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，25.6%的人是16岁以下的儿童。 成人和儿童的手术差异已被确定为美国的一个主要问题，可能是 在患者的医疗保健轨迹上的多个点经历。我们中心的数据显示， 接受手术的拉丁裔儿童中有相当一部分经历了高度焦虑和术后疼痛 与非拉丁裔白人相比，术后心理和身体功能障碍 接受手术的儿童。最近移动设备使用的增长为我们提供了创造低成本的机会 花费mHealth行为干预来减少手术结果中的这种差异。 在之前的NIH奖项中，PI开发并测试了一种基于证据的mHealth定制干预 (WebTips)，旨在为儿童及其家人在手术期间做好准备并成为他们的伴侣。网络提示 旨在通过几种方式促进儿童的康复，如减少焦虑和疼痛，并基于 应对技能的信息提供、建模和教学。然而，WebTips是经过开发和验证的 人口主要是白人，非拉丁裔，说英语的儿童和他们的父母。不幸的是，它是 公认的是，当使用特定种族时，移动健康干预措施的效果明显较差 除非他们经历了一个文化适应的过程，否则他们不会成为少数群体。在过去的4年里，我们已经建立了 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的生态有效性模型来适应文化 网络提示。这种适应文化的干预被称为L-网络提示。 本行政副刊的主要目的是通过最终确定Web来提炼用于部署的L-WebTips 在一群拉丁裔儿童中编程和进行有声思考可用性Beta测试 外科医生和他们的家人。 这一补充的总体目标是减少拉丁裔儿童接受手术的人群中的手术差异。 做手术。美国国立卫生研究院-美国医学会外科差异研究研讨会及由此产生的《美国医学会杂志》文章呼吁使用 以文化相关的方式优化患者结局的技术。本增刊致力于减少这样的 通过从文化上适应以前开发和验证的移动健康干预措施来实现差异。我们使用以下方法提交 对现有干预的文化适应进程将加快，而不是启动从头开始的发展 减少手术差异并将有效的移动健康干预引入临床环境的过程 和常规使用。我们认为，对现有的有效干预使用文化适应过程将 加快缩小手术差异并为临床环境带来有效干预的进程 和常规使用。

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.