Adolescent Adherence Research Articles

Can Automated Text Messaging Successfully Monitor Antibiotic Adherence for Urban Adolescents and Young Women Managed for Pelvic Inflammatory Disease in the Outpatient Setting.

This study evaluates patient responsiveness to an automated text messaging system for pelvic inflammatory disease (PID) self-care support, and measures the reliability of text-reported adherence. Patients aged 13-25-years with mild to moderate PID were recruited from urban, academic outpatient settings. Enrolled patients received antibiotics and were randomized into a standard of care or intervention group. During a 14-day treatment period, participants in the intervention arm received a community-based nursing visit and daily text message medication reminders with evening prompts to report the number of doses taken. Of the 97 participants randomized into the intervention arm, 91 (94%) were eligible for analysis. Most were African American and low income, with a mean age of 18.3 (SD=2.2) years. Participants responded to ~53% (SD=34%) of all dosage inquiry messages. Responsiveness attenuated at approximately 2.2% per day over the treatment period. Ninety-three percent (n=85) of the analyzed intervention arm returned for the two-week follow-up. Despite overall adherence and general responsiveness, text-reported and self-reported medication adherence were not well correlated (r=0.37, p<0.001). Our findings show that text messaging is a feasible strategy for reaching urban adolescents being managed for complicated sexually transmitted infections in outpatient settings. However, patient responsiveness to self-care text messages do vary, limiting the adherence monitoring capacity of this technology. Given the number of unanswered text messages and incomplete text-reported adherence data, additional measures to assess adolescents' adherence to PID medications are needed in clinical trials.

Parental Traits Associated with Adherence to the Mediterranean Diet in Children and Adolescents in Croatia: A Cross-Sectional Study.

The Mediterranean diet (MD) is known to be one of the healthiest dietary patterns. Despite the significance of a healthful diet during the early stage of life, data for young individuals indicate that nutrition problems are common. This cross-sectional study aimed to determine parental factors associated with MD adherence in children and adolescents living in the Mediterranean region in Croatia. In total, 2623 children aged 2 to 18 years and their parents participated in this study. Data were collected during the period from September 2021 to February 2022 by using an anonymous questionnaire. We used KIDMED and MEDAS questionnaires for assessing MD adherence in young individuals and their parents, respectively. To assess the association of children’s MD adherence categories with the parental predictors, we performed multivariate multinomial logistic regression. Results showed that the children of parents with a low MD adherence are much more likely to have poor MD adherence than good (OR = 47.54 (95% C.I 18.24, 123.87), p < 0.001) or average (OR = 5.64 (95% C.I 3.70, 8.6), p < 0.001) MD adherence. Further, children of fathers with higher BMI (OR = 1.035 (95% C.I 1.0, 1.071)) and those who do not live with both parents (OR = 1.703 (95% C.I 0.994, 2.916), p = 0.053) are more likely to have poor MD adherence than good MD adherence. These results indicate that interventions focusing on enhancing the quality of both parents’ diets could effectively improve their children’s eating habits.

Mediterranean Diet Adherence in Adolescents of Different Cultures and Geographical Proveniences: A Pilot Study

The objective of the present research was to evaluate if and to what extent the encounter between different cultures in a context of globalization may have influenced the adherence to the Mediterranean diet (MD) in adolescents. The study comprised a structured questionnaire packet that inquired about anthropometric data, demographic information and both dietary and lifestyle habits. The KIDMED questionnaire was used to evaluate the adherence to the MD. A total of 103 respondents, aged 10–24 years (39.8% born in Italy or first-generation immigrants from Mediterranean countries) were included in the study. The results showed the highest percentage of adolescents having a medium adherence to the MD (44.7%), without differences according to geographical area of origin. Furthermore, the study proved that a higher adherence to the MD was significantly associated with daily breakfast (p = 0.008) and the consumption of fruit and vegetables (p = 0.002 and p = 0.000, respectively). Volunteers representing some of the different cultures and geographical proveniences currently present in Italy were perfectly integrated regarding diet and lifestyle, aspects considered in this study. Our investigation suggests the existence of incorrect dietary habits. It is certainly necessary to implement public health policies targeting adolescents to promote healthier lifestyle choices; the nutritional patterns of the MD should be among these choices.

