title: Stakeholder validation of a model of readiness for transition to adult care.
abstract: OBJECTIVE
  That too few youth with special health care needs make the transition to adult-oriented health care successfully may be due, in part, to lack of readiness to transfer care. There is a lack of theoretical models to guide development and implementation of evidence-based guidelines, assessments, and interventions to improve transition readiness.
  
  
  OBJECTIVE
  To further validate the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) via feedback from stakeholders (patients, parents, and providers) from a medically diverse population in need of life-long follow-up care, survivors of childhood cancer.
  
  
  METHODS
  Mixed-methods participatory research design.
  
  
  METHODS
  A large Mid-Atlantic children's hospital.
  
  
  METHODS
  Adolescent and young adult survivors of childhood cancer (n = 14), parents (n = 18), and pediatric providers (n = 10).
  
  
  METHODS
  Patients and parents participated in focus groups; providers participated in individual semi-structured interviews.
  
  
  METHODS
  Validity of SMART was assessed 3 ways: (1) ratings on importance of SMART components for transition readiness using a 5-point scale (0-4; ratings >2 support validity), (2) nominations of 3 "most important" components, and (3) directed content analysis of focus group/interview transcripts.
  
  
  RESULTS
  Qualitative data supported the validity of SMART, with minor modifications to definitions of components. Quantitative ratings met criteria for validity; stakeholders endorsed all components of SMART as important for transition. No additional SMART variables were suggested by stakeholders and the "most important" components varied by stakeholders, thus supporting the comprehensiveness of SMART and need to involve multiple perspectives.
  
  
  CONCLUSIONS
  SMART represents a comprehensive and empirically validated framework for transition research and program planning, supported by survivors of childhood cancer, parents, and pediatric providers. Future research should validate SMART among other populations with special health care needs.
authors: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Lisa A
authors: LA
authors: Schwartz
authors: Lauren D
authors: LD
authors: Brumley
authors: Lisa K
authors: LK
authors: Tuchman
authors: Lamia P
authors: LP
authors: Barakat
authors: Wendy L
authors: WL
authors: Hobbie
authors: Jill P
authors: JP
authors: Ginsberg
authors: Lauren C
authors: LC
authors: Daniel
authors: Anne E
authors: AE
authors: Kazak
authors: Katherine
authors: K
authors: Bevans
authors: Janet A
authors: JA
authors: Deatrick
mesh_terms: D000293:Adolescent; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009369:Neoplasms / Q000628:therapy*; D010290:Parents; D010372:Pediatrics / Q000458:organization & administration*; D025341:Principal Component Analysis; D036301:Qualitative Research; D015203:Reproducibility of Results; D017741:Survivors; D060305:Transition to Adult Care / Q000458:organization & administration*; D055815:Young Adult
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