Latinx Children and Surgery

拉丁儿童和外科

• 批准号: 10538983
• 负责人: Zeev Kain
• 金额: $ 126.15万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538983
• 关键词: Adult; Age; Algorithms; Ambulatory Surgical Procedures; Analgesics; Anxiety; Award; Behavior Therapy; Behavioral; Child; Clinical; Collaborations; Communities; Companions; Coping Skills; Data; Delirium; Development; Distress; Educational process of instructing; Event; Evidence based intervention; Family; Growth; Health Personnel; Healthcare; Home; Impairment; Internet; Intervention; Language; Latinx; Latinx population; Mobile Health Application; Modeling; Operative Surgical Procedures; Opioid; Output; Pain; Pain management; Parents; Patients; Persons; Phase; Physical Function; Population; Postoperative Pain; Postoperative Period; Process; Recovery; Research; Services; Target Populations; Testing; United States National Institutes of Health; animation; attentional control; base; clinical practice; comparison intervention; cost; disparity reduction; effective intervention; effectiveness evaluation; ethnic minority; evidence base; experience; formative assessment; handheld mobile device; heuristics; improved; innovation; mHealth; opioid use; pain reduction; postoperative recovery; psychologic; satisfaction; surgery outcome; surgical disparities; usability

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 overall aim of this application is to reduce surgical disparities in a population of Latinx children undergoing surgery. The first phase of this application (R61) includes web programming of L-WebTIPS, conduct formative evaluation and conduct feasibly RCT to test this intervention. The second phase (R33) includes a multi-center RCT which aims to determine the effectiveness of L-WebTIPS compared to attention control intervention in decreasing postoperative pain, opioids consumption and lowering anxiety in Latinx children undergoing outpatient surgery. Secondary aims of the R33 include examining the impact of L-WebTIPS on home-based clinical recovery parameters such as pain, analgesic requirements, new onset behavioral changes and return to normal daily activity in Latinx children undergoing outpatient surgery. We also plan to determine if the use of L- WebTIPS reduces anxiety and improve experience among the parents of Latinx children undergoing surgery. Finally we plan to determine if the use of L-WebTIPS reduces anxiety and enhance experience among the parents of Latinx children undergoing surgery. 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.

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， 在沿着患者的健康护理轨迹的多个点处经历。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。 本申请的总体目标是减少接受手术的拉丁裔儿童人群的手术差异。 手术此应用程序的第一阶段（R61）包括L-WebTIPS的Web编程， 评估并进行可行的随机对照试验来测试这种干预。第二阶段（R33）包括多中心 RCT旨在确定L-WebTIPS与注意力控制干预相比的有效性， 减少Latinx儿童术后疼痛、阿片类药物消耗和降低焦虑 门诊手术R33的次要目标包括检查L-WebTIPS对家庭基础设施的影响。 临床恢复参数，如疼痛、镇痛需求、新发行为变化和恢复 接受门诊手术的Latinx儿童的正常日常活动。我们还计划确定是否使用L- WebTIPS减少了焦虑，改善了接受手术的Latinx儿童父母的体验。 最后，我们计划确定L-WebTIPS的使用是否可以减少焦虑，并增强患者的体验。 正在接受手术的拉丁裔儿童的父母。我们认为，使用文化适应过程，为现有的 有效的干预将加速减少手术差异的过程， 干预临床环境和常规使用。