Thwarted belongingness as a factor of lower anxiety of being infected and power adherence to recommendations in pandemic in female adolescents

IntroductionPoor adherence with recommendations during pandemic is wide-spread and increases populational risk of being infected (Smith et al., 2020, Webster et al., 2020, Freeman et al., 2020). Revealing psychological factors of low adherence in adolescents is important for interventions planning. This study tests the role of perceived social support and belongingness in COVID-related anxiety and adherence.ObjectivesThe aim was to reveal relationships between COVID-related anxiety, monitoring of information about pandemic, adherence to recommendations and interpersonal needs in female adolescents.Methods183 female adolescents (13-21 years old) filled Anxiety Regarding Pandemic Scale, Information Monitoring and Adherence To COVID-related Recommendations Scales (Tkhostov, Rasskazova, 2020), Interpersonal Needs Questionnaire (Van Orden et al., 2012).ResultsFemale adolescents moderately (m±sd=3.32±1.40 of 1–6-point scale) worried about negative consequences of pandemic on their life and lowly worried about risk of being infected (m±sd=2.53±1.15). Their adherence to recommendations was upper medium (m±sd=3.42±1.18). Neither worries nor adherence were related to age. Perceived burdensomeness was unrelated to COVID-related anxiety and adherence while thwarted belongingness was related to lower anxiety of being infected (r=-.23, p&lt;.01) and poorer adherence to recommendations (r=-.19, p&lt;.05).ConclusionsIn female adolescents thwarted belongingness is a risk factor of poor adherence to COVID-related recommendations because of lower anxiety of being infected. Research is supported by the Russian Foundation for Basic Research, project No. 20-04-60072.DisclosureResearch is supported by the Russian Foundation for Basic Research, project No. 20-04-60072.

On the Relationship Between Well-Being and Exercise Adherence for Children and Adolescents: A Systematic Mini Review.

Although the close positive relationship between well-being and exercise adherence has been confirmed by numerous studies, it is still unclear whether this relationship exists for children and adolescents, because previous research mainly focuses on adults. The present review systematically explored the relationship between well-being ranging from individual to social aspects and exercise adherence based on extant studies. Seven studies including both quantitative and qualitative studies were analyzed. The results showed that well-being was not related to exercise adherence as strongly as expected. In some cases, well-being was even negatively associated with exercise adherence. Limited sample size, insensitive measurement of exercise adherence, gender, and mental and physical condition of children and adolescents might partially influence the relationship between well-being and exercise studies. However, the studies at hand are still in their infancy. More studies on the relationship between well-being and exercise adherence are needed for children and adolescents, especially in non-western countries.

A social media intervention for the families of young Black men with obstructive sleep apnoea.

To address positive airway pressure (PAP) adherence in adolescents diagnosed with obstructive sleep apnoea (OSA) by pilot testing a novel, online, facilitated, peer-support and health education programme for families. Families participated in separate Facebook peer-groups (adolescent [n=6] and parent [n=6]) for four weeks, followed by face-to-face interviews. Participants received OSA and PAP educational videos and posts, engaged with questions and polls, and viewed de-identified postings of peer PAP use data. Adolescent participants were young Black males aged 13-17 years (n=6) with obesity (n=5), severe sleep apnoea (100%) and 4-15 months of prior PAP use. Parent participants were mothers (n=4) and fathers (n=2). Four of six young males increased their mean PAP use during the intervention period. Overall, parents were more engaged with the Facebook group page than adolescents, but interviews revealed the online group/peer-support and education provided was highly regarded and appreciated by families. Parents were particularly appreciative of being involved in care and diagnosis in this way. Results of this pilot trial provide important data regarding intervention design, content, and delivery approaches to be considered in the development of future interventions aiming to engage families and improve adolescent PAP adherence.

