title: An interactive, bilingual, culturally targeted website about living kidney donation and transplantation for hispanics: development and formative evaluation.
abstract: As the kidney shortage continues to grow, patients on the waitlist are increasingly turning to live kidney donors for transplantation. Despite having a disproportionately higher prevalence of end-stage kidney disease (ESKD), fewer waitlisted Hispanic patients received living donor kidney transplants (LDKTs) than non-Hispanic whites in 2014. Although lack of knowledge has been identified as a barrier to living kidney donation (LKD) among Hispanics, little is known about information needs, and few bilingual educational resources provide transplant-related information addressing Hispanics' specific concerns.
  
  
  
  This paper describes the process of developing a bilingual website targeted to the Hispanic community. The website was designed to increase knowledge about LKD among Hispanic patients with ESKD, their families, and the public, and was inspired by educational sessions targeted to Hispanic transplant patients provided by Northwestern University's Hispanic Kidney Transplant Program.
  
  
  
  Northwestern faculty partnered with the National Kidney Foundation of Illinois for expertise in ESKD and Hispanic community partners across the Chicago area. We established a Community Advisory Board (CAB) of 10 Chicago-area Hispanic community leaders to provide insight into cultural concerns and community and patients' needs. Website content development was informed by 9 focus groups with 76 adult Hispanic kidney transplant recipients, living kidney donors, dialysis patients, and the general Hispanic public. The website development effort was guided by community input on images, telenovela scripts, and messages. After initial development, formal usability testing was conducted with 18 adult Hispanic kidney transplant recipients, dialysis patients, and living kidney donors to identify ways to improve navigability, design, content, comprehension, and cultural sensitivity. Usability testing revealed consistently high ratings as "easy to navigate", "informative", and "culturally appropriate". Bandura's Social Cognitive Theory and Gagne's Conditions of Learning Theory guided website design to facilitate adult learning.
  
  
  
  The website, "Infórmate: Living Kidney Donation for Hispanics/Latinos" (Infórmate Acerca de la Donación de Riñón en Vida), includes six sections: Treatment Options, Donation: Step-by-Step, Benefits and Risks, Financial Issues, Immigrant Issues, and Cultural Beliefs and Myths. Sections host 5-10 interactive messages that summarize important points and link to detailed explanations for users interested in learning more about specific issues. The website hosts interactive videos, multimedia testimonials, telenovelas, games, and quizzes. Photographs and videos of Hispanic living donors are shown to promote pride and ownership.
  
  
  
  Our success in developing a website was driven by a development team with expertise in transplantation, social science, evaluation, instructional design, and Hispanic perspectives, and by a patient-centered approach toward content and design. Based on feedback from usability testing and our CAB, the website is sensitive to Hispanic cultural sensibilities. We have nearly completed a formal evaluation of the website's impact on increasing Hispanics' knowledge about LKD and will disseminate the website thereafter.
authors.affiliation: Center for Healthcare Studies and Comprehensive Transplant Center, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. e-gordon@northwestern.edu.
authors.forename: Elisa J
authors.identifier: 0000-0003-0969-1998
authors.initials: EJ
authors.lastname: Gordon
authors.forename: Joe
authors.identifier: 0000-0002-3665-8897
authors.initials: J
authors.lastname: Feinglass
authors.forename: Paula
authors.identifier: 0000-0001-8677-5736
authors.initials: P
authors.lastname: Carney
authors.forename: Daney
authors.identifier: 0000-0003-1961-8380
authors.initials: D
authors.lastname: Ramirez
authors.forename: Maria
authors.identifier: 0000-0002-5762-192X
authors.initials: M
authors.lastname: Olivero
authors.forename: Kate
authors.identifier: 0000-0002-6596-8958
authors.initials: K
authors.lastname: O'Connor
authors.forename: Jessica
authors.identifier: 0000-0003-1376-6278
authors.initials: J
authors.lastname: MacLean
authors.forename: James
authors.identifier: 0000-0001-5649-6787
authors.initials: J
authors.lastname: Brucker
authors.forename: Juan Carlos
authors.identifier: 0000-0003-3936-6395
authors.initials: JC
authors.lastname: Caicedo
keywords: Hispanic Americans; Internet; Latino; culturally targeted; eHealth intervention; ethics; ethnic groups; immigrants; informed consent; kidney transplantation; living donors; multimedia