Treatment Adherence In Pediatric Sickle Cell Disease : Examining Medication Adherence, Appointment Keeping, And Self-Care Behaviors

Abstract

The present study sought to ascertain whether treatment adherence in a pediatric SCD population is best described as a multidimensional or global construct by 1) examining the relationship between medication adherence, appointment keeping, and self-care behaviors, and 2) examining biological, psychological, and social factors that may predict aspects of treatment adherence. One hundred and twelve children and adolescents with SCD and their guardians completed an initial interview and reported on the participant's SCD pain, sleep patterns, treatment-related activities, psychosocial/academic functioning, family functioning, and demographic information. Medical chart reviews were also conducted to retrieve information regarding medication adherence as indicated by biological markers (mean corpuscular (MCV) and fetal hemoglobin levels) and appointment keeping behaviors. Results indicated that participants evidenced varying degrees of adherence from poor to good across different aspects of treatment adherence. Specifically, participants evidenced poor to moderate adherence to hydroxyurea as indicated by levels of fetal hemoglobin and MCV, respectively. Participants evidenced an average attendance rate of 85% with an average adherence level for the group across all self-care behaviors of 66%. Appointment keeping was significantly and positively related to fetal hemoglobin levels (r = .62, p < .05), but other indicators of treatment adherence were not significantly inter-correlated. SCD type was a significant predictor of medication adherence as indicated by MCV level ([beta] = .30, p < .05), and being female significantly predicted higher adherence in relation to both MCV ([beta] = .31, p < .05) and fetal hemoglobin ([beta] = .58, p < .01) levels. Other biopsychosocial factors were not significant predictors of aspects of treatment adherence. In conclusion, treatment adherence is best conceptualized as a multidimensional construct, with participants evidencing varying levels of adherence across behaviors with highest rates of adherence in relation to appointment keeping and lower levels of adherence in relation to self-care behaviors. Findings indicate the need for more research to promote better understanding of the use of biological markers as indicators of medication adherence and the exploration of other theoretical models that may contribute to the understanding of patterns of treatment adherence behaviors to facilitate the development of effective treatment interventions.