Development of a model of interprofessional support interventions to enhance brace adherence in adolescents with idiopathic scoliosis: a qualitative study

PurposeBrace treatment for adolescent idiopathic scoliosis is recognized as effective if the brace is worn as prescribed (20 to 23 hrs/day). Because of its negative biopsychosocial impact on adolescent patients’ quality of life, brace adherence is a common problem (average bracewear of 12 hrs/day). The purpose of this paper is to develop an interprofessional support intervention model to enhance brace adherence in adolescents with scoliosis.MethodsWe enrolled 9 health professionals working with braced patients to participate in individual interviews. Interview guides were built following the Information-Motivation-Strategy Model (DiMatteo et al., Health Psychol Rev 6:74-91, 2012) and the Interprofessional Care Competency Framework (Education UoTCfI, Toronto Acad Health Sci Network, 2017). Thematic analysis was performed to identify the most relevant concepts for designing the intervention model. A panel of 5 clinical experts was recruited to review and validate the intervention model.ResultsParticipants suggested educational, motivational, functional, psychological and interprofessional teamwork strategies to improve the support provided to patients and parents and potentially increase brace adherence. Using the emerging themes and their relationships, we designed an Interprofessional Adherence Support (IPAS) intervention model that identifies the actors, activities, structure and intended impacts of the intervention. According to the expert panel, the IPAS model is highly relevant to respond to the brace adherence problem and has potential for implementation in practice.ConclusionWe designed an interprofessional support intervention model based on professional perspectives in response to the brace adherence problem in adolescents with scoliosis. Plans for implementation of the IPAS model at our scoliosis clinic are under development and considered essential for improving brace treatment outcomes.

The Roles of Adherence and Usage Activity in Adolescents' Intervention Gains During Brief Guided Online Acceptance and Commitment Therapy.

This study investigated the roles of adherence and usage activity in adolescents' (n = 161) gains during a 5-week web intervention program based on acceptance and commitment therapy (ACT). Program adherence was calculated as adherence percentage in relation to intended usage, whereas completion percentage, usage time, and usage weeks were used as indicators for usage activity. Subjective well-being was measured by self-reported life satisfaction and stress before and after the intervention. First, regression analysis results showed that higher adherence predicted an increase in life satisfaction during intervention. Second, three subgroups of adolescents were identified using K-means cluster analysis in regard to adherence, usage activity and intervention gains: (1) "Adhered, committed users with relatively large intervention gains" (35%), (2) "Less committed users with no intervention gains" (42%), and (3) "Non-committed users with no intervention gains" (23%). The results showed that the highest gains from the Youth Compass intervention program are most likely obtained when the program is used as intended in its design. In addition, time investment and engagement in doing exercises seem as important as filling the minimum adherence criterion. The results support the feasibility of ACT-based web intervention programs in promoting adolescent well-being, although more attention should be paid to motivating adolescents to commit to them and invest enough time in them.

Adolescents' adherence to Centers for Disease Control and Prevention guidelines during the COVID-19 pandemic.

BackgroundThe outbreak of the coronavirus (COVID‐19) pandemic in the United States resulted in safety guidelines from the Centers for Disease Control and Prevention (CDC) intended to curb the spread of the virus. Adolescents are potentially at risk for disregarding these guidelines due to their reduced psychosocial maturity compared with adults. The current study examined the relationship between adolescents' psychosocial maturity, perceived importance of the CDC guidelines and adherence to the CDC guidelines within some of the highest risk groups for contracting COVID‐19 in a county particularly impacted by the pandemic (i.e., Hispanic and low‐SES youth in El Paso, Texas).MethodsParticipants completed a phone interview with a research assistant regarding their thoughts and behaviours in the initial months of the COVID‐19 pandemic. Adolescents (N = 68) were 15.38 years old on average (SD = 1.05, range = 13, 17), predominantly male (60.3%) and nearly exclusively Hispanic/Latino (94.1%).ResultsResults indicated that although more psychosocially mature adolescents reported greater adherence to the CDC guidelines than less psychosocially mature adolescents, the association between psychosocial maturity and adherence was fully mediated by how important adolescents felt it was to follow the guidelines. Specifically, greater perceived importance was associated with greater adherence to the guidelines.ConclusionsThe current study found that more psychosocially mature adolescents adhere to CDC's safety guidelines better than less psychosocially mature adolescents because they are more likely to view the guidelines as important. Information that attempts to increase adolescent adherence to the guidelines should therefore emphasize not only that following the guidelines is important, but why following the guidelines is so important. Less psychosocially mature adolescents may benefit most from interventions efforts and targeted messages regarding the importance of following the CDC's guidelines, as more psychosocially mature adolescents already recognize this importance.

