K M DINGWALL1, J T HUGHES2,3, M SWEET1, A CASS2, D KAVANAGH4, K HOWARD5, F BARZI2, S BROWN6, C SAJIV3,7, S WILLIAM MAJONI2,3,8, T NAGEL2
1Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Alice Springs, Australia, 2Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Casuarina, Australia, 3Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Casuarina, Australia, 4Centre for Children’s Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia, 5Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 6Western Desert Nganampa Walytija Palyantjaku Tjutaku, Alice Springs, Australia, 7Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, Australia, 8Northern Territory Medical Program, Flinders University, Darwin, Australia
Background: End stage kidney disease (ESKD) is associated with many losses and impacts on wellbeing. Few trials have investigated effectiveness of psychosocial interventions for ESKD patients generally and Indigenous people specifically. We investigated efficacy of a culturally adapted digital mental health (dMH) intervention – the AIMhi Stay Strong App for improving wellbeing for Indigenous people receiving haemodialysis.
Methods: This 3-arm, waitlist, single-blind randomised controlled trial examined efficacy of the Stay Strong App for improving psychological distress (K10), depressive symptoms (adapted PHQ-9), quality of life (EQ-5D) and dialysis adherence among Indigenous Australians on haemodialysis in the Northern Territory, with follow-up over two 3-month periods. Effects of the AIMhi Stay Strong App were compared to those from a contact control app (The Hep B Story) and treatment as usual (TAU). Participants in control conditions received the AIMHi intervention after 3 months.
Results: Primary analyses of the full sample (N=156) showed significant decreases in K10 and PHQ-9 scores at 3 months for the Hep B Story but not for the Stay Strong App or TAU. In secondary analyses, when the sample was restricted to only those who were moderately to severely distressed or depressed (K10 ≥ 25 or PHQ-9 ≥ 10), decreased K10 and PHQ-9 scores were observed for both Stay Strong and Hep B groups. No significant differences were observed on the EQ-5D or dialysis attendance.
Conclusion: Findings suggest that simply talking to people about their wellbeing using culturally adapted, locally relevant apps can lead to improved wellbeing for people on dialysis.
Associate Professor Jaquelyne Hughes is a Torres Strait Islander woman, a nephrologist at Royal Darwin Hospital and Principal Research Fellow at Menzies School of Health Research in Darwin. A/Professor Hughes is the convenor of ANZDATA Aboriginal and Torres Strait Islander Health working group, and research leader of the eGFR3 Study (cohort study), involving QLD, WA and NT. Clinically, she leads the Top End Health Service New Start Dialysis Transition Program. This program supports clients with functional and medical optimisation to achieve Care Close to Home with dialysis and transplantation.