A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol.

BACKGROUND: The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. Few interventions have been designed to reduce LDKT disparities. This study aims to reduce Hispanic disparities in LDKT through a culturally targeted intervention. METHODS/DESIGN: Using a prospective effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls, we will implement a complex culturally targeted intervention at two transplant centers in Dallas, TX and Phoenix, AZ. The goal of the study is to evaluate the effect of Northwestern Medicine's® Hispanic Kidney Transplant Program's (HKTP) key culturally targeted components (outreach, communication, education) on Hispanic LDKT rates over five years. The main hypothesis is that exposure to the HKTP will reduce disparities by increasing the ratio of Hispanic to non-Hispanic white LDKTs and the number of Hispanic LDKTs. We will also examine other process and outcome measures including: dialysis patient outreach, education session attendance, marketing efforts, Hispanic patients added to the waitlist, Hispanic potential donors per potential recipient, and satisfaction with culturally competent care. We will use mixed methods based on the Promoting Action on Research Implementation in Health Services (revised PARIHS) and the Consolidated Framework for Implementation Research (CFIR) frameworks to formatively evaluate the fidelity and innovative adaptations to HKTP's components at both study sites, to identify moderating factors that most affect implementation fidelity, and to identify adaptations that positively and negatively affect outcomes for patients. DISCUSSION: Our study will provide new knowledge about implementing culturally targeted interventions and their impact on reducing health disparities. Moreover, the study of a complex organizational-level intervention's implementation over five years is rare in implementation science; as such, this study is poised to contribute new knowledge to the factors influencing how organizational-level interventions are sustained over time. TRIAL REGISTRATION: (ClinicalTrials.gov registration # NCT03276390 , date of registration: 9-7-17, retrospectively registered).

Original: anti-smoking media campaign messages: theory and practice.

This study examined televised anti-smoking advertisements that were designed to discourage adult and teen smoking. A content analysis of 399 television advertisements catalogued in the Media Campaign Resource Center (MCRC) database were evaluated to determine (a) whether the advertising content reflected core health communication theories used in the design of health campaign messages to change behavior and (b) the affective presentation of tobacco-control advertisements aimed to decrease smoking. The results revealed that anti-smoking advertising relied overwhelmingly on appeals to attitudes. Although the benefits of not smoking were mentioned in 61% of advertisements, barriers were mentioned in only 17% of advertisements. Advertisements emphasized the consequences of smoking more than the viewer's self-efficacy. Finally, advertisements were more likely to use informational and humor appeals, rather than sadness, fear, or anger appeals. The research identifies the types of advertisements that are most likely to be utilized and underutilized in national and statewide anti-smoking advertising campaigns catalogued in the MCRC database.