Development of a complex intervention to support parents of adolescents with chronic illness transferring from pediatrics to adult care (ParTNerSTEPs)

BackgroundTransition from pediatric to adult care for adolescents with chronic illness is associated with outpatient non-attendance and low treatment adherence in adolescents, and with anxiety and concerns among parents. Recent studies have shown that parent involvement results in better transitions. The aim of this paper was to describe the development, through participatory design, of a comprehensive transfer program targeted to parents of adolescents with chronic illness.MethodsThe study was based on the UK Medical Research Council’s (MRC) framework on developing and testing complex interventions. To increase the program’s feasibility and relevance, participatory design was chosen as the overall method. A collaboration group of parents, young people and health care professionals (HCP) were actively involved in the development of the program. The program was developed in three development stages, in accordance with the MRC framework: 1) identifying the evidence base, 2) identifying theory, and 3) modelling process and outcomes.ResultsTogether with the collaboration group, we developed a comprehensive transfer program targeting parents, by undertaking an iterative process, involving a literature review, individual interviews, workshops and online brainstorms. The program, called ParTNerSTEPs (Parents in Transition – a Nurse-led Support and Transfer Educational Program) comprised three components: 1) an informative website, 2) online educational events for parents, and 3) transfer consultations with providers from both pediatrics and adult care.ConclusionsThe MRC framework was successfully applied to develop a comprehensive transfer program targeting parents of adolescents with chronic ilness. By incorporating the principles of participatory design in the development phase, we ensured that both parents’ and adolescents’ needs were represented and addressed in the program.Trial registrationClinicalTrials.gov ID NCT04969328.

Self-efficacy, motivation and adolescent's adherence of a health protocol during pandemic COVID-19 in Indonesia.

Compliance with the 5M health protocols of washing hands, wearing masks, keeping a distance of at least one meter, avoiding crowds, and reducing mobility is the best effort to prevent COVID-19. Adolescents are non-compliant in implementing health protocols during the pandemic. Therefore, this study aimed to investigate the level of compliance with the 5M health protocols. It also examines the relationship between self-efficacy, motivation, and compliance with health protocols. Data analysis was conducted on a cross-sectional survey of 978 adolescents in Surabaya, Indonesia. Multiple logistic regression was performed to analyze the relationship between the three. Furthermore, adolescent self-efficacy was measured using the General Self Efficacy Scale (GSES), while motivation scale and sociodemographic questionnaire were measured to assess the motivation and characteristics of the respondents. Adolescent self-efficacy in compliance with health protocols is around (92.0%) with an average GSES score of 25.52 + 4.64. The analysis showed that adolescents with high self-efficacy and motivation had a high level of adherence (OR 2.804, 95% CI 2.008, 3.915) and high motivation (OR 2.926, 95% CI 2.087, 4.102), compared to those with low self-efficacy and motivation. The results suggested that initial identification of self-efficacy and motivation should be addressed to ensure compliance with health protocols to prevent the pandemic.

Ankle-foot orthosis adherence in children and adolescents with cerebral palsy: A scoping review.

Ankle-foot orthoses (AFOs) are commonly supplied to children with cerebral palsy (CP) to support their gait. However, usage is reported to decrease through adolescence. Because AFOs can allow users to engage in daily activities and develop their independence, a wider understanding of nonadherence is essential to determining the most appropriate ways to support orthotic prescription for children with CP in the future. This scoping review will present the literature that investigates AFO adherence of children or adolescents with CP and identify potential avenues for future research and practice.A literature search was carried out using the EBSCO and Web of Science databases to identify literature that investigates AFO adherence by children with CP through measurement of AFO usage and exploration of factors that may influence that usage. Papers that investigated AFO adherence in children/adolescents with CP, either through usage or factors that could affect usage, were included in this review. Data were synthesized using a charting form developed for this review. In total, three papers were included in this review. Two included assessments of AFO usage and all three included at least anecdotal references to factors that could influence that usage.Variation in usage time was seen across participants in all studies, although the method used to record usage may influence reported usage values. Key factors that could affect usage were observed in four key categories: physical/AFO-related factors, personal factors, social factors, and situational appropriateness. Adherence is a complex subject, and both measurement of usage and factors that influence usage are key components needed to understand how children engage with their AFO. By better understanding the motivators and barriers to adherence, it is possible to better support the provision of AFOs in the future.

