An Innovative Tailored Intervention for Improving Children's Postoperative Recovery

摘要

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.