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Conour CN, Duncan CL. Commentary: Considering the Clinical Implications of "A Systematic Review and Meta-Analysis of Adherence Interventions for Youth and Young Adults". J Pediatr Psychol 2024:jsae083. [PMID: 39348277 DOI: 10.1093/jpepsy/jsae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 09/23/2024] [Accepted: 09/23/2024] [Indexed: 10/02/2024] Open
Affiliation(s)
- Cecily N Conour
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Christina L Duncan
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
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Eaton CK, Comer M, Pruette CS, Riekert KA. Medication adherence in youths with CKD: habits for success. Pediatr Nephrol 2023; 38:3791-3802. [PMID: 37306720 PMCID: PMC11587169 DOI: 10.1007/s00467-023-05976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Poor adherence habits are key contributors to nonadherence but there are few clinically feasible methods for evaluating adherence habits, particularly for youths with chronic kidney disease (CKD). This study investigated how participants' qualitative responses to three interview questions about adherence habits mapped to primary principles of habit formation and objectively measured medication adherence in youths with CKD. METHODS Participants (ages 11-21 years) were recruited from a pediatric nephrology clinic as part of a larger study. Participants' daily objective antihypertensive medication adherence was measured with an electronic pill bottle over a 4-week baseline period. Qualitative interviews about adherence habits and routines were conducted with a subset of participants (N = 18). RESULTS Clear qualitative differences emerged in how participants with high-medium adherence (80-100%) discussed adherence habits compared to participants with low adherence (0-79%). Participants with high-medium adherence discussed situational cues for taking medicine, including locations that cue adherence, step-by-step events leading up to taking medicine, and people who cue adherence. Participants with high-medium adherence regularly described taking medicine as "automatic," "second nature," and a "habit." Participants with low adherence rarely discussed these habit features nor did they explicitly acknowledge currently missing doses. Participants with low adherence tended to discuss challenges with organization and routines for taking medicine. CONCLUSIONS Evaluating patient responses to questions about adherence habits may uncover challenges with adherence habit formation, provide direction for habit-strengthening intervention focused on developing automatic cues for taking medication, and support adherence successes for youths with CKD. CLINICAL TRIAL REGISTRATION NUMBER NCT03651596. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Cyd K Eaton
- Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Margaret Comer
- Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Cozumel S Pruette
- Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Kristin A Riekert
- Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA
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3
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Wu Y, Huang L, Sun J, Wang H, Fang L, Miao J. Prevalence and predictors of medication non-adherence in children with inflammatory bowel disease in China: A cross-sectional study. Front Pharmacol 2022; 13:1062728. [DOI: 10.3389/fphar.2022.1062728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Non-adherence to physician-prescribed medications, especially oral medications, is common in children with inflammatory bowel disease (IBD), and medication non-adherence is associated with poorer outcomes in IBD. Therefore, understanding and improving medication adherence in children with IBD is critical for optimizing treatment and improving treatment outcomes. Despite the relatively high prevalence of IBD in children in China, to date, very little is known about medication adherence in these patients.Objective: The aim of this study was to investigate the prevalence of medication non-adherence and its risk factors in children with IBD in China to provide a basis for developing adherence improvement strategies.Methods: A cross-sectional design was employed. Children (aged <18 years) with IBD who visited the Children’s Hospital, Zhejiang University School of Medicine, from September 2020 to December 2021 were included. Data were collected by a general information questionnaire, the 4-item Medication Adherence Report Scale (MARS-4) and Crohn’s and Colitis Knowledge (CCKNOW) questionnaire. Subsequently, forward stepwise binary logistic regression analysis was performed to determine independent predictors of medication non-adherence.Results: A total of 119children were included in this study. The results showed that 33 (27.73%) and 86 (72.27%) children had poor and good medication adherence, respectively. Of these, 83 (69.75%) had forgotten to take their medications sometimes, often, or always. On binary logistic regression, we found that the incidence of medication non-adherence in children with IBD course of 3 years and above [OR 4.82 (95%CI: 1.47-15.88); p = 0.01] was significantly higher than that in children with course of 3 months to 1 year, whereas children with higher parental CCKNOW scores [OR 0.77 (95%CI: 0.67-0.88); p = 0.00] had significantly lower incidence of medication non-adherence than those with lower parental CCKNOW scores, and the results of the correlation between parental knowledge scores of the four categories and children’s medication adherence showed that drug knowledge scores (r = 0.36, p < 0.00) and complication knowledge scores (r = 0.24, p = 0.01) were positively correlated with medication adherence.Conclusion: Poor medication adherence in children with IBD in China was common, and forgetting to take medication was the main barrier. Longer disease duration (3 years and above) in children could act as a risk factor for medication adherence, whereas higher level of parental knowledge about IBD could act as a protective factor, and one interesting novel finding was that the level of parental knowledge about drug and complication were significantly correlated with medication adherence in children with IBD. Our results may inform on the design and implementation of medication adherence interventions for children with IBD.
