Advisor(s)

Matthew Fifolt

Committee Member(s)

Anne Brisendine
Olakunle Alonge
Rhiannon Reed
Vineeta Kumar

Document Type

Dissertation

Date of Award

1-27-2026

Degree Name

Doctor of Public Health (DrPH)

School

School of Public Health

Department

Public Health

Abstract

Living donor kidney transplantation (LDKT) is the most effective treatment for patients with end-stage kidney disease; however, living donation rates have remained suboptimal over the past two decades. As a result, many interventions have been developed and tailored to increase living donation. The Living Donor Navigator (LDN) Program is one effort designed to help transplant candidates identify potential living donors and guide them through the donation process, using a combination of advocacy and systems training. The LDN Program is a lay-navigator-based intervention that equips participants with the knowledge, communication skills, and confidence needed to identify and engage potential living donors. Early implementation of the LDN Program showed positive increases in living donor screenings and approvals; however, it created geographic disparities in access to the program, warranting expansion and alternative delivery options. As the program expanded to include tele-navigation, assessing program implementation became an essential next step before evaluating the LDN Program’s long-term impact across different delivery modalities. The purpose of this dissertation is to evaluate the implementation effectiveness of tele-navigation within the LDN Program, with emphasis on program fidelity, participant engagement, and perceived acceptability in promoting LDKT. This research explores how acceptability and engagement function as independent yet complementary determinants of implementation effectiveness. Specifically, this dissertation comprises three interrelated studies that: objectively compare patterns of behavioral engagement across in-person and telehealth delivery modalities (paper #1); assess the acceptability of tele-navigation (paper #2); and systematically evaluate how participation in LDKT programmatic efforts influences healthcare engagement (paper #3). Collectively, these studies aim to generate evidence on how telehealth-facilitated educational interventions, like the LDN Program, can be implemented and ultimately motivate expanding living donation opportunities, enhancing health equity, and strengthening patient–provider communication across the transplant continuum.

Keywords

Acceptability;Engagement;Implementation Effectiveness;Living Donor Kidney Transplantation;Tele-Navigation

ProQuest Publication Number

32281210

ISBN

9798273349568

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