Abstract
BackgroundThe 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.MethodsTo 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.ResultsStaff 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).ConclusionsWe 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 registrationClinicaltrials.gov number NCT02092727. Registered 13 Mar 2014 (retrospectively registered).
Highlights
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
We report high sustainability of the RaDIANT multicomponent intervention, with two thirds of participating dialysis facilities perceiving the majority of RaDIANT intervention activities as helpful or very helpful, and most participating facilities willing to continue at least one required intervention component
Staff recommended increased use of financial educational resources as a potential improvement to the RaDIANT intervention. These findings suggest that the RaDIANT intervention may not fully address financial barriers in access to kidney transplantation, barriers that persist in the Georgia ESRD population [17, 21, 37,38,39,40]
Summary
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. Multicomponent quality improvement interventions targeting dialysis facilities have shown demonstrated improvements in end stage renal disease (ESRD) patient outcomes and quality of care [1,2,3,4] These studies tend to emphasize effect size in determining the success of complex interventions, with little regard as to why the interventions were successful or the reproducibility of the interventions in diverse contexts [5, 6]. Recent research has increasingly valued process evaluation, which focuses on the degree of implementation of an intervention, as a critical component of randomized controlled trials, especially in multisite trials where implementation may vary by setting [5, 7,8,9] These evaluations are largely underreported in public health research [9, 10], but can provide important information regarding the quality of a complex intervention and its feasibility in practice [9, 11]. Identifying barriers and facilitators to implementation and intervention outcomes can inform modification of complex interventions, ensuring intervention components can reliably produce desired short- and long-term outcomes in diverse contexts [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