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Vernon-Roberts A, Gearry RB, Day AS. Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2021; 3:61-77. [DOI: 10.3390/gidisord3020007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it may help them learn to take control of their complex treatment regimens and lead to positive disease outcomes. The development of self-management skills for children with IBD is vital in order to maximize their potential for health autonomy, but it is still an emergent field in this population. This review provides an over-arching view of the self-management elements specific to children with IBD, and highlights outcome measures that may be used to assess skills within each field as well as the efficacy of targeted interventions.
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Affiliation(s)
| | - Richard B. Gearry
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand
| | - Andrew S. Day
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand
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5
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Ramsey RR, Holbein CE, Powers SW, Hershey AD, Kabbouche MA, O'Brien HL, Kacperski J, Shepard J, Hommel KA. A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine. Cephalalgia 2018; 38:2035-2044. [PMID: 29635937 DOI: 10.1177/0333102418756864] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Effective management of migraine requires adherence to treatment recommendations; however, adolescents with migraine take their daily medications only 75% of the time. Low-cost adherence-focused interventions using technology may improve adherence, but have not been investigated. METHODS Thirty-five adolescents and young adults (13-21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone adherence-promotion application ("app") and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention. RESULTS Relative to baseline, adherence significantly improved during the first month of the intervention. Specifically, improvements existed for older participants with lower baseline adherence. Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates. Participants rated the intervention as acceptable and easy to use. CONCLUSIONS "Apps" have the potential to improve medication adherence and are a promising intervention for adolescents and young adults with low adherence. Involving parents in the intervention is also helpful. Providers should assess barriers to adherence and use of technology-based interventions, encourage parents to incorporate behavioral incentives, and provide referrals for more intensive interventions to improve long-term outcomes. Further, tracking adherence in an app may result in an underestimation of adherence. Future full-scale studies should be conducted to examine adherence promotion app interventions.
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Affiliation(s)
- Rachelle R Ramsey
- 1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christina E Holbein
- 1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- 1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hope L O'Brien
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joanne Kacperski
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Kevin A Hommel
- 1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Kroon Van Diest AM, Ramsey R, Kashikar-Zuck S, Slater S, Hommel K, Kroner JW, LeCates S, Kabbouche MA, O’Brien HL, Kacperski J, Allen JR, Peugh J, Hershey AD, Powers SW. Treatment Adherence in Child and Adolescent Chronic Migraine Patients: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial. Clin J Pain 2017; 33:892-898. [PMID: 28118256 PMCID: PMC5522369 DOI: 10.1097/ajp.0000000000000481] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine treatment adherence among children and adolescents with chronic migraine who volunteered to be in a clinical trial using 3 measures: treatment session attendance, therapy homework completion, and preventive medication use by daily diary. MATERIALS AND METHODS Analyses are secondary from a trial of 135 youth aged 10 to 17 years diagnosed with chronic migraine and with a Pediatric Migraine Disability Score over 20. Participants were randomly assigned to cognitive-behavioral therapy plus amitriptyline (CBT+A, N=64) or headache education plus amitriptyline (HE+A, N=71). Therapists recorded session attendance. Completion of homework/practice between sessions was reported to therapists by patients. Patients reported preventive medication adherence using a daily headache diary. RESULTS Mean session attendance adherence out of 10 treatment sessions was 95% for CBT+A and 99% for HE+A. CBT+A participants reported completing a mean of 90% of home practice of CBT skills between the 10 sessions. Participants reported taking amitriptyline daily at a mean level of 90% when missing diaries were excluded and 79% when missing diaries were considered as missed doses of medication. DISCUSSION Our findings demonstrate that youth with chronic migraine who agree to be a part of a clinical trial do quite well at attending therapy sessions, and report that they are adherent to completing home/practice between sessions and taking medication. These results lend further support to consideration of CBT+A as a first-line treatment for youth with chronic migraine and suggest that measurement of adherence when this treatment is provided in practice will be important.
