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Kinch M, Kroll T, Buckle N, Somanadhan S. Interventions to support young adults and families with the healthcare transition between paediatric and adult nephrology health services: A systematic scoping review. J Pediatr Nurs 2024; 78:e346-e363. [PMID: 39153916 DOI: 10.1016/j.pedn.2024.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Healthcare transition can be challenging for young people and families living with chronic kidney conditions, including those with rare renal disorders who often have multi-systemic conditions, those who have undergone kidney transplantation, and those who face intense treatments like dialysis. Comprehensive, holistic healthcare transition interventions are required, encompassing physical, psychosocial, sexual, educational and vocational support. AIM This manuscript presents a systematic scoping review synthesising the healthcare transition interventions to support youth and families within nephrology services. METHODS This review followed Arksey and O'Malley's five-stage framework, updated by Levac, Colquhoun and O'Brien and the Joanna Briggs Institute. Six databases were systematically searched: CINAHL Plus with Full Text, Embase, PsycINFO, Web of Science, PubMed, and the Applied Social Sciences Index and Abstracts (ASSIA), locating 12,662 records. Following a systematic screening process, 28 articles met the inclusion criteria. Results were analysed systematically and presented using the PAGER framework developed by Bradbury-Jones et al. (2022). RESULTS Various interventions were sourced. Three broad patterns emerged: 1. Contextual Factors, e.g. cultural differences between paediatric and adult services; 2. Major Intervention Components, e.g. parental/familial/peer-to-peer support, and 3. Personal factors, e.g., self-management ability. CONCLUSION Few interventions are available to support youth with rare renal disorders, specifically. Future research must be directed at this cohort. Healthcare transition timing remains hotly contested, with additional guidance required to support decision-making. Finally, limited interventions have been evaluated for practice. IMPLICATIONS This review has provided various considerations/recommendations that should be taken into account when designing, implementing or evaluating future healthcare transition supports.
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Affiliation(s)
- M Kinch
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland; University College Dublin Centre for Interdisciplinary Research, Education & Innovation in Health Systems (IRIS Centre), Ireland.
| | - T Kroll
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland; University College Dublin Centre for Interdisciplinary Research, Education & Innovation in Health Systems (IRIS Centre), Ireland
| | - N Buckle
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - S Somanadhan
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland; University College Dublin Centre for Interdisciplinary Research, Education & Innovation in Health Systems (IRIS Centre), Ireland
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Charlucien-Koech R, Brady J, Fryer A, Diaz-Gonzalez de Ferris ME. School Nurses Practices Promoting Self-Management and Healthcare Transition Skills for Adolescents with Chronic Conditions in Urban Public Schools: A Mixed Methods Study. J Sch Nurs 2024; 40:174-188. [PMID: 34928723 DOI: 10.1177/10598405211053266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Adolescents and young adults (AYA) with chronic conditions should acquire self-management skills as part of their healthcare transition (HCT) from pediatric to adult-focused care. HCT/self-management skills have the potential to help mitigate health disparities among minority AYA with chronic conditions. This study investigated school nurses' practices promoting HCT/self-management skills in urban public schools. Methods: Seventy-nine nurses from three urban school districts in Massachusetts completed a survey of 32 Likert-type questions on HCT/self-management skills, eight demographic questions, and five open-ended practice questions assessing how often they have asked students with chronic conditions about HCT/self-management skills, based on the UNC TRxANSITION IndexTM. Results: Among the 79 school nurses who participated (response rate 76%), 67% never or rarely assessed students' knowledge of HCT/self-management, and 90% would use a tool that promotes/measures HCT/self-management skills. Conclusion: In our study sample, most school nurses acknowledged the importance of assessing HCT/self-management skills. The majority favored using a tool to promote these skills.
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Affiliation(s)
- Roselaine Charlucien-Koech
- Department of Health Services, Boston Public Schools, Boston, Massachusetts
- Department of Nursing and Health Sciences, Regis College, Weston, Massachusetts
| | - Jacqueline Brady
- Department of Health Services, Boston Public Schools, Boston, Massachusetts
| | - Anne Fryer
- Department of Nursing and Health Sciences, Regis College, Weston, Massachusetts
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Hart LC, Chisolm D. Improving the use of transition readiness measures in research and clinical care. Pediatr Res 2023; 94:926-930. [PMID: 37029237 DOI: 10.1038/s41390-023-02596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/21/2023] [Accepted: 03/22/2023] [Indexed: 04/09/2023]
Abstract
Measurement of transition readiness is considered a crucial component of effective transition. It is included as one of the Six Core Elements of Transition in national transitional care guidelines. However, the current measures of transition readiness have not been found to correlate with either current or future health outcomes for youth. In addition, there are challenges in measuring transition readiness in youth with intellectual and developmental disabilities, who may not be expected to achieve skills and knowledge that are considered essential for transition in typically developing youth. These concerns make it difficult to know how best to use transition readiness measures in research and clinical care. This article highlights the appeal of measuring transition readiness in clinical and research contexts, the current barriers that prevent us from fully achieving those benefits, and potential strategies for bridging the gap. IMPACT: Transition readiness measures were developed as an attempt to identify those patients who were ready to successfully navigate the transition from pediatric to adult health care. Thus far, the measures that have been developed do not appear to be related to health outcomes such as disease control or timely attendance of the first adult appointment in adult care. We provide suggestions for how to address the current concerns with the available transition readiness measures.
