Process evaluation of the RaDIANT community study: a dialysis facility-level intervention to increase referral for kidney transplantation

• Type of Material: Article
• Authors: Reem E. Hamoda, Emory University; Jennifer C. Gander, Emory University; Laura J. McPherson, Emory University; Kimberly J. Arriola, Emory University; Loren Cobb, Spelman College; Stephen Pastan, Emory University; Laura Plantinga, Emory University; Teri Browne, University of South Carolina; Erica Hartmann, Piedmont Transplant Institute; Laura Mulloy, Augusta University; Carlos Zayas, Augusta University; Jenna Krisher, End Stage Renal Disease Network 6; Rachel Elizabeth Patzer, Emory University
• Language: English
• Date: 2018-01-15
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2018
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12882-017-0807-z
• Title of Journal or Parent Work: BMC Nephrology
• ISSN: 1471-2369
• Volume: 19
• Issue: 1
• Start Page: 13
• End Page: 13
• Grant/Funding Information: The Reducing Disparities in Access to kidNey Transplantation Community Study was funded in part by NIMHD award R24MD008077.; Support for the preparation of this document was provided by contract number HHSM-500-2013-NW006C, entitled “End Stage Renal Disease Networks Organization for the State (Commonwealth) of GA, NC, and SC”, sponsored by the Centers for Medicare and Medicaid Services- an agency of the US Department of Health and Human Services.; The funders had no role in the design of the study, collection, analysis, or interpretation of data, and writing of this manuscript.
• Keywords: Life Sciences & Biomedicine; Randomized trial; Education; Dialysis facility; HEALTH-CARE; Community-based participatory research; Process evaluation; PATIENT; Kidney transplantation; Science & Technology; COMPLEX INTERVENTIONS; UNITED-STATES; Staff; Urology & Nephrology; STAGE RENAL-DISEASE; RACIAL DISPARITIES; EDUCATION; IMPLEMENTATION FIDELITY; ETHNIC DISPARITIES; LIVING DONOR TRANSPLANT
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Background: The Reducing Disparities in Access to kidNey Transplantation Community Study (RaDIANT) was an End-Stage Renal Disease (ESRD) Network 6-developed, dialysis facility-level randomized trial testing the effectiveness of a 1-year multicomponent education and quality improvement intervention in increasing referral for kidney transplant evaluation among selected Georgia dialysis facilities. Methods: To assess implementation of the RaDIANT intervention, we conducted a process evaluation at the conclusion of the intervention period (January-December 2014). We administered a 20-item survey to the staff involved with transplant education in 67 dialysis facilities randomized to participate in intervention activities. Survey items assessed facility participation in the intervention (fidelity and reach), helpfulness and willingness to continue intervention activities (sustainability), suggestions for improving intervention components (sustainability), and factors that may have influenced participation and study outcomes (context). We defined high fidelity to the intervention as completing 11 or more activities, and high participation in an activity as having at least 75% participation across intervention facilities. Results: Staff from 65 of the 67 dialysis facilities completed the questionnaire, and more than half (50.8%) reported high adherence (fidelity) to RaDIANT intervention requirements. Nearly two-thirds (63.1%) of facilities reported that RaDIANT intervention activities were helpful or very helpful, with 90.8% of facilities willing to continue at least one intervention component beyond the study period. Intervention components with high participation emphasized staff and patient-level education, including in-service staff orientations, patient and family education programs, and patient educational materials. Suggested improvements for intervention activities emphasized addressing financial barriers to transplantation, with financial education materials perceived as most helpful among RaDIANT educational materials. Variation in facility-level fidelity of the RADIANT intervention did not significantly influence the mean difference in proportion of patients referred pre- (2013) and post-intervention (2014). Conclusions: We found high fidelity to the RaDIANT multicomponent intervention at the majority of intervention facilities, with sustainability of select intervention components at intervention facilities and feasibility for dissemination across ESRD Networks. Future modification of the intervention should emphasize financial education regarding kidney transplantation and amend intervention components that facilities perceive as time-intensive or non-sustainable. Trial registration: Clinicaltrials.gov number NCT02092727. Registered 13 Mar 2014 (retrospectively registered).