Digital literacy support was paired with a kidney health app in a pilot CKD trial
Digitally excluded adults are being left further behind as more care shifts online, and chronic kidney disease is one of the clearest examples of why that matters. In a pilot randomized trial published in JMIR Formative Research, investigators tested whether a targeted digital inclusion intervention could be delivered alongside a digital health intervention for adults with chronic kidney disease who lacked the skills or access needed to use it.
The study used Kidney Beam as the digital health intervention, an app-based program designed to promote physical activity and improve quality of life in people with CKD. The second component, called Ex-Tab, was built to address a problem that routinely blocks uptake before any clinical benefit can begin: limited device access, low confidence with technology, and the practical barriers that keep patients from logging on in the first place.
Why digital exclusion is now a kidney care problem
The National Health Service 10-year health plan points toward a stronger reliance on digital care delivery. For patients with long-term conditions, that shift can widen access to education, monitoring, and self-management support when platforms are easy to use and devices are available. It can also widen inequity when the people most in need of support are least likely to have Wi-Fi-enabled devices, digital literacy, or confidence navigating online tools.
CKD is a particularly relevant setting for this question. The disease often requires long-term self-management, repeated education, and sustained engagement with behavior change interventions. Physical activity support is valuable, yet the patients most likely to benefit may be the same patients who struggle to use digital tools consistently. A digital health intervention can be clinically well designed and still fail at the point of access.
The trial was shaped around that gap. Rather than asking whether a digital program works in theory, the investigators asked whether adding digital literacy training could make a kidney-focused digital intervention more feasible and more acceptable for adults who were digitally excluded.
Digital access can be the first therapeutic bottleneck, long before adherence, engagement, or symptom benefit enter the picture.
Pilot randomized design focused on feasibility, not a final efficacy claim
This was a mixed methods, single-site pilot randomized controlled trial enrolling 40 adults with CKD who were digitally excluded. Digital exclusion was defined using access and literacy criteria, including lack of a Wi-Fi-enabled digital device or a low score on the Digital Health Care Literacy Scale. The trial design itself signals an important methodological point: before a digital intervention can be judged effective, researchers have to determine whether the intended users can realistically receive it.
The intervention comparison was straightforward. One group received the kidney-focused digital health intervention alone, while the other received the same digital health intervention paired with digital literacy training through Ex-Tab. That structure allowed the trial to examine whether support directed at device use and digital confidence could improve engagement with the clinical program rather than merely adding another educational layer.
The use of a pilot design matters because it places the emphasis where it belongs for an early-stage study: feasibility and acceptability. Those outcomes are especially important in digitally excluded populations, where dropout can reflect structural barriers rather than lack of interest. A person may want the intervention, benefit from the content, and still be unable to participate without help navigating basic access problems.
Kidney Beam as an exemplar for long-term condition care
Using Kidney Beam as the exemplar DHI gives the trial direct clinical relevance. Physical activity interventions are often difficult to sustain in CKD, where fatigue, multimorbidity, and competing demands can erode participation. A digital platform offers a scalable way to deliver tailored support, but scale only helps if patients can actually reach the program and remain engaged with it.
The pairing with Ex-Tab creates a plausible care pathway. Digital literacy training may reduce friction at enrollment, improve confidence with online navigation, and help patients overcome early technical setbacks that otherwise would be mistaken for poor motivation. In practical terms, this kind of support may be as important as the intervention content itself for patients with low digital readiness.
There is also a broader systems lesson embedded in the trial design. As services move toward app-based education, remote follow-up, and online self-management programs, equity will depend on whether health systems build access support into the intervention rather than assuming all patients start from the same place. For CKD, where chronic disease management is cumulative and longitudinal, the first encounter with a digital tool may determine whether the patient ever benefits from it.
What this pilot can and cannot answer yet
The excerpt identifies a feasibility-focused randomized study, but it does not provide outcome data in the text available here. Without those results, the trial cannot be framed as proof that digital literacy training improves engagement, adherence, or clinical benefit. What it does establish is the clinical and methodological logic for testing that question in a digitally excluded CKD population.
The central issue is not whether digital health will be part of future care; it already is. The harder question is whether digital care can be made usable for adults who have been systematically left out of the digital shift. This pilot trial positions digital inclusion as an intervention in its own right, not just a social concern on the margins of kidney care.
For patients with CKD, that distinction can determine whether a digital program becomes a usable treatment support or another platform that reaches only the already connected. The next step is to see whether the feasibility signals from this pilot hold up in a larger study with clinical outcomes and longer follow-up.