Health advocates to address social adversity in pediatric liver transplantation: A clinical trial

BACKGROUND: Children undergoing liver transplantation experience socioeconomic disparities in long-term outcomes, partly due to unaddressed material economic hardships such as food insecurity and housing instability. Health Advocates-trained lay health workers who assist families in navigating social and medical systems-may mitigate these disparities. We pilot-tested a Health Advocate intervention (NCT05700799) to assess feasibility, acceptability, and preliminary effects on caregiver experience and clinical outcomes in pediatric liver transplant recipients. 

METHODS: In this single-center study, 18 caregivers/child dyads participated in a 90-day Health Advocate program; they were provided weekly support from trained navigators. Navigators helped to identify and connect participants with community-based resources and communicated reported social risks to the transplant team. 

RESULTS: The patients' median age at transplant was 1.1 (0.7, 4.6) and the median age at study enrollment was 8.6 (4.3, 13.1) years; 83% remained in the intervention until their needs were met or the end of the 12-week intervention. Caregivers reported improvement in comfort discussing social risks with the transplant team and improved overall care experience (both median 1-point change). Clinical parameters, including the Medication Level Variability Index, trended toward improvements. Qualitative analysis demonstrated high enthusiasm for the intervention, with themes of enhanced communication, reduced stress, and practical assistance addressing diverse social needs. 

CONCLUSIONS: A Health Advocate intervention for pediatric liver transplant families was feasible, acceptable, and associated with improved caregiver experiences. These preliminary findings support testing this intervention in a multi-center effectiveness and implementation trial to evaluate its impact on improving longer-term transplant outcomes.