Project Summary Living-donor kidney transplantation (LDKT) is the optimal treatment for end-stage kidney disease to increase length and quality of life, yet it is vastly underutilized, putting thousands of transplant candidates at unnecessary risk for premature death. Evidence indicates that transplant candidates need better access to evidence-based education and outreach tools to overcome their substantial informational barriers and help identify and recruit live donors from their social networks. The long-term goal is to devise an educational strategy to increase access to LDKT and, in doing so, reduce kidney disease-related morbidity and mortality. The objective of this R01 application is to increase receptivity to LDKT among transplant candidates through a web-based educational intervention (KidneyTIME) previously developed by the Co-PIs. Although the proposed intervention is evidence-informed and promising, it needs to be effectiveness-tested compared with a control condition prior to larger-scale evaluation. Our central hypothesis is that transplant candidates will most often engage their social networks with information about LDKT when presented with the KidneyTIME educational intervention. The research study will pursue 3 specific aims: (1) determine the effects of KidneyTIME compared to Usual Care to improve transplant candidate LDKT knowledge, attitudes, and outreach behaviors, (2) evaluate the effects of KidneyTIME compared to Usual Care on potential live donor inquiries to donate, and (3) identify and compare the effects of KidneyTIME versus Usual Care on activation of perceived social support among transplant candidates when considering LDKT. For the first aim, validated survey measures will assess LDKT knowledge, concerns, readiness, communication self-efficacy, and outreach behaviors immediately and at 2-weeks, 6-months, and 12-months post-exposure. For the second aim, estimates of living donor inquiries at 12-months post-baseline will be obtained. For the third aim, multivariate regression models that assess perceived social support simultaneously will explore optimal intervention components, dosage, moderators, and interactions on live donor inquiries, and an embedded qualitative process evaluation will be used to examine intervention sustainability, extent to which it is contextually situated, and potential refinements to the intervention. The proposed research is innovative in that it shifts the current paradigm of intervention research to increase access to LDKT from a primary reliance on synchronous education to transplant candidates towards an asynchronous learning approach that facilitates education of others about LDKT. The proposed research is significant in providing web-based education that activates social network outreach—an approach that ultimately may be necessary to increase access to LDKT. Our expected outcome is knowledge of how to effectively reach candidates and their social network with education about LDKT to...