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Affiliation(s)
- Laura C Hart
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
- Departments of Pediatrics and Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Deena Chisolm
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Alvarez-Elías AC, Lou-Meda R, Exeni R, Exantus J, Bonilla-Felix M, González-Camac S, de Ferris MEDG. Addressing Health Inequities and Disparities in Children With Kidney Disease in Disadvantaged Areas: the Latin American and Caribbean Experience. CURRENT PEDIATRICS REPORTS 2023; 11:40-49. [PMID: 37252328 PMCID: PMC10206370 DOI: 10.1007/s40124-023-00287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
Purpose of Review Compared with high-income countries, healthcare disparities and inequities are more evident in low, lower-middle, and upper-middle-income countries with poorer housing and nutrition conditions. At least 20% of Latin America and the Caribbean are low and lower-middle-income countries. Despite the majority of the other countries being upper-middle income, the United Nations Children's Fund had classified all the regions as "less developed," with limited access to health care for the most vulnerable, the children. Latin America and the Caribbean regions represent an extensive territory with communication limitations and an unstable socio-political and economic environment. After considering the vast population affected by poverty worldwide and the long-term impact of kidney disease starting in childhood, it is crucial to better understand and analyze the multifactorial limiting conditions in accessing specialized care such as pediatric nephrology in disadvantaged areas. Recent Findings Constraints in accessing basic healthcare in rural areas make it impossible to receive specialized pediatric nephrology care including dialysis and transplantation. Disturbingly, incidence and prevalence figures of acute kidney injury, chronic and end-stage kidney disease in some Latin American and the Caribbean countries are unknown, and these conditions still represent a death sentence for underprivileged populations. However, the monumental efforts of the dedicated healthcare providers and stakeholders that pioneered the actions in the past 50 years have shown remarkable progress in developing pediatric nephology services across the continent. Summary In this review, we compile some of the latest evidence about the care of children and adolescents with kidney conditions in Latin America and the Caribbean, along with the experiences from the field in the care of these patients facing adverse conditions. We also highlight recommendations to address inequities and disparities.
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Affiliation(s)
- Ana Catalina Alvarez-Elías
- Division of Nephrology, Research Institute, Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St, Toronto, ON M5G 0A4 Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Departamento de Investigacion Clinica, Hospital Infantil de México, Federico Gómez, UNAM, Ciudad de Mexico, México
| | - Randall Lou-Meda
- Division of Nephrology, Hospital Roosevelt, Ciudad de Guatemala, Guatemala
- Fundación Para El Niño Enfermo Renal (FUNDANIER), Ciudad de Guatemala, Guatemala
| | - Ramón Exeni
- Division of Nephrology, Hospital Profesor Doctor Ramón Exeni, Buenos Aires, Argentina
| | - Judith Exantus
- Pediatrics Unit, State University Hospital, University of Haiti, Port-Au-Prince, Haiti
| | - Melvin Bonilla-Felix
- Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Saúl González-Camac
- Division de Nefrologia y Trasplante, Instituto Nacional de Salud del Niño, San Borja, Lima, Peru
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Huang Y, Wang H, Diaz-Gonzalez de Ferris M, Qin J. Translation and validation of the STAR x questionnaire in transitioning Chinese adolescents and young adults with chronic health conditions. J Pediatr Nurs 2022:S0882-5963(22)00272-X. [PMID: 36464544 DOI: 10.1016/j.pedn.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Adolescent/young adults (AYAs) with chronic conditions must undergo healthcare transition (HCT) preparation until their mid-twenties. Valid HCT readiness measures are lacking in China. METHODS The present study translated, back-translated, and adapted the Self-Management and Transition to Adulthood with Rx = Treatment (STARx) Questionnaire. We examined the psychometric properties of this tool in a relatively large in-patient sample of AYAs with various chronic health conditions at a Chinese tertiary general hospital. RESULTS We enrolled 624 AYAs aged 10-25 years (19.66 ± 3.64) with various chronic health conditions. The Chinese version of the STARx Questionnaire demonstrated excellent internal consistency (Cronbach's alpha = 0.83) and reliability with a two-week test-retest (ICC = 0.88, p < .001). Furthermore, the Chinese version revealed a three-factor structure (self-management, disease knowledge, and provider communication) consistent with the revised English version of the STARx Questionnaire. In terms of discriminant validity, the total score of the Chinese STARx Questionnaire showed a significant positive correlation with age but no gender differences were found. In terms of predictive validity, the Chinese STARx Questionnaire was significantly correlated with shorter length of hospitalization and higher frequency of emergency room visit, but the correlations became insignificant after controlling for age. CONCLUSIONS The results suggest that the Chinese version of the STARx Questionnaire is a robust HCT readiness tool in AYAs with chronic conditions and clinicians may find it useful to develop individualized interventions.
