Feasibility and Usability of a Spanish-Transcreated Pediatric Post-Transplant Adherence App (BMT4me)

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PROJECT SUMMARY/ABSTRACT This project seeks to expand upon a current project (PI:Skeens, R00NR019115; Improving Adherence Through mHealth for Pediatric Hematopoietic Stem Cell Transplant Patients), a pilot RCT intervention trial. The goal of the parent project is to assess the acceptability, feasibility, and potential efficacy of the mHealth app, BMT4me, in a prospective, longitudinal pilot RCT with caregivers of children during the acute phase post- HSCT. The rationale is that a mHealth app designed to send medication reminders to caregivers will increase adherence to immunosuppressant medication, thereby potentially reducing graft vs host disease (GVHD), readmissions, and mortality. The need for a Spanish version of the BMT4me adherence app came from knowledge gained in the pilot K99. One-third of families spoke Spanish and were ineligible to participate in the study. Additionally, only 20% of medication apps offer alternative languages. Thus, there is an urgent need to develop and evaluate innovative, accessible, and evidence-based approaches, inclusive of linguistically diverse families, to increase adherence among children receiving HSCT. During this R21, we will transcreate the current BMT4me to Spanish. The digital health app sends medication and refill reminders, tracks reasons for missed doses and symptoms in real time, creates a weekly summary to be exported and shared with providers, and includes a notes section that allows for picture upload and storage to communicate with providers in clinic. The app will also obtain reasons for non-adherence, adding to our knowledge of barriers to adherence in this population. The specific aims of this project are to: 1) use a community-based participatory research approach to transcreate the app for Spanish-speaking families; and 2) conduct user testing with 30 Spanish-speaking caregivers of children receiving HSCT at two sites to further refine BMT4me for inclusion in the ongoing pilot RCT. The rationale for transcreation, using a community based participatory research (CBPR) approach, is that it actively seeks to incorporate the input and recommendations of bilingual native Spanish-speaking research team members and community partners in the translation process to mitigate problems commonly encountered with the standard translation-backtranslation process. A Community Advisory Board will engage in an iterative review of study content and the intervention to improve cultural accuracy, assist in maintaining intended meaning, and advise on culture-specific alterations. The successful completion of this project will enable us to expand enrollment in the R00 to be inclusive of Spanish-speaking families. This project will support a culturally-responsive, mHealth intervention that will significantly advance the science of adherence and inform more equitable approaches to clinical care for linguistically diverse children receiving HSCT, thereby, advancing health equity for all families post-HSCT. The goal is to promote more equitable care and reduce health disparities among children receiving HSCT. In addition, there is great potential to adapt our work for children with other chronic conditions.