The Effect of the SystemCHANGETM Intervention on Systems Thinking in a Randomized Controlled Trial of Adult Kidney Transplant Recipients: A Secondary Data Analysis

Abstract

Objective: The SystemCHANGE™ intervention is an approach that harnesses patients′ recurring personal systems of established routines of daily living, environments, and important others as reliable ′personalized system solutions′ to support habitual medication-taking and improve medication adherence. In a secondary data analysis, we (1) analyzed the association between the longitudinal trajectories of systems thinking and medication adherence, and (2) examined the extent that demographic characteristics and the SystemCHANGE™ intervention influenced these trajectories. Methods: Participants were ≥ 18 years of age who had received a kidney‐only transplant, self‐administered at least one prescribed immunosuppressive medication twice daily, had a functioning kidney transplant, were not in the hospital, and had no diagnosis that would immediately shorten the lifespan. We conducted a single‐blinded (participants), 2‐arm randomized controlled trial (RCT). An intervention group received the 6-month SystemCHANGETM intervention, and the attention-control group received the 6-month education intervention. Systems thinking was measured using the Systems Thinking Scale (adapted for patients). Results: The parallel process growth curve model with time-invariant predictors suggested that participants with higher levels of systems thinking at baseline demonstrated greater gains in systems thinking over time (r=0.407). White participants exhibited greater baseline levels of systems thinking than African-American participants (d=0.76). Participants assigned to the SystemCHANGE™ group maintained their medication adherence rates over time, whereas control counterparts demonstrated significantly different, declining trajectories of medication adherence (d=−0.41). Conclusion: We found shared co-variance between systems thinking and medication adherence and the SystemCHANGE™ intervention. The SystemCHANGE™ intervention was efficacious in improving and sustaining medication adherence in adult kidney transplant recipients.