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Hommel K.A.,Center for the Promotion of Treatment Adherence and Self Management | Hommel K.A.,Cincinnati Childrens Hospital Medical Center | Hommel K.A.,University of Cincinnati | Odell S.,Xavier University | And 4 more authors.
Health and Social Care in the Community | Year: 2011

The objective of this study was to examine patient- and parent-perceived factors that impact adherence to inflammatory bowel disease treatment using a qualitative descriptive individual interview approach. Sixteen adolescents and their parents were recruited from May through August 2007 and interviewed about medication adherence using an open-ended semi-structured interview format. Interviews were audio recorded, transcribed, and coded into themes. Parent-child dyads identified forgetting, interfering activities, parent-child conflict and oppositional behaviour and inadequate planning for treatment as challenges to adherence. Participants reported that family support and good parent-child relationships, routines, monitoring and reminding and organisational tools such as pill boxes facilitated treatment adherence. Other issues that emerged included immediacy of treatment effects and parent-adolescent responsibility for treatment. Patients and parents experience a number of challenges related to adherence within behavioural, educational, organisational and health belief domains. Behavioural interventions should focus on these issues, reduction of perceived barriers, and effective transition of responsibility for treatment adherence. Future research considerations are discussed. © 2010 Blackwell Publishing Ltd.


Hommel K.A.,Center for the Promotion of Treatment Adherence and Self Management | Hommel K.A.,Cincinnati Childrens Hospital | Hommel K.A.,University of Cincinnati | Baldassano R.N.,University of Pennsylvania | Baldassano R.N.,Children's Hospital of Philadelphia
Journal of Pediatric Psychology | Year: 2010

Objective To examine perceived barriers to medication adherence in inflammatory bowel disease (IBD) treatment and their relationship with adherence using a combined forced choice and semi-structured interview assessment approach. Methods Sixteen adolescents with IBD and their parents participated in an open-ended interview regarding adherence barriers and completed quantitative measures of adherence, barriers to treatment, and disease severity. Results The most commonly identified barriers to adherence were forgetting, interference with other activities, difficulty swallowing pills, and not being at home. Number of reported barriers was positively correlated with objective nonadherence for 6-MP/azathioprine. Nonadherence frequency was 42 for 6-MP/azathoprine and 50 for 5-ASA medications. Conclusions Using a combined assessment approach, patients and parents reported several barriers to treatment adherence that are appropriate for clinical intervention. This is critical given the significant medication nonadherence observed in this sample and the relationship between total number of barriers and disease management problems. © 2009 The Author.


Hommel K.A.,Cincinnati Childrens Hospital Medical Center | Hommel K.A.,University of Cincinnati | Hommel K.A.,Center for the Promotion of Treatment Adherence and Self Management | Hente E.A.,Cincinnati Childrens Hospital Medical Center | And 11 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2012

OBJECTIVE: To pilot test the feasibility and acceptability of a family-based group behavioral intervention and to improve medication adherence in adolescents diagnosed with inflammatory bowel disease. METHODS: Participants were 40 adolescents aged 11-18 years diagnosed with inflammatory bowel disease and their primary caregivers, who were randomized to either a four-session Family-Based Group Behavioral Treatment or Usual Care over a 6-week period. Adherence was measured using a multi-method, multi-informant assessment involving caregiver-report and patient-report, pill count data, and electronic monitoring. RESULTS: Adherence rates ranged from 66 to 89% for 6-mercaptopurine/azathioprine and 51 to 93% for mesalamine across assessment methods. The intervention was feasible, as evidenced by the 99% treatment session attendance rate, and acceptable based on patient and caregiver report. Repeated measures analysis of variance tests revealed nonsignificant differences between the conditions from baseline to post-treatment assessments for pill count, electronic monitor, and primary caregiver-reported adherence (P's>0.05). There was a statistically significant improvement in patient-reported mesalamine adherence represented by a significant main effect for Condition (F=22.24, P<0.01; δ=0.79) and Condition×Time interaction (F=13.32, P<0.05; δ=0.69). CONCLUSION: Findings suggest potential for use of behavioral intervention to improve medication adherence in this population. This intervention may be more effective with more complex regimens (e.g. multiple doses per day) such as those prescribed with mesalamine. Further research is needed to examine this type of intervention in more diverse samples with more active disease. Use of alternative adherence measurement approaches, including electronic pill boxes and/or real-time self-report (e.g. by text messaging, electronic diaries, etc.) is also recommended. © 2012 Lippincott Williams & Wilkins, Inc.