A customized adherence enhancement program for adolescents and young adults with suboptimal adherence and bipolar disorder: Trial design and methodological report

BackgroundThe onset of bipolar disorder (BD) is common during late adolescence and young adulthood (AYA). Suboptimal medication adherence is a critical yet modifiable risk factor for negative outcomes among AYAs with BD. MethodsThis research used an iterative process (e.g., focus groups, advisory board, cognitive interviews) to modify an existing adherence intervention to address suboptimal adherence in AYAs with BD. The modified version of Customized Adherence Enhancement for Adolescents and Young Adults (CAE-AYA) will be compared to an Enhanced Treatment as Usual condition (ETAU) in 40 AYAs intervention using a 6-month prospective, randomized controlled trial (RCT) in a high-risk group of 16–21 year old AYAs with BD with demonstrated non-adherence to their prescribed BD medications. ConclusionsThis report describes the methodology and design of the ImprovinG adhereNce In adolescenTs with bipolar disordEr (IGNITE) study. If successful, the CAE-AYA approach has the potential to advance care for vulnerable youth with BD.

"Who am I going to stay with? Who will accept me?": family-level domains influencing HIV care engagement among disengaged adolescents in Kenya.

IntroductionAdolescents living with HIV (ALHIV, ages 10–19) have developmentally specific needs in care, and have lower retention compared to other age groups. Family‐level contexts may be critical to adolescent HIV outcomes, but have often been overlooked. We investigated family‐level factors underlying disengagement and supporting re‐engagement among adolescents disengaged from HIV care.MethodsSemi‐structured interviews were performed with 42 disengaged ALHIV, 32 of their caregivers and 28 healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya, from 2018 to 2020. Disengaged ALHIV had ≥1 visit within the 18 months prior to data collection at one of two sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Transcripts were analysed through thematic analysis. A conceptual model for family‐level domains influencing adolescent HIV care engagement was developed from these themes.ResultsFamily‐level factors emerged as central to disengagement. ALHIV‐particularly those orphaned by the loss of one or both parents‐experienced challenges when new caregivers or unstable living situations limited support for HIV care. These challenges were compounded by anticipated stigma; resultant non‐disclosure of HIV status to household members; enacted stigma in the household, with overwhelming effects on adolescents; or experiences of multiple forms of trauma, which undermined HIV care engagement. Some caregivers lacked finances or social support to facilitate care. Others did not feel equipped to support adolescent engagement or adherence. Regarding facilitators to re‐engagement, participants described roles for household disclosure; and solidarity from caregivers, especially those also living with HIV. Family‐level domains influencing HIV care engagement were conceptualized as follows: (1) adolescent living situation and contexts; (2) household material resources or poverty; (3) caregiver capacities and skills to support adolescent HIV care; and (4) HIV stigma or solidarity at the household level.ConclusionsFamily‐level factors are integral to retention in care for ALHIV. The conceptual model developed in this study for family‐level influences on care engagement may inform holistic approaches to promote healthy outcomes for ALHIV. Developmentally appropriate interventions targeting household relationships, disclosure, HIV stigma reduction, HIV care skills and resources, and economic empowerment may promote adolescent engagement in HIV care.

Adölesanlarda Akdeniz Diyetine Uyum ile Meyve ve Sebze Tüketim Davranışlarının Değerlendirilmesi

Aim: This study aimed to investigate the adherence of adolescents to the Mediterranean diet and to determine their behaviors of fruit and vegetable consumption. &#x0D; Methods: The study involved 487 adolescents studying at high school in Ankara, Turkey. The study data were collected by using the questionnaire form involving general characteristics, anthropometric measurements, dietary habits, the Mediterranean Diet Quality Index (KIDMED), and the Scale of Processes of Change for Fruit and Vegetable Consumption (SPCFVC). The SPCFVC has two sub-dimensions, cognitive and behavioral. Independent Sample-t test, ANOVA, Mann-Whitney-U test, Kruskal-Wallis-H test, Pearson χ2- test, and Spearman correlation coefficient were used to analyze the data.&#x0D; Results: Among the participants, 51.5% were females and 48.5% were males. Of these, 11.1% were overweight and 1.9% were obese. The mean KIDMED, total SPCFVC, and behavioral SPCFVC scores were higher among males than females (p

Determinants of Disclosure, Adherence and Viral Suppression in Children and Adolescents Living With HIV in Ecuador: A Cross-Sectional Study.

