Purpose: The shift in responsibility for health-related tasks from parents to adolescents is essential to the transition to adult care. This study reports the preliminary psychometric properties of an allocation of responsibility for health management tasks measure (AoR), and reviews the association between AoR and adherence.
Methods: Pediatric liver transplant recipients ≥11 years of age and their parents completed a measure of AoR. This is a 13-item measure assessing whether responsibility for tasks is primarily allocated to the parent, adolescent, or is shared. Medication adherence was measured using standard deviations of consecutive tacrolimus trough levels (tacroSD). Higher SD is suggestive of nonadherence. The internal reliability (Cronbach's alpha) for the AoR measure was calculated for all participants. For the patient-parent dyads, agreement was assessed using kappa statistics. The relationships among age, time since transplant, AoR, and tacroSD were assessed using Spearman's correlation coefficients.
Results: To date, 73 recipients, including 56 dyads, have completed the AoR measure. Mean patient age was 15.8y (range 11.2-21.7). Mean time since transplant was 8.9y (range 0.2-18.6). Internal consistency for the AoR (total and subscales) was strong (range Α=0.86-0.92). Kappa statistics ranged from 0.21-0.60. Patient age was significantly correlated with all items on the adolescent AoR measure (p<0.001), items related to medication administration on the parent AoR measure (p<0.01), and tacroSD (rho=0.29, p=0.016). Time since transplant was not associated with adherence or AoR. TacroSD was positively correlated with adolescent report of increased AoR for remembering evening medications (rho=0.27, p=0.045) and lab draws (rho=0.30, p=0.02).
Conclusions: Preliminary results support strong internal consistency for the AoR measure, yet patient-parent agreement was relatively poor, underscoring the importance of obtaining reports from multiple respondents. Older age and increased adolescent responsibility for remembering lab draws and evening medications was related to nonadherence. These adolescents may benefit from additional support as they are at higher risk for nonadherence and poor outcomes as they increase their responsibility for health management.
To cite this abstract in AMA style:Bilhartz J, Lopez M, Magee J, Shieck V, Eder S, Gleit R, Fredericks E. Preliminary Psychometric Properties of a Measure of the Allocation of Responsibility for Health Management Tasks in Pediatric Liver Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/preliminary-psychometric-properties-of-a-measure-of-the-allocation-of-responsibility-for-health-management-tasks-in-pediatric-liver-transplant-recipients/. Accessed October 27, 2020.
« Back to 2013 American Transplant Congress