The stay strong app as a self-management tool for first nations people with chronic kidney disease: a qualitative study

Abstract

Background The high burden of chronic kidney disease in First Nations peoples requires urgent attention. Empowering people to self-manage their own condition is key, along with promotion of traditional knowledge and empowerment of First Nations communities. This study explores the potential of a culturally responsive tool, already found to have high acceptability and feasibility among First Nations people, to support self-management for First Nations people with kidney failure. The Stay Strong app is a holistic wellbeing intervention. This study explores the suitability of the Stay Strong app to support self-management as shown by the readiness of participants to engage in goal setting. Data were collected during a clinical trial which followed adaption of research tools and procedures through collaboration between content and language experts, and community members with lived experience of kidney failure. Methods First Nations (i.e., Aboriginal and Torres Strait Islander) participants receiving haemodialysis in the Northern Territory (n = 156) entered a three-arm, waitlist, single-blind randomised controlled trial which provided collaborative goal setting using the Stay Strong app at baseline or at 3 months. Qualitative data gathered during delivery of the intervention were examined using both content and thematic analysis. Results Almost all participants (147, 94%) received a Stay Strong session: of these, 135 (92%) attended at least two sessions, and 83 (56%) set more than one wellbeing goal. Using a deductive approach to manifest content, 13 categories of goals were identified. The three most common were to: ‘connect with family or other people’, ‘go bush/be outdoors’ and ‘go home/be on country’. Analysis of latent content identified three themes throughout the goals: ‘social and emotional wellbeing’, ‘physical health’ and ‘cultural connection’. Conclusion This study provides evidence of the suitability of the Stay Strong app for use as a chronic condition self-management tool. Participants set goals that addressed physical as well as social and emotional wellbeing needs, prioritising family, country, and cultural identity. The intervention aligns directly with self-management approaches that are holistic and prioritise individual empowerment. Implementation of self-management strategies into routine care remains a key challenge and further research is needed to establish drivers of success.

A web-based application for reducing methamphetamine use amongst Aboriginal and Torres Strait Islander people: A wait-list control randomised trial. (Preprint)

“…Participants' mean (SD) age was 33.9 (8.7) years. They had been using methamphetamine from a median age of 21 years (IQR 18-28 years) and had used methamphetamine on a median (IQR) of 20 [13][14][15][16][17][18][19][20][21][22][23][24][25] days in the past 4 weeks. Eighty-two per cent smoked tobacco (92% of these, daily).…”

“…[9] In a context where demand for specialist alcohol and other drug (AOD) treatment across urban, rural and remote settings in Australia is not met by available services, much of the burden for providing care to people who use methamphetamine falls to primary health care services. [11] The AOD assessment [17,18], psychosocial assessment and care planning [19], and suicide prevention.…”

Evaluation of an mHealth Intervention (Growin’ Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study

“…In a third study, an app was used by clients with a practitioner present, and technical difficulties were reported with an Android emulator to enable compatibility with Windows [ 40 ]. The fourth study used the same app as the previous study [ 40 ] with a different population; thus, it was also used by clients with a practitioner present, but no technical difficulties were reported [ 39 ]. Although many studies evaluating mHealth apps have reported technical challenges, it seems that using a web-based application may have resulted in more users experiencing technical challenges and a more substantial challenge of not being able to log in or save the application.…”

“…The women also commented that it did not "look" like an application and that it was slow. Other application trials with Aboriginal and Torres Strait Islander people have largely used Android or iOS apps [15,[38][39][40][41]. Of these studies, 1 was unable to collect use data for 34% (21/61) of the participants reporting flat batteries, connectivity issues, and other problems [41].…”

Multimodal approaches for inequality in kidney care: turning social determinants of health into opportunities

“…The development of kidney care apps, on the other hand, can provide trustworthy content directly to individuals and provide a secure platform to engage with clinicians. Two Australian studies have developed specific apps; Nagel et al [36] implemented a self-management app for First Nations people in Australia, finding that the majority of users were able to engage with the technology to set a wellbeing goal. A health literacy app for people with kidney failure requiring dialysis has been developed with evaluation of it in progress [37].…”