Barriers to Oral Medication Adherence for Adolescents with Inflammatory Bowel Disease

Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH 45229-3039, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 09/2009; 35(6):683-91. DOI: 10.1093/jpepsy/jsp085
Source: PubMed


To identify family-reported, adherence-related barriers for adolescents with inflammatory bowel disease (IBD) and examine their relationship to 6-MP/azathioprine and 5-ASA medication adherence.
Participants included 74 adolescents, aged 13-17 years, diagnosed with IBD and their caregivers. Adolescents and caregivers jointly completed a measure of barriers to medication adherence. Adherence to medication was measured by family-report, pill-count, and serum assay.
Families endorsed one to seven total barriers to medication adherence. The most commonly reported barriers included forgetting, being away from home, and interference with an activity. Neither demographic nor disease severity variables were related to the total number of reported barriers. Fewer total reported barriers was related to better adherence by adolescent and maternal report.
Most families experience at least one barrier to treatment adherence. Effective problem-solving around these barriers and its integration into future treatment protocols may help improve medication adherence in the pediatric IBD population.

Download full-text


Available from: Lisa Ingerski
  • Source
    • "Management of IBD symptoms may involve a complex, potentially burdensome, treatment regimen consisting of multiple medication doses per day, dietary modifications , and in some cases, surgery (Kappelman et al., 2007). Although dietary modifications are individually tailored , youth may be asked to abstain from foods that commonly cause gastrointestinal discomfort such high fiber pediatric populations (Logan, Zelikovsky, Labay, & Spergel, 2003; Modi & Quittner, 2006; Simons, McCormick, Devine, & Blount, 2010; Zelikovsky, Schast, Palmer, & Meyers, 2008) as well as among adolescents with IBD (Greenley et al., 2010; Ingerski et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Knowledge of factors impacting adolescents' ability to adhere to their inflammatory bowel disease (IBD) regimen is limited. The current study examines the collective impact of barriers to adherence and anxiety/depressive symptoms on adolescent adherence to the IBD regimen. Adolescents (n = 79) completed measures of barriers to adherence, adherence, and anxiety/depressive symptoms at one of two specialty pediatric IBD clinics. Most adolescents reported barriers to adherence and 1 in 8 reported borderline or clinically elevated levels of anxiety/depressive symptoms. Anxiety/depressive symptoms moderated the relationship between barriers to adherence and adherence. Post hoc probing revealed a significant, additive effect of higher anxiety/depressive symptoms in the barriers-adherence relationship, with adherence significantly lower among adolescents with higher barriers and higher anxiety/depressive symptoms. In order to optimize adherence in adolescents, interventions should target not only barriers to adherence but also any anxiety/depressive symptoms that may negatively impact efforts to adhere to recommended treatment.
    Full-text · Article · Nov 2011 · Journal of Pediatric Psychology
  • Source
    • "Adherence to treatment regimens was a prominent barrier in most of the studies under examination. Numerous reasons for medication non-compliance were cited including: cost, dislike of taste, forgetfulness, belief that the medication was ineffective, denial about the condition, complicated or difficult to use, inconvenience, interference with an activity, fear of side effects, embarrassment, laziness and negativity toward health care providers (Buston & Wood 2000, Ayala et al. 2006, Mulvaney et al. 2008, Laster et al. 2009, Rhee et al. 2009, Ingerski et al. 2010). Youth noted the extensive limitations of having diabetes on their social lives and the need for ongoing 'thinking and counting' related to dietary restrictions, injections, blood glucose monitoring, exercise, and dealing with stress. "
    [Show abstract] [Hide abstract]
    ABSTRACT: lindsay S, kingsnorth s & hamdani y (2011) Journal of Nursing and Healthcare of Chronic Illness3, 186–208 Barriers and facilitators of chronic illness self-management among adolescents: a review and future directions Aim. To synthesise findings from empirical studies examining factors that influence adolescents’ self-management of chronic illness and to make recommendations for clinical practice. Background. Given the extent of chronic illness among youth where 1 in 10 adolescents have activity limitations due to chronic illness or disability, the consequences for health care systems and the burden on patients is significant. Understanding the experiences of adolescents is critical because this group undergoes a developmental period of significant physical, emotional and social changes accompanied by a transition from paediatric to adult health services. Most self-management research focuses on adults or children without recognising the importance and impact of these developmental changes, tending to focus on parents’ and health care providers’ perspectives. Little is known about adolescents’ perspectives of self-managing chronic illness. Method. Integrative review of the literature. Results. A qualitative examination of the main findings from the 34 studies identified in the review revealed a consistent pattern of key themes that hindered or facilitated chronic illness self-management. Themes regarding barriers to adolescents’ illness management included: socio-demographic characteristics, medication adherence, psychosocial barriers and parental involvement. Themes associated with facilitating self-management among adolescents included: psychosocial factors, knowledge about illness, effective coping styles and shared management with parents. Conclusions. Understanding the factors that facilitate and hinder the self-management of chronic illness among adolescents is critical to improving interventions and health outcomes for youth. Relevance to clinical practice. The recommendations based on this review encourage clinicians to assess the self-management skills and social contexts of adolescents with chronic conditions to support the range of condition related self-care and life skills needed for optimal health and successful transition to adulthood.
    Full-text · Article · Aug 2011 · Journal of Nursing and Healthcare of Chronic Illness
  • Source
    • "The most commonly reported barriers to treatment adherence were forgetting, interference by other activities, not being at home, and difficulty swallowing pills. In contrast to a recent study demonstrating the relationship between barriers and subjective nonadherence (Ingerski et al., 2009), results of this study revealed a significant correlation between number of reported barriers and objective nonadherence to 6-MP/azathioprine was observed, indicating that as the number of barriers to adherence increases, so does nonadherence to 6-MP/azathioprine. This discrepancy might suggest a unique difference in the barriersadherence relationship between the two study samples or it might underscore the disparate sample sizes resulting in contrasting findings. "
    [Show abstract] [Hide abstract]
    ABSTRACT: 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. 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. 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. 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.
    Full-text · Article · Dec 2009 · Journal of Pediatric Psychology
Show more