The Stay Strong App as a Self-Management Tool for First Nations People with Chronic Kidney Disease: A Qualitative Study
Bibliographic record
Abstract
Abstract Background: The high burden of chronic kidney disease and its substantial impact on quality of life demands innovative patient care strategies. Improved outcomes are linked with patient centred interventions which address psychosocial as well as physical needs. Given the high incidence of kidney disease among First Nations people, culturally responsive approaches are also needed. The Stay Strong app is a holistic wellbeing tool designed with Northern Territory First Nations people. This study explores the suitability of the Stay Strong app as a patient-centred self-management tool as shown by the readiness of participants to engage in goal setting. Data were collected during a clinical trial which showed efficacy of the tool in improving wellbeing for people with both End Stage Kidney Disease and symptoms of distress and depression. 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 for First Nations people. Participants set goals that addressed physical as well as social and emotional wellbeing needs. The goal setting intervention aligns directly with self-management approaches that are holistic and prioritise individual empowerment. While biomedical models focus on the mechanics of illness, the findings share a strong message that healing also comes through family, country, and cultural identity. Implementation of self-management strategies into routine care remains a key challenge and further research is needed to establish drivers of success.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.005 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".