Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Pediatr Blood Cancer. 2020 Oct;67(10):e28492. doi: 10.1002/pbc.28492. Epub 2020 Jul 22.
Sickle cell disease (SCD) is associated with significant medical challenges that often worsen in adolescence when caregivers are beginning to transfer responsibility for disease management. Behavioral activation (BA) is an important precedent to improvements in self-management and ultimately health outcomes; however, few interventions targeting BA have been developed for the SCD population. The goal of the present study was to evaluate a technology-enhanced self-management intervention for adolescents and young adults (AYA) with SCD targeting BA domains (ie, disease knowledge, self-efficacy, motivation, and self-management skills).
DESIGN/METHODS: Participants were randomized to one of two study arms. SCThrive participants (N = 26) completed six weekly group sessions, an in-person booster session, and used a companion app (iManage) to record symptoms, progress on goals, and connect with other group members. Each SCHealthEd participant (N = 27) received six weekly phone calls on SCD-related and general health education topics. All AYA completed questionnaires assessing BA at baseline and posttreatment.
Separate mixed ANOVA analyses to assess for the effects of group (SCThrive/SCHealthEd), time (baseline/posttreatment), and group × time interaction indicated that there was a clinically meaningful improvement (8-point change) in self-efficacy, with a medium effect size, P = .09, η = .06, and there was statistically significant improvement in one self-management skill (tracking health), P = .001, d = .71, among SCThrive participants.
The results support the potential for a self-management intervention to improve self-efficacy in AYA with SCD. Health care providers are encouraged to target BA skills to support self-management of AYA with SCD.
镰状细胞病（SCD）与重大的医疗挑战相关，这些挑战在青少年时期往往会恶化，因为此时照顾者开始转移疾病管理的责任。行为激活（BA）是改善自我管理和最终健康结果的重要前提；然而，针对 SCD 人群开发的 BA 靶向干预措施很少。本研究的目的是评估一种针对 SCD 青少年和年轻成人（AYA）的基于技术的自我管理干预措施，该干预措施针对 BA 领域（即疾病知识、自我效能、动机和自我管理技能）。
设计/方法：参与者被随机分配到两个研究组之一。SCThrive 组（N=26）完成了六次每周小组会议、一次面对面的强化会议，并使用了一个配套应用程序（iManage）来记录症状、目标进展情况并与其他小组成员联系。每个 SCHealthEd 组（N=27）都接受了六次关于 SCD 相关和一般健康教育主题的每周电话。所有 AYA 在基线和治疗后都完成了评估 BA 的问卷。
单独的混合方差分析评估组（SCThrive/SCHealthEd）、时间（基线/治疗后）和组×时间的交互作用表明，自我效能有了显著的临床改善（8 分的变化），具有中等的效应量，P=0.09，η=0.06，并且在 SCThrive 参与者中，一项自我管理技能（健康跟踪）有统计学意义的改善，P=0.001，d=0.71。
结果支持自我管理干预措施有可能改善 SCD AYA 的自我效能。鼓励医疗保健提供者针对 BA 技能，以支持 SCD AYA 的自我管理。