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Affiliation(s)
- Ashley M. Kroon Van Diest
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Shalonda Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - John W. Kroner
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Susan LeCates
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Marielle A. Kabbouche
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Hope L. O’Brien
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Joanne Kacperski
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Janelle R. Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - James Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Andrew D. Hershey
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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7
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Soobraty A, Boughdady S, Selinger CP. Current practice and clinicians’ perception of medication non-adherence in patients with inflammatory bowel disease: A survey of 98 clinicians. World J Gastrointest Pharmacol Ther 2017; 8:67-73. [PMID: 28217376 PMCID: PMC5292608 DOI: 10.4292/wjgpt.v8.i1.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/24/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023] Open
Abstract
AIM The survey ascertains perceptions and describes current practice of clinicians regarding medication non-adherence in patients with Inflammatory Bowel Disease.
METHODS Gastroenterologists, trainees and inflammatory bowel disease (IBD) specialist nurses from the United Kingdom were invited to a web based survey collecting data on clinician demographics, patient volume and level of interest in IBD. Respondents were asked to estimate non-adherence levels and report use of screening tools and interventions to improve adherence.
RESULTS Non-adherence was seen as an infrequent problem by 57% of 98 respondents. Levels of non-adherence were estimated lower than evidence suggests by 29% for mesalazine (5ASA), 26% for immunomodulators (IMM) and 21% for biologics (BIOL). Respondents reporting non-adherence as a frequent problem were more likely to report adherence levels in line with evidence (5ASA P < 0.001; IMM P = 0.012; BIOL P = 0.015). While 80% regarded screening as important only 25% screen regularly (40% of these with validated assessment tools). Respondents stated forgetfulness, beliefs about necessity of medication and not immediately apparent benefits as the main reasons for non-adherence. Patient counselling on benefits and risks of medication was a commonly used intervention.
CONCLUSION Clinicians treating IBD patients frequently underestimate non-adherence and use of validated screening tools is infrequent. Most respondents identified the main factors associated with non-adherence in line with evidence and often counselled patients accordingly. Professional education should focus more on non-adherence practice to avoid adverse treatment outcomes associated with non-adherence.
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Van Diest AMK, Ramsey R, Aylward B, Kroner JW, Sullivan SM, Nause K, Allen JR, Chamberlin LA, Slater S, Hommel K, LeCates SL, Kabbouche MA, O’Brien HL, Kacperski J, Hershey AD, Powers SW. Adherence to Biobehavioral Recommendations in Pediatric Migraine as Measured by Electronic Monitoring: The Adherence in Migraine (AIM) Study. Headache 2016; 56:1137-46. [PMID: 27167502 PMCID: PMC4955694 DOI: 10.1111/head.12836] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this investigation was to examine treatment adherence to medication and lifestyle recommendations among pediatric migraine patients using electronic monitoring systems. BACKGROUND Nonadherence to medical treatment is a significant public health concern, and can result in poorer treatment outcomes, decreased cost-effectiveness of medical care, and increased morbidity. No studies have systematically examined adherence to medication and lifestyle recommendations in adolescents with migraine outside of a clinical trial. METHODS Participants included 56 adolescents ages 11-17 who were presenting for clinical care. All were diagnosed with migraine with or without aura or chronic migraine and had at least 4 headache days per month. Medication adherence was objectively measured using electronic monitoring systems (Medication Event Monitoring Systems technology) and daily, prospective self-report via personal electronic devices. Adherence to lifestyle recommendations of regular exercise, eating, and fluid intake were also assessed using daily self-report on personal electronic devices. RESULTS Electronic monitoring indicates that adolescents adhere to their medication 75% of the time, which was significantly higher than self-reported rates of medication adherence (64%). Use of electronic monitoring of medication detected rates of adherence that were significantly higher for participants taking once daily medication (85%) versus participants taking twice daily medication (59%). Average reported adherence to lifestyle recommendations of consistent noncaffeinated fluid intake (M = 5 cups per day) was below recommended levels of a minimum of 8 cups per day. Participants on average also reported skipping 1 meal per week despite recommendations of consistently eating three meals per day. CONCLUSIONS Results suggest that intervention focused on adherence to preventive treatments (such as medication) and lifestyle recommendations may provide more optimal outcomes for children and adolescents with migraine and their families. Once daily dosing of medication may be preferred to twice daily medication for increased medication adherence among children and adolescents.
