Demand Analysis of Mobile Health Applications for Patients with Chronic Kidney Disease Across Different E-Health Literacy Levels

Purpose: Chronic kidney disease (CKD) requires innovative strategies to support long-term self-management. This study is novel in applying the Kano model to examine preferences for mobile health (mHealth) apps among Chinese patients with CKD and to compare these preferences across different levels of e-health literacy. Patients and Methods: A multicenter cross-sectional survey was conducted among 484 patients with CKD in China. Face-to-face questionnaires were used to assess self-management needs and user interface (UI) preferences for CKD-related mHealth apps. App attributes were classified using the Kano model, and their priorities were further evaluated using Better-Worse coefficients and ranking analysis. Results: Low e-health literacy users prioritized foundational features: must-be attributes included disease knowledge, while one-dimensional attributes were symptom and medication management. High e-literacy users emphasized medical insurance information (must-be) and disease management (one-dimensional). Both groups valued an intuitive UI, in addition to considering privacy protection as must-be attributes, low e-health literacy users required simplified navigation, whereas high e-health literacy users preferred efficient data entry. Conclusion: Preferences for CKD mHealth apps varied by e-health literacy level. Patients with lower e-health literacy may benefit more from basic health education and simplified interfaces, whereas those with higher e-health literacy expect more advanced and efficient functionalities. These findings highlight the value of the Kano model in identifying differentiated user needs and can inform the development of tailored mHealth apps to support equitable CKD self-management. Keywords: chronic kidney disease, e-health literacy, mHealth apps, Kano model