Structured Problem Solving may promote fluid consumption for prevention of urinary stones: PUSH trial

Structured Problem Solving (SPS) is a patient-centered approach designed to facilitate behavior change through collaboration between coaches and participants. This method emphasizes participant autonomy, making it particularly suitable for interventions aimed at lifestyle modifications. The PUSH trial applied SPS to increase fluid intake in patients with low urine output, thereby aiming to prevent recurrent kidney stones.

The primary objective of the PUSH trial was to assess the effectiveness of SPS in promoting fluid consumption among individuals with a history of urinary stone disease. This article focuses on the design, implementation, and assessment of SPS within the trial, providing insights into the training and fidelity assessment of SPS coaches.

The PUSH trial randomized participants with a history of urinary stone disease and low urine output into two groups: a control group and an intervention group receiving a multicomponent intervention, including SPS. Key components of the SPS intervention involved training coaches to support participants in overcoming barriers to fluid consumption. The fidelity of the SPS implementation was rigorously assessed to ensure consistency and effectiveness.

During the initial conduct of the trial, SPS coaches encountered several challenges:

• Variable Participant Engagement: Coaches had to tailor their approaches to accommodate different levels of participant engagement.

• Balancing Rapport and Problem Solving: Maintaining a balance between building rapport and focusing on problem-solving was crucial for effective intervention.

• Role Clarity: Clear definition of the coaches' roles helped in managing their responsibilities and expectations.

• The trial enrolled participants and monitored their progress in increasing fluid intake.

• Coaches applied SPS techniques to help participants identify and overcome barriers to hydration.

• Despite facing implementation challenges, the coaches adapted their strategies to meet the specific needs of participants, thereby promoting better fluid consumption.

• The study involved individuals with a history of urinary stone disease and low urine output.

• Variable participant engagement required tailored coaching approaches.

• Coaches balanced rapport-building with problem-solving and maintained role clarity.

• SPS was successfully adapted for kidney stone prevention, overcoming several implementation barriers.

The implementation of SPS in the PUSH trial highlighted its potential to be adapted for other health behavior change settings, particularly in nephrology. The structured approach allowed coaches to effectively address participant-specific barriers, making it a valuable tool for clinical care interventions aimed at lifestyle modifications.

The study concluded that SPS is an effective method for promoting fluid consumption in patients with a history of urinary stone disease. The tools and strategies developed during the PUSH trial can be applied to other areas of clinical care, demonstrating the versatility and effectiveness of the SPS approach in fostering health behavior change.

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