Sun protection Internet-based program for kidney transplant recipients

描述(申请人提供)：该提案的目标是为肾移植受者开发一种基于互联网的文化敏感的防晒教育干预措施，以预防皮肤癌。肾移植是终末期肾病患者的首选治疗方法；然而，必要的终生免疫抑制治疗与皮肤癌的发生有关，特别是鳞状细胞癌(SCC)和恶性黑色素瘤(MM)。在美国大约100,000名KRR中，降低KDR中的鳞癌和MM的比率是必要的，以挽救生命，纠正因许多外科手术而造成的毁容和功能丧失而损害的生活质量，并减少对SCC和MM复发或扩散的焦虑和恐惧。KDR的发病率和随之而来的死亡率和发病率可以通过定期使用防晒措施来预防。目前，通常在手术后急性期提供的防晒咨询，不会在KDR准备实施行为时进行，也没有提供足够的信息来实施行为。我们对KDR进行的焦点小组研究确定，KDR在移植后2-12个月准备接受这种教育。对所有KDR进行关于防晒重要性的文化敏感教育是必要的。占美国在世KRR的38%的少数民族保留了他们民族的皮肤癌风险认知和防晒行为。在少数KDR中，有一种文化信仰，即肤色可以保护他们免受皮肤癌的侵袭，因此他们不使用防晒。我们的假设是，为每个KTR个性化防晒信息，并在KTR开始感觉好起来并开始寻求户外活动时传递，将增加防晒的使用，减少晒伤和皮肤刺激的数量，并限制色素变暗。五个基于互联网的教育模块的开发将在理论上以健康信念模式和预防采用过程模式为基础。我们将通过与KRR的认知访谈和实用测试，以及与肾脏科工作人员的面值和使用的可行性来评估教育模块。此外，我们还将评估 在说英语的白人、西班牙裔和黑人KRR中，评估每个教育模块和助推短信的有效性，并在随机对照试验中评估干预措施。除了在适当的时候启动教育外，还将通过短信提醒，并将有机会通过KDR接入互联网进行额外的教育。将根据课程、视频和测验的持续时间和使用模式来评估模块的使用情况。这项随机试验的结果指标(使用防晒、晒伤和皮肤刺激的次数以及色素变暗)将与干预的“剂量”以及性别、年龄、自肾移植以来的时间、婚姻状况、种族、教育、就业、家庭年收入和未晒黑皮肤的颜色等人口统计特征相关。

DESCRIPTION (provided by applicant): The goal of this proposal is to develop a culturally sensitive Internet-based sun protection educational intervention for kidney transplant recipients (KTRs) to prevent skin cancer. Kidney transplantation is the treatment of choice for patients with end-stage kidney disease; however, the requisite life-long immunosuppressive therapy is associated with developing skin cancer, especially squamous cell carcinoma (SCC) and malignant melanoma (MM). Among the approximately living 100,000 KTRs in the United States, reducing rates of SCC and MM in KTRs is necessary to save lives, redress the impaired quality of life from disfigurement and loss of function from the many surgical procedures, and reduce the anxiety and fear about the return or spread of SCC and MM. The incidence and the attendant mortality and morbidity can be prevented by the regular use of sun protection by KTRs. Currently, sun protection counseling, which is usually provided during the acute post-operative period, is not performed when KTRs are ready to implement the behavior nor is sufficient information provided to implement the behavior. Our focus group research with KTRs determined that KTRs are ready to receive this education 2- 12 months after transplantation. Culturally sensitive education about the importance of sun protection is necessary for all KTRs. Ethnic minorities, who comprise 38% of living US KTRs, retain the skin cancer risk perception and sun protection behaviors of their ethnic group. Among minority KTRs, there is the cultural belief that skin of color protects them from developing skin cancer, thus they do not use sun protection. Our hypothesis is that personalizing the sun protection message for each KTR and delivering it at the time when KTRs begin to feel better and start seeking outdoor activity will increase use of sun protection, reduce the number of sunburns and skin irritation, and limit pigment darkening. Development of the five Internet-based educational modules will be theoretically grounded in the Health Belief Model and the Precaution Adoption Process Model. We will evaluate the educational modules by cognitive interviews and utility testing with KTRs and for face value and feasibility of use with the nephrology staff. Additionally, we will evaluate the effectiveness of each educational module and the booster text messages among English speaking White, Hispanic, and Black KTRs and evaluate the intervention in a randomized controlled trial. In addition to initiating education at the opportune time, reminders will be provided by text messages and there will be opportunities for additional education by KTRs' accessing the Internet. Usage of modules will be assessed for duration and patterns of use of lessons, videos and quizzes. The outcome measures of the randomized trial (use of sun protection, number of sunburns and skin irritation, and pigment darkening) will be correlated with the "dose" of the intervention as well as the demographic characteristics of gender, age, time since kidney transplant, marital status, ethnicity, education, employment, annual household income and color of the untanned skin.