Latinx Children and Surgery

拉丁儿童和外科

• 批准号: 10538983
• 负责人: Zeev Kain
• 金额: $ 126.15万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538983
• 关键词: Adult; Age; Algorithms; Ambulatory Surgical Procedures; Analgesics; Anxiety; Award; Behavior Therapy; Behavioral; Child; Clinical; Collaborations; Communities; Companions; Coping Skills; Data; Delirium; Development; Distress; Educational process of instructing; Event; Evidence based intervention; Family; Growth; Health Personnel; Healthcare; Home; Impairment; Internet; Intervention; Language; Latinx; Latinx population; Mobile Health Application; Modeling; Operative Surgical Procedures; Opioid; Output; Pain; Pain management; Parents; Patients; Persons; Phase; Physical Function; Population; Postoperative Pain; Postoperative Period; Process; Recovery; Research; Services; Target Populations; Testing; United States National Institutes of Health; animation; attentional control; base; clinical practice; comparison intervention; cost; disparity reduction; effective intervention; effectiveness evaluation; ethnic minority; evidence base; experience; formative assessment; handheld mobile device; heuristics; improved; innovation; mHealth; opioid use; pain reduction; postoperative recovery; psychologic; satisfaction; surgery outcome; surgical disparities; usability

Abstract Over 60 million persons in the U.S. identify themselves as Latinx and 25.6% are children under the age of 16. Surgical disparities for adults and children have been identified as a major problem in the US and can be experienced at multiple points along a patient's health care trajectory. Data from our center indicates that a substantial portion of Latinx children who undergo surgery experience high anxiety and postoperative pain as well as postoperative impairments in psychological and physical functioning as compared to White non-Latin children who undergo surgery. Recent growth in use of mobile devices provides us an opportunity to create low- cost mHealth behavioral interventions to reduce this disparity in surgical outcomes. In a previous NIH award, the PI developed and tested an evidence based mHealth tailored intervention (WebTIPS) that aims to prepare and be a companion of a child and their family during a surgical event. WebTIPS aims to enhance the recovery of the child in several ways such as reducing anxiety and pain and is based on information provision, modeling, and teaching of coping skills. WebTIPS, however, was developed and validated with a population of primarily White non-Latinx English-speaking children and their parents. Unfortunately, it is well established that mHealth interventions are significantly less effective when used with specific ethnic minorities unless they underwent a process of cultural adaptation. Over the past 4-years, we have established multiple academic and community collaborations, conducted extensive participatory research with Latinx stakeholders and used the heuristic framework and a modified ecological validity model to culturally adapt WebTIPS. The culturally adapted intervention is called L-WebTIPS. The overall aim of this application is to reduce surgical disparities in a population of Latinx children undergoing surgery. The first phase of this application (R61) includes web programming of L-WebTIPS, conduct formative evaluation and conduct feasibly RCT to test this intervention. The second phase (R33) includes a multi-center RCT which aims to determine the effectiveness of L-WebTIPS compared to attention control intervention in decreasing postoperative pain, opioids consumption and lowering anxiety in Latinx children undergoing outpatient surgery. Secondary aims of the R33 include examining the impact of L-WebTIPS on home-based clinical recovery parameters such as pain, analgesic requirements, new onset behavioral changes and return to normal daily activity in Latinx children undergoing outpatient surgery. We also plan to determine if the use of L- WebTIPS reduces anxiety and improve experience among the parents of Latinx children undergoing surgery. Finally we plan to determine if the use of L-WebTIPS reduces anxiety and enhance experience among the parents of Latinx children undergoing surgery. We submit that using a cultural adaption process for an existing validated intervention will accelerate the process of reducing surgical disparities and bringing an effective intervention to clinical settings and routine use.

抽象的 在美国，超过6000万人认为自己是拉丁裔，而25.6％的人是16岁以下的儿童。 成人和儿童的手术差异已被确定为美国的主要问题，可以是 沿着患者的医疗保健轨迹多个点经验。来自我们中心的数据表明 接受手术的大部分拉丁裔儿童经历了高度焦虑和术后疼痛 与白色非拉丁蛋白相比，心理和身体机能的术后损害 接受手术的孩子。移动设备的最新使用增长为我们提供了创造低 - 花费MHealth行为干预措施，以减少手术结果的这种差异。 在先前的NIH奖中，PI开发并测试了基于证据的MHealth量身定制干预措施 （WebTips）旨在在外科活动中准备并成为孩子及其家人的伴侣。 WebTips 旨在通过多种方式来增强孩子的康复，例如减轻焦虑和痛苦，并基于 信息提供，建模和应对技能的教学。但是，WebTips已开发和验证 有主要是白人非拉特族人英语的孩子及其父母的人口。不幸的是，是 很好地确定，与特定种族一起使用时，MHealth干预措施的效率明显降低 除非少数群体经历了文化适应过程。在过去的4年中，我们已经建立了 多次学术和社区合作，与拉丁裔进行了广泛的参与研究 利益相关者并使用启发式框架和修改的生态有效性模型来适应 WebTips。文化适应的干预措施称为l-webtips。 该应用的总体目的是减少正在接受的拉丁裔儿童的手术差异 外科手术。该应用程序的第一阶段（R61）包括L-Webtips的网络编程，进行形成 评估和进行可行的RCT来测试此干预措施。第二阶段（R33）包括一个多中心 与注意力控制干预措施相比，旨在确定L-WebTIP的有效性 减轻术后疼痛，阿片类药物的消费量和降低正在接受的拉丁裔儿童的焦虑 门诊手术。 R33的次要目的包括检查L-Webtip对家庭基于家庭的影响 临床恢复参数，例如疼痛，镇痛要求，新发作行为改变并返回 拉丁裔儿童接受门诊手术的正常日常活动。我们还计划确定使用L-是否 WebTips减少了接受手术的拉丁裔儿童父母的焦虑并改善经验。 最后，我们计划确定使用L-webtips是否会减少焦虑并增强焦虑的经验 拉丁裔儿童接受手术的父母。我们认为使用文化适应过程为现有 经过验证的干预措施将加速减少手术差异并带来有效的过程 干预临床环境和常规使用。