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Medication adherence in youths with CKD: habits for success

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Abstract

Background

Poor adherence habits are key contributors to nonadherence but there are few clinically feasible methods for evaluating adherence habits, particularly for youths with chronic kidney disease (CKD). This study investigated how participants’ qualitative responses to three interview questions about adherence habits mapped to primary principles of habit formation and objectively measured medication adherence in youths with CKD.

Methods

Participants (ages 11–21 years) were recruited from a pediatric nephrology clinic as part of a larger study. Participants’ daily objective antihypertensive medication adherence was measured with an electronic pill bottle over a 4-week baseline period. Qualitative interviews about adherence habits and routines were conducted with a subset of participants (N = 18).

Results

Clear qualitative differences emerged in how participants with high-medium adherence (80–100%) discussed adherence habits compared to participants with low adherence (0–79%). Participants with high-medium adherence discussed situational cues for taking medicine, including locations that cue adherence, step-by-step events leading up to taking medicine, and people who cue adherence. Participants with high-medium adherence regularly described taking medicine as “automatic,” “second nature,” and a “habit.” Participants with low adherence rarely discussed these habit features nor did they explicitly acknowledge currently missing doses. Participants with low adherence tended to discuss challenges with organization and routines for taking medicine.

Conclusions

Evaluating patient responses to questions about adherence habits may uncover challenges with adherence habit formation, provide direction for habit-strengthening intervention focused on developing automatic cues for taking medication, and support adherence successes for youths with CKD.

Clinical trial registration number

NCT03651596.

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Abbreviations

CKD:

Chronic kidney disease

References

  1. Wühl E, Schaefer F (2008) Therapeutic strategies to slow chronic kidney disease progression. Pediatr Nephrol 23:705–716. https://doi.org/10.1007/s00467-008-0789-y

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wühl E, Mehls O, Schaefer F (2004) Antihypertensive and antiproteinuric efficacy of ramiprilin children with chronic renal failure. Kidney Int 66:768–776. https://doi.org/10.1111/j.1523-1755.2004.00802.x

    Article  PubMed  Google Scholar 

  3. Pruette CS, Coburn SS, Eaton CK, Brady TM et al (2019) Does a multimethod approach improve identification of medication nonadherence in adolescents with chronic kidney disease? Pediatr Nephrol 34:97–105. https://doi.org/10.1007/s00467-018-4044-x

    Article  PubMed  Google Scholar 

  4. Arden MA, Drabble S, O’Cathain A, Hutchings M, Wildman M (2019) Adherence to medication in adults with cystic fibrosis: an investigation using objective adherence data and the Theoretical Domains Framework. Br J Health Psychol 24:357–380. https://doi.org/10.1111/bjhp.12357

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hoo ZH, Gardner B, Arden MA, Waterhouse S et al (2019) Role of habit in treatment adherence among adults with cystic fibrosis. Thorax 74:197–199. https://doi.org/10.1136/thoraxjnl-2017-211453

    Article  PubMed  Google Scholar 

  6. Phillips LA, Cohen J, Burns E, Abrams J, Renninger S (2016) Self-management of chronic illness: the role of ‘habit’ versus reflective factors in exercise and medication adherence. J Behav Med 39:1076–1091. https://doi.org/10.1007/s10865-016-9732-z

    Article  PubMed  Google Scholar 

  7. Alison Phillips L, Leventhal H, Leventhal EA (2013) Assessing theoretical predictors of long-term medication adherence: patients’ treatment-related beliefs, experiential feedback and habit development. Psychol Health 28:1135–1151. https://doi.org/10.1080/08870446.2013.793798

    Article  CAS  PubMed  Google Scholar 

  8. Yeh EA, Chiang N, Darshan B, Nejati N et al (2019) Adherence in youth with multiple sclerosis: a qualitative assessment of habit formation, barriers, and facilitators. Qual Health Res 29:645–657. https://doi.org/10.1177/1049732318779039

    Article  PubMed  Google Scholar 

  9. Hoegy D, Bleyzac N, Rochet C, De Freminville H et al (2019) Medication adherence after pediatric allogeneic stem cell transplantation: barriers and facilitators. Eur J Oncol Nurs 38:1–7. https://doi.org/10.1016/j.ejon.2018.11.006

    Article  PubMed  Google Scholar 

  10. Claes A, Decorte A, Levtchenko E, Knops N, Dobbels F (2014) Facilitators and barriers of medication adherence in pediatric liver and kidney transplant recipients: a mixed-methods study. Prog Transplant 24:311–321. https://doi.org/10.7182/pit2014873

