Adherence to treatment in adolescents

Abstract

Health care professionals must be alert to the high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complications, contributes to poorer quality of life and an overuse of the health care system. Many different factors have an impact on adherence. However, critical factors to consider in teens are their developmental stage and challenges, emotional issues and family dysfunction. Direct and indirect methods have been described to assess adherence. Eliciting an adherence history is the most useful way for clinicians to evaluate adherence, and could be the beginning of a constructive dialogue with the adolescent. Interventions to improve adherence are multiple - managing mental health issues appropriately, building a strong relationship, customizing the treatment regimen if possible, empowering the adolescent to deal with adherence issues, providing information, ensuring family and peer support, and motivational enhancement therapy. Evaluation of adherence at regular intervals should be an important aspect of health care for adolescents.

Psychosocial Barriers and Facilitators to Clinical Trial Enrollment and Adherence for Adolescents With Cancer

“…However, research has delineated that adolescents who report a strong patientprovider relationship perceive their provider as someone who is nonjudgmental, honest, expresses concern and empathy, and respects the adolescent and members of his or her family. 41 Peer influence has also been a strong predictor of adolescent decision-making and behavior, independent of illness. For adolescent cancer survivors, engaging in social relationships with other adolescents with cancer has been shown to provide several important benefits, including: improved coping skills, increased knowledge acquisition, independence, selfconfidence, self-efficacy, and increased emotional support.…”

Management of Depression in Adolescents with Type 2 Diabetes Mellitus

“…Achieving adherence is especially difficult in adolescent illness when it is accompanied by hopelessness or pessimism [15]. This low adherence increases medical complications and contributes to a poorer quality of life [16]. Moreover, adolescents with T2D and depression are susceptible to peer pressure to participate in social activities that may center around unhealthy eating or sedentary activities that do not align with the lifestyle modifications of a T2D management plan [5].…”

“…Furthermore, depression should always be considered in adolescents who have low adherence and present with a lack of motivation and loss of interest [16]. There is no simple intervention that will apply to every adolescent with comorbid medical illnesses, but family and peer support along with an organized and simplified care plan that the adolescent is able to self-manage may positively impact adherence [16,30].…”

Treatment Outcomes of Adolescents With Drug-Resistant Tuberculosis in Resource-Constrained Settings

“…All these reasons contribute to the high rates of refusal and loss to anti-TB treatment. Multiple interventions to improve adherence have been proposed, as follows: appropriately managing mental health issues; building a strong relationship; customizing the treatment regimen, if possible; empowering adolescents to deal with adherence issues; providing relevant information; ensuring family and peer support; and applying motivational enhancement therapy (5). It is crucial to design new DR-TB treatment strategies targeted at specific adolescent needs and challenges.…”