A social‐ecological model of readiness for transition to adult‐oriented care for adolescents and young adults with chronic health conditions

Schwartz, Lisa A.; Tuchman, Lisa; Hobbie, Wendy L.; Ginsberg, Jill P.

doi:10.1111/j.1365-2214.2011.01282.x

Cited by 308 publications

(282 citation statements)

References 92 publications

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“…The provider, patient, and health system-related factors that shaped transition management in our study are consistent with existing frameworks depicting how such factors intersect to influence longitudinal care, 48 postcancer morbidity, 5 and healthcare transitions. 34 Our study extends those frameworks by describing the interplay among those factors, including across contextual levels. An understanding of this interplay is likely necessary to envision, and then build, a flexible model that keeps AYA-aged survivors connected across transitions.…”

Section: Gaps In Care Commonmentioning

confidence: 94%

“…34 Our findings identify promising points of intervention farther out the social ecologic framework. We conceptualize transition readiness as a clinic and health system level, as well as an individual level, variable.…”

Section: Gaps In Care Commonmentioning

confidence: 99%

“…35 It explains transition readiness as a function of the cultural, political, and healthcare system context (macrosystem and exosystem); reciprocal interactions among the patient, parents, and providers (microsystem); and patient, family, and providers' individual-level characteristics (mesosystem). 34 Schwartz et al used the model to identify modifiable mesosystem-level factors, including parents' and providers' beliefs, as well as patients' knowledge, self-care skills, self-efficacy to navigate healthcare, and future expectations. 34 Three basic care models of LTF described in the literature are largely distinguished by where care is managed as survivors transition into adulthood.…”

mentioning

confidence: 99%

“…34 Schwartz et al used the model to identify modifiable mesosystem-level factors, including parents' and providers' beliefs, as well as patients' knowledge, self-care skills, self-efficacy to navigate healthcare, and future expectations. 34 Three basic care models of LTF described in the literature are largely distinguished by where care is managed as survivors transition into adulthood. 7,36 In the cancer center-based model, survivorship experts continue management.…”

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confidence: 99%

“…The Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) provides a framework for understanding, measuring, and intervening to improve transition readiness. 34 Intended to apply to AYA with disparate complex healthcare needs, the SMART model was developed and validated with 16-28 year old childhood cancer survivors, their parents, and healthcare providers. 35 It explains transition readiness as a function of the cultural, political, and healthcare system context (macrosystem and exosystem); reciprocal interactions among the patient, parents, and providers (microsystem); and patient, family, and providers' individual-level characteristics (mesosystem).…”

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confidence: 99%

See 4 more Smart Citations

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

Mouw

Wertman²,

Barrington³

et al. 2017

Journal of Adolescent and Young Adult Oncology

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Purpose: Most adolescent and young adult (AYA)-aged childhood cancer survivors develop physical and/or psychosocial sequelae; however, many do not receive long-term follow-up (LTF) critical for screening, prevention, and treatment of late effects. To develop a health services research agenda to optimize care models, we conducted qualitative research with LTF providers examining existing models, and successes and challenges in maintaining survivors' connections to care across their transition to adulthood. Methods: We interviewed 20 LTF experts (MDs, RNs, social workers, education specialists, psychologists) from 10 Children's Oncology Group-affiliated institutions, and analyzed data using grounded theory and content analysis techniques. Results: Participants described the complexity of survivors' healthcare transitions. Survivors had pressing educational needs in multiple domains, and imparting the need for prevention was challenging. Multidisciplinary LTF teams focused on prevention and self-management. Care and decisions about transfer were individualized based on survivors' health risks, developmental issues, and family contexts. An interplay of provider and institutional factors, some of which were potentially modifiable, also influenced how transitions were managed. Interviewees rarely collaborated with community primary care providers to comanage patients. Communication systems and collective norms about sharing care limited comanagement capacity. Interviewees described staffing practices, policies, and informal initiatives they found reduced attrition. Conclusions: Results suggest that survivors will benefit from care models that better connect patients, survivorship experts, and community providers for uninterrupted LTF across transitions. We propose research priorities, framing attrition from LTF as a public health concern, transition as the central challenge in LTF, and transition readiness as a multilevel concept.

