Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease

Abstract

Objective To pilot test the feasibility and acceptability of a family-based group behavioral intervention to improve medication adherence in adolescents diagnosed with Inflammatory Bowel Disease (IBD). Methods Participants were 40 adolescents age 11-18 years diagnosed with IBD and their primary caregivers, who were randomized to either a 4-session Family-Based Group Behavioral Treatment or Usual Care over a 6-week period. Adherence was measured using a mutli-method, multi-informant assessment involving caregiver- and patient-report, pill count data, and electronic monitoring. Results Adherence rates ranged from 66-89% for 6-MP/azathioprine and 51-93% for mesalamine across assessment methods. The intervention was feasible, as evidenced by the 99% treatment session attendance rate, and acceptable based on patient and caregiver report. Repeated measures ANOVA tests revealed nonsignificant differences between the conditions from baseline to post-treatment assessments for pill count, electronic monitor, and primary caregiver-reported adherence (p's> .05). There was a statistically significant improvement in patient-reported mesalamine adherence represented by a significant main effect for Condition (F = 22.24, p< .01; δ = .79) and Condition X Time interaction (F = 13.32, p< .05; δ = .69). Conclusions Findings suggest potential for use of behavioral intervention to improve medication adherence in this population. This intervention may be more effective with more complex regimens (e.g., multiple doses per day) such as those prescribed with mesalamine. Further research is needed to examine this type of intervention in more diverse samples with more active disease. Use of alternative adherence measurement approaches, including electronic pill boxes and/or real-time self-report (e.g., via text messaging, electronic diaries, etc.) is also recommended.

"Role of Psychosocial Factors on the Course of Inflammatory Bowel Disease and Associated Psychotherapeutic Approaches. A Fresh Perspective and Review"

“…Group therapy may be especially helpful in adolescents. Adolescents with IBD who were randomized to Family-Based Group Behavioral Treatment (n=20) versus Usual Care (n=20) demonstrated significantly increased patient -reported medication adherence of mesalamine [63]. The other drug that was included in this study, 6-mercaptopurine/azathioprine, did show this effect and thus this invention may be especially helpful with complex medication regimes, such as mesalamine.…”

The role of family nurse practitioners : promoting oral medication adherence to maintenance treatment among adolescents with inflammatory bowel disease

“…Psychosocial interventions were provided as a single intervention strategy in two studies (Cook et al, 2010;Greenley et al, 2011). They were also provided in multi-component interventions in three other studies (Hommel, Herzer et al, 2011;Hommel et al, 2012;Hommel, Hente et al, 2013). Cook et al(2010) conducted a preliminary test of telephone nurse counselling to address cognitive and emotional barriers to medication adherence in 278 patients with UC aged 18 years and older.…”

“…Behavioural interventions were provided in conjunction with other interventions in three studies using multi-component interventions (Hommel, Herzer et al, 2011;Hommel et al, 2012;Moshkovska et al, 2011 ). These studied were reviewed in the above section on multi-component interventions.…”

“…In addition to these practical interventions, development of behavioural contracting or reward systems was also provided in multi-component interventions in Hommel, Herzer et al (2011) andHommel et al (2012). Behavioural contracting or reward systems targeted on adolescents who had attention conduct problems, low motivation, or oppositional behaviours.…”

“…Utilizing this tele-health approach resulted in a per-patient cost savings of over $100 and more Similar multi-component interventions were provided and delivered with different approaches in the above three studies (Hommel, Herzer et al, 2011;Hommel et al, 2012). Medication adherence was objectively assessed based on the levels of urinary 5-ASA and N-acetyl-5-ASA concentration at baseline, mid-study (24 weeks) and at the end of study (48 weeks).…”