1. Low Health Literacy Poor Relationships with Providers Historical Racism in Medical Care Socioeconomic Status Insurance Coverage Religious Beliefs Poor Diet Lack of Exercise Substance Use Housing Instability Religious & Cultural Norms Satisfaction w/ Dialysis Health Probs with Family & Friends Providers’ Beliefs Biologic Factors Low Number of Minority Organ Donors Political Will Staffing Determinants Lack of Self-advocacy Not Completing Evaluation Poor Medical Compliance Refusal of Evaluation Comorbid Health Problems Community Beliefs Lack of Live Donors Nephrologists Lower Referral Rates Lack of Compatible Donors Inadequate Insurance Lack of Education at Dialysis Behavior Causes Environmental Causes Lower Access to Kidney Transplantation for African American Adults with Low SES Higher morbidity Decrease Longevity Dialysis Difficulty working, vacation, etc. Health Problem Quality of Life Step 1 Andrea Kelley

2. Increase Access to Transplantation by Black Adults with Low SES Patient Self- Advocacy Complete Transplant Evaluation Seek Live Donors Maintain Health Adequate Insurance Coverage Education at Dialysis Centers Equal Referrals Across Demographics Scientific Advances in Transplantation Increase Organ Donation by Black Population Community Support of Transplantation Contact Transplant Center Question Providers About Treatments Follow-up on referral Attend all medical appointments Solicit Potential Donors Identify Potential Donors Comply with all Medication/ Treatment Maintain Healthy Lifestyle Government Policy Changes Dialysis Staff Inform patients of options Nephrologists refer all eligible patients Scientists Research New Immunosuppressants Providers Educate Patients About Organ Donation Community Leaders Advocate for Organ Transplantation Lack of knowledge Low Literacy/ Health Literacy Perception of Poor Relationships with Providers Historic Racism in Medical Field Lack of Insurance Coverage Limited Finances Religious Beliefs Poor Diet Lack of Exercise Housing Instability Satisfaction with Dialysis Political Will Staffing shortages Health Problems of Family & Friends Providers Beliefs Biologic Determinants in Donors Religious & Cultural Norms Understand Treatment Options Discuss Transplant Eval with Providers Gain Confidence in Discussing Medical Treatment Ask & Inform Potential Live Donors Dialysis Staff Provide Education to Patients Nephrologists assess their referral practices Nephrologists educated about racial disparities Change ObjectivesDeterminants Performance Objectives Outcomes

3. Understand Treatment Options Discuss Transplant Eval with Providers Gain Confidence in Discussing Medical Treatment Ask & Inform Potential Live Donors Dialysis Staff Provide Education to Patients Nephrologists assess their referral practices Nephrologists educated about racial disparities Change Objectives Education Skill Building Goal Setting Social Networking/ Skill Training Skill Building Facilitation Education Method One-on-one information sessions to dialysis patients Communication techniques Individual planning Review methods for discussing difficult topics Staff trained in presenting options to pts Material provided to review current practices Training session about racial disparities Strategy