Psychosocial predictors of medication non‐adherence in pediatric organ transplantation: A systematic review

Abstract

Adherence to immunosuppressant medication is critical to health and quality-of-life outcomes for children who have received a solid organ transplant. Research on the psychological and social predictors of medication adherence is essential to the advancement of pretransplant assessments and transplant psychosocial services. Despite the importance of identifying risk factors, the literature remains limited regarding psychosocial predictors of non-adherence. A systematic search was conducted to identify studies of the psychosocial predictors of post-transplant medication non-adherence in pediatric solid organ transplantation. From 1363 studies identified in searches of empirical literature, a final sample consisted of 54 publications representing 49 unique studies. Findings regarding psychosocial predictors were inconsistent with non-adherence associated largely with adolescence, racial/ethnic minority status, and presence of mental health issues. Familial predictors of non-adherence problems included single-parent households, lower socioeconomic status, lower family cohesion, presence of family conflict, and poor family communication. Several studies reported an association between non-adherence and social pressures (eg, peer social interaction, wanting to feel normal) among adolescent transplant recipients. While significant methodological and substantive gaps remain in this body of knowledge, this review synthesizes current evidence for assessment for transplant clinicians and researchers.

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

“…Demographic variables (ie, age of child and income) were entered into the first step of the regression based on theory positing that developmental age and family resources can impact adherence. Research has demonstrated that older adolescents and lower income families exhibited greater non‐adherence. The current sample supports this relationship, as the age of the child was significantly related to missed doses and income level to late doses.…”

“…The first hypothesis was examined utilizing a hierarchical multiple Research has demonstrated that older adolescents 1,22 and lower income families 21,22 exhibited greater non-adherence. The current sample supports this relationship, as the age of the child was significantly related to missed doses and income level to late doses.…”

“…Likewise, it has been suggested that low familial efficacy and low flexibility are related to increased barriers to adherence, while increased parental involvement promoted adherence among kidney transplant patients . A more recent meta‐analysis found that in pediatric solid organ transplant populations, a family environment with high stability, greater perceived support, and high emotional expressiveness led to greater adherence . Therefore, family environments that are not overly rigid or chaotic, but instead are adaptable and capable of planning and making informed decisions, and are emotionally present, promote adherence in adolescents.…”

Digital medicine program with pediatric solid organ transplant patients: Perceived benefits and challenges

“…Medication non‐adherence is especially prevalent in adolescent transplant populations with an estimated non‐adherence rate of 15%‐40% . Factors associated with non‐adherence in this population are extensive and include low socioeconomic status, family instability, limited parental supervision, depression, poor coping, disease frustration, longer time since transplant, side effects associated with immunosuppressive medication, and poor knowledge about the risks of medication non‐adherence …”

“…[6][7][8][9][10] Factors associated with non-adherence in this population are extensive and include low socioeconomic status, family instability, limited parental supervision, depression, poor coping, disease frustration, longer time since transplant, side effects associated with immunosuppressive medication, and poor knowledge about the risks of medication non-adherence. 5,11,12 Researchers have studied numerous direct and indirect methods to assess medication adherence in pediatric patients. 2,13 Direct methods include observing a patient taking a medication and/or measurements of patients' blood levels and result in a highly accurate estimate of medication adherence.…”