    Article  PubMed  Google Scholar 

  11. Gardner B (2015) A review and analysis of the use of ‘habit’ in understanding, predicting and influencing health-related behaviour. Health Psychol Rev 9:277–295. https://doi.org/10.1080/17437199.2013.876238

    Article  PubMed  Google Scholar 

  12. Wood W, Neal DT (2007) A new look at habits and the habit-goal interface. Psychol Rev 114:843–863. https://doi.org/10.1037/0033-295X.114.4.843

    Article  PubMed  Google Scholar 

  13. Gardner B, Abraham C, Lally P, de Bruijn GJ (2012) Towards parsimony in habit measurement: testing the convergent and predictive validity of an automaticity subscale of the Self-Report Habit Index. Int J Behav Nutr Phys Act 9:102. https://doi.org/10.1186/1479-5868-9-102

    Article  PubMed  PubMed Central  Google Scholar 

  14. Verplanken B, Orbell S (2003) Reflections on past behavior: a self-report index of habit strength 1. J Appl Soc Psychol 33:1313–1330. https://doi.org/10.1111/j.1559-1816.2003.tb01951.x

    Article  Google Scholar 

  15. Eaton CK, Eakin MN, Coburn S, Pruette CS et al (2019) Patient health beliefs and characteristics predict longitudinal antihypertensive medication adherence in adolescents with CKD. J Pediatr Psychol 44:40–51. https://doi.org/10.1093/jpepsy/jsy073

    Article  PubMed  Google Scholar 

  16. Eaton C, Comer M, Pruette C, Psoter K, Riekert K (2020) Text messaging adherence intervention for adolescents and young adults with chronic kidney disease: pilot randomized controlled trial and stakeholder interviews. J Med Internet Res 22:e19861. https://doi.org/10.2196/19861

    Article  PubMed  PubMed Central  Google Scholar 

  17. Simons LE, McCormick ML, Devine K, Blount RL (2010) Medication barriers predict adolescent transplant recipients’ adherence and clinical outcomes at 18-month follow-up. J Pediatr Psychol 35:1038–1048. https://doi.org/10.1093/jpepsy/jsq025

    Article  PubMed  Google Scholar 

  18. Eaton CK, Lee JL, Simons LE, Devine KA, Mee LL, Blount RL (2015) Clinical cutoffs for adherence barriers in solid organ transplant recipients: how many is too many? J Pediatr Psychol 40:431–441. https://doi.org/10.1093/jpepsy/jsu102

    Article  PubMed  Google Scholar 

  19. Wu YP, Pai ALH, Gray WN, Denson LA, Hommel KA (2013) Development and reliability of a correction factor for family-reported medication adherence: pediatric inflammatory bowel disease as an exemplar. J Pediatr Psychol 38:893–901. https://doi.org/10.1093/jpepsy/jst043

    Article  PubMed  PubMed Central  Google Scholar 

  20. Katz LL, Anderson BJ, McKay SV, Izquierdo R et al (2016) Correlates of medication adherence in the TODAY cohort of youth with type 2 diabetes. Diabetes Care 39:1956–1962. https://doi.org/10.2337/dc15-2296

    Article  PubMed  PubMed Central  Google Scholar 

  21. LeLeiko NS, Lobato D, Hagin S, McQuaid E et al (2013) Rates and predictors of oral medication adherence in pediatric patients with IBD. Inflamm Bowel Dis 19:832–839. https://doi.org/10.1097/MIB.0b013e3182802b57

    Article  PubMed  Google Scholar 

  22. Hommel KA, Davis CM, Baldassano RN (2009) Objective versus subjective assessment of oral medication adherence in pediatric inflammatory bowel disease. Inflamm Bowel Dis 15:589–593. https://doi.org/10.1002/ibd.20798

    Article  PubMed  Google Scholar 

  23. Berg CJ, Rapoff MA, Snyder CR, Belmont JM (2007) The relationship of children’s hope to pediatric asthma treatment adherence. J Posit Psychol 2:176–184. https://doi.org/10.1080/17439760701409629

    Article  Google Scholar 

  24. Marckmann M, Hermansen MN, Hansen KS, Chawes BL (2020) Assessment of adherence to asthma controllers in children and adolescents. Pediatr Allergy Immunol 31:930–937. https://doi.org/10.1111/pai.13312

