An Innovative Tailored Intervention for Improving Children's Postoperative Recovery

摘要 在美国，超过6000万人认为自己是拉丁裔，其中25.6%是16岁以下的儿童。 在美国，成人和儿童的手术差异已被确定为一个主要问题， 在患者医疗保健轨迹的多个点沿着经历。我们中心的数据显示， 相当一部分接受手术拉丁裔儿童经历高度焦虑和术后疼痛， 以及与非拉丁裔白色人相比， 接受手术的儿童。最近移动的设备使用的增长为我们提供了一个机会， 成本移动健康行为干预，以减少这种差异的手术结果。 在之前的NIH奖项中，PI开发并测试了基于证据的移动健康定制干预 （WebTIPS），旨在为手术期间的儿童及其家人做好准备并成为他们的伴侣。WebTIPS 旨在通过多种方式促进儿童的康复，例如减少焦虑和疼痛，并基于 信息提供、建模和应对技能的教学。然而，WebTIPS的开发和验证 人口主要是白色非拉丁裔英语儿童和他们的父母。不幸的是 已经确定，移动医疗干预措施在用于特定种族时， 除非他们经历了文化适应的过程，否则他们是少数民族。在过去的四年里，我们建立了 多个学术和社区合作，与Latinx进行了广泛的参与性研究 利益相关者，并使用启发式框架和修改后的生态有效性模型，以适应文化 网络提示。这种适应文化的干预措施被称为L-WebTIPS。 本行政补充文件的主要目的是完善L-WebTIPS，以便通过最终确定Web 编程和进行有声思维的可用性测试，在拉丁裔儿童的人口， 外科医生和他们的家人 这一补充的总体目标是减少手术的差异，在人口的拉丁裔儿童接受 手术美国国立卫生研究院-ACS外科差异研究研讨会和由此产生的JAMA文章呼吁使用 以文化相关的方式优化患者结果的技术。这种补充的重点是减少这种 通过在文化上适应先前开发和验证的移动健康干预措施，实现差异。我们认为，使用 对现有干预的文化适应过程，而不是重新开始发展，将加速 减少手术差异并将有效的mHealth干预引入临床环境的过程 常规使用。我们认为，对现有的有效干预措施使用文化适应过程将 加快减少手术差异的进程，并将有效的干预措施引入临床环境 常规使用。

Abstract Over 60 million persons in the U.S. identify themselves as Latinx and 25.6% are children under the age of 16. Surgical disparities for adults and children have been identified as a major problem in the US and can be experienced at multiple points along a patient’s health care trajectory. Data from our center indicates that a substantial portion of Latinx children who undergo surgery experience high anxiety and postoperative pain as well as postoperative impairments in psychological and physical functioning as compared to White non-Latin children who undergo surgery. Recent growth in use of mobile devices provides us an opportunity to create low- cost mHealth behavioral interventions to reduce this disparity in surgical outcomes. In a previous NIH award, the PI developed and tested an evidence based mHealth tailored intervention (WebTIPS) that aims to prepare and be a companion of a child and their family during a surgical event. WebTIPS aims to enhance the recovery of the child in several ways such as reducing anxiety and pain and is based on information provision, modeling, and teaching of coping skills. WebTIPS, however, was developed and validated with a population of primarily White non-Latinx English-speaking children and their parents. Unfortunately, it is well established that mHealth interventions are significantly less effective when used with specific ethnic minorities unless they underwent a process of cultural adaptation. Over the past 4-years, we have established multiple academic and community collaborations, conducted extensive participatory research with Latinx stakeholders and used the heuristic framework and a modified ecological validity model to culturally adapt WebTIPS. The culturally adapted intervention is called L-WebTIPS. The primary aim of this administrative supplement is to refine L-WebTIPS for deployment through finalizing web programming and conducting think-aloud usability beta testing in a population of Latinx children undergoing surgery and their family. The overall aim of this supplement is to reduce surgical disparities in a population of Latinx children undergoing surgery. The NIH-ACS Symposium on Surgical Disparities Research and the resulting JAMA article call for using technology to optimize patient outcomes in a culturally relevant way. This supplement focuses on reducing such disparity by culturally adapting a previously developed and validated mHealth intervention. We submit that using a cultural adaption process for an existing intervention rather than start a de novo development will accelerate the process of reducing surgical disparities and bringing an effective mHealth intervention to the clinical settings and routine use. We submit that using a cultural adaption process for an existing validated intervention will accelerate the process of reducing surgical disparities and bringing an effective intervention to clinical settings and routine use.