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Affiliation(s)
- Yunzhen Huang
- Division of Special Education and Counseling, California State University, Los Angeles, Los Angeles 90032, CA, United States
| | - Huaping Wang
- Department of Clinical Nutrition, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | | | - Jian Qin
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Trends and Disparities in Health Care Transition Preparation from 2016 to 2019: Findings from the US National Survey of Children's Health. J Pediatr 2022; 247:95-101. [PMID: 35598644 DOI: 10.1016/j.jpeds.2022.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/28/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate national trends in health care transition preparation over a 4-year period using the National Survey of Children's Health (NSCH) and to identify and examine disparities in receipt of health care transition preparation over the study period. STUDY DESIGN Data from the NSCH, an annual serial cross-sectional survey conducted from 2016 to 2019, were examined. Caregivers answered questions regarding one of their children within each of a random sample of households across the US. The primary analysis examined trends in health care transition preparation based on the year of survey completion. A secondary analysis examined the associations of race/ethnicity, primary household language, insurance type, and children with special health care needs (CSHCN) with receipt of health care transition preparation. RESULTS We included data from 54 434 youths (20 708 in 2016, 8909 in 2017, 12 587 in 2018, and 12 230 in 2019) aged 12-17 years whose caregivers completed the NSCH between 2016 and 2019. The sample was weighted to be nationally representative based on weights provided by the NSCH. The proportion of youths receiving necessary health care transition preparation increased over the study period, from 14.8% in 2016 to 20.5% in 2019 (P < .001). Multivariable logistic regression demonstrated increased odds of receiving health care transition preparation in 2018 and 2019, as well as for White non-Hispanic youths, those with English or Spanish as a primary household language, those with private insurance, and CSHCN. CONCLUSIONS Although the proportion of youths receiving health care transition preparation has increased since 2016, the need for ongoing improvement and elimination of disparities in health care transition preparation remains.
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Abdwani R, Al Saadoon M, Jaju S, Elshinawy M, Almaimani A, Wali Y, Khater D. Age of Transition Readiness of Adolescents and Young Adults With Chronic Diseases in Oman: Need an Urgent Revisit. J Pediatr Hematol Oncol 2022; 44:e826-e832. [PMID: 34985041 DOI: 10.1097/mph.0000000000002389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Ministry of Health in Oman and some of Gulf regions set the cut-off age of "transfer" from child health care to adult health care at 13 years of age. Within the existing health system in this part of the world, there is paucity of evidence on the appropriate age for health care "transfer" of adolescents and young adults to adult health care. Similarly, there is lack of a structured health care "transition" program. The objective of the study is to indirectly determine the appropriateness of present cut-off age of transfer by studying readiness for transition among Omani patients suffering from chronic hematological conditions. METHODS One hundred fifty adolescents and young adults with chronic hematological conditions were recruited from pediatric and adults clinics at Sultan Qaboos University Hospital. Participants were interviewed by a trained research assistant using the Arabic version of UNC TRxANSITION Scale to assess self-management skills and health related knowledge for transition. The score range is 0 to 10; the transition readiness of the patients is assessed as low (0 to 4), moderate (4 to 6), and high (6 to 10) respectively. The continuous variables were analyzed by parametric or nonparametric methods as appropriate. χ2 analysis was done to determine association of age groups within each sexes. RESULTS The study recruited 150 subjects (52.7% males) with 50 patients in each of the 3 age groups of 10 to 13 years (lower), 14 to 17 years (middle), and 18 to 21years (higher). The mean UNC TRxANSITION Scale scores of 5.14 (SD=1.27) in males in the total sample were significantly lower as compared with that of 5.67 (SD=1.50) in females (P=0.022). There is a steady increase in the overall median score with increase in age group, with median score of 4.42 in the lower, 5.26 in the middle and 6.81 in the higher age group (P<0.001). In section wise analysis, except for Adherence and Nutrition sections of the scale, all sections have statistically significant difference in the median scores across various age categories with lowest scores in the 10 to 13 age group and highest scores in the 18 to 21 years group. In the section related to reproduction, females had significantly higher mean ranks (31.52) and compared with 17.19 in males (P=0.001). The overall median transition score when analyzed separately for males and females across age groups showed that in the higher age group, 67% of males (P=0.008) and 90% females (P<0.001) have high transition scores compared with the other 2 groups. CONCLUSIONS Higher age was a significant predictor for transition readiness with median score being "moderate" in the lower and middle age groups, while the higher age groups scoring "high" on transition readiness. However, in the higher age group, the females (90%) showed better transition readiness than males (67%). The current age of transfer of 13 years is just at "moderate" levels. We recommend the need for establishing transition preparation program in Oman; increasing health transfer age in Oman to a cut-off age of 18 years and taking sex differences into consideration when providing interventions.
