Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study

Elisa J. Gordon; Elida Romo; Daniela Amórtegui; Alejandra Rodas; Naomi Anderson; Jefferson Uriarte; Gwen McNatt; Juan Carlos Caicedo; Daniela P. Ladner; Michelle Shumate

doi:10.1111/hex.13124

Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study

Elisa J. Gordon^*, Elida Romo, Daniela Amórtegui, Alejandra Rodas, Naomi Anderson, Jefferson Uriarte, Gwen McNatt, Juan Carlos Caicedo, Daniela P. Ladner, Michelle Shumate

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Despite available evidence-based interventions that decrease health disparities, these interventions are often not implemented. Northwestern Medicine's^® Hispanic Kidney Transplant Program (HKTP) is a culturally and linguistically competent intervention designed to reduce disparities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. The HKTP was introduced in two transplant programs in 2016 to evaluate its effectiveness. Objective: This study assessed barriers and facilitators to HKTP implementation preparation. Methods: Interviews and group discussions were conducted with transplant stakeholders (ie administrators, nurses, physicians) during implementation preparation. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis. Results: Forty-four stakeholders participated in 24 interviews and/or 27 group discussions. New factors, not found in previous implementation preparation research in health-care settings, emerged as facilitators and barriers to the implementation of culturally competent care. Implementation facilitators included: stakeholders’ focus on a moral imperative to implement the HKTP, personal motivations related to their Hispanic heritage, and perceptions of Hispanic patients’ transplant education needs. Implementation barriers included: stakeholders’ perceptions that Hispanics’ health insurance payer mix would negatively impact revenue, a lack of knowledge about LDKT disparities and patient data disaggregated by ethnicity/race, and a perception that the family discussion component was immoral because of the possibility of coercion. Discussion and Conclusions: Our study identified novel barriers and facilitators to the implementation preparation of a culturally competent care intervention. Healthcare administrators can facilitate organizations’ implementation of culturally competent care interventions by understanding factors challenging care delivery processes and raising clinical team awareness of disparities in LDKT.

Original language	English (US)
Journal	Health Expectations
DOIs	https://doi.org/10.1111/hex.13124
State	Accepted/In press - 2020

Keywords

Hispanic/Latinx
consolidated framework for implementation research
health disparities
healthcare administrator
implementation science
living kidney donation

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

Access to Document

10.1111/hex.13124

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@article{7a6e7eb6e2984e21970286dc8be803a0,

title = "Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study",

abstract = "Background: Despite available evidence-based interventions that decrease health disparities, these interventions are often not implemented. Northwestern Medicine's{\textregistered} Hispanic Kidney Transplant Program (HKTP) is a culturally and linguistically competent intervention designed to reduce disparities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. The HKTP was introduced in two transplant programs in 2016 to evaluate its effectiveness. Objective: This study assessed barriers and facilitators to HKTP implementation preparation. Methods: Interviews and group discussions were conducted with transplant stakeholders (ie administrators, nurses, physicians) during implementation preparation. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis. Results: Forty-four stakeholders participated in 24 interviews and/or 27 group discussions. New factors, not found in previous implementation preparation research in health-care settings, emerged as facilitators and barriers to the implementation of culturally competent care. Implementation facilitators included: stakeholders{\textquoteright} focus on a moral imperative to implement the HKTP, personal motivations related to their Hispanic heritage, and perceptions of Hispanic patients{\textquoteright} transplant education needs. Implementation barriers included: stakeholders{\textquoteright} perceptions that Hispanics{\textquoteright} health insurance payer mix would negatively impact revenue, a lack of knowledge about LDKT disparities and patient data disaggregated by ethnicity/race, and a perception that the family discussion component was immoral because of the possibility of coercion. Discussion and Conclusions: Our study identified novel barriers and facilitators to the implementation preparation of a culturally competent care intervention. Healthcare administrators can facilitate organizations{\textquoteright} implementation of culturally competent care interventions by understanding factors challenging care delivery processes and raising clinical team awareness of disparities in LDKT.",

keywords = "Hispanic/Latinx, consolidated framework for implementation research, health disparities, healthcare administrator, implementation science, living kidney donation",

author = "Gordon, {Elisa J.} and Elida Romo and Daniela Am{\'o}rtegui and Alejandra Rodas and Naomi Anderson and Jefferson Uriarte and Gwen McNatt and Caicedo, {Juan Carlos} and Ladner, {Daniela P.} and Michelle Shumate",

note = "Funding Information: A study limitation is that participants{\textquoteright} statements or perceptions may not reflect actual behaviours. Although our results may be transferrable to academic, non‐profit hospitals, results may differ in community hospitals and/or hospitals in other US geographic regions. Study findings may reflect US experiences in implementing culturally competent care interventions highlighted by its market‐based system that may not arise in countries with a single payer system. A social desirability bias may have softened stakeholders{\textquoteright} concerns because grant funding supported HKTP implementation. We used measures to control for social bias including informing participants that their input would be analysed in aggregate and contribute to a better understanding of how to implement the HKTP and deliver culturally sensitive care for Hispanic patients in the future. Perceived barriers may not have prevented implementation. ",

year = "2020",

doi = "10.1111/hex.13124",

language = "English (US)",

journal = "Health Expectations",

issn = "1369-6513",

publisher = "Wiley-Blackwell",

}

Implementing culturally competent transplant care and implications for reducing health disparities : A prospective qualitative study. / Gordon, Elisa J.; Romo, Elida; Amórtegui, Daniela; Rodas, Alejandra; Anderson, Naomi; Uriarte, Jefferson; McNatt, Gwen; Caicedo, Juan Carlos ; Ladner, Daniela P.; Shumate, Michelle.

