Desireé N Williford, Shanna M Guilfoyle, Avani C Modi
{"title":"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。","authors":"Desireé N Williford, Shanna M Guilfoyle, Avani C Modi","doi":"10.1037/cpp0000436","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Twenty-seven children were randomized to treatment (<i>M</i>=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%).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":37641,"journal":{"name":"Clinical Practice in Pediatric Psychology","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10038204/pdf/","citationCount":"0","resultStr":"{\"title\":\"Demystifying a family-based epilepsy adherence problem-solving intervention: Exploring adherence barriers and solutions.\",\"authors\":\"Desireé N Williford, Shanna M Guilfoyle, Avani C Modi\",\"doi\":\"10.1037/cpp0000436\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Twenty-seven children were randomized to treatment (<i>M</i>=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%).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":37641,\"journal\":{\"name\":\"Clinical Practice in Pediatric Psychology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2023-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10038204/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Practice in Pediatric Psychology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1037/cpp0000436\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/2/3 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Practice in Pediatric Psychology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1037/cpp0000436","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/2/3 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
Demystifying a family-based epilepsy adherence problem-solving intervention: Exploring adherence barriers and solutions.
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.
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.
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