Patient-Centered mHealth Living Donor Transplant Education Program for African Americans: Development and Analysis.
BACKGROUND
There is a critical need to expand the pool of available kidneys for African Americans who are on the transplant wait-list due to the disproportionally lower availability of deceased donor kidneys compared with other races/ethnic groups. Encouraging living donation is one method to fill this need. Incorporating mHealth strategies may be a way to deliver educational and supportive services to African American transplant-eligible patients and improve reach to those living in remote areas or unable to attend traditional group-session-based programs. Before program development, it is essential to perform formative research with target populations to determine acceptability and cultivate a patient-centered and culturally relevant approach to be used for program development.


OBJECTIVE
The objectives of this study were to investigate African American kidney transplant recipients' and kidney donors'/potential donors' attitudes and perceptions toward mobile technology and its viability in an mHealth program aimed at educating patients about the process of living kidney donation.


METHODS
Using frameworks from the technology acceptance model and self-determination theory, 9 focus groups (n=57) were administered to African Americans at a southeastern medical center, which included deceased/living donor kidney recipients and living donors/potential donors. After a demonstration of a tablet-based video education session and explanation of a group-based videoconferencing session, focus groups examined members' perceptions about how educational messages should be presented on topics pertaining to the process of living kidney donation and the transplantation. Questionnaires were administered on technology use and perceptions of the potential program communication platform. Transcripts were coded and themes were examined using NVivo 10 software.


RESULTS
Qualitative findings found 5 major themes common among all participants. These included the following: (1) strong support for mobile technology use; (2) different media formats were preferred; (3) willingness to engage in video chats, but face-to-face interaction sometimes preferred; (4) media needs to be user friendly; (5) high prevalence of technology access. Our results show that recipients were willing to spend more time on education than the donors group, they wanted to build conversation skills to approach others, and preferred getting information from many sources, whereas the donor group wanted to hear from other living donors. The questionnaires revealed 85% or more of the sample scored 4+ on a 5-point Likert scale, which indicates high degree of interest to use the proposed program, belief that other mHealth technologies would help with adherence to medical regimens, and doctors would make regimen adjustments quicker. In addition, high utilization of mobile technology was reported; 71.9% of the participants had a mobile phone and 43.9% had a tablet.


CONCLUSIONS
Our study supports the use of an mHealth education platform for African Americans to learn about living donation. However, potential recipients and potential donors have differing needs, and therefore, programs should be tailored to each target audience.
Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
John Christopher
http://orcid.org/0000-0002-0964-4684
JC
Sieverdes
Lynne S
http://orcid.org/0000-0001-8691-1400
LS
Nemeth
Gayenell S
http://orcid.org/0000-0002-2451-4888
GS
Magwood
Prabhakar K
http://orcid.org/0000-0002-1331-8486
PK
Baliga
Kenneth D
http://orcid.org/0000-0002-5733-3485
KD
Chavin
Brenda
http://orcid.org/0000-0002-1518-758X
B
Brunner-Jackson
Sachin K
http://orcid.org/0000-0001-7101-3341
SK
Patel
Kenneth J
http://orcid.org/0000-0001-8504-6988
KJ
Ruggiero
Frank A
http://orcid.org/0000-0001-5495-4131
FA
Treiber
kidney transplantation; living donors; mobile apps; qualitative research; telemedicine