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Section: Gaps In Care Commonmentioning

confidence: 94%

Section: Gaps In Care Commonmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

Mouw

Wertman²,

Barrington³

et al. 2017

Journal of Adolescent and Young Adult Oncology

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Stakeholder Validation of a Model of Readiness for Transition to Adult Care

et al. 2013

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IMPORTANCE That too few youth with special health care needs make the transition to adult-oriented health care successfully may be due, in part, to lack of readiness to transfer care. There is a lack of theoretical models to guide development and implementation of evidence-based guidelines, assessments, and interventions to improve transition readiness. OBJECTIVE To further validate the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) via feedback from stakeholders (patients, parents, and providers) from a medically diverse population in need of life-long follow-up care, survivors of childhood cancer. DESIGN Mixed-methods participatory research design. SETTING A large Mid-Atlantic children's hospital. PARTICIPANTS Adolescent and young adult survivors of childhood cancer (n = 14), parents (n = 18), and pediatric providers (n = 10). MAIN EXPOSURES Patients and parents participated in focus groups; providers participated in individual semi-structured interviews. MAIN OUTCOMES AND MEASURES Validity of SMART was assessed 3 ways: (1) ratings on importance of SMART components for transition readiness using a 5-point scale (0-4; ratings >2 support validity), (2) nominations of 3 “most important” components, and (3) directed content analysis of focus group/interview transcripts. RESULTS Qualitative data supported the validity of SMART, with minor modifications to definitions of components. Quantitative ratings met criteria for validity; stakeholders endorsed all components of SMART as important for transition. No additional SMART variables were suggested by stakeholders and the “most important” components varied by stakeholders, thus supporting the comprehensiveness of SMART and need to involve multiple perspectives. CONCLUSIONS AND RELEVANCE SMART represents a comprehensive and empirically validated framework for transition research and program planning, supported by survivors of childhood cancer, parents, and pediatric providers. Future research should validate SMART among other populations with special health care needs.

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An Updated Equitable Model of Readiness for Transition to Adult Care

Prussien,

Crosby,

Faust

et al. 2024

JAMA Pediatr

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ImportanceDespite elevated health risks during young adulthood, many adolescents and young adults with serious health care needs face barriers during the transfer to an adult specialty practitioner, and health disparities may occur during the transition.ObjectiveTo validate the content of an updated Social-Ecological Model of Adolescent and Young Adult Readiness for Transition to Promote Health Equity (SMART-E) in a group of adolescents and young adults with sickle cell disease (SCD) and their supports.Design, Setting, and ParticipantsHealth equity framework components were reviewed. Systems of power (eg, institutional and practitioner bias) and environments or networks (eg, peer or school support) were added as SMART-E preexisting factors, and health literacy was included within readiness factors. Adolescents and young adults aged 16 to 29 years with SCD, caregivers, and practitioners participated in this convergent, mixed-methods study within Children’s Hospital of Philadelphia between January and August 2022.Main Outcomes and MeasuresContent validity was assessed through nominations of top 3 most important transition barriers prior to interviews and focus groups, ratings on importance of SMART-E factors (0-4 scale; ratings &gt;2 support validity) after interviews and focus groups, nominations of 3 most important factors for transition and for health equity, and qualitative content analysis of interview transcripts.ResultsThe study enrolled 10 pediatric adolescents and young adults (mean [SD] age, 18.6 [2.9] years; 4 female and 6 male), 10 transferred adolescents and young adults (mean [SD] age, 22.9 [2.1] years; 8 female and 2 male), 9 caregivers (mean [SD] age, 49.8 [8.7] years; 5 female and 4 male), and 9 practitioners (mean [SD] age, 45.6 [10.5] years; 8 female and 1 male). Quantitative ratings supported the content validity of SMART-E and met established criteria for validity. Systems of power was the most endorsed transition barrier (14 of 38 participants) reported prior to interviews and focus groups. After the interview, participants endorsed all SMART-E factors as important for transition, with new factors systems of power and environments and networks rated at a mean (SD) 2.8 (1.23) and 3.1 (0.90), respectively, on a 0 to 4 scale of importance. The most important factors for transition and equity varied by participant group, with all factors being endorsed, supporting the comprehensiveness of SMART-E. Qualitative data corroborated quantitative findings, further supporting validity, and minor modifications were made to definitions.Conclusions and RelevanceSMART-E obtained initial content validation with inclusion of health equity factors for adolescents and young adults with SCD, caregivers, and practitioners. The model should be evaluated in other populations of adolescents and young adults with chronic disease.

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A social‐ecological model of readiness for transition to adult‐oriented care for adolescents and young adults with chronic health conditions

Cited by 308 publications

References 92 publications

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

Stakeholder Validation of a Model of Readiness for Transition to Adult Care

An Updated Equitable Model of Readiness for Transition to Adult Care

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