Tailored mHealth Coaching and Social Resource Support to Reduce Health Disparities in Kidney Transplantation - In the US, kidney transplantation is the therapy of choice for end-stage kidney disease, with ~20,000 transplants performed annually. After transplantation, ~30% of recipients are unable to follow their prescribed medication regimen and risk allograft loss due to inadequate patient activation, which is the inability to engage in post-transplant healthcare and effectively communicate with the clinician. This lack of activation is estimated to be the cause of one-third of kidney transplant failures and 125,000 annual deaths. Low-resource communities are disproportionately burdened by insufficient patient activation and post-transplant medication nonadherence. Indeed, inadequate patient activation and insufficient community-level resources, a composite of the neighborhood-level social determinants of health of household composition, language, and mobility and transportation, negatively impact transplant outcomes. Notably, there is a 60% higher risk of kidney transplant failure, particularly in hypertensive patients, and a 50% increased risk of death among Blacks, Latinos/as and those of low socioeconomic status. This negative impact of social determinants of health as above on transplant failure is a major contributor to health disparities in kidney transplantation and confers a total lifetime burden of ~$1.38 billion dollars in additional incremental medical spending for all kidney transplant recipients. Thus, there is a critical need for interventions that effectively target patient activation to mitigate the effects of social determinants of health as above most often experienced by these communities. Coaching, mobile health technologies, and addressing social determinants of health as above have separately been shown to improve chronic conditions, such as hypertension and diabetes but intervention trials in socially vulnerable kidney transplant populations are lacking. Previously, our team demonstrated that the use of MyKidneyCoach, an mHealth application (app) and coaching, prescribed through the electronic health record (EHR), improved short-term patient activation and hypertension control for Black adult kidney transplant recipients. More work is needed to determine whether mHealth tools alone or in conjunction with social work support can improve patient activation and clinical outcomes among individuals at high risk of poor transplant outcomes. Our central hypothesis is that MyKidneyCoach or MyKidneyCoach+SW, with the addition of a dedicated social worker to address social determinants of health as above, both prescribed through EHR, will provide a sustainable improvement in patient activation leading to enhanced clinical outcomes. To achieve this end, we propose a five-year, three-arm, randomized control trial to compare efficacy of MyKidneyCoach and MyKidneyCoach+SW compared to usual care in 339 adult (18-64 years) kidney transplant recipients across 6 months. Our proposed study will provide a comprehensive understanding of patient activation and self-management monitoring, social work support, and coaching strategies that leverage existing health IT and can be implemented for low socioeconomic communities beyond kidney transplantation to improve health disparities within the healthcare system.
