Journal of Pediatric Psychology Advance Access originally published online on January 11, 2008
Journal of Pediatric Psychology 2008 33(6):590-611; doi:10.1093/jpepsy/jsm128
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Meta-Analysis of Psychological Interventions to Promote Adherence to Treatment in Pediatric Chronic Health Conditions
1Center for the Promotion of Adherence and Self Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's; Hospital Medical Center, and 2Cleveland Clinic Foundation
All correspondence concerning this article should be addressed to Shoshana Kahana, Visiting Scientist, Contractor, National Institute of Mental Health, Division of Developmental Translational Research, 6001 Executive Blvd, MSC 9617, Room 6190, Bethesda, MD 20892, USA. E-mail: sykahana{at}gmail.com.
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Objective To estimate the effectiveness of adherence-promoting psychological interventions for pediatric populations with chronic health conditions. Methods A meta-analysis was conducted on 70 adherence-promoting psychological intervention studies among chronically ill youth using a weighted least squares approach and random effect model. Results Medium effects sizes were found for the behavioral (mean d =.54, 95% confidence interval [CI] = 0.34–0.73, n = 10) and multi-component interventions (mean d =.51, 95% CI = 0.45–0.57, n = 46), while educational interventions displayed a small effect size with adherence (mean d =.16, 95% CI = 0.10–0.22, n = 23). Study designs incorporating pre–post comparisons yielded effect sizes approaching the medium range (mean d =.42, 95% CI = 0.36–0.48, n = 30). Conclusions Behavioral and multi-component interventions appear to be relatively potent in promoting adherence among chronically ill youth. Recommendations for future research and methodological issues are presented.
Key words: adherence; chronic health conditions; meta-analysis; pediatric; psychological intervention.
Received April 26, 2007; revision received November 14, 2007; accepted November 19, 2007