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Affiliation(s)
| | | | - Sanjay Jaju
- Family Medicine, College of Medicine and Health Sciences, Sultan Qaboos University
| | - Mohamed Elshinawy
- Departments of Child Health
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Asmaa Almaimani
- General Foundation Program, Oman Medical Specialty Board, Muscat, Oman
| | - Yasser Wali
- Departments of Child Health
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Doaa Khater
- Departments of Child Health
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Abdwani R, Al Sabri R, Al Hasni Z, Rizvi S, Al Wahshi H, Al Lawati B, Al Abrawi S, Wali Y, Al Sadoon M. Transition readiness in adolescents and young adults with chronic rheumatic disease in Oman: today's needs and future challenges. Pediatr Rheumatol Online J 2022; 20:27. [PMID: 35413991 PMCID: PMC9004032 DOI: 10.1186/s12969-022-00687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In Oman, the ""transition" of health care of adolescents to adult care occurs at a young age, like many other GCC countries for cultural reasons. In order to address this concern, this study was conducted to determine the transition readiness skills of adolescents and young adults with childhood onset rheumatic diseases using a cross-cultural adaptation of the UNC TRxANSITION scale. METHODS We used a professionally translated/back translated, provider-administered UNC TRxANSITION Scale. This 32-question scale measures HCT in 10 domains including knowledge about diagnosis or treatment, diet, reproductive health, school/work, insurance, ability to self-manage and identification of new health providers. The maximum transitional score of 10, was categorized as low (1-4), moderate (4 - 7) and high (7 -10) transitional readiness scores. RESULTS We enrolled 81 Omani adolescents and young adults (AYA) with chronic childhood onset rheumatic diseases. The cohort consisted of 79% females, with mean age of 15.8 years (± 3.53) and mean disease duration of 6.95 years (± 4.83). Our cohort's overall mean score is low 5.22 (±1.68). Only 14.8% of the cohort achieved a high transition score (≥7). Significant direct relationship was observed between age and the mean transition readiness score (r = .533, P < .001). The mean transition readiness score in the younger age group (10-13 years) was 4.07 (±1.29), the middle age group (14-18 years) was 5.43 (±1.27), while the older age group (19-21 year), was 6.12 (±1.81). Mean transition score of youngest age group was found to be significantly lower than the other two age groups (p = .003). CONCLUSION Overall, the transition readiness of AYA in Oman is low compared to other western countries indicating the need to initiate a health care transition preparation program for patients with chronic diseases across the country. In addition, we need to establish regional guidelines to address the transfer and transition policies to be in line to international recommendations. As transition continues after transfer, and is preferably guided by adolescent developmental status rather than chronological age, it would be preferable to refer to the transition and transfer policies 9rather than transitional age policy) to be in line to international recommendations.
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Affiliation(s)
- Reem Abdwani
- Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman.
| | - Rumaitha Al Sabri
- Pediatric Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Zawan Al Hasni
- General Foundation Program, Oman Medical Specialty Board, Muscat, Oman
| | - Seyad Rizvi
- grid.412846.d0000 0001 0726 9430Department of Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Humaid Al Wahshi
- grid.416132.30000 0004 1772 5665Department of Medicine, Royal Hospital Muscat, Muscat, Oman
| | - Batool Al Lawati
- grid.412846.d0000 0001 0726 9430Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Safiya Al Abrawi
- grid.416132.30000 0004 1772 5665Department of Child Health, Royal Hospital Muscat, Muscat, Oman
| | - Yassir Wali
- grid.412846.d0000 0001 0726 9430Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman
| | - Mona Al Sadoon
- grid.412846.d0000 0001 0726 9430Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman
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Brito-Suárez JM, Medina-Hernández E, Medeiros M, Cantú-Quintanilla G, Morales-Buenrostro LE, Diaz-González de Ferris ME, Valdez-Ortiz R. A.L.L. Y.O.U. N.E.E.D. I.S. L.O.V.E. Manual on health self-management and patient-reported outcomes among low-income young adult Mexicans on chronic dialysis: Feasibility study. J Pediatr Nurs 2022; 62:129-135. [PMID: 34801325 DOI: 10.1016/j.pedn.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We evaluated disease knowledge/self-management skills among low-income Mexican young adults maintained on dialysis and to test the effectiveness of the A.L.L. Y.O.U. N.E.E.D. I.S. L.O.V.E (AYNIL) Manual - Spanish Version on patient-reported outcomes. This is a low literacy teaching tool designed with patients and educators' input. DESIGN AND METHODS A quasi-experimental study was conducted in 17 chronic dialysis patients at Mexico City's Hospital General de México, Dr. Eduardo Liceaga. Ages 18-30-year-old completed disease knowledge/self-management and quality of life measures before the intervention and 6 weeks later. RESULTS Significant increases were observed on disease knowledge/self-management scores in the STARx questionnaire from 47 (IQ: 40,51) to 50 (IQ: 48,54) p = 0.04. The UNC-TRxANSITION Index increased significantly from 4.8 (IQ: 3.9,5.7) to 7.7 (IQ: 7.5,8.2) p ≤0.001. Significant increases in scores were detected in the "Burden of kidney disease" (p = 0.008), "Effects of kidney disease" " (p = 0.03) and " Dialysis staff encouragement" (p = 0.027) based on the KDQoL survey. CONCLUSIONS In this vulnerable population, the Spanish version of the A.L.L. Y.O.U. N.E.E.D. I.S. L.O.V.E. - AYNIL Manual improved CKD/ESRD disease knowledge/self-management skills and HRQoL. This study highlighted the need for low-literacy educational tools to improve patient-reported outcomes. PRACTICE IMPLICATIONS Young adults with CKD/ESRD can benefit from patient-centered educational interventions to enhance their autonomy and the development of self-management behaviors that improve patient-reported outcomes and potential complications of the disease. Special attention is needed in low-income patients with low rates of adherence to treatments and poor self-management skills.
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Affiliation(s)
- Juliette Marie Brito-Suárez
- Programa de Maestría y Doctorado en Ciencias de la Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico; Unidad de Investigación y Diagnóstico en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Elba Medina-Hernández
- Servicio de Nefrología, Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Mara Medeiros
- Unidad de Investigación y Diagnóstico en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | | | - Luis Eduardo Morales-Buenrostro
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Rafael Valdez-Ortiz
- Servicio de Nefrología, Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico.
