Efficacy of the ALL YOU NEED IS LOVE healthcare transition syllabus among pre- and posttransplant adolescents in Cali, Colombia.

Abstract

Background: To achieve optimal outcomes, adolescents with chronic or end-stage kidney disease must undergo healthcare transition (HCT) preparation from a pediatric- to an adult-focused setting. The pediatric nephrology group at the Fundación Valle del Líli in Cali, Colombia, collaborated with the University of North Carolina Chapel Hill STAR_x Program and Hospital Infantil de México Federico Gómez to start an HCT preparation program using their tools. The objective of this study was to evaluate the efficacy of the "ALL YOU NEED IS LOVE" syllabus (Spanish version) and its effects on HCT readiness in young patients with kidney failure, including renal transplants.

Methods: We conducted a pre-test/post-test quasi-experimental study without control group in 11- to 21-year-old consecutive patients with kidney failure followed at the Fundación Valle de Lili. Using the TRxANSITION Index, we measured HCT readiness skills before and after implementing the "ALL YOU NEED IS LOVE" syllabus, an educational curriculum delivered in three monthly 2-hour sessions. Analysis was performed using linear mixed models in R Studio software to evaluate intervention effects while accounting for participant characteristics.

Results: We enrolled 35 patients (57% female, median age 15.4 years [IQR: 12.6-17.1]). Most patients (77%) had received dialysis pre-transplant and 68% had congenital anomalies of the kidneys and urinary tract. Mothers were primary caregivers for 85% of patients. Linear mixed models showed that post-intervention scores increased significantly across all measures (β = 3.28, 95% CI 2.64-3.92, p < 0.001 for transition scores; β = 1.93, 95% CI 1.48-2.38, p < 0.001 for parent scores; β = 9.31, 95% CI 7.66-10.96, p < 0.001 for total scores). College education was associated with higher baseline scores (β = 2.38, 95% CI 0.42-4.35, p = 0.019 for transition scores; β = 7.58, 95% CI 1.23-13.93, p = 0.021 for total scores). Male participants showed slightly lower initial scores (β = - 0.88, 95% CI - 1.76 to 0.00, p = 0.051).

Conclusion: In this cohort of youth with kidney failure from Cali, Colombia, implementation of the Spanish version of the "ALL YOU NEED IS LOVE" syllabus was associated with significant improvements in HCT readiness. Linear mixed models demonstrated robust intervention effects across all domains, with educational level emerging as a significant moderator of intervention effectiveness. Further longitudinal studies are needed to evaluate the long-term impact and sustainability of these improvements in transition readiness scores.

Trial registration: This study was retrospectively registered at ClinicalTrials.gov (NCT06836544, https://clinicaltrials.gov/ct2/show/NCT06836544 ) on February 10, 2025.