interests.
  We read the article by Torabi Khah et al. with great interest and app...

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  Abstract: Objective: This article critically examines the study "Comparing the effects of mHealth application based on micro-Learning method and face-to-face training on treatment adherence and perception in haemodialysis patients: A randomised clinical trial" by Mohsen Torabi Khah, Zahra Farsi, and Seyedeh Azam Sajadi. Summary of the argument: There are two concerns that the intervention effect may be overestimated and one that the intervention effect may be underestimated. Conclusion: While the study indicates innovative use of mHealth applications in enhancing treatment adherence, it also highlights potential biases that may have resulted in an overestimation and an underestimation of the intervention's effect.
  Full References: Torabi Khah M, Farsi Z, Sajadi SA. Comparing the effects of mHealth application based on micro-learning method and face-to-face training on treatment adherence and perception in haemodialysis patients: A randomised clinical trial. BMJ Open 2023;13:e071982. doi:10.1136/bmjopen-2023-071982
  Authors’ Contributions: The author of this communication article critically analysed the referenced study and authored the article.
  Funding Statement: This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
  Competing Interests Statement: The author declares no competing interests.
  We read the article by Torabi Khah et al. with great interest and appreciate the authors' efforts to assess the effectiveness of mHealth application based on the micro-learning method on treatment adherence in haemodialysis patients. However, we have two concerns about the article. First, the study did not assess whether the face-to-face training was properly implemented. This oversight could mean that the face-to-face training group included participants for whom the training was improperly implemented, potentially leading to worse outcome for this group. Second, participants in the mHealth group may have been more motivated to learn than those in the face-to-face group because they were receiving an advanced treatment. The above two points could have biased the results, leading to an overestimation of the intervention's effect. Third, there is no mention from this paper of whether or not the two groups of participants exchanged views, and if they did, the content of the two groups of interventions would be effectively similar, which may underestimate the intervention effect.
  While we agree with the conclusion of this research that mHealth application is effective in improving treatment adherence and awareness in hemodialysis patients. We are afraid that data of the present study was not able to support that mHealth applications is more effective than face-to-face training. The study provides valuable insights into the potential of mHealth applications in improving treatment adherence, further research is needed to address potential biases and ensure the validity of the findings.

  【cover-letter】
  June 24th, 2023

  Adrian Aldcroft
  Editor-in-Chief
  BMJ Open

  Dear Editor:

  I wish to submit a letter for publication in BMJ open, titled "Questioning the superiority of mHealth applications over face-to-face training in treatment adherence of hemodialysis patients." The paper is co-authored by Masahiro Banno and Takahiro Tsuge.
  In this communication we compared the study by Mohsen Torabi Khah, Zahra Farsi, and Seyedeh, "Comparison of the effects of microlearning methods and mHealth applications based on face-to-face training on treatment adherence and cognition in hemodialysis patients: a randomized clinical trial" A critical review. Azam Sajadi. We discuss concerns that intervention effects may be overestimated or underestimated, which could affect the validity of the results.
  This manuscript has not been published or presented elsewhere in part or in whole and is not under consideration by another journal.We have read and understand your journal’s policies, and believe that neither the manuscript nor the study violates any of these.
  We have no conflicts of interest to declare.
  Thank you for your consideration. I look forward to hearing from you.

  Sincerely,
  Toshinari Kaku, MD
  Department of general medicine, Minami-Satsuma Municipal Bonotsu Hospital
  19, Tomari, Minamisatsuma city, Kagoshima, 898-0102, Japan
  E-mail: m09029tk@icloud.com
  TEL: +81-993-67-1141; FAX: +81-993-67-2180

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  Conflict of Interest:
  None declared.

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