Sun protection Internet-based program for kidney transplant recipients

描述（由申请人提供）：本提案的目标是为肾移植受者（KTRs）开发一种文化敏感的基于互联网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治疗选择；然而，必要的终身免疫抑制治疗与发展中的皮肤癌，特别是鳞状细胞癌（SCC）和恶性黑色素瘤（MM）有关。在美国大约10万名ktr患者中，降低ktr患者的SCC和MM发病率对于挽救生命，纠正许多外科手术导致的毁容和功能丧失造成的生活质量受损，减少对SCC和MM复发或扩散的焦虑和恐惧是必要的。ktr患者可以通过定期使用防晒措施来预防发病率和随之而来的死亡率和发病率。目前，通常在术后急性期提供的防晒咨询，并没有在ktr准备实施该行为时进行，也没有提供足够的信息来实施该行为。我们对KTRs的焦点小组研究确定KTRs在移植后2- 12个月准备接受这种教育。对所有ktr人进行有关防晒重要性的文化敏感教育是必要的。少数民族占美国居住人口的38%，他们保留了本民族的皮肤癌风险认知和防晒行为。在少数民族的ktr中，有一种文化信仰，认为有色皮肤可以保护他们免受皮肤癌的侵害，因此他们不使用防晒霜。我们的假设是，为每个KTR提供个性化的防晒信息，并在KTR开始感觉好转并开始寻求户外活动的时候提供防晒信息，将增加防晒的使用，减少晒伤和皮肤刺激的数量，并限制色素变黑。五个基于互联网的教育模块的开发将以健康信念模型和预防采纳过程模型为理论基础。我们将通过认知访谈和ktr的效用测试来评估教育模块，并与肾病学人员一起评估其使用的表面价值和可行性。此外，我们将评估

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.