Studies on HIV disclosure and adherence among children performed in Latin America are anecdotal. We aimed to assess the factors associated with HIV disclosure, adherence and viral suppression among Ecuadorian children and compare the psychologic consequences and the impact on adherence and viral suppression of early against late disclosure age. Cross-sectional study using a questionnaire and collected data on medical records of HIV-infected children between 6 and 21 years of age in Ecuador. In 250 children included, HIV diagnosis was revealed at a median age of 11 years (p25-p75 9-12). Children 12 years old or older (P < 0.0001), 10 or more years since HIV diagnosis (P = 0.001), antiretroviral initiation above 3 years of age (P = 0.018) and decease of the mother (P = 0.048) were significantly associated with total disclosure in multivariate analysis. Profound sadness or anxiety was significantly more common when diagnosis was disclosed after 12 years of age (28.4%) than before (15.4%, P = 0.047). According to the simplified medication adherence questionnaire, 194 children (78.2%) were adherent to antiretroviral therapy and HIV-RNA viral load was undetectable in 168 (67.7%). In multivariate analysis, variables associated with nonadherence were age ≥14 years (P < 0.001), taking ≥3 daily antiretroviral pills (P = 0.013) and the presence of adverse effects (P < 0.001), whereas nonadherence (P = 0.001) was the only variable significantly associated with an unsuppressed HIV-RNA viral load. Although we failed to show that an earlier disclosure age is followed by better adherence outcomes, psychological outcomes did seem to improve, supporting disclosure before 12 years of age.

Medication adherence among asthmatic adolescents in the Medina region, Saudi Arabia

Background: In most recent studies in Saudi Arabia, the percentage of uncontrolled asthma was higher than the worldwide population, especially among the younger age group. Despite the effectiveness of medications, poor adherence in adolescents is a major barrier that prevents them from achieving good asthma control. The objective of this study was to guide adolescents toward better asthma control. We explored barriers affecting medication adherence among adolescents with asthma in the Medina region. Methods: A cross-sectional study was carried out in the Medina region. Data were collected from online surveys, intermediate and secondary schools, and primary healthcare centers from 221 adolescents between 12 and 18 years old who answered online self-reported questionnaires that included the modified Medication Adherence Rating Scale and the Asthma Control Test (ACT). Result: Our results showed that 63.8% of the study population were non-adherent to asthma medications. Overall, 44.8% had impaired asthma control. Furthermore, poor adherence was significantly associated with uncontrolled asthma scores. Almost two-thirds of participants with uncontrolled asthma based on ACT scores were non-adherent (46 out of 59 patients with uncontrolled asthma). The most important factors contributing to poor adherence include 62% of adolescents forgetting to take their medication and 59% stopping their medication after feeling better. Moreover, there was no statistically significant association between the sociodemographic factors and medication adherence or asthma control score. Conclusion: This study showed a high prevalence of non-adherence to asthma medications among adolescents in the Medina region, significantly affecting their asthma control. The most commonly reported reasons for non-adherence could be adjusted by increasing the adolescents&amp;apos; awareness during a consultation with their healthcare providers.

Adolescent pregnancies and adherence to puerperal consultation.

to determine the profile of pregnancies and prevalence of adherence to puerperal consultation among adolescent puerperal women compared to non-adolescent puerperal women served in an outpatient clinic of a teaching hospital in the rural area of Minas Gerais. cross-sectional study nested in a cohort of puerperal women; non-probabilistic sample, by convenience; adolescent pregnancy - dependent variable; sociodemographic, clinical and obstetric - independent variables. It employed its own instrument, tested by means of a pilot test. Prevalence ratios and confidence intervals were calculated; chi-square and Fisher's exact tests were applied, considering a significance level of 5%, and Poisson regression with robust variance. we interviewed 121 puerperal women, of which 18.2% (22) were adolescents, and observed among them low educational level (p<0.001); fewer pregnancies with pathologies (p=0.016); predominance of primiparous women (p<0.001), and higher rates of normal delivery (p=0.032). The prevalence of adherence to puerperal consultation was 34.7% and 31.8% for adolescents. There were no differences regarding adherence and age of puerperal women. adolescents did not present negative obstetric and neonatal outcomes, although a lower educational level was observed. Association was found between early age and absence of diseases during pregnancy and higher rates of normal vaginal deliveries. Adherence to puerperal return visit was slightly lower, but without statistical significance.

