Demystifying a family-based epilepsy adherence problem-solving intervention: Exploring adherence barriers and solutions.

IF 1.2 Q3 PSYCHOLOGY, CLINICAL

Clinical Practice in Pediatric Psychology Pub Date : 2023-03-01 Epub Date: 2022-02-03 DOI:10.1037/cpp0000436

Desireé N Williford, Shanna M Guilfoyle, Avani C Modi

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引用次数: 0

Abstract

Objective: Barriers to medication adherence are common in pediatric epilepsy and associated with nonadherence, suboptimal seizure outcomes, and quality of life. A manualized, family-tailored education and problem-solving adherence intervention to address adherence barriers was tested in a randomized controlled trial in young children (2-12 years) with epilepsy. Study aims were to identify the adherence barriers and solutions chosen by families during intervention.

Methods: Participants with demonstrated non-adherence were randomized to either education attention control or treatment. In this exploratory, secondary analysis, treatment group data were examined, including adherence barriers and solutions discussed during face-to-face problem-solving sessions and telephone follow-ups. Treatment data were independently coded utilizing codebook thematic analysis.

Results: Twenty-seven children were randomized to treatment (M=7.5±2.9; 59.1% female). Across sessions, coding revealed 10 adherence barriers: Overall Forgetting (38-57%), Routine Change Routine (14-24%), Competing Activities (5-19%), Opposition (0-9%), Transition of Responsibility (0-5%), Running Out of Medication (0-10%), Forgetting During Travel (0-10%), Medication Not a Priority (0-5%), Medication Taste (0-5%), and Pill Swallowing (0-5%). Eight solution types were chosen and implemented by families: Environmental Cuing (29-50%), Multi-Pronged solutions (0-24%), Positive Reinforcement (14-23%), Back-up Doses (0-14%), Refill Tracking (0-10%), Caregiver Modeling of Adherence Behavior (0-5%), Pill Swallowing Intervention (0-5%), and Other (0-5%).

Conclusions: Results highlight key adherence barriers identified by families of children with epilepsy and solutions implemented to address them. These data provide guidance to healthcare teams on how to successfully address adherence barriers in clinical settings.Clinical trials #NCT01851057.

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解密基于家庭的癫痫坚持治疗问题解决干预：探索坚持治疗的障碍和解决方案。

目的：坚持服药的障碍在小儿癫痫患者中很常见，并与不坚持服药、癫痫发作效果不理想和生活质量有关。在一项随机对照试验中，针对患有癫痫的幼儿（2-12 岁）测试了一种手册化、针对家庭的教育和解决问题的坚持用药干预措施，以解决坚持用药的障碍。研究目的是确定干预过程中家庭选择的坚持治疗障碍和解决方案：方法：将已证明不坚持治疗的参与者随机分配到注意教育对照组或治疗组。在这项探索性的二次分析中，对治疗组的数据进行了检查，包括在面对面解决问题和电话随访中讨论的坚持治疗的障碍和解决方案。治疗数据采用编码本主题分析法进行独立编码：27名儿童被随机分配到治疗小组（中=7.5±2.9；59.1%为女性）。在各个疗程中，编码揭示了 10 种坚持治疗的障碍：总体遗忘（38%-57%）、常规改变（14%-24%）、竞争性活动（5%-19%）、反对（0%-9%）、责任转换（0%-5%）、药物用完（0%-10%）、旅行中遗忘（0%-10%）、药物不是优先事项（0%-5%）、药物味道（0%-5%）和吞药（0%-5%）。家庭选择并实施了八种解决方案：环境提示（29%-50%）、多管齐下的解决方案（0%-24%）、正面强化（14%-23%）、备用剂量（0%-14%）、再充填跟踪（0%-10%）、护理人员对依从性行为的示范（0%-5%）、吞药干预（0%-5%）和其他（0%-5%）：研究结果强调了癫痫患儿家庭发现的坚持服药的主要障碍，以及为解决这些障碍而实施的解决方案。这些数据为医疗团队如何在临床环境中成功解决依从性障碍提供了指导。

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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来源期刊

Clinical Practice in Pediatric Psychology Psychology-Clinical Psychology

CiteScore

2.30

自引率

18.20%

发文量

期刊介绍： Clinical Practice in Pediatric Psychology® publishes articles representing the professional and applied activities of pediatric psychology. The journal comprehensively describes the breadth and richness of the field in its diverse activities;complements the scientific development of the field with information on the applied/clinical side;provides modeling that addresses the ways practicing pediatric psychologists incorporate empirical literature into day-to-day activities;emphasizes work that incorporates and cites evidence from the science base; andprovides a forum for those engaged in primarily clinical activities to report on their activities and inform future research activities. Articles include a range of formats such as commentaries, reviews, and clinical case reports in addition to more traditional empirical clinical studies. Articles address issues such as: professional and training activities in pediatric psychology and interprofessional functioning;funding/reimbursement patterns and the evaluation of the cost-effectiveness of clinical services;program development;organization of clinical services and workforce analyses;applications of evidence based interventions in "real world" settings with particular attention to potential barriers and solutions and considerations of diverse populations;critical analyses of professional practice issues;clinical innovations, e.g., emerging use of technology in clinical practice;case studies, particularly case studies that have enough detail to be replicated and that provide a basis for larger scale intervention studies; andorganizational, state and federal policies as they impact the practice of pediatric psychology, with a particular emphasis on changes due to health care reform.