Investigating Pathways of Medication (Non)Adherence in Adolescent Solid Organ Transplant Patients: The Correspondence Analysis Approach
Adherence to immunosuppressive medications is critical for the health of solid organ transplant recipients, and yet nonadherence is a common phenomenon in this population, particularly among adolescents. The primary aim of the current study was to identify patterns of patient and caregiver variables associated with adherence, moderate adherence, and nonadherence to inform future development of more targeted interventions to promote medication adherence in this and other chronically ill populations. This study conducted a secondary analysis of data from the largest currently established cohort of adolescent kidney, liver, heart, and lung transplant recipients [Clinical Trials in Organ Transplantation in Children, Protocol number 11 (CTOTC-11), NCT02892266]. CTOTC-11 data was collected via medical chart review and psychosocial questionnaires administered to both patients and their caregivers. Correspondence analysis (CA), a statistical approach intended specifically for the visualization and interpretation of categorical data, was conducted to determine whether the three adherence levels were defined by distinct patterns of patient and caregiver variables and whether these patterns were based on severity levels. CA results demonstrated that the three adherence categories represented distinct constructs characterized by unique patterns of patient and caregiver variables, although these patterns were not consistently based on severity level. With the exception of organ transplant type and patient sex, caregiver-level factors (marital status, education level, and potentially posttraumatic stress symptoms) and health care-level factors (insurance status) were the most important factors for distinguishing adherent, moderately adherent, and nonadherent patients. To date, there is little empirical support for the effectiveness of existing medication adherence interventions. These interventions generally tend to focus on patient-level factors, but the current study’s findings suggest that patient-level approaches may not be optimized if caregiver- and health care-level interventions are not leveraged as well. Future stepped care approaches to medication adherence interventions may benefit from providing patient-level strategies (e.g., problem solving, education, and barriers identification) as standard care to support adherence and then layering more intensive caregiver- and health care-level approaches when adherence lapses.
Clinical psychology|Health sciences|Medicine|Pharmaceutical sciences|Public health
Duncan-Park, Sarah, "Investigating Pathways of Medication (Non)Adherence in Adolescent Solid Organ Transplant Patients: The Correspondence Analysis Approach" (2021). ETD Collection for Fordham University. AAI28496709.