Lestishock Lisa, Cuomo Carrie, Hickam Teresa, Johnson-Hooper Tisa, Maddux Michele, Muzzall Evan, McManus Margaret, White Patience
Ravenswood Family Health Center, 1885 Bay Rd, East Palo Alto, CA 94303, USA.
Stanford Medicine Children's Health, 4600 Bohannon Dr, Suite 105, Menlo Park, CA 94025, USA.
Health Care Transit. 2024 Nov 28;3:100086. doi: 10.1016/j.hctj.2024.100086. eCollection 2025.
Motivational interviewing (MI) techniques are used by health care teams to engage adolescents and young adults (AYAs) in health care self-management and pediatric to adult health care transition (HCT) planning efforts. The aim of this study was to assess the initial level of motivation of AYAs prior to receipt of HCT anticipatory guidance and to determine associations with demographic and health coverage factors.
This retrospective study included 5112 AYAs, aged 12-26 years, from four health systems. All AYAs completed the Got Transition readiness assessment that includes MI questions on importance and confidence related to the move to an adult provider.Independent variables included demographic and health coverage factors: age, sex, race, ethnicity, language, and insurance type. The statistical approach included summary statistics, chi-square tests of independence and log-likelihood ratio tests, and generalized linear models and contrasts.
The study results demonstrate initial trends in importance and confidence scores for AYAs before they became part of a HCT planning process. Importance scores increased from 12-14 through 18-20 years of age, then decreased in the 21-26-year group. Confidence scores increased from the 12-14 through the 21-26-year group.Confidence scores were generally higher than importance scores and were accompanied by smaller standard deviations. Ethnicity and insurance type also demonstrated an association with MI scoring.
This study provides baseline scores on two key MI importance and confidence questions that can facilitate clinician understanding of AYA engagement in discussing the changes needed to move to adult care and guides the clinician to start earlier than just before transfer that often occurs around age 21.
医疗团队运用动机性访谈（MI）技巧，促使青少年和青年（AYA）参与医疗自我管理以及儿科到成人医疗过渡（HCT）规划工作。本研究的目的是评估AYA在接受HCT预期指导之前的初始动机水平，并确定其与人口统计学和医保覆盖因素之间的关联。
这项回顾性研究纳入了来自四个医疗系统的5112名年龄在12至26岁之间的AYA。所有AYA都完成了“过渡准备度评估”，其中包括关于转向成人医疗服务提供者的重要性和信心的MI问题。自变量包括人口统计学和医保覆盖因素：年龄、性别、种族、民族、语言和保险类型。统计方法包括描述性统计、独立性卡方检验和对数似然比检验，以及广义线性模型和对比分析。
研究结果显示了AYA在成为HCT规划流程一部分之前，其重要性和信心得分的初始趋势。重要性得分在12至14岁到18至20岁之间上升，然后在21至26岁组下降。信心得分从12至14岁组到21至26岁组呈上升趋势。信心得分通常高于重要性得分，且标准差较小。种族和保险类型也与MI评分存在关联。
本研究提供了关于MI两个关键问题（重要性和信心）的基线得分，这有助于临床医生理解AYA在讨论转向成人医疗所需变化时的参与度，并指导临床医生比通常在21岁左右的转诊前更早开始行动。
