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Abstract: Objective: Approximately 1 in 5 children in the United States live with a chronic illness that affects their daily functioning. Due to the high prevalence of chronic conditions requiring children and their caregivers to take on treatment and disease management responsibilities, it is crucial to (a) examine the empirical support for and (b) consider the clinical application of evidence-based assessment and intervention designed to target pediatric adherence and self-management. Thus, the purpose of this special issue is to highlight applications of evidence-based adherence and self-management assessment and intervention across various chronic conditions. Methods: Articles including a topical review and a clinical application of an evidence-based adherence and self-management assessment and/or intervention were considered for this issue. Results: This special issue includes 8 articles highlighting topical reviews and clinical applications of adherence and self-management assessment and/or intervention for diverse pediatric populations. Additionally, this issue explores ethical considerations, clinically-integrated brief interventions, as well as the use of technology and digital tools to promote adherence and self-management. Conclusions: This special issue highlights the clinical application of evidence-based assessment and intervention within the field of pediatric adherence and self-management. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 05 Dec 2022 00:00:00 GMT DOI: 10.1037/cpp0000469
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Abstract: Objective: Failure to thrive/faltering growth (FTT/FG) is often multiply determined and involves caregiver adherence to various recommendations to optimize child weight gain. The current study at an interdisciplinary FTT/FG clinic (a) documented the taxonomy of treatment recommendations made for children with FTT/FG (Study 1) and (b) developed an adherence measure, which was used by trained clinicians to examine the relationship between adherence and weight gain (Study 2). Methods: In Study 1, all treatment recommendations made to caregivers of 102 children with FTT/FG were recorded and categorized into domains. Based on domains identified in Study 1, a seven-domain adherence measure was developed. Using a new sample in Study 2 (n = 131, aged 1 to 10 years), clinicians assessed caregiver adherence to recommendations made at the prior clinic visit and examined the association between adherence and weight gain. Results: From Study 1, clinic recommendations fell within seven domains, including the following four that were expected to be associated with weight gain: liquids, food, behavior, and meal structure. Study 2 found that caregiver adherence, overall, was generally high (M = 3.0, SD = .80, rated on a 0 to 4 scale). Greater overall adherence was associated with greater weight gain (r = .253, p = .02). Examining specific recommendations, adherence to using high-calorie add-ons and limiting long mealtimes were associated with greater weight gain. Conclusions: The adherence measure developed in this study can be used to assist clinicians in the management of FTT/FG. Future research is needed to further identify specific treatment recommendations whose adherence is most closely associated with children’s weight gain. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 05 Dec 2022 00:00:00 GMT DOI: 10.1037/cpp0000466
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Abstract: Objective: The purpose of this manuscript is to provide an overview of evidence-based strategies designed to promote adherence to and self-management of positive airway pressure (PAP) for the treatment of pediatric obstructive sleep apnea syndrome (OSAS) with an emphasis on those who are disproportionately impacted by OSAS. Methods: Utilized four recently published review articles and a book chapter, as well as a search of the literature since the most recent scoping review was published, to identify factors impacting pediatric adherence to PAP. Proposed conceptual models for self-management and adherence were also evaluated and strategies addressing factors within the context of these models were reviewed for application. Results: Evidence-based cognitive–behavioral strategies within a bio-socioecological framework and interdisciplinary team-based model are presented. A case study highlights the application of these interventions using an interdisciplinary coordinated care model, including clinical outcome data (e.g., objective adherence measures from the PAP device). Conclusions: Existing evidence supports a family-centered interdisciplinary approach to initiating PAP and supporting long-term PAP adherence for the treatment of pediatric OSAS. A bio-socioecological framework provides structure for assessment and flexibility in which interventions, such as education, cognitive–behavioral strategies, and social support, can be tailored to the unique needs of each child and family. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 05 Dec 2022 00:00:00 GMT DOI: 10.1037/cpp0000465
