American Indians and Alaska Natives (Al/ANs) experience a disproportionate burden of end stage renal disease, primarily due to having the highest prevalence of type 2 diabetes of any racial or ethnic minority population in the United States. There are many sociocultural, geographic, and economic barriers to receiving education on living kidney donation and transplantation (LKDT) for Al/ANs. These barriers must be addressed with a relevant, theory-based and culturally-derived approach to dialysis center based education for AI/AN patients who may still be eligible for transplant. The purpose of this proposal is to develop and examine the preliminary outcomes of a new culturally-targeted LKDT educational intervention for AI/AN renal dialysis patients who have not been ruled out for transplant eligibility. The interpersonal intervention integrates LKDT education with the population's oral tradition of story-telling. There are three overall aims: (1) Conduct a formative study to assess the knowledge, attitudes, and beliefs about LKDT among AI/AN dialysis patients. (2) Develop a culturally-targeted intervention for AI/AN dialysis patients focused on knowledge of LKDT and how to have a conversation with family members about living donation. (3) Conduct a group randomized test of the intervention and examine its effect on the outcomes of knowledge of LKDT and related conversations with family members. The program is delivered by tribal research coordinators through dialysis sites.The design is a two-group randomized trial (N = 100) that employs a community-based participatory research approach. Dialysis sites that serve eligible AI/AN patients will be randomized to the experimental intervention or delayed intervention control. Tribal members who are research coordinators will deliver the interactive intervention. The primary outcome of LKDT knowledge is measured at baseline and after intervention exposure (or no exposure). Stage of motivational readiness to have a LKDT conversation with family and actual family conversations are both measured using a staging algorithm. This innovative approach to reaching dialysis patients who may be transplant eligible has the potential for diffusion and replication with diverse AI/AN tribes and even other minoritv populations who share similar health disparities.
There is an urgent need to address organ donation and transplantation disparities for American Indians and Alaska Natives (Al/ANs). This study will develop and test a culturally-targeted living kidney donation and transplantation (LKDT) educational intervention for Al/ANs who are on renal dialysis. This research has a great potential to improve the health and quality of life for this minority population.
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