ORIGINAL PAPER
Digital storytelling intervention to support hemodialysis decision-making among chronic kidney disease patients
1
Department of Nursing, Pelamonia Institute of Health Sciences, Makassar, Indonesia
2
Department of Nursing, Nani Hasanuddin College of Health Sciences, Makassar, Indonesia
3
Department of Nursing, Pasapua School of Health Sciences, Ambon, Indonesia
Submission date: 2026-05-03
Final revision date: 2026-06-22
Acceptance date: 2026-07-24
Online publication date: 2026-09-24
Corresponding author
KEYWORDS
TOPICS
ABSTRACT
Background:
Chronic kidney disease (CKD) patients face substantial psychological and informational burdens when deciding whether to initiate hemodialysis (HD). Anxiety, uncertainty, low self-efficacy, limited therapy readiness, and inadequate understanding of treatment options contribute to delayed or poorly informed decisions. Digital storytelling offers a patient-centered ap-proach to support engagement and confidence during complex decision-making in renal and critical care pathways. This study developed and evaluated NephroStory, a narrative-based digital storytelling intervention, to strengthen self-efficacy, therapy readiness, and HD decision-making among CKD patients preparing for dialysis.
Participants and procedure:
This research employed a research and development (R&D) design using a sequential explanatory mixed-methods approach conducted in five phases: needs assessment, application design, expert validation, pilot implementation, and pre–post out-come evaluation. A total of 30 CKD patients preparing for hemodialysis participated in the intervention over two weeks, attending 2-3 sessions per week with an average duration of 20 minutes per session.
Results:
Significant improvements were observed across all primary outcomes following the intervention. Mean self-efficacy scores increased from 22.43 ± 4.52 to 35.33 ± 5.07, therapy readiness improved from 23.10 ± 7.78 to 36.70 ± 6.65, and decision-making scores rose from 27.97 ± 13.51 to 39.87 ± 8.20 (all p < .001). Although participants with higher educational levels demonstrated greater numerical gains, no statistically significant differences were identified between groups. Large effect sizes were observed across all outcomes (r = .69-.87), indicating substantial changes following intervention exposure.
Conclusions:
NephroStory was associated with significant improvements in self-efficacy, therapy readiness, and hemodialysis decision-making among CKD patients. Narrative-based digital decision-support tools may represent a promising and scalable ap-proach for improving patient engagement and confidence during time-sensitive treatment decisions.
Chronic kidney disease (CKD) patients face substantial psychological and informational burdens when deciding whether to initiate hemodialysis (HD). Anxiety, uncertainty, low self-efficacy, limited therapy readiness, and inadequate understanding of treatment options contribute to delayed or poorly informed decisions. Digital storytelling offers a patient-centered ap-proach to support engagement and confidence during complex decision-making in renal and critical care pathways. This study developed and evaluated NephroStory, a narrative-based digital storytelling intervention, to strengthen self-efficacy, therapy readiness, and HD decision-making among CKD patients preparing for dialysis.
Participants and procedure:
This research employed a research and development (R&D) design using a sequential explanatory mixed-methods approach conducted in five phases: needs assessment, application design, expert validation, pilot implementation, and pre–post out-come evaluation. A total of 30 CKD patients preparing for hemodialysis participated in the intervention over two weeks, attending 2-3 sessions per week with an average duration of 20 minutes per session.
Results:
Significant improvements were observed across all primary outcomes following the intervention. Mean self-efficacy scores increased from 22.43 ± 4.52 to 35.33 ± 5.07, therapy readiness improved from 23.10 ± 7.78 to 36.70 ± 6.65, and decision-making scores rose from 27.97 ± 13.51 to 39.87 ± 8.20 (all p < .001). Although participants with higher educational levels demonstrated greater numerical gains, no statistically significant differences were identified between groups. Large effect sizes were observed across all outcomes (r = .69-.87), indicating substantial changes following intervention exposure.
Conclusions:
NephroStory was associated with significant improvements in self-efficacy, therapy readiness, and hemodialysis decision-making among CKD patients. Narrative-based digital decision-support tools may represent a promising and scalable ap-proach for improving patient engagement and confidence during time-sensitive treatment decisions.
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