Objective confirmation of asthma diagnosis, treatment adherence and patient outcomes in children and adolescents.

The aim of this study was to investigate the diagnostic workup in children with asthma hypothesising that objective confirmation of the diagnosis is associated with improved treatment adherence and patient outcomes. We reviewed medical records of children aged 5-18years diagnosed with asthma at the Department of Paediatric and Adolescent Medicine, Herlev-Gentofte Hospital, Denmark, in 2018. Objective confirmation of the diagnosis was based on either (1) lung function, (2) bronchodilator response, (3) bronchial hyperresponsiveness and/or (4) elevated FeNO and was associated with treatment adherence (proportion of days covered, PDC), lung function development and exacerbations during a two-year follow-up period. A total of 88 children were included. Asthma was objectively confirmed in 67 (76%). Children with objective confirmation of the diagnosis were more likely to redeem short-acting beta-2-agonist prescriptions: at least once, aOR=1.3 (95% CI, 1.1-13.1), p=0.036, and were more adherent to inhaled corticosteroid treatment: PDC>80%, aOR=10.4 (1.8-201.1), p=0.033. Further, objective confirmation was associated with improved lung function and reduced bronchodilator response, but not with exacerbations. Objective confirmation of the asthma diagnosis in children is associated with an increased treatment adherence and improved lung function, which underlines the importance of conducting objective tests in the diagnostic workup in paediatric asthma management.

Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review.

BackgroundeHealth systems provide new opportunities for the delivery of antiretroviral therapy (ART) adherence interventions for adolescents. They may be more effective if grounded in health behavior theories and behavior change techniques (BCTs). Prior reviews have examined the effectiveness, feasibility, and acceptability of these eHealth systems. However, studies have not systematically explored the use of health behavior theories and BCTs in the design of these applications.ObjectiveThe purpose of this review was to explore whether health behavior theories and BCTs were considered to ground designs of eHealth systems supporting adolescents’ (10-24 years) ART adherence. More specifically, we examined which specific theories and BCTs were applied, and how these BCTs were implemented as design features. Additionally, we investigated the quality and effect of eHealth systems.MethodsA systematic search was performed on IEEE Xplore, ACM, ScienceDirect, PubMed, Scopus, and Web of Science databases from 2000 to 2020. Theory use and BCTs were coded using the Theory Coding Scheme and the Behavior Change Technique Taxonomy version 1 (BCTTv1), respectively. Design features were identified using the lenses of motivational design for mobile health (mHealth). The number of BCTs and design features for each eHealth system and their prevalence across all systems were assessed.ResultsThis review identified 16 eHealth systems aiming to support ART adherence among adolescents. System types include SMS text message reminders (n=6), phone call reminders (n=3), combined SMS text message and phone call reminders (n=1), electronic adherence monitoring devices (n=3), smartphone apps (n=1), smartphone serious games (n=1), gamified smartphone apps (n=1), leveraging existing social media (n=2), web-based applications (n=1), videoconferencing (n=1), and desktop applications (n=1). Nine were grounded in theory, of which 3 used theories extensively. The impact of adolescent developmental changes on ART adherence was not made explicit. A total of 42 different BCTs and 24 motivational design features were used across systems. Ten systems reported positive effects on 1 or more outcomes; however, of these ten systems, only 3 reported exclusively positive effects on all the outcomes they measured. As much as 6 out of 16 reported purely no effect in all the outcomes measured.ConclusionsBasic applications (SMS text messaging and phone calls) were most frequent, although more advanced systems such as mobile apps and games are also emerging. This review indicated gaps in the use of theory and BCTs, and particularly the impact of developmental changes on ART adherence was not adequately considered. Together with adopting a developmental orientation, future eHealth systems should effectively leverage health theories and consider developing more advanced systems that open the door to using BCTs more comprehensively. Overall, the impact of eHealth systems on adolescent ART adherence and its mediators is promising, but conclusive evidence on effect still needs to be provided.