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Biagioli V, Spitaletta G, Kania V, Mascolo R, Gawronski O, Liburdi A, Manzi G, Salata M, Vellone E, Tiozzo E, Dall'Oglio I. Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review. Front Pediatr 2022; 10:832453. [PMID: 35419323 PMCID: PMC8995847 DOI: 10.3389/fped.2022.832453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education.
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Affiliation(s)
- Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Kania
- Department of Paediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michele Salata
- Rheumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Hart LC, Díaz-González de Ferris M, Nazareth M, Faldowski RA, Rak E, Hooper SR, Ndugga M, van Tilburg MAL. Evaluation of the TRxANSITION Index-Parent Version for Assessment of Readiness to Transition to Adult Care Among Youth with Chronic Conditions. J Pediatr Nurs 2021; 58:1-8. [PMID: 33278706 DOI: 10.1016/j.pedn.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop and evaluate a parent-proxy measure of youth HCT readiness: the TRxANSITION Index-Parent Version. DESIGN AND METHODS We recruited parents (77% female) and youth (ages 12 to 25) to complete transition readiness measures during outpatient clinic visits. The TRxANSITION Index-Parent Version contains two domains: the Parent Knowledge Domain assessing a parent's knowledge of their youth's illness, and the Parent Proxy Domain, which provides a parental perspective regarding a youth's transition readiness skills. We evaluated the TRxANSITION Index - Parent Version for differences between parent and youth reports of HCT readiness, associations between parent's score and youth's characteristics, and item-category, item-sub-index, and sub-index category correlations. RESULTS Data from 93 parents-youth dyads were analyzed. Parents scored significantly higher than youth in the Parent Knowledge Domain and similarly in the Parent Proxy Domain. Parents of daughters had significantly higher scores in the Parent Knowledge Domain than parents of sons and reported similar scores to Parents of sons in the Parent Proxy Domain. Only the self-management sub-index significantly correlated with youth's age. The sub-index-domain, item-sub-index, and item-domain correlations assessed were generally large in magnitude (r > 0.5). CONCLUSIONS The TRxANSITION Index-Parent Version shows promise as a means of assessing parent knowledge of a youth's illness and may provide an accurate proxy assessment of a youth HCT readiness skills. PRACTICE IMPLICATIONS Obtaining parental perspective on a youth's HCT readiness may provide useful clinical information during the transition process.
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Affiliation(s)
- Laura C Hart
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, United States of America.
| | - Maria Díaz-González de Ferris
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, 231 MacNider Building, NC, United States of America
| | - Meaghan Nazareth
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, 231 MacNider Building, NC, United States of America
| | - Richard A Faldowski
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC, United States of America
| | - Eniko Rak
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC, United States of America
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC, United States of America
| | - Maggwa Ndugga
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, 231 MacNider Building, NC, United States of America
| | - Miranda A L van Tilburg
- Department of Medicine, University of North Carolina at Chapel Hill, NC, United States of America; College of Pharmacy and Health Sciences, Campbell University, NC, United States of America; School of Social Work, University of Washington, NC, United States of America
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Parfeniuk S, Petrovic K, MacIsaac PL, Cook KA, Rempel GR. Transition readiness measures for adolescents and young adults with chronic health conditions: a systematic review. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractBackgroundTransition from pediatric to adult healthcare for adolescents with chronic health conditions has emerged as a critical period influencing health outcomes. Suitable transition readiness measures are necessary to facilitate effective planning. Currently, there is little consensus about well-validated transition readiness measures. The purpose of this systematic review was to identify best practices in transition readiness measurement for adolescents and young adults with chronic health conditions.Data sourcesAcademic databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, Google Scholar and Athabasca University Library’s Discover.Study selectionArticles were included that discussed the development and psychometric properties of transition readiness measures for adolescents and young adults (11–25 years) with chronic health conditions and/or that utilized a previously developed measure.Data extractionThe primary and secondary reviewers extracted data from the selected articles as per the data extraction tool developed for this review.ResultsForty-eight articles, representing 19 tools, were included in the review. Ten of the tools were disease-specific; nine were disease-neutral. According to the Cohen criteria, eight measures were “well-established assessments”. The Transition Readiness Assessment Questionnaire was deemed the best measure of transition readiness available. The literature search included only articles published in peer-reviewed journals; measures nearing completion or awaiting publication were not included. In addition, only English manuscripts were included, many from North America.ConclusionsDespite national practice guidelines and ongoing policy development, there is slow movement towards achieving a gold standard or best-practice measure of transition readiness.
