Bilhartz Jacob L, Lopez M James, Magee John C, Shieck Victoria L, Eder Sally J, Fredericks Emily M
Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.
Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Pediatr Transplant. 2015 Aug;19(5):538-46. doi: 10.1111/petr.12466. Epub 2015 Mar 31.
Given the increased risk for non-adherence and poor health outcomes in late adolescence, there is a need for better methods to evaluate and improve the transition process as adolescent patients are prepared to be independent adults. This study assessed the psychometrics and concurrent validity of a newly developed measure of AoR for health management in pediatric liver transplant patients. A total of 48 patients and 37 parents completed a 13-item measure of AoR. We performed an exploratory PCA on survey results and used component scores to assess the relationship between AoR and age, age at transplant, adherence, and health outcomes. Two primary components were identified: communication with the healthcare system and self-management tasks. Parent perception of adolescent responsibility for tasks related to communicating with the healthcare system was correlated, in younger patients, with increased non-adherence while responsibility for tasks related to self-management was correlated, in older patients, with decreased non-adherence. These results support AoR as a two-domain construct, and they provide targets for monitoring and intervention as adolescent patients advance toward transfer.
鉴于青春期后期不依从风险增加以及健康状况不佳，随着青少年患者准备成为独立成年人，需要更好的方法来评估和改善过渡过程。本研究评估了一种新开发的用于儿科肝移植患者健康管理的自主性准备度（AoR）测量工具的心理测量学特性和同时效度。共有48名患者和37名家长完成了一项包含13个条目的AoR测量。我们对调查结果进行了探索性主成分分析，并使用成分得分来评估AoR与年龄、移植时年龄、依从性和健康状况之间的关系。确定了两个主要成分：与医疗系统的沟通和自我管理任务。在较年轻的患者中，家长对青少年在与医疗系统沟通相关任务上的责任感与不依从增加相关，而在较年长的患者中，对自我管理相关任务的责任感与不依从减少相关。这些结果支持将AoR作为一个双领域结构，并为随着青少年患者向转诊过渡进行监测和干预提供了目标。
