Transition readiness in adolescents with congenital heart disease during transfer to adult care: A secondary analysis of the STEPSTONES randomized controlled trial

Health Care Transitions Pub Date : 2026-01-01 Epub Date: 2026-10-13 DOI:10.1016/j.hctj.2026.100154

Hilda Malmesjö, Mariela Acuna Mora, Ewa-Lena Bratt, Carina Sparud-Lundin, Philip Moons, Markus Saarijärvi PhD, RN

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Abstract

Purpose

Adolescents with congenital heart disease (CHD) are at risk of discontinuity of care during transfer from pediatric to adult services. Transition readiness is considered essential for a safe transfer. This study evaluated the effect of the STEPSTONES person-centered transition program on adolescents’ self-reported transition readiness compared with usual care.

Design and methods

This secondary analysis was based on a randomized controlled trial conducted at two Swedish CHD centers. A total of 139 adolescents (age 16 years) were randomized to intervention (n = 70) or usual care (n = 69). The intervention group received the STEPSTONES program in addition to usual care over two years. Transition readiness was assessed at ages 16 (T0), 17 (T1), and 18.5 (T2) using the Readiness for Transition Questionnaire. Between-group differences were analyzed with Mann–Whitney U tests, and longitudinal changes were examined using mixed-design ANOVA.

Results

At T2, the intervention group demonstrated significantly higher overall transition readiness compared with controls (p = .011–.015), with a small effect size (r ≈ .23–.24). A significant main effect of time was found (p < .001), indicating increased readiness across adolescence in both groups. No significant group-by-time interaction was detected (p = .177), and no differences were identified at the level of individual questionnaire items.

Conclusions

The STEPSTONES program was associated with higher overall transition readiness at the time of transfer, although effect sizes were small. Structured, person-centered transition programs may enhance preparedness for adult care.

Practice implications

Pediatric nurses are key in supporting transition readiness. Structured transition programs may strengthen adolescents’ overall preparedness for adult-oriented healthcare.

Trial registration

ClinicalTrials.gov NCT02675361.

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患有先天性心脏病的青少年在转到成人护理期间的过渡准备：STEPSTONES随机对照试验的二次分析

目的：患有先天性心脏病（CHD）的青少年在从儿科转到成人服务期间面临护理不连续性的风险。过渡准备被认为是安全转移的必要条件。本研究评估了STEPSTONES以人为中心的过渡项目对青少年自我报告的过渡准备程度的影响，并与常规护理进行了比较。设计和方法本二次分析基于在瑞典两个冠心病中心进行的随机对照试验。共有139名青少年（16岁）被随机分为干预组（n = 70）和常规组（n = 69）。干预组在常规护理的基础上接受了两年的STEPSTONES项目。在16岁（T0）、17岁（T1）和18.5岁（T2）时使用过渡准备问卷评估过渡准备程度。采用Mann-Whitney U检验分析组间差异，采用混合设计方差分析检验纵向变化。结果在T2阶段，干预组的整体转变准备程度明显高于对照组（p = .011 -）。015)，效应量较小（r ≈ .23 -.24）。时间的主效应显著（p <； ）。001)，表明两组青少年的准备程度都有所提高。各组间无显著的时间交互作用（p = ）。177)，在个别问卷项目的水平上没有发现差异。结论STEPSTONES项目与转移时较高的整体转移准备度相关，尽管效应量很小。结构化的，以人为中心的过渡方案可以加强成人护理的准备。实践意义儿科护士是支持过渡准备的关键。结构化的过渡方案可以加强青少年面向成人的医疗保健的全面准备。临床试验注册：clinicaltrials .gov NCT02675361。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Health Care Transitions

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