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Affiliation(s)
- Ashley M. Kroon Van Diest
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Brandon Aylward
- Department of Pediatrics, Emory University School of Medicine
- Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta
| | - John W. Kroner
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Stephanie M. Sullivan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Katie Nause
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Janelle R. Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Leigh A. Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Shalonda Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Headache Center, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Susan L. LeCates
- Division of Neurology, Cincinnati Children’s Hospital Medical Center
- Headache Center, Cincinnati Children’s Hospital Medical Center
| | - Marielle A. Kabbouche
- Division of Neurology, Cincinnati Children’s Hospital Medical Center
- Headache Center, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Hope L. O’Brien
- Division of Neurology, Cincinnati Children’s Hospital Medical Center
- Headache Center, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Joanne Kacperski
- Division of Neurology, Cincinnati Children’s Hospital Medical Center
- Headache Center, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Andrew D. Hershey
- Division of Neurology, Cincinnati Children’s Hospital Medical Center
- Headache Center, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Headache Center, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
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Abstract
OBJECTIVES The aim of this study was to systematically review the rates of nonadherence to oral maintenance treatment in adolescents with inflammatory bowel disease (IBD), and to describe perceived barriers to adherence and psychosocial factors involved. METHODS The article considered studies published in MEDLINE, Embase, and PsycINFO up to March 2015. Studies that had collected data on adherence to thiopurines or aminosalicylates in a cohort of adolescents with IBD. Case reports and case series were excluded. RESULTS A total of 25 studies were included. Lack of uniformity of outcome measures made pooling of data impossible. Rates of medication nonadherence ranged from 2% to 93%. The most frequently reported barriers were "just forgot," "wasn't home," and "interferes with activity." Family dysfunction, peer victimization, poor health-related quality of life, poor child-coping strategies, anxiety, and depressive symptoms were associated with medication nonadherence. CONCLUSIONS Nonadherence to oral maintenance therapy in adolescents with IBD is a significant health care problem and can lead to unnecessary escalation in therapy. Difficulties in family and social interactions, and psychosocial dysfunction can jeopardize IBD treatment outcome and should receive attention early in the course of the disease.
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Eaton CK, Lee JL, Simons LE, Devine KA, Mee LL, Blount RL. Clinical Cutoffs for Adherence Barriers in Solid Organ Transplant Recipients: How Many Is Too Many? J Pediatr Psychol 2014; 40:431-41. [DOI: 10.1093/jpepsy/jsu102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/30/2014] [Indexed: 11/13/2022] Open
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Duncan CL, Mentrikoski JM, Wu YP, Fredericks EM. Practice-Based Approach to Assessing and Treating Non-Adherence in Pediatric Regimens. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2014; 2:322-336. [PMID: 25506046 PMCID: PMC4258819 DOI: 10.1037/cpp0000066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With advances in medical care, youth with chronic illness have the potential for higher quality of life; however, these treatments often come with cost (i.e., burden, financial) that can result in non-adherence. Pediatric non-adherence, on average, is approximately 50% across chronic health conditions. Research has identified effective, evidence-based assessment measures and intervention strategies to promote regimen adherence in youth. Yet, these measures and strategies typically are designed for clinical trials and thus may not be feasible or practical in typical clinic settings. As the field of adherence assessment and intervention expands, it will be important to devise evidence-based tools that are pragmatic and can be translated easily into practice. To guide this future direction, the goals of this paper are to review evidence-based adherence assessment and intervention strategies that can be used with youth and families in clinical practice, to illustrate the complexities of addressing adherence concerns in routine practice, and to discuss the challenges of disseminating and implementing evidence-based strategies in the real world.
