Journal of Pediatric Psychology, Vol. 26, No. 5, 2001, pp. 285-286
© 2001 Society of Pediatric Psychology
Book Review
Adherence to Pediatric Medical Regimens
Department of Child and Family Psychiatry Rhode Island Hospital/Brown University School of Medicine
In recent decades, remarkable advances have been made in the medical treatment of pediatric conditions. Despite these advances, many children with acute and chronic physical illnesses continue to require repeated hospitalizations, frequent visits to emergency departments, and numerous school absences. One primary reason for continued morbidity due to illness is poor adherence to treatment regimens. Michael Rapoff's Adherence to Pediatric Medical Regimens provides a comprehensive overview of the factors related to adherence, theoretical models of adherence, methods for assessing adherence and related constructs (e.g., disease and health status), strategies to improve adherence, and a critical analysis of existing adherence interventions. These issues are covered with a focus on both chronic diseases (e.g., asthma, diabetes, cancer) and acute illnesses (e.g., otitis media).
The text begins with a review in chapter 1 of the relevant literature on prevalence rates of pediatric chronic illness, negative consequences of nonadherence, and various correlates of adherence such as patient factors, family variables, aspects of the illness, and the specifics of the medical regimen itself. Effects of nonadherence on research protocols and their implications for clinical decisions and general health care (e.g., increasing morbidity, decreasing cost-effectiveness) are highlighted. Patients at risk for poor adherence are identified. The author provides not only a convincing rationale for the study of adherence but also integral information for allied health professionals and researchers alike to pinpoint the children and families most likely to be affected and the potential consequences they may experience as a result of poor adherence.
One of the most important contributions of this text is its review and
critical evaluation of adherence theories potentially applicable to pediatric
populations (chapter 2). This focus is commensurate with a primary goal of the
Society for Pediatric Psychology to extend the use of theory-driven research
in pediatric psychology (Drotar,
1994
; Wallander,
1992). Rapoff provides summaries of various theories of health
behavior relevant to the study of adherence. These summaries can serve as a
framework from which to organize and formulate testable hypotheses about the
mechanisms underlying adherence behavior. The author finishes each theory
description with a critical analysis of the model and clinical implications
for each approach using case examples. One limitation to these theories is
that many of them have been applied to adults exclusively. Rapoff's discussion
on theoretical perspectives of pediatric adherence could benefit from
considering how these theories translate across development. For example, is
the transtheoretical model of change (TTM,
Prochaska & DiClemente,
1983) applicable for 7-year-olds, given that the model is based on
future-oriented cognitions about potential behavior change?
Subsequent chapters focus on identifying components of children's behavior to assess, the types of methods available, and the advantages and disadvantages to these various methods. Rapoff also includes sections on the assessment of children's disease and health status. Such an approach acknowledges the comprehensive nature of adherence and is informative for both the researcher and health care provider. Researchers learn details about medication half-life, reliability and validity—information requisite for adherence study design. Health care providers acquire knowledge about potential behavioral issues that may obscure adherence data (e.g., behavioral reactivity in response to observational assessments of adherence, medication "dumping").
Rapoff ends the book with a critical appraisal of current interventions designed to improve adherence to pediatric medical regimens. This chapter, although cursory, is useful for students and researchers as it highlights current and relevant investigations and provides a critique of strengths and limitations of this area of research. Ideas for future research designs are proposed briefly to help inform students and researchers interested in pursuing this field.
Overall, this book has several strengths. Rapoff highlights integral factors associated with the study of pediatric adherence including theoretical approaches, obstacles to adherence assessment, and selection of assessment methods for adherence to a wide range of chronic and acute pediatric diseases. The scope is wide and applicable to the student, researcher, and health care provider with its focus on learner objectives, study design issues, and clinical utility. To aid the reader, case examples are used frequently throughout the text to illustrate the clinical efficacy of various adherence methods. The text provides a good overview and reference point for the reader to begin learning about issues related to the study and implementation of adherence assessment. The primary limitation to the text is that the interface between development and adherence behavior, integral to any discussion of pediatric adherence, receives limited attention. For example, applying a developmental perspective to the utility of the different theoretical models discussed would have been useful.
In conclusion, this is a well-conceptualized and well-researched book that can benefit a wide range of academic and clinical pursuits. The strengths of this book far outweigh the noted limitations. Adherence to Pediatric Medical Regimens integrates a diverse empirical literature and outlines the utility of various theories to aid in the conceptualization of relevant research and clinical approaches.
Notes
Michael A. Rapoff. New York: Kluwer Academic/Plenum Publishers, 1999. 172 pp. $75.00 (hard), $24.95 (paper).
References
Drotar, D. (1994). Psychological research with
pediatric conditions: If we specialize, can we generalize. Journal
of Pediatric Psychology, 19,
403-414.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.[Web of Science][Medline]
Wallander, J. L. (1992). Theory-driven research in
pediatric psychology: A little bit on why and how. Journal of
Pediatric Psychology, 17,
521-535.
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