title: Further exploration: maturity and adherence in adolescent and young adult heart transplant recipients.
abstract: BACKGROUND
  Pediatric transplant clinicians note high rates of nonadherence with medications, appointment keeping, and laboratory tests and high rates of engagement in high-risk behaviors among older adolescents and young adult recipients. The caregivers also report symptoms of identity confusion, social immaturity, and failure to appreciate consequences of risky behavior among recipients.
  
  
  OBJECTIVE
  To build on an earlier study that identified developmental characteristics that distinguish poor from good adherers.
  
  
  METHODS
  Qualitative methods were used to explore key themes identified in the first study with heart transplant recipients and their significant others.
  
  
  RESULTS
  This research confirmed the themes of developmental maturity suggested by the first study: good adherers were able to integrate the transplant into sense of self, become independent adults, and achieve normalcy; poor adherers continued to "push away" the transplant experience and worried that they would never be normal. The good adherers, their parents, and friends had views of relationships that were congruent, acknowledging difficulties, discussing them, and moving toward mutual satisfaction. The poor adherers, their parents, and friends expressed incongruent views of the relationships, avoiding discussion of problems and idealizing relationships.
  
  
  CONCLUSIONS
  Strategies for clinicians, family, and friends to increase maturity and independence among older adolescent and young adult heart transplant recipients are described.
authors.affiliation: Children's Hospital of Pittsburgh, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lawrence
authors.forename: Carol S
authors.initials: CS
authors.lastname: Stilley
authors.forename: Ellen
authors.initials: E
authors.lastname: Olshansky
authors.forename: Ann
authors.initials: A
authors.lastname: Bender
authors.forename: Steven A
authors.initials: SA
authors.lastname: Webber
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D041923:Adolescent Development; D000328:Adult; D005190:Family / Q000523:psychology; D005260:Female; D033062:Friends / Q000523:psychology; D016027:Heart Transplantation / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D015404:Nursing Methodology Research; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D010414:Pennsylvania; D000297:Psychology, Adolescent; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology; D012649:Self Concept