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Affiliation(s)
| | | | - Yelena P. Wu
- University of Utah, Department of Family and Preventive Medicine
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12
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Pai ALH, McGrady M. Systematic review and meta-analysis of psychological interventions to promote treatment adherence in children, adolescents, and young adults with chronic illness. J Pediatr Psychol 2014; 39:918-31. [PMID: 24952359 DOI: 10.1093/jpepsy/jsu038] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This meta-analysis examined the effectiveness of recent adherence-promoting interventions for youth with chronic health conditions. METHODS Peer-reviewed randomized controlled trials of adherence-promoting interventions for youth with a chronic illness published between 2007 and 2013 (n = 23) were reviewed. Intervention delivery (in-person vs. technology-based) and outcome measurement (e.g., self-report) were examined as potential moderators of treatment effects. RESULTS Mean effect sizes were small at posttreatment (d = 0.20, 95% confidence interval (CI): 0.08, 0.31, n = 23) and follow-up (d = 0.29, 95% CI: 0.15, 0.43, n = 9). Intervention delivery and outcome measurement did not account for variation in treatment effects (p > .05). CONCLUSIONS The small treatment effects of recent adherence-promoting intervention (APIs) reflect the methodological limitations of the included studies and the need to reexamine the delivery and mechanisms of adherence-promoting interventions.
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Affiliation(s)
- Ahna L H Pai
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Meghan McGrady
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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13
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Nelson TD, Lundahl A, Molfese DL, Waford RN, Roman A, Gozal D, Molfese VJ, Ferguson MC. Estimating child sleep from parent report of time in bed: development and evaluation of adjustment approaches. J Pediatr Psychol 2014; 39:624-32. [PMID: 24781412 DOI: 10.1093/jpepsy/jsu020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To develop and evaluate adjustment factors to convert parent-reported time in bed to an estimate of child sleep time consistent with objective measurement. METHODS A community sample of 217 children aged 4-9 years (mean age = 6.6 years) wore actigraph wristwatches to objectively measure sleep for 7 days while parents completed reports of child sleep each night. After examining the moderators of the discrepancy between parent reports and actigraphy, 3 adjustment factors were evaluated. RESULTS Parent report of child sleep overestimated nightly sleep duration by ∼24 min per night relative to actigraphy. Child age, gender, and sleep quality all had small or nonsignificant associations with correspondence between parent report and actigraph. Empirically derived adjustment factors significantly reduced the discrepancy between parent report and objective measurement. CONCLUSIONS Simple adjustment factors can enhance the correspondence and utility of parent reports of child sleep duration for clinical and research purposes.
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Affiliation(s)
- Timothy D Nelson
- Department of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of Louisville
| | - Alyssa Lundahl
- Department of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of Louisville
| | - Dennis L Molfese
- Department of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of LouisvilleDepartment of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of Louisville
| | - Rachel N Waford
- Department of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of Louisville
| | - Adrienne Roman
- Department of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of Louisville
| | - David Gozal
- Department of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of Louisville
| | - Victoria J Molfese
- Department of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of Louisville
| | - Melissa C Ferguson
- Department of Psychology, University of Nebraska-Lincoln, Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Emory University School of Medicine/Grady Memorial Hospital, Department of Psychological and Brain Sciences, Indiana University, Department of Pediatrics, University of Chicago, Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, and Department of Psychiatry and Behavioral Sciences, University of Louisville
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