title: Health care provider-delivered adherence promotion interventions: a meta-analysis.
abstract: OBJECTIVE
  Improving medical regimen adherence is essential for maximizing the therapeutic potential of treatments for pediatric chronic illness. Health care providers are uniquely positioned to deliver adherence promotion interventions. However, no studies have summarized the effectiveness of health care provider-delivered adherence interventions. The objective of this study was to describe the effectiveness of health care provider-delivered adherence promotion interventions in improving adherence among children who have chronic illness. Data sources include PubMed, PsycINFO, CINAHL, and Scopus. Studies were included if they were randomized-controlled trials of pediatric interventions aiming to increase adherence to the primary regimen for a chronic illness and at least 1 health care provider delivered the intervention.
  
  
  RESULTS
  A total of 35 randomized-controlled studies including 4616 children were included. Greater improvements in adherence were observed immediately after health care provider-delivered interventions (d = 0.49; 95% confidence interval, 0.32 to 0.66) than at longer-term follow-up (d = 0.32; 95% confidence interval, 0.10 to 0.54). Treatment effect sizes differed across the adherence behaviors measured. There was significant heterogeneity in treatment effects; however, no moderators of treatment effectiveness were identified. This meta-analysis focused on the published literature. In addition, the majority of studies involved children who had asthma and younger children.
  
  
  CONCLUSIONS
  Health care provider-delivered interventions for children who have chronic illness can be effective in improving adherence. Gains in adherence are highest immediately after intervention. Future interventions and studies should include multiple methods of assessing adherence, include active comparators, and address long-term maintenance of adherence gains.
authors.affiliation: Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah; and yelena.wu@utah.edu.
authors.forename: Yelena P
authors.initials: YP
authors.lastname: Wu
authors.affiliation: Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Ahna L H
authors.initials: AL
authors.lastname: Pai
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D009723:Nurse-Patient Relations; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology*; D010817:Physician-Patient Relations; D011369:Professional-Patient Relations; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000523:psychology; D016896:Treatment Outcome
keywords: chronic disease; health personnel; medication adherence; patient compliance; pediatrics; self care