Latinx Children and Surgery

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。 这项应用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。本申请的第一阶段(R61)包括L的网页编程--WebTips，进行形成性 评估并进行可行的随机对照试验，以检验这种干预措施。第二阶段(R33)包括多中心 RCT旨在确定L网络提示与注意控制干预在 减少拉丁裔儿童手术后疼痛、阿片类药物消耗和降低焦虑 门诊手术。R33的次要目标包括研究L-网络提示对以家庭为基础的影响 临床康复参数，如疼痛、止痛药需求、新的发作行为变化和恢复 接受门诊手术的拉丁裔儿童的日常活动正常。我们还计划确定是否使用L- WebTips降低了接受手术的拉丁裔儿童的父母的焦虑，改善了他们的体验。 最后，我们计划确定使用L-WebTips是否可以减少焦虑并增强 正在接受手术的拉丁裔儿童的父母。我们认为，使用文化适应过程来适应现有的 有效的干预将加速减少手术差异的进程，并带来有效的 对临床环境和常规使用的干预。

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.