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Journal of Pediatric Psychology Advance Access published online on September 10, 2007
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsm064
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© The Author 2007. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology

Alexandra L. Quittner, PhD1, Avani C. Modi, PhD2, Kathleen L. Lemanek, PhD3, Carolyn E. Ievers-Landis, PhD4 and Michael A. Rapoff, PhD5

1Department of Psychology, University of Miami, 2Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3Department of Clinical Pediatrics, Columbus Children's Hospital, Ohio State University College of Medicine, 4Division of Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine and 5Division of Behavioral Pediatrics, University of Kansas School of Medicine

All correspondence concerning this article should be addressed to Alexandra L. Quittner, PhD, Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd. Coral Gables, FL 33146. E-mail: aquittner{at}miami.edu.


  Abstract

Objectives Adherence to medical regimens for children and adolescents with chronic conditions is generally below 50% and is considered the single, greatest cause of treatment failure. As the prevalence of chronic illnesses in pediatric populations increases and awareness of the negative consequences of poor adherence become clearer, the need for reliable and valid measures of adherence has grown. Methods This review evaluated empirical evidence for 18 measures utilizing three assessment methods: (a) self-report or structured interviews, (b) daily diary methods, and (c) electronic monitors. Results Ten measures met the "well-established" evidence-based (EBA) criteria. Conclusions Several recommendations for improving adherence assessment were made. In particular, consideration should be given to the use of innovative technologies that provide a window into the "real time" behaviors of patients and families. Providing written treatment plans, identifying barriers to good adherence, and examining racial and ethnic differences in attitudes, beliefs and behaviors affecting adherence were strongly recommended.

Key words: adherence; diary methods; electronic monitors; empirically-supported; measurement..

Received November 15, 2006; revision received July 12, 2007; accepted July 12, 2007


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