A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol
A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol
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DOI：
10.1186/s12913-018-3151-5
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发表时间：
2018-05-16
影响因子：
2.8
通讯作者：
Shumate, Michelle D.
中科院分区：
文献类型：
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作者：
Gordon, Elisa J.;Lee, Jungwha;Shumate, Michelle D.
背景资料：在美国的西班牙裔/拉丁美洲人中，终末期肾病（ESRD）患者肾移植器官的短缺被放大。活体供肾移植（LDKT）是ESRD的首选治疗方法。然而，与他们在移植等待名单上的代表相比，西班牙裔接受LDKT的人数少于非西班牙裔白人。拉丁美洲裔的障碍包括：缺乏知识，文化问题和语言障碍。为减少最不发达国家之间的差距而设计的干预措施很少。本研究的目的是减少西班牙裔的差异，通过文化有针对性的intervention.Methods/Design：使用前瞻性的有效性，实施混合设计，涉及前后干预评估与匹配的控制，我们将实施一个复杂的文化有针对性的干预在两个移植中心在达拉斯，德克萨斯州和凤凰城，亚利桑那州。该研究的目标是评估西北医学（R）西班牙裔肾移植计划（HKTP）的关键文化目标组成部分（外展，沟通，教育）对西班牙裔LDKT率的影响超过五年。主要假设是，暴露于HKTP将通过增加西班牙裔与非西班牙裔白色LDKT的比例和西班牙裔LDKT的数量来减少差异。我们还将研究其他过程和结果的措施，包括：透析患者外展，教育会议出席率，营销工作，西班牙裔患者添加到候补名单，西班牙裔潜在捐助者每潜在的收件人，并与文化能力的护理满意度。我们将根据《卫生服务研究实施促进行动》采用混合方法（经修订的PARIHS）和实施研究综合框架（CFIR）框架，以形成性地评估两个研究地点对香港主题公园组成部分的忠实性和创新适应性，以确定最影响实施忠实性的调节因素，讨论：我们的研究将提供有关实施文化针对性干预措施及其对减少健康差距的影响的新知识。此外，一个复杂的组织层面的干预措施的实施超过五年的研究是罕见的实施科学，因此，这项研究准备贡献新的知识的影响因素，如何组织层面的干预措施是持续随着时间的推移。
Background: The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. Few interventions have been designed to reduce LDKT disparities. This study aims to reduce Hispanic disparities in LDKT through a culturally targeted intervention.Methods/Design: Using a prospective effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls, we will implement a complex culturally targeted intervention at two transplant centers in Dallas, TX and Phoenix, AZ. The goal of the study is to evaluate the effect of Northwestern Medicine's (R) Hispanic Kidney Transplant Program's (HKTP) key culturally targeted components (outreach, communication, education) on Hispanic LDKT rates over five years. The main hypothesis is that exposure to the HKTP will reduce disparities by increasing the ratio of Hispanic to non-Hispanic white LDKTs and the number of Hispanic LDKTs. We will also examine other process and outcome measures including: dialysis patient outreach, education session attendance, marketing efforts, Hispanic patients added to the waitlist, Hispanic potential donors per potential recipient, and satisfaction with culturally competent care. We will use mixed methods based on the Promoting Action on Research Implementation in Health Services (revised PARIHS) and the Consolidated Framework for Implementation Research (CFIR) frameworks to formatively evaluate the fidelity and innovative adaptations to HKTP's components at both study sites, to identify moderating factors that most affect implementation fidelity, and to identify adaptations that positively and negatively affect outcomes for patients.Discussion: Our study will provide new knowledge about implementing culturally targeted interventions and their impact on reducing health disparities. Moreover, the study of a complex organizational-level intervention's implementation over five years is rare in implementation science; as such, this study is poised to contribute new knowledge to the factors influencing how organizational-level interventions are sustained over time.