title: Effect of a Mobile Web App on Kidney Transplant Candidates' Knowledge About Increased Risk Donor Kidneys: A Randomized Controlled Trial.
abstract: Kidney transplant candidates (KTCs) must provide informed consent to accept kidneys from increased risk donors (IRD), but poorly understand them. We conducted a multisite, randomized controlled trial to evaluate the efficacy of a mobile Web application, Inform Me, for increasing knowledge about IRDs.
  
  
  
  Kidney transplant candidates undergoing transplant evaluation at 2 transplant centers were randomized to use Inform Me after routine transplant education (intervention) or routine transplant education alone (control). Computer adaptive learning method reinforced learning by embedding educational material, and initial (test 1) and additional test questions (test 2) into each chapter. Knowledge (primary outcome) was assessed in person after education (tests 1 and 2), and 1 week later by telephone (test 3). Controls did not receive test 2. Willingness to accept an IRD kidney (secondary outcome) was assessed after tests 1 and 3. Linear regression test 1 knowledge scores were used to test the significance of Inform Me exposure after controlling for covariates. Multiple imputation was used for intention-to-treat analysis.
  
  
  
  Two hundred eighty-eight KTCs participated. Intervention participants had higher test 1 knowledge scores (mean difference, 6.61; 95% confidence interval [95% CI], 5.37-7.86) than control participants, representing a 44% higher score than control participants' scores. Intervention participants' knowledge scores increased with educational reinforcement (test 2) compared with control arm test 1 scores (mean difference, 9.50; 95% CI, 8.27-10.73). After 1 week, intervention participants' knowledge remained greater than controls' knowledge (mean difference, 3.63; 95% CI, 2.49-4.78) (test 3). Willingness to accept an IRD kidney did not differ between study arms at tests 1 and 3.
  
  
  
  Inform Me use was associated with greater KTC knowledge about IRD kidneys above routine transplant education alone.
authors.affiliation: 1 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL. 2 Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL. 3 Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, IL. 4 Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA. 5 Rehabilitation Institute of Chicago, Chicago, IL. 6 Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL. 7 Kovler Organ Transplantation Center, Northwestern Memorial Hospital, Chicago, IL. 8 Abdominal Transplant Operations, University of Minnesota Medical Center-Solid Organ Transplantation, Minneapolis, MN. 9 Department of Medicine, Division of Nephrology, Department of Surgery, Division of Transplantation, Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Gordon
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chang
authors.forename: Gwen
authors.initials: G
authors.lastname: McNatt
authors.forename: Karina
authors.initials: K
authors.lastname: Vera
authors.forename: Nicole
authors.initials: N
authors.lastname: Beauvais
authors.forename: Emily
authors.initials: E
authors.lastname: Warren
authors.forename: Roslyn B
authors.initials: RB
authors.lastname: Mannon
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ison
mesh_terms: D000328:Adult; D000407:Alabama; D002641:Chicago; D046148:Donor Selection; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D063731:Mobile Applications; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D012054:Reinforcement, Psychology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*