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Abstract: Objective: Asthma disproportionately impacts youth who have been systemically marginalized and underserved, henceforth termed underserved for brevity. Disparities are driven by systemic and structural racism and social determinants of health. We aimed to synthesize findings from interventions delivered among youth who have been underserved, highlight effective intervention strategies, and provide recommendations to promote health equity. To demonstrate, we also present a case example of clinical application. Methods: We conducted a systematic literature search of randomized trials among youth (≤18 years old) who are often underserved, delivered in clinical, community, or home-based settings with medication adherence and/or self-management behaviors as an intervention outcome. We used descriptive statistics to synthesize study characteristics and outcomes. Results: Twenty-four articles, representing 21 unique interventions, met inclusion criteria. Forty-six percent reported significant improvements in adherence or self-management for the intervention group. Self-management interventions focused on symptom recognition and monitoring demonstrated the greatest percentage of significant intervention findings (71.4%); controller medication adherence interventions demonstrated the fewest (33.3%). Conclusions: Interventions are not consistently effective for youth who have been underserved. Findings suggest that pediatric psychologists can help patients from underserved backgrounds by bolstering symptom recognition and monitoring skills, providing self-management skill education, and problem-solving ways to reduce triggers through individually tailored, multicomponent approaches. Pediatric psychologists should simultaneously strive to consider and address systemic, structural, and social determinants of asthma disparities in their work. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 05 Dec 2022 00:00:00 GMT DOI: 10.1037/cpp0000462
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Abstract: Objective: The purpose of this article is to characterize the current evidence base related to peer support interventions for adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) and to describe a peer support program to enhance self-management for AYAs with IBD through a case study. There is strong theory and compelling evidence suggesting that AYAs with IBD could benefit from and are interested in receiving peer support to enhance self-management; however, literature on peer support interventions for AYAs with IBD is lacking. Methods: This study (a) presents a topical review describing qualitative factors AYAs with IBD would seek in a peer support program as well as existing peer support programs for this population, (b) presents an innovative one-to-one peer support program targeting self-management through a case study, and (c) discusses clinical implications and directions for future research. Results: Peer support offers a promising approach for AYAs with IBD that is feasible and acceptable to patient populations. However, results from the present topical review identified only two studies that examined peer support interventions for AYAs with IBD. The case study demonstrates how a theoretically driven program uses peer support to promote self-management and adaptive behavioral change. Conclusions: The paucity of literature in this area reveals a critical opportunity for future research and clinical programming to improve existing practices by leveraging peer support. We present the application of an innovative mobile-based peer coaching intervention that has the potential to support AYAs with IBD in their self-management. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 05 Dec 2022 00:00:00 GMT DOI: 10.1037/cpp0000468
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Abstract: Objective: Many pediatric treatment regimens require oral medications, rendering the ability to swallow pills is an essential skill for adherence and an important target for pediatric psychology intervention. This article sought to (a) review existing evidence for pill- swallowing interventions in pediatrics, (b) describe a pill-swallowing training intervention currently employed in a large, pediatric tertiary care hospital and utilized in diverse patients with a wide range of medical conditions, (c) report data from pill-swallowing intervention records from 2011 to 2020 to depict intervention outcomes in inpatient and outpatient settings, and (d) offer strategies for commonly encountered challenges. Methods: A topical review of the literature was conducted utilizing search terms “pill-swallowing training” and “pediatrics,” with filters applied for peer-reviewed articles published between 2000 and 2022. Articles were selected with relevance to pill-swallowing protocols. Description of a pill-swallowing protocol utilizing shaping and modeling techniques is then presented, followed by outcome data gleaned through retrospective chart review. Variables related to implementation of this protocol in a tertiary care hospital with various medical conditions were examined. Illustrative case examples of pill-swallowing training with diverse patients in real-world pediatric psychology practice are also provided. Results: The study found 88% (n = 246) of patients were able to learn to swallow a placebo pill. Further, 73% (n = 179) of patients were able to learn to swallow a clinically useful placebo size. Conclusions: Pill-swallowing training is effective in teaching the majority of pediatric patients to swallow capsules in a short period of time. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 05 Dec 2022 00:00:00 GMT DOI: 10.1037/cpp0000460
