Changes in stage of readiness after exposure to "Sharing the Gift of Life"

Growing waiting lists for organ transplantation require special attention to populations whose demand for organs is high coupled with a low donation rate. American Indians (AI) experience a high demand for kidney transplantation due to an epidemic of type-2 diabetes, yet donation consent rates are low in this group. There is a critical need for interventions designed to increase intent to serve as an organ and tissue donor among AI people. The purpose of this study was to examine behavioral outcomes after exposure to ‘‘Sharing the Gift of Life,'' a culturally-targeted and theory-driven educational intervention designed for reservation dwelling AI adults living in the Northern Plains region of the United States. The specific aim was to determine whether the intervention produced changes in intention to serve as an organ or tissue donor. A community-based and quasi-experimental pre/post-test design was used. The setting was four rural American Indian reservations. Participants were reservation dwelling AI adults (N=1850, 58% women). Using findings from a prior qualitative study, the intervention messages (print, video and social marketing materials) were developed based upon the cultural traditions of story-telling and gift giving. Traditional music, prayer, local photography, historical picture archives and personal interviews of donors, recipients and donor families were used to develop the materials. Messages were selected based upon their relationship to constructs in the Transtheoretical Model of Behavior Change. The primary outcome measure was stage of motivational readiness to be an organ/tissue donor (measured pre/post intervention). McNemar's test of significance for dependent samples was used to compare pre- and post-intervention stage of motivational readiness. Participants were categorized as stage non-progressed (no change is stage of motivational readiness, 43%), or stage progressed (progressed one or more stages of motivational readiness, 57%). There were no participants who regressed in stage of change. Progression in stage of change from pre- to post-intervention was significant, ÷2 (1) = 18.32, p <.05. This culturally-targeted intervention for organ and tissue donation resulted in important changes in intention to serve as donor for reservation dwelling AI adults.