In: Health Expectations, 2020.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Implementing culturally competent transplant care and implications for reducing health disparities

T2 - A prospective qualitative study

AU - Gordon, Elisa J.

AU - Romo, Elida

AU - Amórtegui, Daniela

AU - Rodas, Alejandra

AU - Anderson, Naomi

AU - Uriarte, Jefferson

AU - McNatt, Gwen

AU - Caicedo, Juan Carlos

AU - Ladner, Daniela P.

AU - Shumate, Michelle

N1 - Funding Information: A study limitation is that participants’ statements or perceptions may not reflect actual behaviours. Although our results may be transferrable to academic, non‐profit hospitals, results may differ in community hospitals and/or hospitals in other US geographic regions. Study findings may reflect US experiences in implementing culturally competent care interventions highlighted by its market‐based system that may not arise in countries with a single payer system. A social desirability bias may have softened stakeholders’ concerns because grant funding supported HKTP implementation. We used measures to control for social bias including informing participants that their input would be analysed in aggregate and contribute to a better understanding of how to implement the HKTP and deliver culturally sensitive care for Hispanic patients in the future. Perceived barriers may not have prevented implementation.

PY - 2020

Y1 - 2020

N2 - Background: Despite available evidence-based interventions that decrease health disparities, these interventions are often not implemented. Northwestern Medicine's® Hispanic Kidney Transplant Program (HKTP) is a culturally and linguistically competent intervention designed to reduce disparities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. The HKTP was introduced in two transplant programs in 2016 to evaluate its effectiveness. Objective: This study assessed barriers and facilitators to HKTP implementation preparation. Methods: Interviews and group discussions were conducted with transplant stakeholders (ie administrators, nurses, physicians) during implementation preparation. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis. Results: Forty-four stakeholders participated in 24 interviews and/or 27 group discussions. New factors, not found in previous implementation preparation research in health-care settings, emerged as facilitators and barriers to the implementation of culturally competent care. Implementation facilitators included: stakeholders’ focus on a moral imperative to implement the HKTP, personal motivations related to their Hispanic heritage, and perceptions of Hispanic patients’ transplant education needs. Implementation barriers included: stakeholders’ perceptions that Hispanics’ health insurance payer mix would negatively impact revenue, a lack of knowledge about LDKT disparities and patient data disaggregated by ethnicity/race, and a perception that the family discussion component was immoral because of the possibility of coercion. Discussion and Conclusions: Our study identified novel barriers and facilitators to the implementation preparation of a culturally competent care intervention. Healthcare administrators can facilitate organizations’ implementation of culturally competent care interventions by understanding factors challenging care delivery processes and raising clinical team awareness of disparities in LDKT.

AB - Background: Despite available evidence-based interventions that decrease health disparities, these interventions are often not implemented. Northwestern Medicine's® Hispanic Kidney Transplant Program (HKTP) is a culturally and linguistically competent intervention designed to reduce disparities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. The HKTP was introduced in two transplant programs in 2016 to evaluate its effectiveness. Objective: This study assessed barriers and facilitators to HKTP implementation preparation. Methods: Interviews and group discussions were conducted with transplant stakeholders (ie administrators, nurses, physicians) during implementation preparation. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis. Results: Forty-four stakeholders participated in 24 interviews and/or 27 group discussions. New factors, not found in previous implementation preparation research in health-care settings, emerged as facilitators and barriers to the implementation of culturally competent care. Implementation facilitators included: stakeholders’ focus on a moral imperative to implement the HKTP, personal motivations related to their Hispanic heritage, and perceptions of Hispanic patients’ transplant education needs. Implementation barriers included: stakeholders’ perceptions that Hispanics’ health insurance payer mix would negatively impact revenue, a lack of knowledge about LDKT disparities and patient data disaggregated by ethnicity/race, and a perception that the family discussion component was immoral because of the possibility of coercion. Discussion and Conclusions: Our study identified novel barriers and facilitators to the implementation preparation of a culturally competent care intervention. Healthcare administrators can facilitate organizations’ implementation of culturally competent care interventions by understanding factors challenging care delivery processes and raising clinical team awareness of disparities in LDKT.

KW - Hispanic/Latinx

KW - consolidated framework for implementation research

KW - health disparities

KW - healthcare administrator

KW - implementation science

KW - living kidney donation

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U2 - 10.1111/hex.13124

DO - 10.1111/hex.13124

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