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Affiliation(s)
| | | | | | | | - Gwen R. Rempel
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB T9S 3A3, Canada, Tel.: +855-833-5699
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Hart LC, van Tilburg MAL, Campbell R, Faldowski RA, Nazareth M, Ndugga M, Coltrane C, de Ferris MDG. Association of youth health care transition readiness to role overload among parents of children with chronic illness. Child Care Health Dev 2019; 45:577-584. [PMID: 31049987 DOI: 10.1111/cch.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 11/13/2018] [Accepted: 04/15/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND A parent's level of role overload, a situation in which the demands of an individual's roles are beyond their capacity to perform adequately, has been associated with poor outcomes in adolescents. It is unknown if role overload in parents is associated with less health care transition (HCT) readiness in their children with chronic conditions. We sought to assess this relationship. METHODS Youth with chronic conditions attending a therapeutic camp and their parents completed online consents/assents and de-identified surveys. Parents reported on parental role overload using the Reilly Role Overload Scale and a proxy assessment of the youth's HCT readiness using the STARx -Parent Questionnaire. Youth self-reported on their HCT readiness using the STARx Questionnaire. Linear regression measured the relationship between parent role overload and HCT readiness, controlling for youth's age, sex, and degree of youth's educational support. RESULTS One hundred fifty-two parents and 50 youth completed the measures. Greater parental role overload was associated with less overall HCT readiness on the parent proxy measure (β = -.12, P ≤ .008) and a lower level in the self-management domain on the parent proxy measure (β = -.20, P ≤ .001). We found no associations between parent role overload and youth self-report of HCT readiness. CONCLUSION Parent's level of role overload had no association with youth's self-report of HCT readiness but was negatively associated with parent proxy report of their youth's HCT readiness, suggesting that parents with high levels of role overload may perceive their youth as less ready to transition to adult-focused care.
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Affiliation(s)
- Laura C Hart
- Division of General Internal Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Ambulatory Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Miranda A L van Tilburg
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,College of Pharmacy and Health Sciences,, Campbell University, Buies Creek, North Carolina.,School of Social Work, University of Washington, Seattle, Washington
| | - Robert Campbell
- Graduate Program in Public Health, Eastern Virginia Medical School/Old Dominion University, Norfolk, Virginia
| | - Richard A Faldowski
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Meaghan Nazareth
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Maggwa Ndugga
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Straus EJ. Challenges in Measuring Healthcare Transition Readiness: Taking Stock and Looking Forward. J Pediatr Nurs 2019; 46:109-117. [PMID: 30928897 DOI: 10.1016/j.pedn.2019.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/25/2019] [Accepted: 03/20/2019] [Indexed: 11/16/2022]
Abstract
THEORETICAL PRINCIPLES The construct of transition readiness has become commonplace in healthcare transition (HCT) research, yet conceptualization of this construct is rarely considered. Given the centrality of construct conceptualization in measure development and validity theory, analysis of measurement implications of conceptualizations of transition readiness is essential. PHENOMENON ADDRESSED The purpose of this paper is to provide a review and critical analysis of transition readiness measurement through the lens of construct conceptualization and its implications for validation and healthcare transition research. RESEARCH LINKAGES Drawing on contemporary validity theory, theoretical discussions of construct conceptualization from management studies, and transition readiness measurement research, this paper will explore how transition readiness has been conceptualized and operationalized in HCT research and articulate problems, challenges and gaps relevant to transition readiness. There remains a lack of consensus on what transition readiness is or should be and careful attention to the implications of elements of conceptual definitions are essential to move the field of transition readiness measurement forward. Recommendations for future work in the field in relation to conceptual clarity, the implications of multidimensionality, change over time, and consequences of measurement are suggested.
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Affiliation(s)
- Elizabeth J Straus
- School of Nursing, University of British Columbia, Vancouver, BC, Canada; School of Nursing, Linfield College, Portland, Oregon, United States of America.
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Longitudinal Self-Management and/or Transition Readiness per the TR xANSITION Index among Patients with Chronic Conditions in Pediatric or Adult Care Settings. J Pediatr 2018; 203:361-370.e1. [PMID: 30201183 DOI: 10.1016/j.jpeds.2018.06.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/26/2018] [Accepted: 06/15/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the roles of key individual, family, and illness characteristics on the levels of and gains in longitudinal healthcare transition (HCT) readiness in the pediatric setting and/or self-management skills (SMS) in the adult-focused setting, we used a large dataset with longitudinal measurements from 2006 to 2015. STUDY DESIGN This longitudinal observational study followed 566 adolescents and young adults with chronic conditions at University of North Carolina Hospitals. TRxANSITION Index measurements, which represent learning outcomes rather than health outcomes, were collected multiple times per patient and analyzed using a novel application of an education-based approach. RESULTS Levels of and gains in HCT/SMS scores increased with age (P < .001) with smaller increases at older ages. Mastery of skills varied by age with self-management achieved after 20 years of age. Scores varied positively by father's education and negatively by mother's education and duration of diagnosis. Gains in scores further varied positively with private insurance and negatively with mother's education and duration of diagnosis. CONCLUSIONS We found diminishing positive increases in HCT/SMS scores as patients become older and smaller levels of and gains in readiness among younger patients with more educated mothers. Risk factors for absolute level of HCT/SMS readiness and inadequate longitudinal gains are not always the same, which motivates a deeper understanding of this dynamic process through additional research. This information can guide providers to focus HCT/SMS preparation efforts on skills mastered at particular ages and to identify patients at risk for inadequate development of HCT/SMS skills.