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Abstract: Objective: Social media is a large facet of contemporary culture, particularly for adolescents and young adults (AYAs). Likewise, digital health interventions have proliferated. Yet understanding of how social media can be leveraged to deliver empirically informed adherence interventions is more limited. This topical review provides a synthesis of literature related to improving AYA treatment adherence through social media approaches. To illustrate a clinical application, we describe an initiative that codeveloped and codisseminated adherence education with AYAs with cancer via TikTok. Methods: Literature searches were conducted on databases including PubMed and PsycINFO, using keywords such as adolescents or young adults; social media; and adherence, self-management, or health. Adherence TikTok videos were developed through user-centered design approaches with AYAs with cancer and clinicians/staff. Results: Results from the review suggested that AYAs use social media to research general health information and obtain support. Research-derived adherence-promotion interventions with social-media-like features appear to be acceptable, and some have led to improvements in adherence. Our process of translating empirically informed adherence education to TikTok was rapid and low cost and obtained 30,797 views. Conclusions: Social media has great promise for advancing the uptake and reach of evidence-based adherence care for AYAs. We highlight opportunities for advancing current clinical practices and future research in this area, including forming clinical partnerships with AYAs to disseminate credible adherence content via the social media platforms that are already part of their daily technology use. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 05 Dec 2022 00:00:00 GMT DOI: 10.1037/cpp0000459
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Abstract: Objective: Adherence to prescribed medical regimens is a key behavior for managing disease burden and progression. Despite the importance of understanding a child’s adherence, many evidence-based assessment strategies have not been implemented into subspecialty clinical practice. The aim of this article was to highlight the potential ethical and regulatory challenges of using electronic monitoring (EM) of adherence in clinical care and offer practical solutions. Methods: Relevant ethical and legal standards were researched and summarized as applicable to EM of adherence. Results: Issues related to Human Relations, Privacy and Confidentiality, Record Keeping, and Assessment all apply to EM of adherence. Conclusions: Clinicians should be mindful and seek to proactively address issues related to informed consent, autonomy, privacy, and equity before starting an EM program of adherence. Multidisciplinary teams should thoroughly consider the ethical and legal aspects of implementing this form of adherence assessment into clinical practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 05 Dec 2022 00:00:00 GMT DOI: 10.1037/cpp0000463
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Abstract: Objective: Hemophilia is a complex medical condition in which home-based self-management by children, adolescents, and their families is the standard of care. However, research on hemophilia self-management is limited. Because of its complexity and self-management standard, understanding the development of adherence and self-management in hemophilia may provide insights into supporting pediatric patients and their families in managing complex health care needs that can be generalized and adapted for other conditions. Methods: A topical review and retrospective case report are provided to illustrate issues in the development of adherence and self-management, and to highlight clinical applications, for pediatric patients with severe hemophilia. Results: Individual, social, and contextual factors influence adherence in pediatric severe hemophilia. Interventions that support individual autonomy and competence, such as medical play and education, and social-contextual supports, such as community-building and technological supports, have been shown to improve adherence and self-management in pediatric severe hemophilia, particularly when tailored to patients’ individual needs. Conclusions: Though the literature on adherence and self-management in pediatric severe hemophilia is limited, evidence of positive effects of adherence and self-management interventions is promising and could be applied to management of other complex conditions. Future work should examine emerging adults, and roles of health literacy, executive functioning, and pediatric psychologists in adherence and self-management in pediatric severe hemophilia. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 14 Nov 2022 00:00:00 GMT DOI: 10.1037/cpp0000467
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