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.
The almost 100,000 living kidney transplant recipients (KTRs) with functioning grafts in the United States, who are estimated to be 65 times more likely to develop squamous cell carcinoma and are more than twice as likely to develop melanoma as the general population, can prevent skin cancer by the regular use of sun protection. Currently, sun protection counseling is not performed when KTRs are ready to implement the behavior nor is sufficient information provided to implement the behavior. The research will develop and evaluate a novel Internet-based culturally sensitive approach to sun protection counseling to prevent skin cancer which can be disseminated to all living kidney transplant recipients.