Enhancing Kidney Donation Through Live Organ Video Educated Donors (LOVED)

描述（由申请人提供）：非裔美国人（AAs）被诊断为慢性肾脏疾病的人数是白人的四倍，而死于这种疾病的非裔美国人几乎是白人的两倍。肾移植为终末期肾病（ESRD）患者提供了最好的结果，但获取尸体器官的比率远远超过尸体器官的可获得性，特别是在AAs中。一个更好的选择是活体肾移植（LDKT）。由于AA仅占LDKT接受者的18.5%，因此需要创新和文化偏好的策略来增加AA社区的LDKT。我们假设，以患者为中心，针对AA ESRD患者和使用移动医疗（mHealth）技术的潜在捐赠者（pd）的两层文化敏感教育/动机干预将导致：1)增加ESRD患者要求捐赠的意愿；2)完成医学评估的pd人数增加；3) ldkt数量增加。我们将利用移动医疗技术作为交付机制，最大限度地发挥大规模传播潜力。在行为改变和技术可接受性理论的指导下，活体器官视频教育捐赠者（LOVED）计划将解决两个领域的问题。lovei将为AA ESRD患者量身定制，并由AA LDKT接受者导航。loveii将为潜在的LDKT捐赠者量身定制，并由AA LDKT捐赠者进行导航。iPad程序交付将包括推荐音频/视频剪辑、家庭作业、视频会议、聊天室会话和文本/电子邮件。拟议的混合方法研究在3个阶段的开发过程中利用定性和定量研究，包括：1)在行为和技术理论指导下开发LOVED I和II的技术内容和交付形式，使用9个焦点小组（每组8人），包括AA LDKT受者/供者、ESRD LDKT合格患者、未能完成筛查的pd和移植医疗保健提供者团队。2)进行为期3个月的LOVED I和II概念验证研究（LOVED I = 24名LDKT符合条件的患者；LOVED II = 24名未完成筛查的pd），以评估项目的可接受性、可行性、自我效能感和态度的变化。还将评估识别出pd的ESRD患者的百分比，完成筛查的pd的百分比，ldkt的百分比以及参与者对干预的文化能力的感知，包括信任，歧视，共同决策和识字水平。3)进行两项为期6个月的两组随机对照试验（LOVED I vs.标准治疗组，N=60; LOVED II vs.标准治疗组，N=80），以产生设计大规模RCT所需的估计。

DESCRIPTION (provided by applicant): Chronic Kidney Disease is diagnosed in four times as many African Americans (AAs) as Whites and nearly twice as many AAs perish from the condition. Kidney transplantation offers the best outcomes for patients with End Stage Renal Disease (ESRD) but rates of procurement far outnumber cadaver organ availability, especially among AAs. A superior option is living donor kidney transplantation (LDKT). Since AAs comprise only 18.5% of LDKT recipients, innovative and culturally preferred strategies are needed to increase LDKT within the AA community. We hypothesize that a patient-centered, two tiered culturally sensitive education/motivation intervention targeting AA ESRD patients and potential donors (PDs) using mobile health (mHealth) technology will result in: 1) increased ESRD patients' willingness to ask for donation; 2) increased number of PDs who complete medical evaluation; and, 3) increased number of LDKTs. We will leverage mHealth technology as the delivery mechanism to maximize large scale dissemination potential. Guided by behavioral change and technology acceptability theories, the Live Organ Video Educated Donor [LOVED] program will be developed to address two domains. LOVED I will be tailored for AA ESRD patients and navigated by an AA LDKT recipient. LOVED II will be tailored for potential LDKT donors and navigated by an AA LDKT donor. iPad program delivery will include testimonial audio/video clips, home-work assignments, videoconferencing, chat room sessions, and text/emails. The proposed mixed methods research utilizes qualitative and quantitative studies in a 3 phase process of development that will involve: 1) Development of LOVED I and II technical content and delivery formats guided by behavioral and technological theories using 9 focus groups (8 per group) of AA LDKT recipients/donors, ESRD LDKT eligible patients, PDs who failed to complete screening and transplant healthcare provider team. 2) Conduct 3 month LOVED I and II proof of concept studies (LOVED I = 24 LDKT eligible patients; LOVED II = 24 PDs who did not complete screening) to assess program acceptability, feasibility, changes in self efficacy and attitudes. Also assessed will be % ESRD patients who identify PDs, % PDs who complete screening, % LDKTs and participants' perceptions of cultural competence of intervention including levels of trust, discrimination, shared decision making and literacy. 3) Conduct two 6 month 2-arm randomized control trials (LOVED I vs. standard of care, N=60; LOVED II vs. standard of care, N=80) to generate estimates needed for design of a large scale RCT.