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Survey on Management of Transition and Transfer From Pediatric- to Adult-based Care in Pediatric Kidney Transplant Recipients in Europe. Transplant Direct 2018; 4:e361. [PMID: 30046651 PMCID: PMC6056275 DOI: 10.1097/txd.0000000000000798] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022] Open
Abstract
Supplemental digital content is available in the text. Background Transition from pediatric- to adult-based healthcare is a challenging period and bears a high risk of medication nonadherence and transplant loss in adolescents and young adults after kidney transplantation. Yet, it remains unclear how the 2011 International Society of Nephrology (ISN)/International Pediatric Nephrology Association (IPNA) guidelines on transition are implemented in practice and which healthcare transition modalities are currently used in Europe. Methods We performed an online survey inviting all members of the European Society of Paediatric Nephrology mailing list to participate. Adherence to ISN/IPNA guidelines was scored with a maximum of 15 points. Results Thirty-nine centers from 24 countries accounting for approximately 2500 children after kidney transplantation participated in the survey. At 3 centers, patients remained under pediatric care for their whole life, and 5 centers did not use any transition procedure. From the remaining 31 centers, 82% confirmed the existence of at least 1 unwritten transition procedure. None of these centers used IT or social media for patient training in transition. Specialized transition clinics are held at 15 of 31 centers for the patients. Most patients were transferred at 16 to 21 years of age. Transfer age was subject to regulation at 20 of 36 centers. Median score of guidelines adherence was 10 (range, 0-14). The adherence score was significantly correlated with gross national income (r2 = 0.631, P < 0.0001). Conclusions The 2011 ISN/IPNA guidelines on transition are implemented insufficiently in European pediatric nephrology centers. Therefore, further development is needed, and the use of information technology and social media should be promoted.
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Filler G, Diaz-Gonzalez de Ferris M. We have to do more for former paediatric renal transplant recipients! Transpl Int 2017; 31:152-154. [PMID: 28865119 DOI: 10.1111/tri.13058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Guido Filler
- Division of Nephrology, Department of Paediatrics, University of Western Ontario, London, ON, Canada
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Prüfe J, Dierks ML, Bethe D, Oldhafer M, Müther S, Thumfart J, Feldkötter M, Büscher A, Sauerstein K, Hansen M, Pohl M, Drube J, Thiel F, Rieger S, John U, Taylan C, Dittrich K, Hollenbach S, Klaus G, Fehrenbach H, Kranz B, Montoya C, Lange-Sperandio B, Ruckenbrod B, Billing H, Staude H, Brunkhorst R, Rusai K, Pape L, Kreuzer M. Transition structures and timing of transfer from paediatric to adult-based care after kidney transplantation in Germany: a qualitative study. BMJ Open 2017; 7:e015593. [PMID: 28606904 PMCID: PMC5734418 DOI: 10.1136/bmjopen-2016-015593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents' lives with an increased risk for non-adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. SETTING In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. RESULTS This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of successful transition. Key elements of transitional care are well understood and mutually agreed on. Nonetheless, implementation within daily routine seems challenging, and the absence of written, structured procedures may hamper successful transition. CONCLUSIONS While professionals aim for an individual timing of transfer based on medical, social, emotional and structural aspects, rigid regulations on transfer age as given by the relevant health authorities add on to the challenge. TRIAL REGISTRATION NUMBER ISRCTN Registry no 22988897; results (phase I) and pre-results (phase II).
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Affiliation(s)
- Jenny Prüfe
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Marie-Luise Dierks
- Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
| | - Dirk Bethe
- Division of Paediatric Nephrology, Centre for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Silvia Müther
- Berliner TransitionsProgramm (BTP), DRK-Kliniken (German Red Cross Hospitals) Berlin Westend, Berlin, Germany
| | - Julia Thumfart
- Department of Paediatric Nephrology, Charité, Berlin, Germany
| | | | - Anja Büscher
- Department of Paediatrics II, Essen University Hospital, Essen, Germany
| | | | - Matthias Hansen
- KfH Centre of Paediatric Nephrology, Clementine Children’s Hospital, Frankfurt, Germany
| | - Martin Pohl
- Department of General Paediatrics, Adolescent Medicine and Neonatology, Freiburg University Hospital, Freiburg, Germany
| | - Jens Drube
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Florian Thiel
- University Children’s Hospital Eppendorf, Hamburg, Germany
| | - Susanne Rieger
- Division of Paediatric Nephrology, Centre for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike John
- University Children’s Hospital, Jena, Germany
| | - Christina Taylan
- Department of Paediatric Nephrology, University Hospital of Cologne, Cologne, Germany
| | | | - Sabine Hollenbach
- KfH Centres of Paediatric Nephrology, St. Georg Hospital, Leipzig, Germany
| | - Günter Klaus
- KfH Centres of Paediatric Nephrology, University Hospital of Marburg, Marburg, Germany
| | - Henry Fehrenbach
- KfH Centre of Paediatric Nephrology, Children’s Hospital Memmingen, Memmingen, Germany
| | - Birgitta Kranz
- University Children’s Hospital Münster, Münster, Germany
| | - Carmen Montoya
- KfH Centre of Paediatric Nephrology, University Children’s Hospital, München, Germany
| | | | - Bettina Ruckenbrod
- Children’s Hospital, Olgahospital Klinikum Stuttgart, Stuttgart, Germany
| | - Heiko Billing
- University Children’s Hospital Tübingen, Tübingen, Germany
| | - Hagen Staude
- University Children’s Hospital, Rostock, Germany
| | - Reinhard Brunkhorst
- KfH Centre of Nephrology, Hospitals of the Hannover Region, Hannover, Germany
| | | | - Lars Pape
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Martin Kreuzer
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Stollon N, Zhong Y, Ferris M, Bhansali S, Pitts B, Rak E, Kelly M, Kim S, van Tilburg MAL. Chronological age when healthcare transition skills are mastered in adolescents/young adults with inflammatory bowel disease. World J Gastroenterol 2017; 23:3349-3355. [PMID: 28566896 PMCID: PMC5434442 DOI: 10.3748/wjg.v23.i18.3349] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/04/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the longitudinal course of acquisition of healthcare transition skills among adolescents and young adults with inflammatory bowel diseases.
