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Journal of Pediatric Psychology Advance Access published online on January 11, 2008
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsm128
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© The Author 2008. 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

Meta-Analysis of Psychological Interventions to Promote Adherence to Treatment in Pediatric Chronic Health Conditions

Shoshana Kahana, PhD1, Dennis Drotar, PhD1 and Tom Frazier, PhD2

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.


  Abstract

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


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