Medication adherence in pediatric renal transplant patients: The role of family functioning and parent health locus of control

Abstract

Children and adolescents with renal disease experience daily social, emotional, and medical challenges. Renal transplantation can help to improve quality of life but requires a lifelong regimen of immunosuppressant medication to maintain health. Adherence to a daily complex regimen can be difficult, particularly for adolescents who are beginning to develop autonomy from caregivers and are faced with a unique set of socio‐emotional challenges. This study examines two factors that have shown to influence adherence in other pediatric populations, namely family functioning and parent health locus of control, from mothers’ perspectives, in predicting medication non‐adherence for adolescents (ages 12‐19 years) 1 year post‐transplant. Non‐adherence was defined as the percentage of missed doses and late doses of the weekly immunosuppressant doses prescribed. Regression results demonstrated that mothers’ perceptions of poorer overall family functioning predicted missed medication doses (ΔR2 = 0.383, F(7, 21) = 2.570, P = 0.044) with significant contributions in the domains of problem‐solving (β = −0.795, t(21) = −2.927, P = 0.008) and affective involvement (β = 0.872, t(21) = 3.370, P = 0.003). Moreover, mothers who perceived that their adolescent had control over his/her health also predicted more missed medication doses (ΔR2 = 0.133, F(1, 27) = 5.155, P = 0.031). Important implications for these findings include implementation of family‐based interventions that promote developmentally appropriate skills for adolescents and cultivate emotional involvement within the family.

Psychological functioning and psychosocial issues in pediatric kidney transplant recipients

“…Parental stress and mental health concerns and family functioning impairment may impact adherence to medications post‐transplant 24,89,90 and are captured as a risk factor on the PTRI. Increased pretransplant parent emotional distress, child anxiety, and child depression were associated with worse family adjustment at 6 months post‐transplant, and additional research across organs demonstrates similar results up to 10 years post‐transplant 91 .…”

“…Parental stress and mental health concerns and family functioning impairment may impact adherence to medications post-transplant 24,89,90 and are captured as a risk factor on the PTRI.…”

Empowering patients to adhere to their treatment regimens: A multifaceted approach

“…Similarly, Kraenbring et al examined the association between medication adherence and family functioning and parent health locus of control in pediatric renal transplant recipients 11 . The authors examined a cohort of 50 adolescents aged 12‐19 years who were 1 year post‐transplant and their mothers.…”

“…1 There are also tremendous ripple effects with non-adherence impacting the individual's family dynamic, and increasing emotional stress and burden over adherence management ( Figure 1). 10,11 On a greater scale, non-adherence has profound costs in terms of healthcare utilization. It has been estimated that among adult transplant recipients in the United States, medical care costs are over $33,000 greater per individual patient for persistently high versus persistently low adherence groups.…”

From Nonadherence to Adherence

“…early. 60,61 Many observational studies showed a patient preference for the once-daily formulation (QD) of tacrolimus and expressed a positive effect on quality of life. 62,63 The first prospective randomized controlled trial that examined the effect of switching from the twice-daily (BID) to the once-daily formulation of tacrolimus in kidney recipients on medication adherence was the ADMIRAD study.…”