Hommel K.A.,Cincinnati Childrens Hospital Medical Center | Hommel K.A.,University of Cincinnati | Hommel K.A.,Center for the Promotion of Treatment Adherence and Self Management | Franciosi J.P.,Cincinnati Childrens Hospital Medical Center | And 8 more authors.
Pediatric Allergy and Immunology | Year: 2012

Objective: To examine behavioral predictors of treatment adherence in patients with eosinophilic gastrointestinal disorders (EGID). Methods: Participants were 96 patients 2.5-18yr of age with eosinophilic esophagitis or eosinophilic gastroenteritis and their caregivers (mother, father). We assessed maternal and paternal report of child/adolescent internalizing symptoms (e.g., anxiety, depression) and externalizing symptoms (e.g., aggression, anger) using the Behavior Assessment System for Children, 2nd edition (BASC-2). A multi-informant adherence assessment approach and an 80% cut point were used to classify patients as adherent or non-adherent. Results: Sociodemographic predictors did not distinguish between adherent and non-adherent patients. Maternal report of internalizing symptoms significantly correlated with non-adherence (p<0.001). Post hoc probing revealed a significant contribution of depression, with depressed patients being more likely (OR=7.27; p<0.05) to be non-adherent than non-depressed patients. Paternal report of internalizing and externalizing symptoms was not associated with non-adherence. Conclusions: Maternal report of patient internalizing behavioral symptoms, particularly depression, is significantly associated with non-adherence in patients with EGID. These symptoms are potential risk factors and should be considered when assessing and treating non-adherence. Clinical care of patients with EGID should include routine screening for depression. © 2012 John Wiley & Sons A/S.


Hommel K.A.,Cincinnati Childrens Hospital | Hommel K.A.,University of Cincinnati | Hommel K.A.,Center for the Promotion of Treatment Adherence and Self Management | Hommel K.A.,Cincinnati Childrens Hospital Medical Center | And 8 more authors.
Journal of Pediatric Psychology | Year: 2012

ObjectiveExamine treatment adherence rates in pediatric eosinophilic gastrointestinal disorders (EGID).MethodsParticipants were children aged 2.5-18 years with eosinophilic esophagitis or eosinophilic gastroenteritis (EGE) and their caregivers. A multimethod, multi-informant assessment including parent report and electronic monitoring was utilized, with a 90 cut point for nonadherence.ResultsMedication nonadherence prevalence was 30. Adherence frequency was 91±14 (0-100) per parent report and 100±69 (0-194) per electronic monitors. Tube-feeding adherence was 99±3. Food allergen exposures were less than 1 per 2 weeks, with 33 nonadherence prevalence. Patients with EGE and toddlers with both conditions demonstrated poorer medication adherence (p's<.05). Caregivers reported higher number of missed medication doses than food exposures (p<.05).ConclusionsThe prevalence and range of nonadherence demonstrates that subsets of these patients are nonadherent. Adherence to treatment in EGID is complex and multifaceted, with nonadherence varying across treatments. © The Author 2011 . Published by Oxford University Press on behalf of the Society of Pediatric Psychology.


Wu Y.P.,Cincinnati Childrens Hospital Medical Center | Wu Y.P.,Center for the Promotion of Treatment Adherence and Self Management | Franciosi J.P.,Cincinnati Childrens Hospital Medical Center | Franciosi J.P.,University of Cincinnati | And 5 more authors.
Pediatric Allergy and Immunology | Year: 2012

Background: Children with eosinophilic gastrointestinal disorders (EGID) and their families are asked to adhere to dietary restrictions which can present significant daily challenges. However, little is known about child and family functioning and adaptation and the impact of psychosocial functioning (e.g., behavioral feeding problems) on adherence to dietary restrictions in this pediatric population. Methods: We conducted a gender- and age-matched case-control study wherein parents of children with EGID and healthy control children completed measures of behavioral feeding problems, parenting stress, and adherence to prescribed dietary restrictions. Results: Children with EGID (n=92) have significantly higher levels of behavioral feeding problems than healthy controls (n=89; t=5.7, p<0.001; t=7.9, p<0.001). In particular, younger children demonstrated higher levels of behavioral feeding problems than older children. While behavioral feeding problems were not predictive of adherence to dietary restriction recommendations, they were positively associated with parenting stress. Conclusions: The study results indicate that, for families caring for a child with EGID, higher levels of behavioral feeding problems are associated with parent maladjustment or dysfunction. A multidisciplinary treatment team is needed to provide comprehensive psychosocial and feeding evaluations and treatment in EGID families. © 2012 John Wiley & Sons A/S.

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