    Article  PubMed  Google Scholar 

  25. Holbein CE, Smith AW, Peugh J, Modi AC (2019) Allocation of treatment responsibility in adolescents with epilepsy: associations with cognitive skills and medication adherence. J Pediatr Psychol 44:72–83. https://doi.org/10.1093/jpepsy/jsy006

    Article  PubMed  Google Scholar 

  26. Gutiérrez-Colina AM, Eaton CK, Lee JL, Reed-Knight B et al (2016) Executive functioning, barriers to adherence, and nonadherence in adolescent and young adult transplant recipients. J Pediatr Psychol 41:759–767. https://doi.org/10.1093/jpepsy/jsv107

    Article  PubMed  Google Scholar 

  27. Ding K, Reynolds CM, Driscoll KA, Janicke DM (2021) The relationship between executive functioning, type 1 diabetes self-management behaviors, and glycemic control in adolescents and young adults. Curr Diab Rep 21:10. https://doi.org/10.1007/s11892-021-01379-3

    Article  PubMed  Google Scholar 

  28. Johnson RJ, Harshman LA (2021) Neurocognition in pediatric chronic kidney disease: a review of data from the Chronic Kidney Disease in Children (CKiD) study. Semin Nephrol 41:446–454. https://doi.org/10.1016/j.semnephrol.2021.09.007

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gardner B, Phillips LA, Judah G (2016) Habitual instigation and habitual execution: Definition, measurement, and effects on behaviour frequency. Br J Health Psychol 21:613–630. https://doi.org/10.1111/bjhp.12189

    Article  PubMed  Google Scholar 

  30. Gardner B, Lally P, Wardle J (2012) Making health habitual: the psychology of ‘habit-formation’ and general practice. Br J Gen Pract 62:664–666. https://doi.org/10.3399/bjgp12X659466

    Article  PubMed  PubMed Central  Google Scholar 

  31. Schaefer MR, Kavookjian J (2017) The impact of motivational interviewing on adherence and symptom severity in adolescents and young adults with chronic illness: a systematic review. Patient Educ Couns 100:2190–2199. https://doi.org/10.1016/j.pec.2017.05.037

    Article  PubMed  Google Scholar 

  32. Caccavale LJ, Corona R, LaRose JG, Mazzeo SE, Sova AR, Bean MK (2019) Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes. Pediatr Diabetes 20:217–225. https://doi.org/10.1111/pedi.12810

    Article  PubMed  PubMed Central  Google Scholar 

  33. Glenn TW, Riekert KA, Roter D, Eakin MN et al (2021) Engagement and affective communication during pediatric nephrology clinic visits: associations with medication adherence. Patient Educ Couns 104:578–584. https://doi.org/10.1016/j.pec.2020.08.039

    Article  PubMed  Google Scholar 

  34. Ellingson LD, Lansing JE, DeShaw KJ, Peyer KL, Bai Y, Perez M, Phillips LA, Welk GJ (2019) Evaluating motivational interviewing and habit formation to enhance the effect of activity trackers on healthy adults’ activity levels: randomized intervention. JMIR MHealth UHealth 7:e10988. https://doi.org/10.2196/10988

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kaushal N, Rhodes RE, Spence JC, Meldrum JT (2017) Increasing physical activity through principles of habit formation in new gym members: a randomized controlled trial. Ann Behav Med 51:578–586. https://doi.org/10.1007/s12160-017-9881-5

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Tumasi Agyapong, Eric Fei, Merry Qian, You Wang, and Marin Langlieb for their contributions to the conduct of this investigation.

Funding

This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health Ruth L. Kirschstein Postdoctoral Individual National Research Service Award (F32DK118988), and the Society of Pediatric Psychology/American Psychological Association Division 54 Drotar-Crawford Postdoctoral Fellowship Research Grant (both awarded to C.K.E.).

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, 4200 Eastern Avenue, Baltimore, MD, 21224, USA

    Cyd K. Eaton, Margaret Comer, Cozumel S. Pruette & Kristin A. Riekert

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  1. Cyd K. Eaton
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  2. Margaret Comer
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  3. Cozumel S. Pruette
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Correspondence to Cyd K. Eaton.

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Eaton, C.K., Comer, M., Pruette, C.S. et al. Medication adherence in youths with CKD: habits for success. Pediatr Nephrol 38, 3791–3802 (2023). https://doi.org/10.1007/s00467-023-05976-0

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  • DOI: https://doi.org/10.1007/s00467-023-05976-0

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