METHODS We recruited adolescents and young adults (AYA) with inflammatory bowel diseases (IBD), from the pediatric IBD clinic at the University of North Carolina. Participants completed the TRxANSITION Scale™ at least once during the study period (2006-2015). We used the electronic medical record to extract participants’ clinical and demographic data. We used ordinary least square regressions with robust standard error clustered at patient level to explore the variations in the levels and growths of healthcare transition readiness.
RESULTS Our sample (n = 144) ranged in age from 14-22 years. Age was significantly and positively associated with both the level and growth of TRxANSITION Scale™ scores (P < 0.01). Many healthcare transition (HCT) skills were acquired between ages 12 and 14 years, but others were not mastered until after age 18, including self-management skills.
CONCLUSION This is one of the first studies to describe the longitudinal course of HCT skill acquisition among AYA with IBD, providing benchmarks for evaluating transition interventions.
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Hart LC, Pollock M, Hill S, Maslow G. Association of Transition Readiness to Intentional Self-Regulation and Hopeful Future Expectations in Youth With Illness. Acad Pediatr 2017; 17:450-455. [PMID: 27979748 DOI: 10.1016/j.acap.2016.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/04/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about how transition readiness relates to other developmental skills of adolescence in youth with chronic illness. Better understanding of how transition readiness relates to these other developmental skills could lead to a broader array of tools to improve transition readiness. Intentional self-regulation (ISR) and hopeful future expectations (HFE) are 2 developmental skills of adolescence that improve with participation in developmental programming and thus are modifiable. METHODS We explored associations between transition readiness, as measured by the Transition Readiness Assessment Questionnaire 29 (TRAQ-29) and ISR and HFE in youth with chronic illness recruited from a variety of subspecialty clinics from a major southeast medical center. RESULTS A total of 71 adolescents with chronic illness were included in the analysis. The TRAQ-29 Self-Advocacy domain showed positive associations to both ISR (P = .03) and HFE (P = .009). In addition, the TRAQ-29 overall had positive associations to HFE (P = .04). CONCLUSIONS The significant associations between TRAQ-29 Self-Advocacy domain scores and ISR and HFE suggest that transition readiness is developing within the context of other developmental areas in adolescence. More work is needed to see if the programming that improves these other developmental skills might also improve transition readiness.
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Affiliation(s)
- Laura C Hart
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - Sherika Hill
- Center for Developmental Epidemiology, Duke University, Durham, NC
| | - Gary Maslow
- Duke University School of Medicine, Durham, NC
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Javalkar K, Johnson M, Kshirsagar AV, Ocegueda S, Detwiler RK, Ferris M. Ecological Factors Predict Transition Readiness/Self-Management in Youth With Chronic Conditions. J Adolesc Health 2016; 58:40-6. [PMID: 26707228 DOI: 10.1016/j.jadohealth.2015.09.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Health care transition readiness or self-management among adolescents and young adults (AYA) with chronic conditions may be influenced by factors related to their surrounding environment. METHODS Study participants were AYA diagnosed with a chronic condition and evaluated at pediatric- and adult-focused subspecialty clinics at the University of North Carolina Hospital Systems. All participants were administered a provider-administered self-management/transition-readiness tool, the UNC TRxANSITION Scale. Geographic area and associated characteristics (ecological factors) were identified for each participant's ZIP code using the published U.S. Census data. The Level 1 model of the hierarchical linear regression used individual-level predictors of transition readiness/self-management. The Level 2 model incorporated the ecological factors. RESULTS We enrolled 511 AYA with different chronic conditions aged 12-31 years with the following characteristics: mean age of 20± 4 years, 45% white, 42% black, and 54% female. Participants represented 214 ZIP codes in or around North Carolina, USA. The Level 1 model showed that age, gender, and race were significant predictors of transition readiness/self-management. On adding the ecological factors in the Level 2 model, race was no longer significant. Participants from a geographic area with a greater percentage of females (β = .114, p = .005) and a higher median income (β = .126, p = .002) had greater overall transition readiness. Ecological factors also predicted subdomains of transition readiness/self-management. CONCLUSIONS In this cohort of adolescents and young adults with different chronic conditions, ecological disparities such as sex composition, median income, and language predict self-management/transition readiness. It is important to take ecological risk factors into consideration when preparing patients for health self-management or transition.
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Affiliation(s)
- Karina Javalkar
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Meredith Johnson
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Abhijit V Kshirsagar
- Department of Medicine, Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sofia Ocegueda
- College of Arts and Sciences, University of North Carolina, Chapel Hill, North Carolina
| | - Randal K Detwiler
- Department of Medicine, Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Maria Ferris
- Department of Medicine, Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
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