title: A review of biopsychosocial strategies to prevent and overcome early-recognized poor adherence in growth hormone therapy of children.
abstract: BACKGROUND
  Adherence to growth hormone (GH) therapy among children is variable and remains a problem, possibly affecting growth outcomes and future health, and having economic consequences.
  
  
  OBJECTIVE
  To provide a review of the issues related to poor adherence to GH therapy in children and describe integrative strategies that may improve adherence.
  
  
  RESULTS
  Poor adherence may be caused by various factors, affecting both the children and their families. The key reasons for adherence difficulties are psychological/emotional problems, social/everyday problems and technical handling issues of the drug delivery device. Correspondingly a broad range of strategies to address adherence to GH therapy often revolve around counseling and education, not just for the patient but also for the family giving care.
  
  
  CONCLUSIONS
  This review is intended as a general survey of strategies which could help, in clinical practice, to overcome poor adherence to growth hormone therapy in children; it summarizes the representative literature but it does not aim to be a rigorous database literature search in every aspect.
  
  
  CONCLUSIONS
  If poor adherence is recognized early on during treatment, appropriate steps may be taken to identify barriers that are amenable to change for encouraging the child to adhere to the treatment regimen. A preventative approach may also be considered; for example, doctors could address adherence issues early and train families of children treated with GH to recognize the resources as well as the barriers to adherence. The broad range of different causes for poor adherence demands a great variety of interventions, making it important to individualize optimal treatment behavior. Additionally, economic studies are required to quantify the cost of poor adherence to GH therapy and to show the financial benefits of good adherence.
authors.affiliation: University of Applied ScienceBochum, Immanuel-Kant-Strasse 18–20, Bochum, Germany. f.haverkamp@efh-bochum.de
authors.forename: Fritz
authors.initials: F
authors.lastname: Haverkamp
authors.forename: Christoph
authors.initials: C
authors.lastname: Gasteyger
mesh_terms: D001827:Body Height; D002648:Child; D003376:Counseling; D004334:Drug Administration Schedule; D005195:Family Relations; D007722:Health Knowledge, Attitudes, Practice; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D007279:Injections, Subcutaneous; D055118:Medication Adherence / Q000523:psychology*; D011994:Recombinant Proteins / Q000008:administration & dosage* / Q000191:economics; D012959:Socioeconomic Factors
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone