Pediatric Self-management: A Framework for Research, Practice, and Policy

Abstract

Self-management of chronic pediatric conditions is a formidable challenge for patients, families, and clinicians, with research demonstrating a high prevalence of poor self-management and nonadherence across pediatric conditions. Nevertheless, effective self-management is necessary to maximize treatment efficacy and clinical outcomes and to reduce unnecessary health care utilization and costs. However, this complex behavior is poorly understood as a result of insufficient definitions, reliance on condition-specific and/or adult models of self-management, failure to consider the multitude of factors that influence patient self-management behavior, and lack of synthesis of research, clinical practice, and policy implications. To address this need, we present a comprehensive conceptual model of pediatric self-management that articulates the individual, family, community, and health care system level influences that impact self-management behavior through cognitive, emotional, and social processes. This model further describes the relationship among self-management, adherence, and outcomes at both the patient and system level. Implications for research, clinical practice, and health care policy concerning pediatric chronic care are emphasized with a particular focus on modifiable influences, evidence-based targets for intervention, and the role of clinicians in the provision of self-management support. We anticipate that this unified conceptual approach will equip stakeholders in pediatric health care to (1) develop evidence-based interventions to improve self-management, (2) design programs aimed at preventing the development of poor self-management behaviors, and (3) inform health care policy that will ultimately improve the health and psychosocial outcomes of children with chronic conditions.

Improving Depression Screening for Adolescents With Type 1 Diabetes

“…1 Advancements in technology, pharmacology, and delivery of multidisciplinary specialty care have improved health outcomes, but medical treatment regimens place significant demands upon children and families. Type 1 diabetes is an example of a common chronic condition in children with a complex regimen.…”

It's the adherence, stupid (that determines asthma control in preschool children)!

“…A number of factors may influence this relationship over longer periods of follow-up. First, short-term adherence is likely to increase when parents know that adherence is being monitored, or when a follow-up visit is approaching, while long-term adherence decreases over time [6,8]. Secondly, individual characteristics such as significant comorbidity and seasonal changes in asthma control may influence the relationship of long-term asthma control and adherence [9].…”

Supporting Self-Management of Chronic Health Problems

“…6 In pediatric care there are at least 3 participants: the health care provider, the parent, and the child. 7 Pediatric patients are also distinguished by their development; thus, SMSs must be tailored to the changing status of the child and family, from infancy through childhood and adolescence.…”